Single-layer Continuous Suture Research Articles

Ultrasonographic Evaluation of Cesarean Scar Defect after Double-layered Uterine Suture versus Single-layer Continuous Uterine Suture

Ultrasonographic Evaluation of Cesarean Scar Defect after Double-layered Uterine Suture versus Single-layer Continuous Uterine Suture

Double-layered purse string uterine suture compared with single-layer continuous uterine suture: A randomized Controlled trial

BackgroundWith the aim of preventing cesarean scar defects, we introduced a new technique involving a purse string uterine suture. To date, this uterine suture technique has not been formally evaluated. The objective of the study was to test the hypothesis that compared to single layer continuous uterine suture (SLCUS), a double layered purse string uterine suture (PSUS) significantly reduces cesarean scar defect (CSD) rates, without increasing the perioperative maternal morbidity. MethodsA prospective randomized study. Primary outcome was the rate of CSD. 100 patients were enrolled in 2 groups according to the uterine suture technique. A hysterosonography was performed by the same senior obstetrician blinded to the uterine suture technique 6 months after surgery .Operative time and calculated blood loss (CBL) were used for the short time analysis. Uterine and CSD measurements were used for the mid time analysis. ResultsDespite a longer operative time with PSUS (7.17 ± 2.31 min Vs. 6.31 ± 3.04 min, p = 0.028; p <10‾³); there was no significant difference in terms of CBL (520 ± 58 with PSUS vs. 536 ± 50 ml, p = 0.724). There was a significant decrease in the rate of CSD with PSUS: 6.66% Vs.40% with SLUCS; p<0.001. Moreover, SLUCS was the leading risk factor for CSD: adjusted OR=6; 95% CI [0–1], p<10‾³). ConclusionCompared to single layer continuous suture, double layered purse stringuterine suture significantly reduces cesarean scar defect rates, without increasing the perioperative maternal morbidity.

Impact of selected risk factors on uterine healing after cesarean section in women with single-layer uterine closure: A prospective study using two- and three-dimensional transvaginal ultrasonography.

Modern obstetrics must meet many challenges, including long-term complications resulting from the presence of a uterine niche after cesarean section. To assess the impact of selected risk factors on the uterine healing process after cesarean section. The uterus was closed with a single-layer continuous suture covering the entire thickness of the myometrium, excluding the decidua. A prospective, case-controlled study was carried out at 2nd Department of Gynecology and Obstetrics, Wroclaw Medical University, Poland. Women who delivered by cesarean section at our Department were invited to undergo an ultrasonographic assessment of the cesarean section scar from 6 to 9 weeks after the procedure. In all cases, the uterus was closed with a single-layer continuous suture. The ultrasound examination of the niche was performed according to the modified Delphi protocol. The volume of the niche was calculated and a 3D model was created. The obtained data were analyzed with clinical information from the maternal medical history and the course of the pregnancy. A total of 204 patients participated in the study. Five patients had a residual myometrial thickness (RMT) <2.2 mm and 35 had a residual myometrial thickness to adjacent myometrial thickness ratio (RMT/AMT) ≤0.5. In 45% of women, pregnancy course was complicated by gestational diabetes mellitus (GDM), gestational hypertension and hypothyroidism. The cervical canal was colonized with pathogenic flora in 22% of women. No correlation between maternal and gestational age at delivery, presence of medical complications during pregnancy, colonization of the cervical canal, and presence of niche and its parameters were found. Our study revealed that the selected risk factors, such as systemic diseases during pregnancy and in the maternal medical history, as well as the colonization of the cervical canal, have no impact on uterine scar healing in women undergoing single-layer uterine closure spanning the entire thickness of the myometrium, excluding the decidua.

Two- and three-dimensional transvaginal ultrasound in assessment of the impact of selected obstetric risk factors on cesarean scar niche formation: the case-controlled study.

