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Selli, C., M. Carini und A. Costantini. „Le Anastomosi Uretero-Caliciali“. Urologia Journal 52, Nr. 2 (April 1985): 168–74. http://dx.doi.org/10.1177/039156038505200205.
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Lechaux, J. P., und D. Lechaux. „Anastomosi biliodigestive nella litiasi biliare“. EMC - Tecniche Chirurgiche Addominale 14, Nr. 1 (Januar 2008): 1–9. http://dx.doi.org/10.1016/s1283-0798(08)70473-x.
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SHIMA, Takeshi, Yoshikazu OKADA, Shigejiro MATSUMURA, Masahiro NISHIDA, Tohru YAMADA, Takashi HATAYAMA und Shinji OKITA. „Cortical Arterial Pressure and Anastomotic Blood Flow Measurements during STA-MCA Anastomosi“. Neurologia medico-chirurgica 28, Nr. 4 (1988): 340–45. http://dx.doi.org/10.2176/nmc.28.340.
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Franch, L., A. Rippa, P. M. Ferri und I. Vavassori. „Anastomosi Cervico-Uretrale Dopo Adenomectomia Prostatica Retropubica“. Urologia Journal 54, Nr. 3 (Juni 1987): 345–49. http://dx.doi.org/10.1177/039156038705400318.
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Walker, Patrick F., Joseph D. Bozzay, David W. Schechtman, Faraz Shaikh, Laveta Stewart, M. Leigh Carson, David R. Tribble, Carlos J. Rodriguez und Matthew J. Bradley. „Anastomotic Outcomes in Military Exploratory Laparotomies in the Modern Combat Era“. American Surgeon 88, Nr. 4 (13.01.2022): 710–15. http://dx.doi.org/10.1177/00031348211050281.
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Background Intestinal anastomoses in military settings are performed in severely injured patients who often undergo damage control laparotomy in austere environments. We describe anastomotic outcomes of patients from recent wars. Methods Military personnel with combat-related intra-abdominal injuries (June 2009-December 2014) requiring laparotomy with resection and anastomosis were analyzed. Patients were evacuated from Iraq or Afghanistan to Landstuhl Regional Medical Center (Germany) before being transferred to participating U.S. military hospitals. Results Among 341 patients who underwent 1053 laparotomies, 87 (25.5%) required ≥1 anastomosis. Stapled anastomosis only was performed in 57.5% of patients, while hand-sewn only was performed in 14.9%, and 9.2% had both stapled and hand-sewn techniques (type unknown for 18.4%). Anastomotic failure occurred in 15% of patients. Those with anastomotic failure required more anastomoses (median 2 anastomoses, interquartile range [IQR] 1-3 vs. 1 anastomosis, IQR 1-2, P = .03) and more total laparotomies (median 5 laparotomies, IQR 3-12 vs. 3, IQR 2-4, P = .01). There were no leaks in patients that had only hand-sewn anastomoses, though a significant difference was not seen with those who had stapled anastomoses. While there was an increasing trend regarding surgical site infections (SSIs) with anastomotic failure after excluding superficial SSIs, it was not significant. There was no difference in mortality. Discussion Military trauma patients have a similar anastomotic failure rate to civilian trauma patients. Patients with anastomotic failure were more likely to have had more anastomoses and more total laparotomies. No definitive conclusions can be drawn about anastomotic outcome differences between hand-sewn and stapled techniques.
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Ujihira, Kosuke, und Akira Yamada. „Novel Dry-Lab Training Method for Totally Endoscopic Coronary Anastomosis“. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 12, Nr. 5 (September 2017): 363–69. http://dx.doi.org/10.1097/imi.0000000000000406.
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Objective We describe our original dry-lab training system for nonrobotic and beating heart endoscopic coronary artery anastomosis. Methods All the materials used for this training were commercially available. We selected a boxed machine, which can produce pulsatile movements of artificial vessels, and on its roof, we installed a two-dimensional home video camera and a monitor. A multiple-holed plate was placed in front of the machine, and through these holes, a trainee inserted endoscopic surgical instruments and anastomosed the artificial vessels by running fashion while watching the monitor. This training program has four stages. During the first stage, a trainee has to demonstrate mastery in conducting a conventional off-pump coronary artery anastomosis without assistance. The second stage is the “nonbeating” version, and the third stage is the “beating” version with the model mentioned previously. After a trainee gets accustomed to the third stage, the original artificial vessel is replaced with an extremely fragile one, and this is the fourth stage. Our trainee conducted one hundred fourth-stage anastomoses and each procedure was recorded with the video camera. We analyzed several factors from the videos and evaluated the efficacy of the training method. We compared the outcomes of the first 50 consecutive anastomoses with the following 50 ones and described the learning curves. Results The comparison showed a significant decrease in anastomotic time and vessel injury. We considered the quality of anastomosis acceptable after 47 anastomoses, and anastomotic time fell below 15 minutes at the 81st training at the fourth stage. Conclusions Our dry-lab system might be an effective training method for endoscopic coronary anastomosis.
