Stapling Technique Research Articles

Optimal anastomotic technique in rectal surgery to prevent anastomotic leakage.

Complications after colorectal surgery remain inevitable, and anastomotic leakage is one of the most severe and potentially fatal complications. Generally, anastomotic leakage is associated with severe peritonitis, the need for emergency reoperation, and an increased mortality rate. Additionally, particularly after rectal cancer surgery, it has a negative impact on long-term outcomes, including postoperative anorectal function, local recurrence, and survival. To prevent anastomotic leakage, understanding the characteristics of each anastomotic technique and establishing a stable anastomotic procedure are important. Transanal total mesorectal excision (TaTME) is a relatively new advanced surgical access technique for pelvic dissection and facilitates different anastomotic techniques without the need for transabdominal rectal transection. Especially, stapled anastomosis in TaTME, also known as double purse-string circular stapled anastomosis or the single stapling technique (SST), has gained much attention as an alternative to the conventional double stapling technique (DST). In this article, we describe the DST, SST, and hand-sewn anastomosis as anastomotic techniques after rectal surgery, focusing mainly on the differences between conventional anastomotic techniques and SST in TaTME. Furthermore, the blood flow evaluation method for the reconstructive colon before anastomosis, which is extremely important in anastomotic leakage prevention regardless of the anastomotic type, is also described.

Influence of staple line reinforcement on the occurrence of bleeding complications following laparoscopic sleeve gastrectomy: a retrospective analysis.

Laparoscopic sleeve gastrectomy (LSG) has gained prominence as a therapeutic option for obesity and metabolic diseases. The choice of staple line reinforcement technique in LSG remains a subject of debate, particularly concerning postoperative bleeding complications. The aim of this retrospective analysis is to assess the influence of different staple line reinforcement techniques on the occurrence of bleeding complications LSG. We conducted a retrospective analysis of patients undergoing LSG between September 2021 and April 2023 at our institution. Patients were stratified into two groups based on the staple line reinforcement method: continuous suturing (n = 53) and clipping (n = 28). Surgical outcomes, including operative time, length of hospital stay, and bleeding complications, were assessed. Complications were classified using the Clavien-Dindo classification. Continuous suturing was associated with a significantly longer operative time (88.15 min vs. 74.64 min, p < 0.05) but a similar length of hospital stay. Notably, no bleeding complications occurred in the continuous suturing group, while the clipping group experienced postoperative bleeding in 7.14% of cases (p < 0.05). Continuous suturing exhibited a slightly higher incidence of minor complications classified as Class I in the Clavien-Dindo classification (7.55% vs. 0%). This retrospective analysis suggests that continuous suturing may provide enhanced hemostasis along the staple line, reducing the risk of postoperative bleeding compared to clipping. Despite the longer operative time and a slightly higher rate of minor complications, the clinical significance of these findings should be considered within the context of individual patient risk profiles.

Pressure resistance evaluation in esophagojejunostomy using the transorally inserted anvil (OrVilTM)

Aim: The transorally inserted anvil (OrVilTM) is often selected for esophagojejunostomy after total laparoscopic gastrectomy due to its versatility. During anastomosis with OrVilTM, it is possible to select a double stapling technique (DST) or a hemi-double technique (HDST) by overlapping the linear stapler and the circular stapler, although there has been no report on the anastomotic strength. Thus, an animal experiment was conducted and verified this study. Methods: This experiment used 10 fresh porcine esophageal and jejunal specimens. Two models were created: a model in which the rod is placed at the center of the esophageal transection line (DST model) and a model in which the rod is placed at the lateral end of the esophageal transection line (HDST model). A pressure gage was inserted into the anastomosed intestine while continuously measuring pressure to determine the leakage site and leakage pressure. Results: The leakage site in both the DST (n = 5) and HDST models (n = 5) were at the staple overlapping with a leakage pressure of 151.2 ± 14.2 mmHg in the DST model and 148.2 ± 6.3 mmHg in the HDST model (P = 0.678). When the leakage site was repaired with hand-sewn sutures and conducted remeasuring pressure, leakage was observed from the contralateral crossing in the DST model and the leakage pressure was 155.8 ± 12.2 mmHg. In the HDST model, all models were capable of withstanding 300-mmHg pressures. Conclusion: HDST with a single staple intersection is beneficial for esophagojejunostomy, in terms of pressure resistance, and the repairing suture at the staple intersection can increase pressure resistance.