Incomplete healing of the uterine scar after cesarean section may result in formation of a niche. The aim of this study is to identify the potential risk factors for the improper uterine healing after cesarean section in women with single layer, full thickness uterine closure with the use of two- and three-dimensional transvaginal ultrasonography. 204 women with a history of at least one low transverse cesarean section (CS) with a single layer uterine closure participated in the study. Residual myometrial thickness (RMT), adjacent myometrial thickness (AMT), width (W), depth (D) and volume of the niche, RMT/AMT, RMT/D, RMT/W ratio and clinical characteristics were analyzed. A niche after cesarean section was found in 153 cases. However only five patients had a RMT < 2.2 mm, and 35 had an RMT/AMT ratio ≤ 0.5. The RMT and RMT/AMT ratio among women who had undergone more than one cesarean section was lower than among women who underwent the first cesarean section. No statistically significant relationship was found between the incidence of niche, its parameters and cervical dilation, uterine contractions, cesarean section in the second stage of labor, type of uterus incision expansion and flexion, operator's experience. Healing of the uterine cesarean section scar in women with single-layer continuous suture covering the entire thickness of the myometrium, excluding the decidua is not affected by the mode of caesarean section, type of uterine incision expansion and flexion, operator's experience, stage of labor at the time of caesarean section.

Novel single-layer continuous suture of pancreaticojejunostomy for robotic pancreaticoduodenectomy.

The best technique for pancreatic anastomosis after pancreaticoduodenectomy (PD) remains controversial, and the procedure for robotic PD (RPD) has not been previously reported. This study aimed to evaluate the safety and feasibility of a novel technique of pancreaticojejunostomy (PJ) for RPD. The demographics and perioperative outcomes of a consecutive series of RPD patients who underwent single-layer continuous suture (SCS) for PJ between September 2018 and November 2018 were analyzed. Thirty patients were included in the study. Twenty patients had a soft pancreas, and 15 patients had a small main pancreatic duct (MPD) (<3mm). The mean operative time was 234.1min, the mean duration of PJ was 14.9min, and the median estimated blood loss was 100.0ml. No patients required conversion to laparotomy. Postoperative pancreatic fistula (POPF) included seven cases of Grade A and two cases of Grade B. No case of Grade C POPF occurred. The mean postoperative hospital stay was 12.3days. No 90-day readmission or mortality was observed. Neither pancreatic texture nor MPD size affected the perioperative outcomes. Single-layer continuous suture is easy to perform and is associated with favorable clinical outcomes, regardless of the pancreatic duct size and texture.

2676 Laparoscopic Myomectomy: A New Suturing Technique

Study Objective The aim of the present study was to find a surgical technique that allows to perform laparoscopic myomectomy even of large fibroids located in difficultly accessible locations, such as the posterior uterine wall, by reducing both the operative time and the risk of bleeding related to the suture of the uterine wound. Design Prospective case control study, lasting 8 months. Setting Department of Gynecology in Nuona Villa Claudia Clinic, Rome (Italy). Patients or Participants Forty women of reproductive age with an intramural-underserous posterior uterine wall myoma, measuring 6-8 cm, undergoing laparoscopy to remove it. Interventions The 40 women enrolled underwent laparoscopic myomectomy according to the classical technique: transversal incision in the most distended part of the myometrium down to the pseudocapsule, identification of the cleavage plane and enucleation of the myoma. All of the study women had the myometrial wound repaired using an absorbable 2/0 barbed polygliconate wound closure device, but while in 20 of them a single layer continuous suture was performed, starting from the left end of the wound up to the right, in the remaining 20 women a single stitch was initially placed in the central part of the wound and transversal to it. That thread was cut sufficiently long to be grasped with a joanne and lifted upwards, while a single layer semicontinuous suture was performed. Measurements and Main Results The evaluation showed, in group 1 and 2 respectively, an average surgery duration of 55 and 42 minutes and a mean intraoperative blood loss of 1.5 and 0.8 g/dl of hemoglobin. Conclusion The suturing technique proposed in group 2 significantly facilitates the operator work, allowing both a shorter duration of the surgical procedure and a reduction in intraoperative blood loss. It could be, then, a valid alternative to the classic suturing technique, especially in cases of myomectomy of large fibroids of the posterior uterine wall.