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Gerdisch, Marc, Thomas Hinkamp und Stephen D. Ainsworth. „Blood Flow Pattern and Anastomotic Compliance for Interrupted versus Continuous Coronary Bypass Grafts“. Heart Surgery Forum 6, Nr. 2 (02.02.2005): 65. http://dx.doi.org/10.1532/hsf.740.
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<P>Background: Use of the interrupted coronary anastomosis has largely been abandoned in favor of the more rapid continuous suturing technique. The Coalescent U-CLIP anastomotic device allows the surgeon to create an interrupted distal anastomosis in the same amount of time that it would take to create a continuous anastomosis. This acute bovine study examined the effect of the anastomotic technique on blood flow and vessel wall function. </P><P>Methods: End-to-side coronary anastomoses were created in an open chest bovine model using the left and right internal thoracic arteries and the left anterior descending coronary artery. All other variables except suturing technique were carefully controlled. In each animal, one anastomosis was completed using a continuous suturing technique and the other was performed in an interrupted fashion using the Coalescent U-CLIP anastomotic device. Volumetric flow curves through each graft were analyzed using key indicators of anastomotic quality, and anastomotic compliance was evaluated using intravascular ultrasound. Luminal castings were created of each vessel to examine the interior surface of each anastomosis for constrictions and deformities. </P><P>Results: The interrupted anastomoses created with the Coalescent U-CLIP anastomotic device showed significant differences with respect to anastomotic compliance, pulsatility index, peak flow, and percentage of diastolic flow. The cross-sectional area and degree of luminal deformity were also different for the two suturing techniques. </P><P>Conclusions: In this acute bovine model, interrupted coronary anastomoses demonstrated superior geometric consistency and greater physiologic compliance than did continuously sutured anastomoses. The interrupted anastomosis also caused fewer disturbances to the flow waveform, behaving similarly to a normal vessel wall. The combination of these effects may influence both acute and long-term patency of the coronary bypass grafts.</P>
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Khajanchee, Yashodhan S., W. Cory Johnston, Maria A. Cassera, Paul D. Hansen und Chet W. Hammill. „Characterization of Pancreaticojejunal Anastomotic Healing in a Porcine Survival Model“. Surgical Innovation 24, Nr. 1 (28.10.2016): 15–22. http://dx.doi.org/10.1177/1553350616674638.
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Introduction: Anastomotic leak after pancreaticoduodenectomy is the most important cause of postoperative morbidity and mortality. Histological studies of bowel anastomoses have provided valuable insights regarding causes of anastomotic failure. However, this crucial information is lacking for pancreatico-enteric anastomoses. Methods: Pancreaticoduodenectomy was performed in a porcine model. Animals were survived up to 10 days and then the pancreatico-enteral anastomosis specimen was resected en bloc. Anastomotic bursting pressure was measured and histological sections of the anastomoses were examined. Results: Six out of 8 animals had excellent healing of the anastomoses. One animal developed a clinically significant leak at the pancreaticoduodenal anastomosis (12.5%) and one animal had a subclinical duodeno-duodenal leak discovered on necropsy (12.5%). Both anastomoses that failed had a collagen-to-tissue ratio less than 40%. In contrast, none of the anastomoses with a ratio greater than 40% showed any evidence of disruption. Conclusion: Our results indicate that quantitative measurement of collagen deposition at the pancreatic anastomosis provides objective assessment of healing of the pancreatic anastomosis. A survival porcine model of pancreaticoduodenectomy results in a similar leak rate to published data on pancreaticoduodenectomy in humans and will be useful for future studies assessing novel pharmacologic or technical interventions aimed at improving outcomes.