Cyclobutane-bearing restricted anchoring residues enabled geometry-specific hydrocarbon peptide stapling.

Stapled peptides are regarded as the promising next-generation therapeutics because of their improved secondary structure, membrane permeability and metabolic stability as compared with the prototype linear peptides. Usually, stapled peptides are obtained by a hydrocarbon stapling technique, anchoring from paired olefin-terminated unnatural amino acids and the consequent ring-closing metathesis (RCM). To investigate the adaptability of the rigid cyclobutane structure in RCM and expand the chemical diversity of hydrocarbon peptide stapling, we herein described the rational design and efficient synthesis of cyclobutane-based conformationally constrained amino acids, termed (E)-1-amino-3-(but-3-en-1-yl)cyclobutane-1-carboxylic acid (E7) and (Z)-1-amino-3-(but-3-en-1-yl)cyclobutane-1-carboxylic acid (Z7). All four combinations including E7-E7, E7-Z7, Z7-Z7 and Z7-E7 were proven to be applicable in RCM-mediated peptide stapling to afford the corresponding geometry-specific stapled peptides. With the aid of the combined quantum and molecular mechanics, the E7-E7 combination was proven to be optimal in both the RCM reaction and helical stabilization. With the spike protein of SARS-CoV-2 as the target, a series of cyclobutane-bearing stapled peptides were obtained. Among them, E7-E7 geometry-specific stapled peptides indeed exhibit higher α-helicity and thus stronger biological activity than canonical hydrocarbon stapled peptides. We believe that this methodology possesses great potential to expand the scope of the existing peptide stapling strategy. These cyclobutane-bearing restricted anchoring residues served as effective supplements for the existing olefin-terminated unnatural amino acids and the resultant geometry-specific hydrocarbon peptide stapling provided more potential for peptide therapeutics.

Application of reversely connecting circular stapler technique in cervical esophagogastric anastomosis.

The incidence of anastomotic leakage is relatively high (6-26%) in esophagogastrocervical anastomosis. The traditional anastomotic mode has high tissue tension in the process of anastomosis, which can easily cause tissue tear in the anastomotic area and increase the incidence of anastomotic leakage. To investigate the usefulness of reversely connecting circular stapler technique for reducing anastomotic tension and injury of the esophageal and gastric wall, preventing anastomotic leakage in minimally invasive McKeown esophagectomy. A total of 133 patients with esophageal cancer who underwent minimally invasive McKeown esophagectomy from January 2021 to December 2021 were collected. Characteristics, surgical data, and outcomes of patients were recorded and retrospectively analyzed. There were 83 patients in the reverse order connecting circular stapler group and 50 patients in the conventional order connecting group. Anastomotic leakage was observed in 2 (2.4%) cases in the reverse order connecting circular stapler group. Compared with the conventional connection group, the reverse connecting group had lower incidence of anastomotic leakage, shorter anastomotic time, shorter hospital stay, and lower incidence of pulmonary and chest infections and hoarseness. The reversely connecting circular stapler technique could reduce the incidence of anastomotic leakage. The technique is simple to perform and easy to learn. Therefore, it is useful for the prevention of anastomotic leakage.