Prognosis control surgery: From theory to practice

Rapid advances of big data and artificial intelligence (AI) techniques have pushed the envelope of traditional surgery to intelligent surgery, which revolutionizes the traditional medicine model dominated by the experiences of interveners and evidence-based medicine. Intelligent surgery requires to judiciously integrate the clinical experience of interveners and medical evidences with the new AI techniques, so as to achieve the best therapeutic effect for patients through effective disease risk control. This paper puts forward a new theory of prognostic control surgery in the long-term clinical practice of hepato-pancreato-biliary surgery. Our theory takes the optimal prognosis of patients as the goal, and pre-controls the disease risk through the best combination of the optimal intervener, intervention methods and intervention timing to achieve the maximum clinical benefits of patients with minimal medical trauma. This theory also takes full advantage of information technologies such as neural networks, deep learning, big data and imaging system, and uses high-dimensional network decision making to replace the traditional two-dimensional decision making tree model. A main technical challenge in the theory is how to effectively exploit the AI techniques in to improve the production efficiency of large hospitals, enhance the service level of primary medical care, and improve the diagnosis, prediction, treatment of diseases. Prognostic control surgery advocates the exploitation of emerging information technology methods, such as medical image recognition and prediction, 3D reconstruction based surgical planning, intraoperative navigation, and remote intelligent robotic surgical system, to promote the rapid and balanced surgical diagnosis and treatment. Guided by the theory of prognosis control surgery, our team successfully established minimally invasive anatomic hepatectomy, individualized pancreatic surgical approaches, modular hepatectomy, single-layer continuous suture of pancreaticojejunostomy, and end-to-end pancreatic anastomosis and advocated en-bloc resection of pancreatic cancer. This paper also provides the details of four core surgical strategies proposed in our prognosis control surgery, namely, blood control technique, surgical approach selection, resection technique and reconstruction technique, by which to achieve the minimally invasive surgery regularization and the complex surgery simplification.

Abdominal Wall Plication and Correction of Deformities of the Myoaponeurotic Layer: Focusing on Materials and Techniques Used for Synthesis.

The different types of sutures utilized in plications and for correction of diastasis during abdominoplasty are reviewed and discussed. Because correction of abdominal deformities also involves fascia and muscle advancement, this review also covers the suture materials used in muscle advancement. The selection of specific techniques to treat different types of abdominal wall deformity is also considered. This is important, because the outcome when correcting these deformities depends not only on suture materials but also on employing the optimum technique. A PubMed/Medline search was performed with the following search terms: rectus diastasis, diastasis recti, diastasis recti abdominis, correction of rectus diastasis, abdominoplasty. Relevant articles identifying the type of suture (rapidly absorbable, slowly absorbable, nonabsorbable), monofilament or multifilament sutures, antibiotic-coated sutures, and barbed sutures were evaluated. In addition, articles about surgical technique comparing continuous and interrupted sutures, in both the anterior and posterior aponeurosis, to correct rectus diastasis are discussed. Efficacy of suture materials was evaluated based on the long-term results and recurrence rates reported in these articles. The current literature provides sufficient data to recommend a single-layer continuous suture, with slowly absorbable sutures of 0 polydioxanone or 2-0 nylon, for correction of abdominal diastasis. An interrupted triangular suture is a good alternative to correct the vertical elongation of the myoaponeurotic layer that occurs after pregnancy.

Novel single-layer continuous suture of pancreaticojejunostomy for robotic pancreaticoduodenectomy

Introduction: Robotic pancreaticoduodenectomy (RPD) is one of the most technically challenging procedures in robotic abdominal surgery. The best technique for pancreatic anastomosis after PD remains controversial, and the procedure for performing this anastomosis by a robotic approach has not been previously reported. This study aimed to evaluate the safety and feasibility of a novel technique of pancreaticojejunostomy (PJ) for RPD. Method: The demographics and perioperative outcomes of a consecutive series of RPD patients who underwent single-layer continuous suture (SCS) for PJ between September 2018 and November 2018 were analyzed. Result: Thirty patients (19 men and 11 women; mean age, 55.0 years) were included in the study. Twenty patients had a soft pancreas, and 15 patients had a small main pancreatic duct (MPD) (<3 mm). The mean operative time was 234.1 minutes, the mean duration of PJ was 14.9 min, and the median estimated blood loss was 100.0 mL (interquartile range, 50-150 mL). No patients required conversion to laparotomy or a blood transfusion. Postoperative major morbidities (Clavien ≥C) occurred in 3 patients (10%), and all recovered after conservative treatment. The overall incidence of postoperative pancreatic fistula was 30% and included 7 cases (23.2%) of Grade A, 2 cases (6.7%) of Grade B, and no case of Grade C pancreatic fistula. The mean postoperative hospital stay was 12.3 days. No 90-day readmission mortality or 90-day mortality was observed. Neither pancreatic texture nor MPD size affected the perioperative outcomes. Conclusion: SCS is a safe and feasible PJ technique for RPD. SCS is easy to perform and is associated with favorable clinical outcomes, regardless of the pancreatic duct size and texture.

