Single Anastomoses Research Articles

Effects of Hepatic Artery Type And Number on Bile Complications in Right Lobe Living Donor Liver Transplant Recipients: Single Center Experience Without Hepatic Artery Thrombosis

Purpose: Hepatic artery provides blood supply to the biliary tract of the graft, one of the causes of the biliary complications that may occur in the post-transplant period may be the problems of the recipient's hepatic artery. We examined the effect of post-transplant biliary complications according to the type and number of recipient hepatic artery. Materials and Methods: One hundred eighty five patients older than 18 years of age who underwent right lobe LDLT for end-stage liver cirrhosis were included in the study. The recipient's right hepatic artery (RHA), left hepatic artery (LHA), propria hepatic artery (PHA) and common hepatic artery (CHA), which were anastomosed to the graft artery and double hepatic artery anastomoses formed of the right and left hepatic arteries, were examined. Biliary complications were analyzed statistically in terms of single or double artery anastomosis and anastomoses with the right or the other hepatic arteries. Results: There was no statistically significant difference between single and dual artery anastomoses in terms of bile duct stricture or leakage (p=0.767). No statistically significant difference was observed between RHA, LHA, PHA, CHA, and between single and dual arteries in the evaluation of artery selection between those with and without biliary tract complications (p=0.445) Conclusion: Hepatic artery type selection and number of the recipient does not change the biliary tract complication.

A Single-Center's Early Surgical Outcomes of Living Donor Liver Transplantation

Living donor liver transplantation (LDLT) has become an increasingly common surgical option because the number of cadaveric donors is insufficient to fulfill the organ needs of patients facing end-stage cirrhosis. Many centers are investigating different surgical techniques to achieve lower complication rates. We aimed to examine our complication rates in light of demographic data, graft data, and perioperative findings as a single-center experience. The study included one hundred and three patients who underwent LDLT for end-stage liver cirrhosis. Demographic data; sex; age; blood group; Model for End-Stage Liver Disease score; Child score; etiology; liver side; graft-to-recipient weight ratio; hepatic artery, portal vein, and bile anastomosis type rates; anhepatic phase; cold ischemia time; operation time; and blood product transfusion rates were analyzed. Biliary complications in patients with single or multiple biliary anastomoses, right or left liver transplants, and with or without hepatic artery thrombosis were analyzed statistically. There was no significant difference in biliary complications between patients who underwent single or multiple bile anastomosis (P=.231) or patients receiving right lobe and left lobe transplants (P=.315). Although there was no statistically significant difference in the rate of portal vein thrombosis between the regular and reconstructed portal vein anastomosis groups (P=.693), the postoperative portal vein thrombosis rate was statistically higher in patients with left lobe transplants (P=.044). Vascular and biliary complication rates can be reduced with increasing experience.

Single versus dual venous anastomosis in radial forearm free flaps in head and neck reconstruction

A retrospective cohort study of 253 radial forearm free flap (RFFF) procedures in head and neck reconstruction performed in our department between 2005 and 2018 was reviewed. In order to explore the effects between single and dual anastomoses, we applied Fisher’s exact test for statistical analysis. Although no flap failure was identified, more venous compromises were observed in single anastomosis group (5/80 vs. 1/173). We conclude that dual venous anastomoses can reduce venous compromise resulted from unexpected causes in RFFF transfer. Therefore, we especially recommend dual venous anastomoses for those who cannot withstand a second surgery.

One or two venous pedicles by anastomoses for free flaps in reconstruction of the lower extremity: A systematic review and meta-analysis.