Video-assisted thoracoscopic surgery lobectomy with guillotine stapler technique for the second primary adenocarcinoma of the lung after immunotherapy

Video-assisted thoracoscopic surgery lobectomy with guillotine stapler technique for the second primary adenocarcinoma of the lung after immunotherapy

Comparison of stapler and hand-sewn roux en Y jejunal anastomosis in children

outcomes of stapled and hand-sewn Roux-en-Y intestinal anastomoses in childhood.&#x0D; Materials and Methods: At a university hospital, the records of the children who underwent roux-en-Y anastomosis between December 2007 and December 2014 were reviewed. The data were compared according to the roux-en-Y anastomosis technique used (stapled versus hand-sewn).&#x0D; Results: A total of 52 patients had undergone roux-en-Y anastomosis. All had biliary atresia or choledochal cyst. Thirty-one of the patients were diagnosed with biliary atresia and 21 with choledochal cysts. Staple anastomosis technique was used in 16 of the patients with biliary atresia and 9 of the patients with choledochal cyst. Both in biliary atresia and choledochal cyst cases; operations with stapled anastomosis were significantly shorter than the ones with hand-sewn anastomosis. Among the biliary atresia cases, post-operative oral feeding was initiated significantly earlier in the stapled group, with its lower risks of post-operative cholangitis and longer hospital stay than 7 days.&#x0D; Conclusion: This is the first study in children, confirming the time-saving advantage of stapled anastomosis over hand-sewn, during roux-en-Y anastomosis for biliary atresia and choledochal cyst; along with the safety of stapler use, including the neonates. Stapled anastomosis yields lower complication rates, faster function gain with earlier feeding and hospital discharge.

Robotic Multidisciplinary Management of Extensive Deep Endometriosis

<h3>Study Objective</h3> To demonstrate a robotic multidisciplinary technique for extensive deep endometriosis ranging from Douglas pouch obliteration, rectal endometriosis and ureteral and appendiceal endometriosis. <h3>Design</h3> Case report. <h3>Setting</h3> Gynecology and Obstetrics department of a general hospital. <h3>Patients or Participants</h3> A 46-year-old para 3-1-2-2 woman who presented with severe dysmenorrhea and difficulty in defecation with right flank pain for 3 years. <h3>Interventions</h3> Robotically assisted hysterectomy with bilateral salpingo-oophrecetomy followed by LAR, appendectomy and urinary tract resection and reconstruction using psoas hitch, and appendectomy was performed on this patient early 2022. As the patient suffered from Douglas pouch obliteration, during hysterectomy we dissected the Douglas pouch and removed the deep endometriosis surrounding the sacral uterine ligament. Low anterior resection was performed using a double stapling technique. The bowel was transected below the pathologic site using a linear stapler. The oral stump of the bowel was extracted through the extended (to 3cms) left iliac port-site and outside the body, the pathologic segment was resected and the anvil for stapling was placed. The bowel was anastomosed using a circular stapler. Perfusion of the anastomotic site is confirmed via ICG firefly technology. Then the appendectomy was performed. After dissection of the mesoappendix, the appendix was transected at the base using a linear stapler. Finally, the lower segment of the ureter which became stenotic due to ureteral endometriosis was resected. Ureteroneocystostomy was performed using the psoas hitch. All of the procedure was caried out using the double bipolar technique, where the left Maryland forceps are used for coagulation and hemostasis and the right are used only for cutting. <h3>Measurements and Main Results</h3> The duration of the surgery was 4h4m. Estimated blood loss was 100mL. The postoperative course was completely benign. <h3>Conclusion</h3> Even complex procedures can be managed safely using robotic technology and multidisciplinary techniques.

