Anastomosis Stapler Research Articles

A Modified Sugiura Procedure

The Sugiura procedure for esophageal varices combines splenectomy with esophagogastric devascularization, which destroys the intraesophageal portacaval shunt but preserves periesophageal portacaval shunts. We have modified the total vagotomy and pyloroplasty and sutured esophageal anastomosis of the original operation. A single left thoracoabdominal incision is used. Esophagogastric devascularization is performed without dividing the main vagus trunks; only a proximal gastric vagotomy is done, thereby avoiding a pyloroplasty. The esophageal transection and reanastomosis are performed with the circular End-to-End Anastomosis stapler and protected with a loose fundal wrap. Fifteen of 20 patients have had good to excellent results, with rapid recovery and no recurrent esophagogastric bleeding or any hepatic encephalopathy in follow-up of two months to two years. Four patients, who were bleeding massively at the time of operation and who were in Child's class C with gross ascites, muscle wasting, and coagulopathy, died in the postoperative period. Conceptually, the operation is original and exciting because it preserves hepatic blood flow and the beneficial periesophageal shunt, while destroying the harmful intraesophageal shunt. Our early experience encourages us to continue using this operation, except in those patients who bleed massively and are in Child's C, end-stage, class.

The automatic staple versus the conventional gastrointestinal anastomosis in gynecological malignancies

Seventy-four patients with gynecologic malignancies and two with benign tumors under-went different types of gastrointestinal resections to relieve bowel obstruction or to correct fistulas. All but 2 of these patients had gynecologic cancer with one or more modalities of therapy prior to resection. The anastomoses of 47 patients were performed with open conventional techniques which included closure of the full thickness of the bowel. In 28 patients, the automatic stapler was used 63 times. In 3 of the 28 staple anastomosis patients, the EEA (end-to-end anastomosis) was used. In this study, the use of the staple anastomosis was shown to be as effective as the conventional method because it shortened the operating time, provided less contamination of the abdominal cavity, and provided a better blood supply.

Use of the Automatic Surgical Stapler for Intestinal Anastomosis Associated with Gynecologic Malignancy

Abstract Between the years 1974 and 1980, 283 intestinal stapling procedures involving the large and small bowel have been performed on the Gynecologic Oncology service. The automatic surgical staplers used in this series were: the gastrointestinal anastomosis (GIA), the thoracoabdominal (TA-55/30), and the end-to-end anastomosis (EEA) stapler (United States Surgical Corp., Stamford, Conn.). The 283 stapling operations were performed on 162 patients. Fifty-three of the patients had received pelvic irradiation prior to the intestinal operations. The complication rate was low, and compared very favorably with other techniques of gastrointestinal anastomosis which were performed by the same authors. There was one disruption of a small-bowel anastomosis, temporary stricture in three anastomoses of rectum to colon, a leak in a low colonie-rectal anastomosis which resulted in a pelvic abscess, and a rectovaginal fistula. Fifty-two patients underwent urinary diversion by bowel conduit. In all of these cases the conduit was fashioned with the aid of the automatic stapler. The low complication rate in gastrointestinal anastomoses performed with the automatic surgical staplers supports the conclusion that this is a technically superior method which provides better utilization of operating time on radical pelvic procedures.

IMPROVED TECHNIQUES IN E.E.A. STAPLING FOR ULTRA LOW COLORECTAL AND COLO-ANAL ANASTOMOSIS

Techniques for routinely achieving intact ultralow end-to-end colorectal or colo-anal staple anastomoses have been examined in eight dogs and undertaken in six human subjects having segmental excision for low middle-third rectal carcinoma. A per-anum purse-string suturing technique into an ultra-short anorectal stump was used. Two methods were employed to appose the proximal divided rectum and the anorectal stump prior to stapling: (i) orthograde entry of the E.E.A. into the bowel (4 dogs and 3 humans); and (ii) high retrograde entry of the E.E.A. into the bowel (4 dogs and 3 humans). These techniques appear reliable methods to ensure complete envelopment of the cartridge and anvil by colon or rectal stump. Intact colo-anal anastomoses were achieved in seven dogs, and there was one anastomotic deficiency in the six patients. Anorectal incontinence in the patients has been a postoperative problem, but does improve with time. The techniques appear to offer greater reliability in construction of ultra-low colorectal or colo-anal end-to-end staple anastomosis after segmental excision of the rectum for low middle-third tumours than do more conventional stapling techniques.

