Stapler Closure Research Articles

Comparative study of time taken for skin closure, infection rate and postoperative pain in skin closure with sutures and staplers in open inguinal hernioplasty

Wound healing is a complex and dynamic process and is influenced by surgical technique. Optimal wound healing, with a minimal scar that compromises neither appearance nor function, is the desired result. This process is affected by both local and systemic factors. Many local conditions are readily controlled at the time of wound closure, and several fundamental principles of surgical wound closure exist that should be adhered to in the management. Skin is usually closed with sutures then later with skin staplers.Skin staplers are quick and easy to use, but an assistant is usually required to hold the skin edges accurately with forceps or skin hooks.Stapler's closure also causes considerably less damage to wound defenses than closure with least reactive non-absorbable suture. Standard suturing causes significantly more necrosis than stapling in myocutaneous flaps. We did this study to compare the time required for the closure of skin, infection rate, pain at the operated site with sutures and staplers in open inguinal hernia repair. 80 patients who were posted for elective open inguinal hernia surgery at Sri Ramachandra Medical College & Research Institute, porur, Chennai was included in this study. Time taken for closure of skin, infection rate and the pain was less in patients with stapler closure than with skin sutures

Analysis of the effect of linear stapler closure pharyngeal after total laryngectomy

Objective:To compare the effect of closure of pharyngeal cavity with linear stapler and manual suture in total laryngectomy. Method:A retrospective study was conducted on 32 patients who underwent total laryngectomy with linear stapler to close the pharyngeal from December 2014 to March 2019. Among them, 25 patients used closed technique and 7 patients used open technique. At the same time, 23 patients who underwent total laryngectomy with manual suture the pharyngeal by the same operator from January 2010 to December 2014 were collected. The clinical parameters of the two groups were compared and analyzed. Result:Compared with the control group, the closed technical group had no significant difference in terms of gender, diabetes mellitus, second surgery, T stage, and surgical method（P> 0.05）. While the age （63.60 ± 9.46） years and （54.35 ± 11.13） years , operation time （239.67 ± 88.43） min and （474.35 ± 140.16） min , oral feeding time （12.84 ± 3.65） min and （17.3 ± 9.71）min , hospitalization days after operation （ 15.48 ± 3.78） d and （20.22 ± 10.14） d, incidence of Pharygocutaneous fistula 4.0% （1/25） and 26.1% （6/23）, had significant statistical differences （P <0.05） Between two groups; Compared with the control group, the opener group had no statistically significant difference in gender, T stage, oral feeding time, hospitalization days after operation，surgical method and incidence of Pharygocutaneous fistula （P> 0.05），while there was a statistically significant difference in diabetes mellitus, second surgery, and operation time （P<0.05）. Conclusion:The linear stapler closed closure technique can reduce the incidence of Pharygocutaneous fistula, shorten the operation time and oral feeding time, and reduce the length of hospital stay.

The Impact of Stump Closure Techniques on Pancreatic Fistula Stratified by the Thickness of the Pancreas in Distal Pancreatectomy

Background: The purpose of this retrospective study was to evaluate the impact of stump closure techniques on pancreatic fistula (PF) focusing on pancreatic thickness after distal pancreatectomy (DP). Methods: A total of 213 patients who underwent DP between 2007 and 2017 were retrospectively reviewed. The risk factors of PF were investigated. Results: In all patients, age ≥65 years (odds ratio [OR]: 3.60, p = 0.012), operation time ≥300 min (OR: 3.05, p = 0.013) and thickness of transected pancreas (OR: 1.37, p < 0.001) were identified as independent risk factors for clinically relevant PF. A receiver operating curve analysis revealed the optimum cut-off values of thickness to be 14 mm with stapler closure and 17 mm with the clamp-crushing method. There were no significant differences regarding PF between the stapler closure and clamp-crushing methods in the thin (<14 mm) and very thick pancreas (≥17 mm) groups (p = 0.822, p = 0.072). In contrast, stapler closure was the only independent risk factor for developing PF in the moderately thick (≥14, <17 mm) pancreas group (OR: 6.75 and p = 0.004, respectively). Conclusion: The clamp-crushing method was superior to stapler closure for pancreatic transection, especially in patients with moderately thick pancreas.