The effect of staple height and rectal-wall thickness on anastomotic leakage after laparoscopic low anterior resection

BackgroundThe aim of this study was to evaluate the effect of staple height and rectal wall thickness on the development of an anastomotic leak after laparoscopic low anterior resection performed with the double stapling technique. MethodsOne hundred ninety-nine patients treated from 2013 to 2021 were enrolled. Patients were divided into two groups: those who developed an anastomotic leak (AL (+)) and those who did not (AL (−)). Clinicopathological factors were compared between the groups. ResultsAnastomotic leaks were observed in 8/199 patients (4%). A 1.5 mm linear stapler was used for 35/199 patients (17%), 1.8 mm for 89 (45%), and 2 mm for 75 (38%). In the AL (+) group (n = 8), lower staple height (1.5 mm or 1.8 mm) was used more frequently than in the AL (−) group (n = 191). Rectal wall thickness and the rectal wall thickness to staple height ratio was significantly (p < .05) greater in the AL (+) group. However, rectal wall thickness was significantly (p < .05) greater in patients who received neoadjuvant treatment and those with advanced T stage (T3,4) lesions. ConclusionLinear stapler staple height and rectal wall thickness are significantly associated with the development of an anastomotic leak after laparoscopic low anterior resection. Larger staples should be selected in patients with a thicker rectal wall due to neoadjuvant treatment or adjacent advanced rectal tumors.

Efficacy of staple line reinforcement by barbed suture for preventing anastomotic leakage in laparoscopic rectal cancer surgery.

BACKGROUNDAnastomotic leakage (AL) is a severe complication in rectal cancer surgery. Various methods, including intracorporeal reinforcing suturing, have been used to reduce the incidence of AL. However, little is known about the efficacy of staple-line reinforcement by barbed suture for preventing AL.AIMTo evaluate the efficacy of staple-line reinforcement using barbed suture for preventing AL in laparoscopic surgery for rectal cancer.METHODSWe retrospectively reviewed the clinical datum of 319 patients undergoing laparoscopic low anterior resection combined with double stapling technique between May 1, 2017 and January 31, 2021. All surgeries were performed by the same surgical team specializing in colorectal surgery. Patients were divided into two groups depending on whether they received reinforcing sutures. Patients’ baseline characteristics did not show any significant difference between the two groups. We analyzed patient-, tumor-, as well as surgery-related variables using univariate and multivariate logistic analyses. RESULTSThere were 168 patients in the reinforcing suture group and 151 patients in the non-reinforcing suture group. AL occurred in 25 cases (7.8%). Its incidence was significantly higher in the non-reinforcing suture group than in the reinforcing suture group (4.8% vs 11.3%, P = 0.031). The multivariate analyses demonstrated that the tumor site, tumor size and presence of staple-line reinforcement were independent risk factors for AL. We divided these patients into two risk groups based on the combination of tumor site and tumor size. Patients without any risk factor were assigned to the low-risk group (n = 177), whereas those having one or two risk factors were assigned to the high-risk group (n = 142). In the high-risk group, the AL incidence considerably decreased in the reinforcing suture group compared with that in the non-reinforcing suture group (P = 0.038). Nonetheless, no significant difference was found in the low-risk group between the two groups.CONCLUSIONStaple-line reinforcement by barbed suture may decrease the incidence of AL. A large-scale prospective randomized controlled trial is needed for evaluating the efficacy of staple-line reinforcement for preventing AL.

A comparison of robotic versus laparoscopic distal pancreatectomy: a single surgeon's robotic experience in a high-volume center.

Robotic surgery is the most recent advanced minimally invasive approach for distal pancreatectomy. However, its benefits over laparoscopic distal pancreatectomy (LDP) remain undetermined. Previous studies were limited by their small sample size or variations in surgeon skills. This study aimed to compare robotic distal pancreatectomy (RDP) performed by a single surgeon with LDP performed by skilled laparoscopic surgeons in a high-volume center. We retrospectively analyzed consecutive RDP performed by a single surgeon between December 2020 and November 2021 with LDP performed by experienced surgeons during the same period in a high-volume center. Patient characteristics and perioperative variables were compared. The analysis included 55 RDP and 146 LDP procedures. The operative time in the RDP group was significantly shorter than the LDP group (171 vs. 222min, P < 0.001), both in spleen-preserved (154 vs. 212min, P < 0.001) and spleen-removed (192 vs. 230min, P = 0.005) procedures. The RDP group made more frequent use of the stapler technique for pancreas transection (87.3 vs. 68.5%, P = 0.007), and its estimated blood loss was lower (79 vs. 155mL, P < 0.001) than the LDP group. The postoperative hospital stay in the RDP group was significantly shorter than the LDP group (8 vs. 12days, P < 0.001). The groups were similar in their complication distributions. RDP is as safe and feasible a minimally invasive approach as LDP. The advanced manipulation and visualization capabilities of the robotic approach in distal pancreatectomy could help reduce operative time and blood loss, and is related to shorter postoperative hospital stay.