Microsurgical free tissue transfers are a mainstay of lower extremity reconstruction. Despite being a reliable source of soft tissue, complications do arise. Venous congestion is among the most common causes of flap failure in lower extremity reconstruction, an issue that is attributed to venous stasis and impaired venous return in this region. There remains significant debate whether dual venous drainage improves outcomes. The aim of this study was thus to compare one versus two venous anastomoses in lower limb free flap reconstruction. A systematic review of Medline, EMBASE, EBSCO CINAHL, SCOPUS, Proquest Dissertations and Theses Global, Cochrane Library, and PROSPERO from inception to May 20, 2020, was conducted. Two independent reviewers screened titles and extracted data. Our primary outcome was total free flap necrosis. Secondary outcomes were partial flap necrosis, minor complications, flap reoperation, venous thrombosis, and amputation. Methodological quality was assessed using the MINORS criteria and level of evidence. Three-hundred and fourteen unique titles were identified. All studies were level VI evidence and had a mean MINORS score of 16.1/24. Seven studies (comprising 1499 patients, 910 single venous anastomoses, and 579 double venous anastomoses) met criteria for inclusion. The mean (SD) patient age was 46.5 (7.1) years. Double venous anastomoses did not reduce the rate of minor complications, flap takeback, venous thrombosis, total flap necrosis, or partial flap necrosis when compared to a single vein (all p > .05). In microvascular lower extremity reconstruction, two venous anastomoses did not reduce the rate of minor or major complications.

Study of clinical outcome of patients undergoing intestinal anastomoses with single layer extramucosal technique and double layer anastomoses

Background: Intestinal anastomosis is one of the common surgeries for cases like bowel obstruction, incarcerated hernias, benign and malignant tumours of small and large bowel. The ideal intestinal anastomosis does not leak and allow normal function of the gastrointestinal tract. This study compared single layer versus double layer intestinal anastomosis in terms of duration, postoperative complications like anastomotic leak.Methods: A total of 100 patients admitted in Hamidia hospital, based on history and clinical examinations and radiological examinations, placed in two groups, group A (single layer anastomosis) and group B (double layer anastomosis) and were operated by a qualified surgical specialist. Data analysis of anastomotic time, anastomotic leak was done and statistical tests of significance were applied. A p value less than 0.05 is considered as significant.Results: In group A (single layer) the time required to perform in 30 (60%) patients is between 16-20 minutes. In double layer, maximum were done in between 26 to 30 minutes, 32 (64%). In our study of 100 patients, there were 6 anastomotic leaks, of which four of them were in group A (single layer) and 2 of them in group B (double layer).Conclusions: In our study, the duration required to perform a single layer intestinal anastomosis is significantly lesser when compared to double layer. There is no significant difference in anastomotic leak between two groups. Less time with no difference in complications, a move towards single layer anastomosis should be preferred.

Outcomes of Single Anastomoses for Superficial and Deep-System Venous Drainage of Radial Forearm Free Flaps.

ObjectiveVenous insufficiency occurs in radial forearm free flaps (RFFFs) when either the deep venous system (DVS) or superficial venous system (SVS) is used as the venous outlet. We report our experience using the antecubital perforating vein (APV) in a single-vessel anastomosis to the median-cubital or cephalic vein to drain both systems.Study DesignRetrospective review.SettingSingle, academic, tertiary care center.MethodsData were collected from 72 patients who underwent RFFF from October 2009 to January 2017. In all cases, DVS and SVS were dissected, and an APV single-vessel anastomosis was attempted.ResultsAnatomical variations precluded single-vessel anastomosis in 11 (15.3%) cases. In 61 (84.7%) cases, single-vessel anastomosis produced unobstructed drainage for DVS and SVS without intrinsic venous insufficiency. Venous thrombosis and total loss occurred in 2 (3.3%) and 1 (1.6%) patients, respectively. Proximal dissection of the cephalic vein addressed a vessel-depleted neck in 3 cases.ConclusionThe antecubital perforating vein is present and functional in most patients, allowing for single anastomosis techniques for RFFF. Antecubital perforators capture DVS and SVS outflow through a single, extended venous pedicle, eliminating the risk of venous insufficiency and need for vein grafts.

Patency of Hemashield grafts versus ringed Gore-Tex grafts in middle hepatic vein reconstruction for living donor liver transplantation.