Stapler versus polyamide sutures for skin closure for sternal wounds in coronary artery bypass graft surgery - our experience.

IntroductionPatients undergoing coronary artery bypass graft surgery constitute a large population of patients with anatomically similar incisions created under similar circumstances.AimOur study aimed at analysing and comparing rates of surgical site infections (SSIs) at the sternotomy sites based on the material used for skin closure of the sternal wound with special emphasis on presence of risk factors such as diabetes (glycated haemoglobin (HbA1c) > 9) and obesity (body mass index (BMI) > 30 kg/m2) in the 2 respective groups.Material and methodsThis is a retrospective observational study. A total of 864 patients were included in the study. The patients were grouped into 2 groups depending on the sternal wound closure strategy used. One group consisted of patients in whom polyamide sutures were used for skin closure, while the other group comprised patients in whom skin staples were used for skin closure. Incidence of sternal wound SSIs in both groups was noted. Co-morbid conditions such as diabetes mellitus (with HbA1c > 9) and obesity (BMI > 30 kg/m2) were noted and analysed as contributory factors for SSIs.ResultsGroup A comprised 432 patients out of whom 42 (9.72%) had sternal wound SSIs. Group B comprised the other 432 patients of whom only 20 (4.62%) developed sternal wound SSIs. Co-morbid conditions were analysed in each group. Group A showed SSI in 22/64 (34.3%) diabetic patients, 6/28 (21.8%) obese patients and 16/22 (72.72%) with diabetes and obesity. Group B showed SSIs in 6/56 (10.715) diabetics, 4/26 (6.01%) obese and 4/24 (16.67%) with diabetes and obesity.ConclusionsBy pairing staples and sutures, we observed a significantly lower incidence of total wound complications with suture than with staple closure.

Comparison of skin closure technique with stapler and subcuticular suture in patients with inguinal hernia undergoing lichtenstein tension-free mesh repair – An open-label randomized controlled trial

Background: Both subcuticular suturing and stapler closure are used for skin closure. However, the superiority of one over the other is yet to be established clearly. Aims: This study compares the efficacy of skin closure technique by stapler and subcuticular suture in patients undergoing Lichtenstein repair for inguinal hernia. Methods: Elective inguinal hernia repair patients were randomized to undergo skin closure using either subcuticular sutures or staplers. Skin closure time in minutes, postoperative wound site pain using the Visual Analog Scale, wound cosmesis and scar outcome using the Patient and Observer Scar Assessment Scale, and patient satisfaction using the Likert scale were assessed. Results: A total of 38 patients with inguinal hernia were included: 20 in subcuticular suture group and 18 in stapler group. The scar outcomes assessed by patients (3.05 ± 1.83 vs. 4.94 ± 2.54; P = 0.0013) and observers (2.83 ± 0.98 vs. 4.44 ± 1.67; P = 0.0105) were significantly better in the subcuticular group. The time taken for skin closure was significantly longer in the suture group (P

888: Continuous versus Interrupted subcutaneous tissue closure during cesarean delivery