Comparison of pressure resistance of double-rows and triple-rows circular stapler in rectal double stapling technique: In vitro study.

Anastomotic leak after gastrointestinal anastomosis is a serious complication. Anastomotic failure depends on various parameters. The aim of our study was to evaluate the pressure resistance of a new device, EEA™ circular stapler with Tri-Staple™ technology 28 mm Medium/Thick (Triple-rows circular stapler; TCS) compared with EEA™ circular stapler with DST series™ technology 28 mm, 4.8 mm staples (double-rows circular stapler; DCS). We performed 30 anastomoses (DSC: 15, TCS: 15) of DST with porcine colon model in vitro. We performed following 3 comparative experiences; Experiment 1: observation of staple shape with a colonoscopy, Experiment 2: comparison of the pressure resistance, Experiment 3: comparison of leakage points. There was no hypoplasia of staples and the shapes were well-formed by colonoscopy. The leakage pressure of DCS was 19.6 ± 4.4 mm Hg (mean ± standard deviation) and that of TCS was 38.6 ± 10.2 mm Hg (mean ± standard deviation). There was a significantly difference between 2 groups (P < .001). 12 cases of DCS (80%) and 10 cases of TCS (66.7%) had leakages from Circular stapler point. 2 cases of DCS (13.3%) and 5 cases of TCS (33.3%) had leakages from Crossing points. Only 1 case of DCS had leakages from Dog ear point (6.7%). There was no significantly difference in leakage site between 2 groups (P = .195). TSC showed high pressure resistance during DST compared with that of DCS. It was suggested that TCS may contribute to the reduction of anastomotic leakage rate.

A COMPARATIVE STUDY OF STAPLERS VERSUS HAND SEWN ANASTOMOSIS IN INTESTINAL SURGERIES

INTRODUCTION: Intestinal anastomosis is a surgical procedure to establish communication between two separated portions of the intestine. This procedure restores intestinal continuity after removal of a pathological condition affecting the bowel. Intestinal anastomosis can be performed by a hand-sewn technique using absorbable or non-absorbable sutures, mechanical stapling devices. Sutured anastomosis (hand-sewn technique) is the commonly used method. The newer stapling devices for intestinal anastomosis has provided an alternative option to perform rapid anastomosis.1 Various studies have contradictory results in terms of duration of procedure, post operative recovery and anastomotic leak. There are insufcient evidence to demonstrate superiority of either technique and more studies are needed to demonstrate the superiority of either technique. AIM MATERIAL AND METHODS:: To study and compare the effectiveness of staplers vs hand sewn anastomosis in Intestinal surgeries. A comparative observational study Consists of patients presenting with need of bowel resection and anastomosis inclusion criteria at Apollo Hospital Gandhinagar, Gujarat. The patients who are admitted for elective as well as emergency resection &amp; anastomosis of small and large intestines for various illnesses are selected after thorough clinical examination and investigations to conrm the diagnosis co- morbid conditions. Details were recorded in the proforma prepared. : 62.5% complications in comorbid subjects and 37.5% complications in non comorbid subjects.RESULTS The mean of anastomotic time for hand sewn group was 27.8 minutes whereas for the stapler group it was 9.0 minutes mins .With respect to return of bowel sounds, mean time was 46.32 hours in the hand sewn group and 35 hours in the stapler group Mean day of hospitalization was 8.16 days in hand sewn and 7.8 days in stapler technique. mean time taken for resumption of oral feeds the was 66.96 hours in hand sewn group and was 59.52 hours in stapler group .hand sewn group had total ve complications(20%), whereas stapler group had three complications(12%) Both the groups did not have any mortality. The mean cost of hand sewn anastomosis is 717.4 Rs which is signicantly less than mean cost of stapled anastomosis which is 33,754 Rs. : Stapler anastomosis signicantly reduces operative time and time taken for return of normal bowel sounds.CONCLUSION Because of the shortened total operating time in the stapled anastomosis .There is increased risk of overall complications in patients having co- morbidities in both hand sewn and stapled anastomosis. Mechanical staplers are far more costly than suture materials. Stapling technique can be used safely and effectively