Backgrounds/AimsOwing to the short supply of homologous vein allografts, we previously used ringed Gore-Tex vascular grafts for middle hepatic vein (MHV) reconstruction in living donor liver transplantation. When ringed Gore-Tex grafts became unavailable, we used Hemashield vascular grafts. This study aimed to compare the patency and complication rates of Hemashield and ringed Gore-Tex grafts.MethodsThis retrospective two-arm study compared the study group that received Hemashield grafts (n=157) and the propensity score-matched control group that received ringed Gore-Tex grafts (n=157).ResultsIn the Hemashield and Gore-Tex groups, the recipient age was 54.7±9.4 and 53.3±6.3 years; Model for End-stage Liver Disease scores were 15.9±9.2 and 16.9±8.3; and graft-recipient weight ratios were 1.07±0.24 and 1.10±0.23, respectively. In the Hemashield group, V5 reconstruction was performed using single (n=113, 72.0%), double (n=39, 24.8%), and triple (n=3, 1.9%) anastomoses. The proportion of double and triple anastomoses for V5 and V8 was higher in the Hemashield group than in the Gore-Tex group. Two (1.3%) patients required MHV conduit stenting owing to early thrombosis of the Hemashield graft. There was no difference in conduit occlusion- free patient survival rates between groups (p=0.91). The incidence of accidental conduit migration in the Hemashield and Gore-Tex groups was 0 (0%) and 2 (1.3%), respectively.ConclusionsHemashield grafts used in MHV reconstruction demonstrated acceptably high short- and mid-term patency rates, no incidences of conduit migration, easy handling, and good flexibility for length adjustment. Therefore, we suggest that the Hemashield graft is the preferentially suitable prosthetic material for MHV reconstruction.

Single layer extramucosal versus double layer anastomosis for colostomy closure in children with anorectal malformation

Background: Intestinal anastomosis is one of the commonly performed procedure in gastrointestinal surgeries. The purpose of this study is to Assess safety, efficacy, cost effectiveness of single layer anastomosis over double layer anastomosis for colostomy closure in children with Anorectal Malformation at tertiary care centre. Materials and Methods: This prospective observational comparative study conducted between February 2016 to January 2021 consisting of 47 patients. All the children admitted for colostomy closure after definitive staged procedure for anorectal malformation were enrolled in the study. All anastomoses were of end-to-end type. The single layered anastomoses were performed by using interrupted 3-0 polydioxanone suture beginning at the mesenteric border and taking all layers of bowel wall except the mucosa into the bite. The double layered anastomoses were performed using interrupted 3-0 polydioxanone suture for the transmural inner layer and interrupted 3-0 polydioxanone Lembert sutures for outer seromuscular layer. Outcome parameters assessed were, quantity and cost of suture material used, time taken for anastomosis, time taken for surgery, postoperative return of peristalsis and passage of flatus, postoperative complications like paralytic ileus, bowel obstruction, anastomotic dehiscence diagnosed by presence of enteric contents like bile or faeces in drain or wound or diagnosed on radiological imaging like CT scans and hospital stay. Data were recorded in the case record form. Qualitative data was expressed in terms of proportions. Quantitative data was expressed in terms of Mean and Standard deviation. All the data collected was analysed by using SPSS 24.0 version IBM USA. Results: Out of total 47 children enrolled in study, 25 (53.19%)children were allocated to single layered extra mucosal intermittent anastomosis and 22 (46.81%) children to double layered anastomosis. All children admitted for colostomy closure had age ranges between 7 months to 36 months with mean age of 11.5 ±3.8 months.Amongst all the children undergoing anastomosis 35(74.47%) were males and 12(25.53%) were females. Observed outcome parameters like mean time taken for surgery in minutes (120.4±15.3 Vs 135.7±12.5), mean time taken for anastomosis in minutes (15.1±2.3 Vs 24.4±2.3), mean day of return of bowel sounds on postoperative day (2.40 Vs 3.74), mean day of first postoperative bowel movement (3.41 Vs 4.89 ) were significantly less in single layer anastomosis group than in double layer anastomosis. Suture material used in single layer anastomosis was lesser in quantity than used in double layer anastomosis. Post-operative complications were seen in 3 (06.38%) children of in single layer anastomosis group and 5 (10.63%) children of double layer anastomosis group. One child who underwent double layer anastomosis had anastomosis leak while none of child in single layer anastomosis group had leak. Mean duration of hospital stay was 5.95±1.40 days in single layer anastomosis group which is lesser than mean duration of hospital stay of 7.45 ± 1.95 days in double layer anastomosis group. Conclusion: Single layer intestinal anastomosis resulted in significant reduction in operative time, hastens the postoperative recovery of bowel function, reduces suture material, hospital stay and cost; without any difference in complications.

Efficacy of single layered intestinal anastomosis over double layered intestinal anastomosis-an open labelled, randomized controlled trial.