Interrupted Subcutaneous Tissue Closure (i-STC) during cesarean delivery (CD) reduces risk of wound disruption in women with fat thickness greater than 2 cm. It does not alter the incidence of wound infection. We aimed to compare the effects of the standard i-STC to an alternative technique, namely the Continuous Subcutaneous Tissue Closure (c-STC). A retrospective study between 2008-2018. Group allocation was based on type of STC. Eligible for analysis were term singleton pregnancies who underwent either elective or emergent CD. Metal staple skin closure was the rule. Performance of i-STC/c-STC was up to surgeon discretion. We excluded women with suspected infectious morbidity prior to CD. The primary outcome was surgical site infection (SSI) rate, defined as localized tenderness with or without maternal fever >38°C, and at least one of the following: purulent drainage from the superficial incision, culture positive or incision opened by the surgeon. Secondary outcome included re-admission rates due to suspected SSI within 90 days. Maternal characteristics (age, BMI, gestational age at delivery and number of previous CDs) were comparable between groups. The final analysis included 6,281 women. A total of 4,988 (79.4%) underwent elective CD, of which 1,867 (37.4%) had c-STC. Of the 1,293 that underwent emergent CD, 592 (45.8%) had c-STC. The rate of SSI was significantly lower after c-STC compared to i-STC in both elective (2.7% vs. 4.5%, P=0.031) and emergent CD (3.2% vs. 5.4%, P=0.036). Similarly, re-admission rates due to suspected SSI were also significantly lower after c-STC compared to i-STC in both elective (0.9% vs. 1.7%, P=0.0025) and emergent CD (1.5% vs. 3.2%, P< 0.0001). When stratified into nulliparous or multiparous, significant findings were in favor of the c-STC group as well. c-STC appears to yield a lower rate of CD SSI complications compared to i-STC. This might imply that c-STC is superior to i-STC in prevention of surgical scar complications. A prospective randomized controlled trial is currently being launched to validate these findings.

Evaluation of Incisional Negative Pressure Wound Therapy in the Prevention of Surgical Site Occurrences After Radical Cystectomy: A New Addition to Enhanced Recovery After Surgery Protocol

BackgroundSurgical site infection (SSI) remains a significant complication after radical cystectomy (RC). Enhanced recovery after surgery (ERAS) focuses on interventions to decrease length of stay, but few address wound-related complications directly. ObjectiveTo determine the impact that prophylactic incisional negative pressure wound therapy (iNPWT) will have to reduce the rate of surgical site occurrences (SSOs = SSI + seroma + superficial dehiscence) after RC. Design, settings, and participantsWe retrospectively reviewed patients undergoing RC by a single surgeon from 2012 to 2017. As part of our ERAS pathway, we employed prophylactic iNPWT during abdominal closure and compared it with a contemporary cohort of standard wound closure. Outcome measurements and statistical analysisWe compared 90-d SSIs, SSOs, and readmissions between iNPWT and standard skin staple closure. Univariate and multivariate regressions were used to compare the two groups. Results and limitationsWe identified 158 (104 iNPWT, 54 standard) patients from 2012 to 2017. The rates of SSIs and SSOs were 9.7% and 19.0%, respectively. The overall readmission rate for the cohort was 21.5%, with 4.4% of patients requiring readmission for SSI. The iNPWT group had lower rates of SSIs (5.8% vs 16.7%, p = 0.03) and SSOs (11.5% vs 33.3%, p < 0.01). There was no difference between the groups for readmission (21.1% vs 22.2%, p = 0.5). The iNPWT protected against both SSI (odds ratio [OR] 0.89, 95% confidence interval [CI]: 0.81–0.98) and 90-d SSO (OR 0.77, 95% CI: 0.68–0.87). ConclusionsProphylactic iNPWT is feasible after RC with a modest decrease in both 90-d SSIs and 90-d SSOs, but not readmissions. Wound closure assisted by iNPWT should be considered in RC ERAS pathways. Patient summaryIn this report, we looked at the impact of new vacuum suction dressing on the prevention of surgical infections after radical cystectomy (RC). We found that this wound dressing can decrease the impact of surgical infections and aid in recovery after RC.

Modified Reinforced Staple Closure Technique Decreases Postoperative Pancreatic Fistula After Distal Pancreatectomy.