A light-activated amnion wrap strengthens colonic anastomosis and reduces peri-anastomotic adhesions.

Colonic anastomotic failure is a dreaded complication, and multiple surgical techniques have failed to eliminate it. Photochemical tissue bonding (PTB) is a method of sealing tissue surfaces by light-activated crosslinking. We evaluated if a human amniotic membrane (HAM), sealed over the anastomotic line by PTB, increases the anastomotic strength. Sprague-Dawley rats underwent midline laparotomy followed by surgical transection of the left colon. Animals were randomized to colonic anastomosis by one of the following methods (20 per group): single-layer continuous circumferential suture repair (SR); SR with a HAM wrap attached by suture (SR+ HAM-S); SR with HAM bonded photochemically over the anastomotic site using 532 nm light (SR+ HAM-PTB); approximation of the bowel ends with only three sutures and sealing with HAM-PTB (3+ HAM-PTB). A control group underwent laparotomy alone with no colon resection (NR). Sub-groups (n = 10) were sacrificed at days 3 and 7 post-operatively and adhesions were evaluated. A 6 cm section of colon was then removed and strength of anastomosis evaluated by burst pressure (BP) measurement. A fourfold increase in BP was observed in the SR+ HAM-PTB group compared to suture repair alone (94 ± 3 vs. 25 ± 8 mm Hg, P < 0.0001) at day 3. At day 7 the burst pressures were 165 ± 40 and 145 ± 31 mm Hg (P = 1), respectively. A significant decrease in peri-anastomotic adhesions was observed in the SR+ HAM-PTB group compared to the SR group at both time points (P < 0.001). Sealing sutured colonic anastomotic lines with HAM-PTB increases the early strength of the repair and reduces peri-anastomotic adhesions. Lasers Surg. Med. 48:530-537, 2016. © 2016 Wiley Periodicals, Inc.

Single-Layer Continuous Versus Double-Layer Continuous Suture in Colonic Anastomoses—a Randomized Multicentre Trial (ANATECH Trial)

PurposeApart from stapling methods, single- or double-layer continuous hand sutures are established techniques for colonic anastomoses. It is unclear which hand suture technique has superior anastomotic safety. This randomized trial evaluated the incidence of postoperative complications depending on anastomosis technique. MethodsThis multicentre randomized trial enrolled adult elective patients between February 2004 and June 2012 in four German university hospitals. Primary endpoint was incidence of clinical anastomotic leakage until 3 months postoperatively. Estimated sample size was 768 randomized patients. Main secondary endpoints were duration of anastomotic suture, postoperative morbidity and stool patterns at 3-month follow-up. Patients and postoperative outcome assessors were blinded to the group assignment. This trial is registered (NCT00996554). ResultsDue to slow recruitment, the trial was stopped prematurely. Two hundred fifty-two patients (129 to single-layer suture anastomosis (SLA), 123 to double-layer suture anastomosis (DLA)) were randomized and analysed. Nine patients (3.6 %) were lost during follow-up. Exploratory primary endpoint analysis by intention-to-treat principle showed no significant difference for clinical anastomotic leakage between suturing techniques (SLA, 4 of 129 (3.1 %) vs. DLA, 6 of 123 (4.9 %), p = 0.532). Secondary endpoint analysis showed on average a 6-min shorter suture duration for SLA than DLA (18 min (4–49) vs. 24 min (8–50), p < 0.001). At 3-month follow-up, subjective well-being and stool patterns were not significantly different between groups. ConclusionsThe present study did not reach sufficient power and cannot confirm whether both techniques might be equally or if one technique might be superior. Exploratory analysis suggests that in elective colonic resections, the single-layer continuous hand suture technique may be equally effective as the double-layer technique regarding incidence of anastomotic leakage, length of hospital stay, overall postoperative complications, subjective short-term well-being and stool patterns. Lessons learned from this trial course are summarized. Trial RegistrationThis trial is registered (Trial registration: NCT00996554). Link: https://clinicaltrials.gov/ct2/show/NCT00996554.