The hand-sewn method of bowel anastomosis is the most common because of its affordability, familiarity and easy availability of materials. It can be done in single or double layers, with different surgeons preferring one technique over the other. Double layer intestinal anastomosis (DLIA) is time-consuming, challenging to perform, and carries possibly a higher risk of devascularisation, infection, and necrosis. Studies conducted so far do not show a significant difference between the two, but have concluded that more studies are required to determine this definitively. This study attempted to see whether the single layer intestinal anastomosis (SLIA) is non-inferior to DLIA in terms of incidence of anastomotic leak. It also compared mortality, morbidity, and length of hospitalization (LOH) between the two groups. This was a parallel arm, open labelled, non-inferiority randomized controlled trial conducted in the department of surgery in a tertiary care centre between October 2016 and March 2018. Patients who fulfilled the inclusion criteria were randomly allotted to two groups: Patients undergoing SLIA and patients undergoing DLIA. After the procedure, all patients were assessed for anastomotic leak, morbidity, mortality and LOH in the postoperative period. A 3-month follow-up period was observed for complications. A total of 106 patients were randomised, 52 in SLIA and 54 in DLIA. Baseline demographic and clinicopathological characteristics between the two groups were comparable. The most common indication for intestinal anastomosis was ostomy closure in both groups. There was no significant difference between the two groups in terms of anastomotic leak, other complications, mortality and LOH. SLIA was comparable to DLIA with respect to incidence of anastomotic leak, morbidity, mortality, and the length of hospitalization, and can be considered as a safe and feasible alternative, in elective and emergency settings.

MULTIPLE LYMPHATIC-VENOUS ANASTOMOSES (MLVA) FOR MICROSURGICAL DRAINAGE OF PRIMARY PENO-SCROTAL LYMPHEDEMA: A CASE REPORT

Single site Multiple Lymphatic-Venous Anastomoses (MLVA) provides optimal functional and cosmetic results with low complication rates in treatment of lower limb lymphedema. However, no evidence exists in literature concerning the use of this technique in treatment of peno-scrotal lymphedema. We report a case of a 44-year-old male patient who developed secondary peno-scrotal lymphedema with severe lymphorrhea, following a laser treatment for scrotal pustolosis, leading to recurrent infections and finally an established peno-scrotal lymphedema. Utilizing MLVA, a complete remission of scrotal lymphedema was achieved with significant volume reduction of the penile lymphedema. The post-operative course was uneventful with clear improvement in lymphatic flow demonstrable on lymphoscintigraphy (6 months) and no recurrence of scrotal lymphedema at 2 years follow-up. This article reports very promising results of a novel application of MLVA in the treatment of genital lymphedema and suggests that MLVA provides the possibility to shunt both superficial and deep lymphatics to improve the lymphatic drainage from the peno-scrotal area using a single surgical site.

Outcome of Single Layer Gastrointestinal Anastomoses in Pediatric Age Group

Outcome of Single Layer Gastrointestinal Anastomoses in Pediatric Age Group

Venous Anastomoses in Anterolateral Thigh Flaps for the Lower Extremity: Vessel Selection In Lieu of Obligatory Number.

Dual venous drainage for anterolateral thigh flaps has been proposed to protect against flap-related complications in head and neck applications. Here we report our experience with single vs dual venous anastomosis during lower extremity free-tissue transfer. All free anterolateral thigh flaps for lower extremity reconstruction from 2011 to 2017 were retrospectively reviewed. An algorithm was used to determine the type and number of venous anastomoses, emphasizing patient anatomy, venous quality, and size match. Patients were divided into single- and dual-venous-anastomosis groups. Univariate analysis determined differences between the groups. A multivariable analysis identified independent risk factors. Fifty patients met the inclusion criteria. Patient demographics, recipient sites, wound type, and flap characteristics were similar in 1 and 2 vein groups. Average follow-up was 9.6 months. Forty-two percent underwent single venous drainage anastomoses. Mean age was 52.7 years, 78.0% were male, and 60% had defects of the foot and ankle. Increased flap area and early dangling did not increase flap demise. Thirty-three percent of single-drainage patients and 31.0% of dual-drainage patients had a complication. A body mass index of greater than 30 kg/m 2 was a predictor for both flap complication ( P = 0.025) and partial flap loss ( P = 0.031) in univariate analysis. No independent predictors were found in multivariate analysis. The number of venous anastomoses, area, and dangling protocol did not influence outcomes while using our lower extremity vein method. Thoughtful evaluation of venous egress should outweigh the routine use of multiple veins in perforator flap reconstructions of the lower extremity.