Circular vs. linear stapling after minimally invasive and robotic-assisted esophagectomy: a pooled analysis

PurposeCurrent data states that most likely there are differences in postoperative complications regarding linear and circular stapling in open esophagectomy. This, however, has not yet been summarized and overviewed for minimally invasive esophagectomy, which is being performed increasingly.MethodsA pooled analysis was conducted, including 4 publications comparing linear and circular stapling techniques in minimally invasive esophagectomy (MIE) and robotic-assisted minimally invasive esophagectomy (RAMIE). Primary endpoints were anastomotic leakage, pulmonary complications, and mean hospital stay.ResultsSummarizing the 4 chosen publications, no difference in anastomotic insufficiency could be displayed (p = 0.34). Similar results were produced for postoperative pulmonary complications. Comparing circular stapling (CS) to linear stapling (LS) did not show a trend towards a favorable technique (p = 0.82). Some studies did not take learning curves into account. Postoperative anastomotic stricture was not specified to an extent that made a summary of the publications possible.ConclusionsIn conclusion, data is not sufficient to provide a differentiated recommendation towards mechanical stapling techniques for individual patients undergoing MIE and RAMIE. Therefore, further RCTs are necessary for the identification of potential differences between LS and CS. At this point in research, we therefore suggest evading towards choosing a single anastomotic technique for each center. Momentarily, enduring the learning curve of the surgeon has the greatest evidence in reducing postoperative complication rates.

Single-incision clipless laparoscopic total colectomy for intractable slow transit constipation: a single surgeon's experience.

In our institution, patients with intractable slow transit constipation (STC) have undergone single-incision clipless laparoscopic total colectomy (SCLTC) with ileorectal anastomosis (IRA) since 2011. We aimed to examine the feasibility and usefulness of SCLTC with IRA for patients with intractable STC. From January 2011 to December 2018, twenty-two patients with intractable STC underwent SCLTC with IRA at Kashiwa Hospital, Jikei University, by a single surgeon, were retrospectively registered in this study. They consisted of the first 12 consecutive patients undergoing the double stapling technique (DST) with IRA (DST group) and the last 10 consecutive patients undergoing functional end-to-end anastomosis (FEEA) with IRA (FEEA group). The median surgical time was 185 (150-249) min for the FEEA group and 230 (180-266) min for the DST group. A significant difference was identified between the two groups (0.035). There were no significant differences between the groups with respect to the median age, sex, body mass index, constipation type, intraoperative blood loss, postoperative hospital stay, or no use of laxatives daily stool frequency 1month after surgery. No postoperative complications, such as anastomotic leakage, bowel obstruction, or bleeding related to vessel sealing device, were encountered in either group more than 3years after surgery. Our results suggest that SCLTC with IRA is feasible and safe for patients with intractable STC. SCLTC with IRA using FEEA is especially preferred to that using DST for patients with intestinal contents in the rectum that cannot be completely removed by pre- and intraoperative preparation.