Postoperative pancreatic fistula (POPF) is a serious complication that can occur following distal pancreatectomy (DP). Recent studies demonstrated that the use of reinforced staplers with bioabsorbable mesh significantly reduced the incidence of POPF, although the safety and efficacy of this approach remain controversial. Therefore, we originally developed a modified closure technique that combines the use of a reinforced stapler with bioabsorbable mesh with suture closure of the main pancreatic duct. The aim of this study was to determine whether our closure technique is predictive of POPF after DP. Fifty-nine consecutive patients who underwent DP were retrospectively enrolled. Based on the closure technique, we divided the cohort into a suture group (group A; n = 39) and a modified closure group (group B; n = 20). Using multivariate analysis, surgical closure techniques, including our method, and other well-known POPF risk factors were independently assessed. Multivariate logistic regression analysis identified no pathological fibrosis (odds ratio [OR], 5.41; p < 0.01), body mass index (> 25kg/m2) (OR, 3.01; p = 0.02), and pancreatic stump closure technique (group A) (OR, 2.04; p = 0.01) as independent risk factors for POPF. The present study indicated that our modified closure technique is an additional useful technique to reduce POPF after DP.

Prevention value of four treatments of pancreatic stump for pancreatic fistula after distal pancreatectomy: a Meta-analysis

Objective To systematically evaluate the clinical effects of four treatments of pancreatic stump including stapler closure, hand-sutured closure, stapler with hand-sutured closure, and manual anastomosis on the prevention of postoperative pancreatic fistula after pancreatectomy. Methods Databases including PubMed, Embase, the Cochrane Library, CBM, CNKI, and VANFUN were searched for from January 1979 to January 2019 with the key words including distal pancreatectomy, left pancreatectomy, pancreatic resection, left pancreatic resection, pancreatic fistula, fistula, leak, stapler, suture, anastomosis,胰腺远端切除术,胰体尾切除术,闭合器,手工缝合,吻合,胰瘘 . Patients undergoing dissection of pancreas with Endo-GIA stapler were allocated into stapler group, patients undergoing hand-sutured closure of pancreatic stump after dissection of prancreas with electrotome or ultrasonic scalpel were allocated into hand-sutured closure group, patients undergoing dissection of pancreas with Endo-GIA stapler and hand-sutured closure of pancreatic stump were allocated into stapler with hand-sutured closure group, patients undergoing pancreaticojejunostomy or pancreatogastrostomy after dissection of pancreas were allocated into manual anastomosis group, respectively. Two reviewers independently screened literatures, extracted data and assessed the risk of bias. Count data were described as odds ratio (OR) and 95% confidence interval (95%CI). The heterogeneity of the studies included was analyzed using the I2 test. Funnel plot was used to test potential publication bias if the studies included ≥ 5, and no test was needed if the studies included <5. Results (1) Document retrieval: a total of 10 available prospective studies were included. There were 1 363 patients, including 565 in the stapler group, 484 in the hand-sutured closure group, 182 in the stapler with hand-sutured closure group, and 132 in the manual anastomosis group. (2) Results of Meta-analysis. ① There was no statistically significant difference in postoperative fistula after pancreatectomy between the stapler group and the hand-sutured closure group (OR=0.75, 95%CI: 0.45-1.25, P>0.05). Further study showed that there was no statistically significant difference in the incidence of grade B and C postoperative fistula between the two groups (OR=0.45, 95%CI: 0.14-1.52, P>0.05). The left-right asymmetry was presented in the funnel plot based on the 8 studies, suggesting that publication bias may exsited. ② There was no statistically significant difference in postoperative fistula after pancreatectomy between the stapler group and the stapler with hand-sutured closure group (OR=0.96, 95%CI: 0.48-1.91, P>0.05). ③There was no statistically significant difference in postoperative fistula after pancreatectomy between the stapler with hand-sutured closure group and manual anastomosis group (OR=0.80, 95%CI: 0.49-1.32, P>0.05). ④ There was no statistically significant difference in postoperative fistula after pancreatectomy between the manual anastomosis group and the stapler group (OR=0.73, 95%CI: 0.39-1.34, P>0.05). Further study showed that there was no statistically significant difference in the incidence of grade B and C postoperative fistula between the two groups (OR=0.60, 95%CI: 0.21-1.68, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 5 studies, suggesting that publication bias had little influence on results of Meta-analysis. ⑤ There was no statistically significant difference in postoperative fistula after pancreatectomy between the manual anastomosis group and the hand-sutured closure group (OR=0.24, 95%CI: 0.08-0.74, P<0.05). The bilateral symmetry was presented in the funnel plot, suggesting that publication bias had little influence on results of Meta-analysis. Conclusions Compared with hand-sutured closure, pancreaticojejunostomy or pancreatogastrostomy after pancreatectomy can help to reduce the incidence of postoperative pancreatic fistula. However, there was equivalent prevention value of stapler, hand-sutured closure, and stapler with hand-sutured closure for postoperative fistula after pancreatectomy. The manual anastomosis group has equivalent prevention value with stapler group. Key words: Pancreatic fistula; Distal pancreatectomy; Stapler; Manual suture; Anastomosis; Meta-analysis