Randomized prospective evaluation of the EEA stapler for colorectal anastomoses

A randomized, prospective study should be done to evaluate any new procedure or instrument. Our experience with the end-to-end anastomosis (EEA) stapler suggests that an anastomosis can be created in a shorter time than is required for the traditional hand-sewn technique. This difference is even greater when the anastomosis is technically difficult and located deep within the pelvis. There appears to be little difference in the security of a hand-sewn anastomosis compared with that of stapled anastomosis. Postoperative complications appear similar. With the stapler, however, there is an increased risk of intraoperative complications that are not apparent with the traditional hand-sewn technique. These include rectal tears and anastomotic defects. It appears that the EEA stapler can save as many as 12 percent of rectums that otherwise might have to be removed because of technical inability to perform an anastomosis.

PURSE STRING PLACEMENT FOR STAPLE ANASTOMOSIS USING THE END-TO-END ANASTOMOSIS STAPLING INSTRUMENT

There may be technical difficulties in the use of recommended clamp for the insertion of the purse-string suture during the construction of an end-to-end staple anastomosis. Hand sewing the purse string eliminates some of the problems, but unless the suture is positioned within a few millimetres of the cut edge of the bowel, ischaemic tissue may be included in the staple line. In dogs, this leads to anastomotic dehiscence. The anastomosis may, however, be protected by excising the ischaemic tissue and reinforcing the staple line with sutures. An "over and over" purse-string technique is now preferred to minimize the risk of this occurring.

Urolithiasis from stapler anastomosis: J. Bisson, R. K. Vinson, and G. W. Leadbetter. Am J Surg 137:280–282, (February), 1979

Urolithiasis from stapler anastomosis: J. Bisson, R. K. Vinson, and G. W. Leadbetter. Am J Surg 137:280–282, (February), 1979

Urolithiasis from stapler anastomosis

The simplicity of operation and versatility and speed of automatic stapling devices in the creation of ileal loops have been amply documented. Three cases of stone formation in the ileal loop, secondary to encrustation about the staples, are reported herein, and the modification to the surgical technic which would obviate this problem is presented.

Stenosis after stapler anastomosis

Two cases of anastomotic stenosis after the use of the GIA Auto Suture Stapler are presented as examples of the potential problem that does exist in using this instrument. Possible causes and a suggestion for eliminating this complication have been outlined.

Bleeding from stapler anastomosis

Three patients with massive bleeding after stapler-performed intestinal anastomosis are reported on. Two patients required secondary operation for control. The cause was mechanical instrument failure. Periodic in vitro testing is recommended as a preventive measure.

Micro-vascular Surgery

This conference brought together for the first time surgeons with a common interest in small vessel surgery. Authors of original contributions include pioneers in the application of stapling devices, adhesives, prosthetic connectors, electrocoaptation, and laser for nonocclusive anastomosis. Suture repair of small arteries involves three problems: adequate magnification, proper instruments, and suitable suture material. Jacobson defines these problems and describes his important contributions to their solution. The introduction of pneumatically operated instruments for suturing 1-mm vessels approaches the ultimate in surgical precision by any technique. Staple anastomosis allows more rapid restoration of blood flow but, like prosthetic connectors, has the disadvantage of shortening the vessel. Vascular electrocoaptation and the use of liquid plastic adhesives are treated in detail, and Swedish workers report their experience with two vascular suture machines. Donaghy describes the evolution of an in-lying T-tube bypass and the application of vein patch grafts. The longest section describes the