A Comparative Study of Stapler Versus Handsewn Gastrointestinal Anastomosis

Background: In gastro intestinal surgery after resection of bowel loops, anastomosis of the bowel loops is the central part. Stapler technique, commonly used by many of the surgeons is more useful than the hand sewn anastomosis for safety, easy accessibility, duration of procedure, efficiency. This study compares the hand sewn anastomosis with stapler Anastomosis. The purpose of the presentation is to compare the feasibility and outcome of stapler and hand sewn anastomosis in gastro intestinal surgeries. Material &amp; Method: This study was conducted in the department of surgery of our hospital between the groups of hand sewn and stapler anastomosis gastro intestinal surgeries conducted by open technique in period from January 2021 to September 2021. Results: Various parameters like operative time, hospital stay, and post op day of starting oral diet, post op day of appearance of bowel sound, anastomotic leak, time taken to return to work and mortality were compared. Conclusion: Results of this study were comparable to many studies done previously which showed there was not much significant difference in post op outcomes after hand sewn or stapled technique of gastrointestinal anastomosis. Key-words: Anastomosis, stapler, handsewn

Optimizing the Pulvertaft Weave Technique: A Comprehensive Systematic Review of Comparative Biomechanical Studies.

The Pulvertaft weave continues as a staple technique for tendon coaptations. Many have proposed minor alterations to the original technique to improve its strength, although a lack of consensus exists. The authors' aim was to explore how the number of weaves and suture characteristics contribute to the overall strength of the coaptation. A comprehensive electronic search was conducted using the PubMed, Cochrane Library, and Scopus databases. Criteria for inclusion consisted of cadaveric human or animal biomechanical studies evaluating ultimate failure load (in newtons) and the number of weaves, suture characteristics, tendon source, and number of coaptations. Weaves with minimum averages of 75 N were deemed successful, and those with greater than 120 N were considered high performing. A total of 347 tendon coaptations from 15 studies met inclusion criteria. Average strength by number of weaves was 36.4 N ( n = 52) for one weave, 54.2 N ( n = 58) for two weaves, 115.9 N ( n = 174) for three weaves, and 81.7 N ( n = 63) for four weaves. Statistical differences were observed between one and two weaves ( p < 0.0001); two and three weaves ( p < 0.0001); three and four weaves ( p < 0.003); and two and four weaves ( p < 0.0001). High-performing tendon transfers used three weaves, 3-0 or 4-0 braided sutures, and figure-of-eight or mattress core sutures. Contrary to the current dogma of "the more the better," the authors' findings show that Pulvertaft weave strength is optimized when three weaves are used to combine donor and recipient tendons. Braided sutures with either figure-of-eight or mattress sutures were associated with the highest strength of repair.

Utility of Drain Fluid Culture and Gram Stain in Early Intervention for Occult Anastomotic Leakage in Colorectal Cancer.

Although occult leakage after colorectal surgery does not usually cause critical illness, it can cause long-term complications that decrease the quality of life of patients. There is currently no established diagnostic, treatment, or follow-up method for occult leakage. We assessed the risk factors of occult leakage and examined the efficacy of drain fluid culture and Gram staining for its early detection and appropriate treatment intervention. Data from 243 consecutive colorectal cancer patients who underwent resection with reconstruction by the double stapling technique between 2016 and 2020 were reviewed. Sixteen (6.6%) patients had postoperative occult leakage. Multivariate analysis revealed that preoperative treatment was significantly associated with occult leakage (odds ratio=12.423; 95% confidence interval=4.095 to 17.680; p<0.001). Among the 16 patients, 1 experienced stenosis, and none experienced a fistula or chronic sinus. Drain fluid samples of 34 patients (14.0%) were Gram stainpositive, and those of 76 patients (31.3%) were culturepositive. The positive and negative predictive values of drain fluid culture were 18.4% and 98.7%, respectively, and those of Gram staining were 38.2% and 98.6%, respectively, for occult leakage. Among cases with occult leakage, more than two bacterial species were detected in 71.5% of the cultures. Antibiograms indicated that the three major species tended to be resistant to cephem antibiotics, which are used for prophylaxis, but susceptible to carbapenem antibiotics, which are used for empiric therapy. Drain fluid culture and Gram staining may enable early detection and appropriate treatment intervention for occult leakage.