Has the pancreatic fistula already occurred in the operation? An intraoperative predictive factor of clinical relevant-postoperative pancreatic fistula after the distal pancreatectomy

PurposeThe aim of this study was to assess the predictive effect of intraoperative amylase value from pancreatic remnant on the development of clinical relevant-postoperative pancreatic fistula after distal pancreatectomy. MethodsPatients undergoing distal pancreatectomy between June 2017 and October 2018 were studied retrospectively. The intraoperative amylase value was measured followed by drain fluid for amylase on postoperative day 3. The analysis of clinical relevant-postoperative pancreatic fistula predictors was carried out using the logistic regression. The receiver operating characteristic analysis was performed to evaluate the discriminative capacity of intraoperative amylase value as a predictive risk factor. ResultsThe study population consisted of 40 patients. The clinical relevant-postoperative pancreatic fistula occurred in 13 patients, no grade C pancreatic fistula (PF). The intraoperative amylase value correlated significantly with clinical relevant-postoperative pancreatic fistula. An intraoperative amylase value >3089 U/L was proposed as the cut-off level to predict clinical relevant-postoperative pancreatic fistula by the receiver operating characteristic curve. The sensitivity, specificity and accuracy of this level were respectively 84.6%, 88.9% and 88.5%. The multivariate logistic regression analysis revealed that intraoperative amylase value and suture closure for the pancreatic stump were the significant predictive risk factors for the clinical relevant-postoperative pancreatic fistula. ConclusionThe intraoperative amylase value can be early and easily measured as a predictive risk factor, which seems useful for postoperative management of clinical relevant-postoperative pancreatic fistula after distal pancreatectomy. While, the stapler closure might be a feasible way for the pancreatic transection during the operation.

Barbed sutures versus staples for closure in total hip arthroplasty using wound ooze as a primary outcome measure: A prospective study

Prosthetic joint infection is a rare, but devastating complication of primary total hip arthroplasty (THA). Postoperative wound discharge and deep infection are related. We examined whether barbed sutures were associated with a decrease in the incidence of postoperative wound discharge when compared with skin closure using metal staples. Prospective nonrandomized comparison between two groups (35 barbed suture closures vs. 49 staple closures). Wounds were assessed daily for postoperative wound discharge until dry. Hemoglobin and hematocrit were recorded at the preoperative assessment and on day 3 postoperative. There were no significant differences between the groups with regard to age, body mass index, gender, preoperative hemoglobin, preoperative hematocrit, or estimated blood volume. The number of days elapsed until the wound was dry was significantly lower in the barbed suture group than the staples group (p < 0.0001). In the staples cohort, ongoing wound ooze resulted in delayed hospital discharge in three (6%) patients, six bed days total. Barbed sutures reliably reduce the period of postoperative wound ooze following primary THA compared to staple closure. The use of barbed sutures may prevent delayed patient discharge from hospital, decreasing the bed burden.