COMPARATIVE DESCRIPTION OF EXPERIMENTAL BILIODIGESTIVE ANASTOMOSIS, FORMED BY HIGH FREQUENCY ELECTRIC WELDING TISSUES METHOD AND LIGATURE METHOD (PATHOMORPHOLOGICAL RESEARCH)

In the experiment on 50 rabbits cholecysto-entero and entero-entero anastomoses were formed on intestinal Roux loop. Animals were divided into the main group (n = 35) and the comparison group (n = 15). In the main group a single layer everting anastomoses by using HF-electric welding method were formed, in the comparison group single row suture anastomoses has been done. Welding and suture anastomosis were performed both on the not inflamed tissues, and against a background of bile peritonitis. To establish the changes that occur in the tissue welding, histological investigations of weld area and surrounding tissues at different times postoperative period were performed.It was established that when carried out HF-electric welding connective tissue safety was achieved by termoadhesion. Electro-injuries area almost did not spread beyond the regions of direct thermal influence, coagulation scar was narrow, thermal damage walls was local (2700-3000 µm). The processes of regeneration in the area of weld were similar as in anastomosis formation by traditional suture method. Scar formation and completed its epithelization was fully completed in terms from 3 to 6 months.

Single versus double venous anastomoses in head and neck reconstruction: systematic review and cumulative meta analysis

Single versus double venous anastomoses in head and neck reconstruction: systematic review and cumulative meta analysis

Experimental Substantiation Efficiency of new Polymer Membrane for Sealing the Suture Line During the Formation of Colonic Anastomoses

В современной абдоминальной хирургии проблема поиска новых способов и методов профилактики несостоятельностишвов анастомозов при наложении на толстую кишку продолжает оставаться открытой и постоянно требует новыхусовершенствований. Использование полимерных пленочных материалов позволяет повысить механическую прочность ибиологическую герметичность межкишечных анастомозов.Цель настоящего исследования состояла в оценке эффективности герметизации линии однорядных швов толстокишеч-ных анастомозов с помощью новых образцов пленочных имплантатов на основе полимеров карбоксиметилцеллюлозы.Материалы и методы. Проведен эксперимент на 60 кроликах. Было сформировано 3 группы исследования: контрольнаягруппа 1 – межкишечный анастомоз с использованием техники двурядного кишечного шва – шов Шмидена (первый ряд) ишов Матешука (второй ряд); контрольная группа 2 – межкишечный анастомоз с использованием однорядного шва Шми-дена; экспериментальная группа 1 – межкишечный анастомоз с использованием однорядного шва Шмидена, герметизиро-ванный образцом полимерной мембраны. Механическая прочность на разных сроках эксперимента определялась методомпневмопрессии.Результаты и их обсуждение. Во время оперативного вмешательства установлено, что изучаемый образец полимерногопленочного импланта обладает оптимальными манипуляционными свойствами, необходимыми для герметизации линиикишечного шва (эластичность, прочность, адгезивность, не требуется дополнительной фиксации шовным материалом,простота наложения мембраны, сокращение времени формирования анастомоза). Снижается повышенная проницае-мость и увеличивается уровень герметичности кишечного шва, за счет высокой степени адгезии полимерной мембраны,на фоне еще не наступившей регенерации краев серозной оболочки (феномен «биологической негерметичности»).Заключение. Полученные доклинические данные подтверждают эффективность применения новых полимерных мембранпри герметизации однорядных швов толстокишечных анастомозов.Ключевые слова: полимерные мембраны, герметичность анастомоза, прочность швов, кишечный шов.