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Herr, Leonard J. „Relationship of binucleate Rhizoctonia isolates used for biocontrol of rhizoctonia crown rot of sugar beet to anastomosis systems“. Canadian Journal of Microbiology 37, Nr. 5 (01.05.1991): 339–44. http://dx.doi.org/10.1139/m91-055.
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The relationships of 10 binucleate Rhizoctonia isolates used as biocontrol agents of rhizoctonia crown and root rot of sugar beet in Ohio to described binucleate Rhizoctonia anastomosis systems were investigated. Ten Ohio binucleate Rhizoctonia (Ohio BNR) isolates, paired in all combinations, cross anastomosed with one another, indicating that all belong to the same anastomosis group. Four representative Ohio BNR isolates failed to anastomose with any tester isolates of the Ceratobasidium anastomosis grouping system, indicating that none belong in that system. However, all 10 Ohio BNR isolates anastomosed with an AG-B (o) tester isolate (binucleate Rhizoctonia anastomosis grouping system), indicating that the Ohio agents belong in this anastomosis grouping system and to the (o) intraspecific group of AG-B. None of the Ohio BNR isolates anastomosed with either of the other two intraspecific group tester isolates (AG-Ba, AG-Bb) of the AG-B group. Moreover, the AG-B intraspecific group tester isolates, AG-Ba, AG-Bb, AG-B (o), self-anastomosed but did not cross anastomose with one another. Variations in cultural characteristics noted among the 10 Ohio BNR isolates indicated that considerable heterogeneity exists within these AG-B (o) isolates. Key words: binucleate Rhizoctonia, anastomosis, rhizoctonia crown rot, sugar beet.
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Vilhjalmsson, Dadi, Per Olofsson, Ingvar Syk, Henrik Thorlacius und Anders Grönberg. „The Compression Anastomotic Ring-Locking Procedure: A Novel Technique for Creating a Sutureless Colonic Anastomosis“. European Surgical Research 54, Nr. 3-4 (16.12.2014): 139–47. http://dx.doi.org/10.1159/000368354.
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Background/Aim: Compression anastomoses might represent an improvement over traditional hand-sewn or stapled techniques. Herein, we describe a novel concept of sutureless colonic anastomosis named compression anastomotic ring-locking procedure (CARP). Materials and Methods: The surgical device consists of two anastomotic rings and their associated helping tools, facilitating the placement of the rings into the intestinal ends. Furthermore, four catheters are connected to the surgical device, allowing the evaluation of the anastomosis during and after surgery. A total of 31 pigs underwent a low colocolic anastomosis using the anastomotic rings. The compression pressure was measured perioperatively and up to 96 h after surgery. Anastomotic integrity and morphology were analyzed by use of radiology and histology, respectively. A long-term follow-up was conducted in a subgroup of pigs up to 108 days after surgery when the bursting pressure and stricture formation were examined. Results: All animals recovered uneventfully, and macroscopic examination revealed intact anastomoses without signs of pathological inflammation or adhesions. The perioperative compression pressure was inversely proportional to the gap size between the anastomotic rings. For example, an anastomotic gap of 1.5 mm created a colonic anastomosis with a perioperative compression pressure of 91 mbar, which remained constant for up to 48 h and resulted in a markedly increased compression pressure. Contrast infusion via the catheters effectively visualized the anastomoses, and no leakage was detected within the study. The surgical device was spontaneously evacuated from the intestines within 6 days after surgery. Histology showed collagen bridging of the anastomoses already 72 h after surgery. Long-term follow-up (54-108 days) revealed no stricture formation in the anastomoses, and the bursting pressure ranged from 120 to 235 mbar. The majority of bursts (10/12) occurred distant from the anastomoses. Conclusion: We conclude that the surgical device associated to CARP is safe and efficient for creating colonic anastomoses. Further studies in patients undergoing colorectal surgery are warranted.
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Yokote, Fumi, Yoshikane Yamauchi, Hiroko Komura, Tadashi Tanuma, Yukinori Sakao, Masafumi Kawamura und Makoto Komura. „A novel method of tracheal anastomosis healing using a single submucosal injection of basic fibroblast growth factor: initial report“. European Journal of Cardio-Thoracic Surgery 61, Nr. 4 (16.12.2021): 917–24. http://dx.doi.org/10.1093/ejcts/ezab542.