The rate of postoperative pancreatic fistula after distal pancreatectomy is independent of the pancreatic stump closure technique – A retrospective analysis of 284 cases

Many techniques have been developed to prevent postoperative pancreatic fistula (POPF) after distal pancreatectomy, but POPF rates remain high. The aim of our study was to analyze POPF occurrence after closure of the pancreatic remnant by different operative techniques. Between 2006 and 2017, 284 patients underwent distal pancreatectomy in our institution. For subgroup analysis the patients were divided into hand-sewn (n=201) and stapler closure (n=52) groups. The hand-sewn closure was performed in three different ways (fishmouth-technique, n=27; interrupted transpancreatic U-suture technique, n=77; common interrupted suture, n=97). All other techniques were summarized in a separate group (n=31). Results were gained by analysis of our prospective pancreatic database. The median age was 63 (range 23-88) years. 74 of 284 patients (26%) were operated with spleen preservation (similar rates in subgroups). ASA-classes, median BMI as well as frequencies of malignant diseases, chronic pancreatitis, alcohol and nicotine abuse were also comparable in the subgroups. Neither the rates of overall POPF (fishmouth-technique 30%, common interrupted suture 40%, stapler closure 33% and interrupted U-suture 38%) nor the rates of POPF grades B and C showed significant differences in the subgroups. However is shown to be associated with pancreatic function and parenchymal texture. In our experience the technique of pancreatic stump closure after distal resection did not influence postoperative pancreatic fistula rate. As a consequence patient specific reasons rather than surgical techniques may be responsible for POPF formation after distal pancreatectomy.

Why Does Postoperative Pancreatic Fistula Occur After Hand-sewn Parenchymal Closure and Staple Closure in Distal Pancreatectomy?

Hand-sewing (HS) and stapling are common parenchymal closure techniques after distal pancreatectomy. However, these methods cannot completely prevent postoperative pancreatic fistula (POPF). The mechanisms of POPF formation after closure are unknown. We performed distal pancreatectomy in mongrel dogs to identify the mechanisms of POPF formation after HS and staple closure. We measured the closed pancreatic duct burst pressures and examined the histology of the remnant pancreas. The after staple-closure burst pressures depended on stapler height; lower pressures were associated with greater stapler heights. Post-HS closure burst pressures were significantly higher than those at each stapler height (P<0.01). Post-HS closure pathologic findings showed extensive necrosis (day 3), and some regenerated pancreatic duct stumps (day 5). Necrosis was not observed around the stapled tissues. Although HS completely closes the pancreatic ducts, stump necrosis and blood flow disturbances may cause POPF. With stapler closure, pancreatic fluid leakage may occur even with appropriate stapler heights.

Non-invasive, Zip Type Skin Closure Device vs. Conventional Staples in Total Knee Arthroplasty: Which Method Holds Greater Potential for Bundled Payments?

Introduction: A new, noninvasive zip surgical skin closure device has recently been introduced into the market and introduces a new alternative to the traditional staple closure method which has dominated the industry for many years.Methods: This was a retrospective chart review and case study of a consecutive series of 130 patients who underwent primary total knee arthroplasty (TKA) from April 2016 to November 2016. The first 65 patients in this series underwent a primary TKA utilizing the standard staple closure method (staple group). The next 65 patients underwent a primary TKA through the new zip surgical skin closure method (zip group). Charts were reviewed for incision-related phone calls to the clinic, additional clinic visits due to incision concerns, antibiotic prescriptions due to incision complications, and incision-related emergency room (ER) admits.Results: The staple group had a significantly higher amount of incision-related phone calls made to the clinic as compared to the zip group (20 versus 8, P < .05, respectively). The staple group also had more incision-related ER admits, more incision-related clinic visits, and more antibiotics prescribed due to incisional complications than the zip group (1 versus 0, 5 versus 2, and 4 versus 1, respectively), although it was not proven to be significant (P > .05).Conclusion: This is the largest patient cohort study comparing the noninvasive zip-type closure device to staple closures in TKA cases and provides insight on how a simple change in the closure methodology can lead to many potential downstream savings when considering a bundled payment model.