Efficacy of single-layer continuous suture of the posterior wall in anastomosis involving a difficult location of the digestive tract.

Surgery for digestive tract disease predominantly consists of reconstruction and anastomosis. Due to the difficult location, anastomosis is extremely challenging and the risk of complication increases accordingly. Traditional manual anastomosis and the application of a stapling device are insufficient. Therefore, the aim of this study was to investigate the feasibility and safety of a novel manual method in a difficult anastomotic location, consisting of a single-layer continuous suture in the posterior wall. In total, 15 beagle dogs were included in the study; eight underwent surgery with the novel manual method for reconstruction and anastomosis of the digestive tract, while seven underwent surgery with the stapler device as a control. The subsequent postoperative complications were observed and, three months later, the anastomotic ports were excised, and the pathological formation and morphological changes were evaluated. No statistically significant differences were identified between the total (50.0 vs. 57.1%; P=0.782) and anastomotic (0.0 vs. 28.6%; P=0.200) complication rates in the manual suture and staple suture groups, respectively. Compared with the control group, the operative expenditure was lower in the manual group (1726.7±33.5 vs. 2135.7±43.1 renminbi; P=0.001), the diameter of the anastomotic port was larger in the manual group (3.04±0.07 vs. 2.24±0.25 cm; P=0.004) and the thickness of the anastomotic port (in cm) was thinner in the manual group (2.94±0.06 vs. 5.07±0.85; P=0.002). Furthermore, the pathological formation of the anastomositic port in the manual group was improved. The results of the current study suggest single-layer continuous suture of the posterior wall in anastomosis of the digestive tract to be a novel method with feasibility and safety, particularly in difficult anastomotic locations.

Single-layer continuous suture contributes to the reduction of surgical complications in digestive tract anastomosis involving special anatomical locations

The key point of digestive cancer surgery is reconstruction and anastomosis of the digestive tract. Traditional anastomoses involve double-layer interrupted suturing, manually or using a surgical stapler. In special anatomical locations, however, suturing may become increasingly difficult and the complication rate increases accordingly. In this study, we aimed to investigate the feasibility and safety of a new manual suturing method, the single-layer continuous suture in the posterior wall of the anastomosis. Between January, 2007 and August, 2012, 101 patients with digestive cancer underwent surgery in Xi'an Gaoxin Hospital. Of those patients, 27 underwent surgery with the new manual method and the remaining 74 underwent surgery using traditional methods of anastomosis of the digestive tract. Surgical time, intraoperative blood loss, drainage duration, complications, blood tests, postoperative quality of life (QOL) and overall expenditure were recorded and analyzed. No significant differences were observed in surgical time, intraoperative blood loss, temperature, blood tests and postoperative QOL between the two groups. However, compared with the control group, the new manual suture group exhibited a lower surgical complication rate (7.40 vs. 31.08%; P=0.018), lower blood transfusion volume (274.07±419.33 vs. 646.67±1,146.06 ml; P=0.053), shorter postoperative hospital stay (14.60±4.19 vs. 17.60±6.29 days; P=0.038) and lower overall expenditure (3,509.85±768.68 vs. 6,141.83±308.90 renminbi; P=0.001). Our results suggested that single-layer continuous suturing for the anastomosis of the digestive tract is feasible and safe and may contribute to the reduction of surgical complications and overall expenditure.

Duct-to-duct biliary reconstruction after radical resection of Bismuth IIIa hilar cholangiocarcinoma

At present, radical resection remains the only effective treatment for patients with hilar cholangiocarcinoma. The surgical approach for R0 resection of hilar cholangiocarcinoma is complex and diverse, but for the biliary reconstruction after resection, almost all surgeons use Roux-en-Y hepaticojejunostomy. A viable alternative to Roux-en-Y reconstruction after radical resection of hilar cholangiocarcinoma has not yet been proposed. We report a case of performing duct-to-duct biliary reconstruction after radical resection of Bismuth IIIa hilar cholangiocarcinoma. End-to-end anastomosis between the left hepatic duct and the distal common bile duct was used for the biliary reconstruction, and a single-layer continuous suture was performed along the bile duct using 5-0 prolene. The patient was discharged favorably without biliary fistula 2 wk later. Evidence for tumor recurrence was not found after an 18 mo follow-up. Performing bile duct end-to-end anastomosis in hilar cholangiocarcinoma can simplify the complex digestive tract reconstruction process.