Outcomes of Microsurgical Vasovasostomy for Vasectomy Reversal: A Meta-analysis and Systematic Review

To perform a systematic review and meta-analysis of the published literature evaluating vasovasostomy for vasectomy reversal outcomes. We conducted a review of English language articles describing results of microscopic vasovasostomy for vasectomy reversal. Two reviewers independently examined the studies for eligibility and evaluated data from each study. Meta-analysis was performed using a random effects model. Thirty-one studies with 6633 patients met inclusion criteria. Mean patient age at time of vasectomy reversal was 38.9years with a mean obstructive interval of 7.2years. The mean postprocedure patency and pregnancy rates weighted by sample size were 89.4% and 73.0%, respectively. A meta-analysis comparing an obstructive interval (OI) of<10years to an OI of at least 10years duration produced a pooled incidence ratios (IR; meta-IR) of 1.17 (95% confidence interval [CI], 1.09-1.25) for patency and 1.24 (95% CI, 1.12-1.38) for pregnancy. Incidence of patency for modified 1-layer technique was similar to that after a 2-layer procedure with a meta-IR of 1.04 (95% CI, 1.00-1.08). Because of a small number of relevant studies, a meta-analysis for other predictors of success such as sperm granuloma, quality of vasal fluid, and female factors was not feasible. We found no statistically significant difference in vasovasostomy outcomes when comparing the impact of single vs multilayer anastomoses. Patients with an OI<10years showed higher patency and pregnancy rates compared with those with an OI≥10years. Uniform definitions of patency are necessary to characterize success and standardize outcome reporting.

One versus two venous anastomoses in microsurgical free flaps: a meta-analysis.

Various reports suggest the augmentation of venous drainage through performing two venous anastomoses as a means of reducing the rate of thrombosis in free flap surgery. However, some suggest dual venous drainage may actually reduce venous blood flow velocity causing a potential risk for thrombosis. On the basis of the Preferred Reporting Items for Systematics Reviews and Meta-analysis statement, a systematic search was conducted using PubMed and Medline databases. A total of 12,190 articles relating to "free flaps" and "one versus two venous anastomoses" were found between January 1992 and November 2012. Of the 12,190 articles, 23 studies were included in a meta-analysis performed using STATA 11.2 (StrataCorp, College Station, TX). Studies with case control groups for both single and double venous anastomoses and clearly defined results for flap failure and venous thrombosis were included. 95% confidence interval (CI) were calculated for each study and pooled in both fixed and random-effects models for both flap failure and venous thrombosis events. The analysis shows a significant reduction in flap failure (risk ratio, 0.64; 95% CI, 0.41-0.99; p = 0.03) and venous thrombosis (risk ratio, 0.66; 95% CI, 0.46-0.97; p = 0.047) when performing two venous anastomoses compared with one in free flap surgery. The results show that performing two venous anastomoses is associated with a reduction in the incidence of flap failure by 36% and venous thrombosis by 34% compared with one venous anastomoses. Given that the performing of an additional venous anastomoses confers a lower risk of complication and is technically feasible, where possible two venous anastomoses should be performed in free flap procedures, however, this should be decided on a flap by flap basis.

Recipient surgical complications of renal transplantation in children: our initial experience

Objectives The aim of the study was to evaluate the operative and early postoperative surgical complications of renal transplantation in pediatric recipients. Background Renal transplantation is considered the treatment of choice in children with end-stage renal disease; however, it is still associated with several surgical complications. Patients and methods From July 2010 to January 2013, 50 consecutive pediatric kidney transplants were studied. Immediately before transplantation, a thorough history and physical examination with appropriate laboratory and radiological evaluation were performed to search for any medical or surgical problems that contraindicate the transplantation. We removed the kidney from a living donor through an open surgical technique. The kidney graft was placed extraperitoneally in the right iliac fossa. The arterial anastomoses were performed to the lower aorta or right common iliac artery. The venous anastomoses were performed to the lower inferior vena cava or the right common iliac vein. Our ureteral reimplantation technique was an extravesical, Lich-Gregoir technique. A ureteral stent was placed. We evaluated the ischemia time and any intraoperative or postoperative surgical complications. Results Our patients included 36 boys (72%) and 14 girls (28%). Kidneys came from live-related donors in all cases (27 mothers, 19 fathers, two aunts, one uncle, and one brother). At transplantation, the mean recipient age was 9.9 years (range 3-17 years) and mean body weight was 20.9 kg (range 11-45 kg). The graft was placed in an extraperitoneal position in the right iliac fossa in all cases (100%). In cases of single arterial anastomoses (94%), the mean ischemia time was 53.51 ± 11.68 min. In cases of double arterial anastomoses (6%), the mean ischemia time was 68.33 ± 5.77 min. There was significant association between single or double arterial anastomosis and ischemia time, where double arterial anastomosis had longer ischemia time ( P = 0.004). There was no intraoperative surgical complication in most of our patients (98%) except in one case (2%) in which the kidney has been transplanted upside down due to misdirection of the upper pole from the lower pole of the kidney. Postoperatively, there were no surgical complications in most of our patients (92%), but there were three cases with high debit urine leaks (6%), and unfortunately there was a case of graft renal vein thrombosis (2%). The mean serum creatinine at 6 months post-transplant was 0.6 mg/dl (range 0.4-0.9 mg/dl). There were no cases of hyperacute rejection. All donors are alive with a good renal function after first 6 months postoperatively. Conclusion Our initial surgical experience with renal transplantation carried a low (but clinically significant) risk for vascular and urological recipient complications that increased morbidity, but improvements in our surgical techniques and experience decreased these complications.