Complicaciones asociadas al reservorio ileal en colitis ulcerativa versus poliposis familiar adenomatosa: Impacto en la calidad de vida del paciente

BackgroundProctocolectomy with ileal reservoir is the surgical procedure of choice for patients with ulcerative colitis and familial adenomatous polyposis. ObjectivesTo evaluate long-term postoperative complications (1994-2019) in patients operated for familial adenomatous polyposis (FAP) and ulcerative colitis (UC) and the degree of satisfaction with the procedure. MethodsObservational study based on the analysis of a retrospective database with prospective follow-up in 115 consecutive patients: 79 with UC and 36 with FAP. A total of 88 patients were followed up, 60 with UC and 28 with PFA. Results48 males (54.4%) with a mean age of 44.8 ± 10.6 years were evaluated. Indications for surgery were intractable disease in 54 patients (47%), dysplasia/cancer in 43 (37%), severe bleeding in 4 (4%) and perforation in 3 (3%). A proctectomy and mucosectomy of the rectal stump was performed in 67 (76.1%), and a double stapling technique in 21. A protective ileostomy was performed in all patients with UC and FAP. No differences were found in early complications between the two groups. Late complications showed a higher rate of reservoritis in UC patients compared to FAP (44.9 vs. 14.3%, p = 0.001), with more refractory reservoritis in the UC group (13.3 vs. 0%, p = 0.04) with no differences in bowel obstruction, strictures, or anastomotic fistulas. Overall satisfaction and adaptation were considered good in 87% of UC patients and only 57% in the FAP group (p < 0.01). ConclusionsProctocolectomy with ileal reservoir has comparable morbidity and mortality, except for the higher rate of reservoritis in patients with a history of UC, despite this contingency there is a better quality of life and greater acceptance of surgery in UC patients than in FAP patients.

Outcomes of Modified Tissue Selection Therapy Stapler in the Treatment of Prolapsing Hemorrhoids

ObjectiveTissue selection therapy staplers (TSTs) are widely used to treat prolapsing hemorrhoids; however, some disadvantages exist. We describe a modified technique for the treatment of prolapsing hemorrhoids, with the aim of minimizing the risk of anal stenosis and anal incontinence and reducing the impact of postoperative complications from the stapling technique. We applied a modified TST procedure, and the preliminary data were used to test the efficacy and safety of this new technique.MethodsWe conducted a retrospective study of patients who underwent modified TST for prolapsing hemorrhoids at our department between January 2018 and January 2020. All patients received a modified TST. Most prolapsing hemorrhoids were not segmentally resected and were instead selectively removed. The demographics, preoperative characteristics, postoperative complications, therapeutic effects, and patient satisfaction were collected and analyzed.ResultsA total of 106 patients were included in the study; 53 were men and 53 women (mean age, 49.24 years). The mean operative time was 55.01 min, and the mean hospital stay was 7.82 days. After surgery, three patients experienced bleeding (2.83%), 2 patients experienced anal discharge (1.89%), 2 patients experienced tenesmus (1.89%), and 5 patients experienced anal tags (4.72%). Anal incontinence, persistent post stapler pain, rectovaginal fistula and anal stenosis did not occur. Two patients developed recurrent symptomatic hemorrhoids (1.89%). The total effective rate of the surgery and the total satisfaction rate of the patients was 97.17%.ConclusionsThe modified tissue selection therapy stapler technique was a satisfactory and economical treatment for prolapsing hemorrhoids at a follow-up period of 1 year. The modified TST was associated with reduced anal stenosis and anal incontinence, less persistent post stapler pain and a minimal risk of rectovaginal fistula.