Aesthetic Comparison between Subcuticular Suture and Staple Closure of Anterior Cervical Decompression and Fusion Incision Scars: A Prospective Controlled Single-blinded Trial.

Introduction: Anterior cervical decompression and fusion (ACDF) procedures are common and neck scar appearance is important aesthetically. This study compared subcuticular suture closure with staple closure regarding the aesthetics of the neck incision scar.Methods: A single-blinded comparative prospective study with two cohorts involving one facility and multiple surgeons was done to study all consecutive patients who underwent one/two-level ACDF operations from 2015-2016. We excluded patients with corpectomies, postoperative wound infection, reoperations in the same admission, any previous ACDF operations, non-compliance in follow-up, and inability to give informed consent. We did single-layer skin stapling without platysma closure or subcuticular suture with platysma closure. Patients followed up between 1.5 and six months. We used the Stony Brook Scar Evaluation Scale (SBSES), range 0-5 with five being the best score. Digital images were taken in a standardized manner and saved in a secure database. A blinded plastic surgeon and a blinded neurosurgeon, not involved in the operation, evaluated the scars using SBSES. A priori sample size using a clinically significant difference of one was determined. Wilcoxon rank-sum test was used; a p-value <0.05 was considered statistically significant.Results: We studied 93 staple and 66 suture closures. There is no significant difference between the groups regarding age, sex, the incidence of diabetes, smoking, obesity (body mass index (BMI) >30 kg/m2), chemotherapy or the length of the incision. There is no statistically significant difference regarding SBSES as evaluated by the plastic surgeon (staples vs. sutures, median 2 vs. 2, range 0-5, p = 0.32). There is a statistically significant difference as evaluated by the neurosurgeon (staples vs. sutures, median 4 vs. 3, range 0-5, p = 0.003). Post hoc power analysis was 0.90.Conclusion: Using the validated SBSES to assess the aesthetic outcome of ACDF scars, we demonstrated that staples and sutures provide equivalent aesthetic outcomes per plastic surgeon evaluation, and staple closure results in statistically significant better aesthetic outcomes per neurosurgeon evaluation.

BioGlue® sealed fish-mouth closure of the pancreatic remnant as a feasible alternative to stapler closure during laparoscopic distal pancreatectomy

Background: Postoperative pancreatic fistula formation (POPF) remains the main problem after distal pancreatectomy (DP). Stapler closure of the pancreatic remnant is considered the standard technique during laparoscopic DP but is limited especially in “hard” pancreatic tissue remnants. After promising results during open DP we have now developed a novel BioGlue® sealed hand sutured fish-mouth closure technique of the pancreatic remnant during laparoscopic DP. Methods: 14 patients underwent BioGlue® sealed hand sutured fish-mouth closure of the pancreatic remnant during laparoscopic DP at our institution. Perioperative and postoperative results were analysed with regard to clinically relevant POPF and overall postoperative morbidity. Essential technical steps will be demonstrated as a video presentation. Results: Indications for distal pancreatectomy included pancreatic adenocarcinoma, IPMN, MCN, chronic pancreatitis, neuroendocrine tumor and SPN. 4 out of 14 patients (29%) developed a grade B pancreatic fistula, which could all be treated conservatively. There was no postoperative mortality. The median length of hospital stay was 11 days. Conclusion: The performance of a BioGlue® sealed hand sutured fish-mouth closure of the pancreatic remnant during laparoscopical DP was shown to be technically feasible and may thus be considered as a safe alternative to standard stapler closure especially in patients with a “hard” pancreatic tissue remnant.