Single versus dual venous anastomoses of the free fibula osteocutaneous flap in mandibular reconstruction: A retrospective study

The present study was to compare the success rates of single venous anastomosis with dual venous anastomoses of the free fibula osteocutaneous flap in mandibular reconstruction. Retrospective review of all cases of mandibular reconstruction using free fibula osteocutaneous flaps performed by a single surgeon in our department during the period January 2005 to April 2012. All the flaps were harvested and transplanted by the standard protocols. Microvascular anastomosis of either one or two veins was performed. In addition to routine clinical evaluation, the viability of the flap was evaluated by a portable Doppler at the tenth day after surgery. Two hundred and one free fibula osteocutaneous flaps were performed during this time period. Single venous anastomosis was performed in 112 flaps and dual venous anastomoses were performed in 89 flaps. The overall incidence of vascular thrombosis was 3%, and the success rate of the transplantation was 98.5%. Six cases developed vascular thrombosis postoperatively. One was arterial thrombosis that occurred 12 hours after initial operation in the dual venous anastomoses group. Three venous thrombosis occurred 24 hr after the operation in the single venous anastomosis group. In dual venous anastomoses group, two venous thrombosis occurred 3-4 days after initial operation and attempt to salvage failed in both the cases. Fisher's exact test showed that there was no significant difference of the success rate between single and dual anastomoses groups (P = 0.59). There is no difference in success rates between single venous anastomosis and dual venous anastomoses for mandibular reconstruction with free fibula osteocutaneous flap.

Complications and Graft Survival in Kidney Transplants With Vascular Variants: Our Experience and Literature Review

IntroductionIn the literature several reconstructive techniques for vascular anastomoses in case of kidney graft vascular variants are reported. This article reports our experience in kidney transplants with vascular anomalies. Materials and methodsBetween January 1996 and June 2012, 154 cadaveric kidney transplantations were performed at our center. In 35 case, vascular variants were found. Among the arterial variants we observed 27 double arteries, 2 cases with 3 arteries, and 1 case with 4 arteries. All cases of Venous variants were double veins. Based on the type of reconstructive technique used, we divided transplants into group A (n = 22) separate multiple arterial anastomoses; group B (n = 8) anastomosis on the aortic patch; group C (n = 4) single anastomosis in case of 2 arteries with a common ostium at the aortic origin. The venous variants were treated with ligation of the vein of smaller caliber. ResultsKidney preparation to the back table lasted on average 50 minutes with no significant differences between the 3 groups and no significant timing increase compared to renal transplants without vascular anomalies (mean warm ischemia 40 minutes, range 30–60 minutes). The mean cold ischemia time was limited to 16 hours from the removal and the mean warm ischemia was 50 minutes (range 30–70 minutes). There were no differences in timing between group C and single anastomoses, whereas groups A and B showed mean warm ischemia time was slightly increased compared to group C (P < .05). There were no significant differences in terms of delayed upturn of graft function and graft survival between groups A, B, and C and compared to transplants without vascular anomalies. ConclusionsIn our series we observed similar results performing the reimplantation on aortic patch and separate multiple arterial anastomoses. Considering our experience, we believe that vascular variants are not an indication to exclude a graft for transplantation.