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Abstract OBJECTIVES For the technical management of tracheal anastomosis, developing new and simple methods is required to relieve anastomotic tension. This study aimed to investigate whether basic fibroblast growth factor (bFGF) only once injected immediately before anastomosis promotes cartilage regeneration at the tracheal anastomosis and whether the regenerated cartilage has the effect of reinforcing the anastomosis in a rabbit model. METHODS New Zealand white rabbits were anaesthetized, and the cervical trachea was exposed through a cervical midline incision, followed by resection of the 10th tracheal cartilage. The rabbits were categorized into 2 groups: the bFGF group (n = 6) and the control group (n = 6). In the former group, bFGF (25 μg) was administered into the submucosal layer of the cartilage using a 27-G needle immediately before tracheal anastomosis. The animals were sacrificed 4 weeks later. Histological, mechanical and biochemical evaluations were performed on this anastomosed trachea. RESULTS At 4 weeks of age, the anastomoses were spindle-shaped and displayed maximum diameter at the injection site compared with those in the control group. Histological evaluation showed that cartilage tissue had regenerated between the 9th and 11th tracheal cartilage rings. Tensile test showed that the anastomoses displayed a significantly high strain/stress ratio (P = 0.035). The collagen type II and glycosaminoglycan levels were significantly increased, and the collagen type I level was significantly decreased (P = 0.019, P = 0.013 and P = 0.045, respectively). CONCLUSIONS A new wound-healing concept of airway anastomosis could be provided by the results that single injection of bFGF regenerated tracheal cartilage in rabbits and strengthened the anastomosis by bridging the regenerated and well-matured cartilage. Further investigation of this method will lead to potential clinical applications for reinforcement of tracheal anastomoses.
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Sánchez-Guillén, L., M. Frasson, Á. García-Granero, G. Pellino, B. Flor-Lorente, E. Álvarez-Sarrado und E. García-Granero. „Risk factors for leak, complications and mortality after ileocolic anastomosis: comparison of two anastomotic techniques“. Annals of The Royal College of Surgeons of England 101, Nr. 8 (November 2019): 571–78. http://dx.doi.org/10.1308/rcsann.2019.0098.
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Introduction There are no definitive data concerning the ideal configuration of ileocolic anastomosis. Aim of this study was to identify perioperative risk factors for anastomotic leak and for 60-day morbidity and mortality after ileocolic anastomoses (stapled vs handsewn). Materials and methods This is a STROBE-compliant study. Demographic and surgical data were gathered from patients with an ileocolic anastomosis performed between November 2010 and September 2016 at a tertiary hospital. Anastomoses were performed using standardised techniques. Independent risk factors for anastomotic leak, complications and mortality were assessed. Results We included 477 patients: 53.7% of the anastomoses were hand sewn and 46.3% stapled. Laterolateral anastomosis was the most common configuration (93.3%). Anastomotic leak was diagnosed in 8.8% of patients and 36 were classified as major anastomotic leak (7.5%). In the multivariate analysis, male sex (P = 0.014, odds ratio, OR, 2.9), arterial hypertension (P = 0.048, OR 2.29) and perioperative transfusions (P < 0.001, OR 2.4 per litre) were independent risk factors for major anastomotic leak. The overall 60-day complication rate was 27.3%. Male sex (31.3% vs female 22.3%, P = 0.02, OR 1.7), diabetes (P = 0.03 OR 2.0), smoking habit (P = 0.04, OR 1.8) and perioperative transfusions (P < 0.001, OR 3.3 per litre) were independent risk factors for postoperative morbidity. The 60-day-mortality rate was 3.1% and no significant risk factors were identified. Conclusion Anastomotic leak after ileocolic anastomosis is a relevant problem. Male sex, arterial hypertension and perioperative transfusions were associated with major anastomotic leak. Conversion to open surgery was more frequently associated with perioperative death.
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Raghunandan R. „A Clinical Study – Resection and Anastomosis of Bowel in Our Surgical Practice“. Academia Journal of Surgery 3, Nr. 1 (26.05.2020): 1–7. http://dx.doi.org/10.47008/ajs/2020.3.1.1.