Impact of surgical site infection (SSI) following gynaecological cancer surgery in the UK: a trainee-led multicentre audit and service evaluation

ObjectivesSurgical site infection (SSI) complicates 5% of all surgical procedures in the UK and is a major cause of postoperative morbidity and a substantial drain on healthcare resources. Little is...

Is there any different risk factor for clinical relevant pancreatic fistula according to the stump closure method following left-sided pancreatectomy?

Backgrounds/AimsConsistency on risk factors for postoperative pancreatic fistula (POPF) after left-sided pancreatectomy (LP) according to the stump closure methods has not been revealed. Appropriate surgical stump closure method after LP is still in debate. This study investigates risk factors for POPF according to the closure methods in LP.MethodsA total of 49 consecutive patients underwent LP with a stapler closure (ST) or hand-sewn closure (HS) between June 2001 and September 2016. The risk factors of pancreatic fistulas were investigated in 49 LPs according to stump closure methods, HS (n=19), and ST (n=30).ResultsThere was no significant difference in the incidence of overall POPF (HS 42.1% vs. ST 50.0%) and clinical relevant POPF (CR-POPF) (HS 5.3% vs. ST 6.7%) between two groups. In the ST group, the pancreas was significantly thick in patients with CR-POPF (27 mm vs. 17 mm) and the tumor was also larger (58 mm vs. 27 mm). In the HS group, the operation time was longer in CR-POPF group (515 min vs 292 min). In univariate analysis, wider diameter of the pancreatic duct (27 mm vs 16 mm) was associated with POPF in the HS group. There was no meaningful risk factor for POPF in the ST group.ConclusionsIncidence of overall POPF between the ST and HS group were clinically insignificant in this study. The thickness of the pancreas and the tumor diameter are factors significantly associated with CR-POPF in the ST group. Long operation time was the only factor associated with CR-POPF in the HS group.

Robotic distal pancreatectomy with selective closure of pancreatic duct: surgical outcomes.

Pancreatic fistula is the main post-operative complication of distal pancreatectomy associated with other further complications, such as intra-abdominal abscesses, wound infection, sepsis, electrolyte imbalance, malabsorption and hemorrhage. Surgeons have tried various techniques to close the stump of the remaining pancreas, but the controversy regarding the impact of stapler closure and suture closure of the pancreatic stump is far from resolved. In this study, we reported our technique and results of robotic assisted distal pancreatectomy with ultrasound identification and consequent selective closure of pancreatic duct. Twenty-one patients underwent consecutive robotic-assisted distal pancreatectomy were included in our study. We describe our technique and analyzed the operative and peri-operative data including mean operative time, intra-operative bleeding, blood transfusions necessity, conversion rate, mortality and morbidity rate, pancreatic fistula rate and grade, time of refeeding and canalization, length of hospital stay and readmission. Median operative time was 260min. No conversion occurred. Estimated blood loss was 100mL (range 50-200). No blood transfusions were performed. Mortality rate was 0%. One (5%) patient had a major complication, while 9 (43%) patients had minor complications (grade I). Three (14%) patients developed pancreatic fistula (grade B), while two (10%) patients had a biochemical leak. No late pancreatic fistula and re-operation occurred. The refeeding was started at second day (range 1^-6^) and the median canalization time was 4days (range 2-7). The median hospital stay was 6days (range 3-25) with a readmission rate of 0%. Robotic distal pancreatectomy can be considered safe and feasible. Our technique is easily reproducible, with good surgical results.

A comparison of subcuticular and staple skin closure techniques for Caesarian Section: A randomized controlled trial in King Abdul-Aziz Medical City, Riyadh, Saudi Arabiaa

A comparison of subcuticular and staple skin closure techniques for Caesarian Section: A randomized controlled trial in King Abdul-Aziz Medical City, Riyadh, Saudi Arabiaa