Effectiveness of external drainage of the bile duct in pancreaticoduodenectomy: a single surgeon's experience.

Backgrounds/AimsThe rates of surgery-related complications during and after pancreaticoduodenectomy (PD) remain very high, reaching up to 41%. They were primarily caused by leakage of pancreatic juice. We evaluated the effectiveness of external drainage of the bile duct using a pigtail drain to prevent pancreatic leakage in patients undergoing PD.MethodsWe evaluated 79 patients who underwent PD using a single-layer continuous suture between the pancreatic parenchyma and jejunum after duct-to-mucosa anastomosis by a single surgeon from April 2005 to December 2008. Of the 79, 44 underwent external drainage (ED) of the bile duct using a pigtail drain, performed in the intraoperative field via a retrograde transhepatic approach, whereas 35 did not undergo ED.ResultsAge, sex distribution, number of total complications, pancreatic duct size, pancreatic texture and duration of hospital stay did not differ between patients who did and did not undergo ED. In groups with or without ED, 0 and 4 patients, respectively, showed leakage of pancreatic juice and the difference was statistically significant (p=0.02).ConclusionsThe fact that none of the patients who underwent external drainage experienced pancreatic leakage, suggests that external drainage of the bile duct with a pigtail drain to decompress the jejunum and to drain pancreatic and bile juice is useful in preventing the complications of pancreatic leakage.

Risk factors for morbidity and mortality after single-layer continuous suture for ileocolonic anastomosis

The study was designed to determine the suitability of a single-layer continuous anastomosis for ileo-colonic anastomoses and to determine perioperative risk factors for morbidity and mortality in a teaching hospital. Perioperative data of 463 patients undergoing colonic surgery with an ileocolonic anastomosis between 2000 and 2007 were retrospectively reviewed. Outcomes were compared using univariate and multivariate analyses to identify risk factors for morbidity, including anastomotic leakage, and mortality. The overall anastomotic leakage rate was 2.1%. In more than 50% right hemicolectomies were performed for colonic cancer. Univariate analysis showed a significant association of the underlying diagnosis with the leakage rate (ischemia 3.0% vs. carcinoma 1.3%). Multivariate analysis identified age, ASA score, diagnosis, and urgency as risk factors for morbidity; and an urgent operation setting (vital indications), a body mass index >25, diabetes mellitus, and a hypotensive circulation upon admission as predictors of anastomotic leakage. The mortality rate was 20% (2/10) among patients with anastomotic leakage and 2.9% (13/453) in those without anastomotic leakage. Single-layer continuous anastomoses for ileo-colonic surgery can be safely performed, even in a teaching setting. Four preoperative risk factors for morbidity and four different factors for anastomotic leakage could be identified in multivariate analysis. If feasible, these factors should have an impact on the preoperative decision-making progress.

Surgical Technique of Small Bowel Transplantation in a Large Animal Model

An experiment was carried out on pigs during preparation of a clinical project of intestinal transplantation. The objective of this study was to find the best surgical technique of vascular and intestinal anastomosis in different experimental settings (animals with and without immunosuppression) which could have a major impact on everyday veterinary practice. Transplantation was performed in 43 pigs. In the surgical part of the experiment we examined the most suitable surgical technique of vascular anastomosis. A running continuous single-layer seromuscular suture was used for all types of intestinal anastomoses. With regard to vascular anastomosis, the animals were divided into two groups. In group 1 (n = 18) one animal was both donor and recipient of the intestinal graft. Anastomoses were constructed to the mesenteric vessel bed. In group 2 (n = 25), one animal was the graft donor and another was the graft recipient, with revascularization to the central vessel bed. In the second part of the study, we examined the impact of immunosuppressive drug administration on acute cellular rejection and animal survival. Animals that died due to technical failure and reasons unrelated to transplantation were excluded from the evaluation (19 pigs). A total of 24 pigs were included in the second part of the study. The animals were divided into four experimental groups. Group A - autotransplantation (n = 3), group B - allotransplantation on tacrolimus monotherapy (n = 7), group C on combined immunosuppression with tacrolimus and sirolimus (n = 8), and control group D - without immunosuppression (n = 6). Results: A high rate of vascular complications occurred in the first group; 67% (12 out of 18). In the second group, the rate of complications was reduced to 12% (3 out of 25). In the second part of the study the shortest survival was found in group D and the longest in group A. In neither of the immunosuppressed groups (B + C) did we find any significant difference in survival. No complication with the healing of intestinal anastomosis was found in any group. In conclusion we can state the single-layer continuous running suture was safe for all kinds of intestinal anastomoses. Vascular reconstruction to the central vessels was safer for graft survival.

Bypass gástrico laparoscópico com uso reduzido de suturas mecânicas

RACIONAL: A execução de bypass gástrico laparoscópico em hospital universitário público tem sido difícil devido ao elevado custo dos grampeadores cirúrgicos que prejudica o treinamento de médicos residentes e tem motivado a busca por técnicas alternativas, de baixo custo, mantendo a eficácia. OBJETIVO: Apresentar a viabilidade de um método com menor uso de suturas mecânicas. MÉTODOS: Foram operados 63 pacientes em 2 hospitais universitários, sendo 12 homens e 51 mulheres (81%), com média de 33,5 anos de idade e IMC médio de 43. Aplicou-se a seguinte padronização técnica: Secção da alça com bisturi elétrico a 50 cm do ângulo duodeno-jejunal, anastomose término-lateral, passagem da alça retrocólica e retrogástrica, confecção da parede lateral da bolsa gástrica com 1 carga azul de 45 e outra de 60 mm após a secção horizontal com bisturi elétrico, sutura do estômago excluso e anastomose gastrojejunal. As anastomoses foram manuais e contínuas com fio absorvível. RESULTADOS: O tempo operatório médio foi de 5,5 horas. As complicações precoces foram: fístula no ângulo de esôfago-gástrico (1,6%), estenose (1,6%) e fístula na anastomose gastrojejunal (1,6%) e torção da anastomose intestinal (1,6%). A estenose foi tratada por dilatação endoscópica e as outras complicações através de 3 re-operações (2 laparoscópicas e 1 laparotômica). O tempo de internação variou de 2 a 20 dias, com média de 4 dias, não havendo óbito. CONCLUSÃO: Este método é viável e com baixo custo operacional; todavia, é complexo e requer habilidade principalmente em suturas laparoscópicas.

Multisegmental lobe bronchoplasty for the treatment of non-small-cell lung cancer

Bronchoplasty was extended to the segmental level and the effect of the multi-segmental surgery for the central non-small lung cancer was observed. The involved lobular bronchi and part of main bronchi were resected and single-layer continuous suture with 5-0 Prolene was used for suturing of the carina of the reconstructed segmental bronchi to form lobular bronchi. Then, single-layer continuous suture with 4-0 Prolene was employed to anastomose the "lobular bronchi" with main bronchi. Our results showed that the 15 bronchoplasties were successfully performed. The tumors were completely removed and postoperatively, the pulmonary functions of the patients were substantially improved. No broncho-pleural fistula and stomal stenosis took place in all the cases. The quality of life of the patients were obviously improved. It is concluded that multisegmental bronchoplasty can completely remove the tumor of central non-small-cell lung cancer and conserve more non-involved lung. The procedure is especially suitable for those patients with severely impaired lung functions and it expands the indications of surgical resection of lung cancer.

Continuous single-layer gastrointestinal anastomosis: A prospective audit

Single-layer bowel anastomoses have conventionally been constructed using an interrupted suture technique. A single-layer continuous technique has been avoided on the grounds that it may predispose to ischaemia of the bowel ends. We have routinely used a single-layer continuous suture technique with an absorbable suture material (polyglycolic acid) to construct all recent intraperitoneal bowel anastomoses, and we present a 3-year audit of this technique. A total of 131 patients were studied of whom 66 had undergone upper gastrointestinal resections and 65 had had colonic resections. Twenty-two patients had emergency operations. Anastomotic failure was noted in 4.5 and 6.2 per cent of patients in each group respectively. The incidence of minor wound infection was 1.5 and 7.7 per cent respectively. The overall mortality rate was 8.4 per cent. This study suggests that a single-layer continuous suture technique gives acceptably reliable results when used in gastrointestinal anastomosis.