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Background: Anastomotic leaks are among the most dreaded complications after bowel surgery. In the present era, even with better understanding of the impact of local and systemic factors on anastomotic healing, dehiscence and leakage remains frequent and serious problem associated with high morbidity and mortality. However, problems with definitions and the retrospective nature of previous analyses have been major limitations. The aim of the study to use a prospective database to study the incidence of intestinal resection and anastomoses, to determine important factors and their significance in the healing of the anastomosis along with identifying the most ideal suture material for these techniques in our practice. Subjects and Methods: This study was carried out on 40 patients who underwent resection and anastomosis of bowel for various pathological causes in Kamineni Institute of Medical Sciences & Hospital Hyderabad during September 2018 to September 2019. Results: Out of the 40 patients who underwent resection and anastomosis of bowel, Anastomotic leaks were observed in 10 (25%) cases and all of them belonged to the group who were operated on emergency basis. Hypoproteinaemia, peritonitis and perioperative blood transfusions, hypovolemia were important attributable factors identified in the leak group. Minimal leaks were observed in the group of patients who were anastomosed with vicryl suture material alone. Mortality was observed in 3patients in the leak group. At 6 month follow up none of them developed anastomosis related complications like stenosis, diverticulum. Conclusion: The present study shows majority of the patients undergoing resection and anastomosis were dealt on an emergency basis. Multivariate analysis showed six predictive variables i.e., serum albumin less than 3 g/l, use of corticosteroids, bacterial peritonitis, malignancy, COPD, perioperative blood transfusions had a higher risk of developing anastomotic leaks. Vicryl when used alone being the suture material of choice.
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Vajner, Yu S., K. V. Atamanov, E. R. Atamanova, M. N. Chekanov, E. I. Vereshchagin, I. V. Peshkova und A. S. Polyakevich. „The use of a modified “end-to-side” small intestine anastomosis in patients with acute obstruction of the terminal section of the small and right colon“. Experimental and Clinical Gastroenterology 1, Nr. 6 (31.08.2021): 82–87. http://dx.doi.org/10.31146/1682-8658-ecg-190-6-82-87.
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Introduction. The prevalence of colorectal cancer in the world is increasing every year. In more than 40% of patients, the disease debuts with a clinical picture of acute intestinal obstruction, while in one third of cases the tumor is located in the right half of the colon. This leads to the necessity to perform colon resection or bypass surgery, the main stage of which is making entero- colic anastomosis. However, up to 15% of these anastomoses has a leakage. Development of methods of forming a reliable anastomosis is thus critical.Materials and methods. 37 patients with acute intestinal obstruction, divided into 2 groups (17 and 20 people), are included into the study. All of them, as a surgical stage of treatment, underwent a right hemicolectomy with the formation of an entero- colic anastomosis or a bypass surgery. A double-row side-to-side anastomosis was used in the comparison group, and a single-row “end-to-side” anastomosis in the main group (patent No. 2709253). The incidence of anastomotic leakage and mortality were assessed. Comparison was performed using Fisher’s exact test.Results. There were no cases of anastomotic leakage and mortality in the main group. In the comparison group, there were 5 leakages and 1 death.Discussion. When a modified entero-colic anastomosis is formed, adequate blood flow is maintained in the walls of the anastomosed intestinal loops, which contributes to adequate regeneration.Conclusion. The first clinical experience with the modified end-to-side entero- colic anastomosis is successful. It is planned to further recruit patients and study the features of the postoperative period.
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Valverde, A. „Anastomosi digestive: principi e tecnica (chirurgia aperta e laparoscopica)“. EMC - Tecniche Chirurgiche Addominale 21, Nr. 3 (September 2015): 1–20. http://dx.doi.org/10.1016/s1283-0798(15)72323-5.
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Kadaba, RS, KA Bowers, S. Khorsandi, RR Hutchins, AT Abraham, S.-J. Sarker, S. Bhattacharya und HM Kocher. „Complications of biliary-enteric anastomoses“. Annals of The Royal College of Surgeons of England 99, Nr. 3 (März 2017): 210–15. http://dx.doi.org/10.1308/rcsann.2016.0293.
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INTRODUCTION Biliary-enteric anastomoses are performed for a range of indications and may result in early and late complications. The aim of this study was to assess the risk factors and management of anastomotic leak and stricture following biliary-enteric anastomosis. METHODS A retrospective analysis of the medical records of patients who underwent biliary-enteric anastomoses in a tertiary referral centre between 2000 and 2010 was performed. RESULTS Four hundred and sixty-two biliary-enteric anastomoses were performed. Of these, 347 (75%) were performed for malignant disease. Roux-en-Y hepaticojejunostomy or choledocho-jejunostomy were performed in 440 (95%) patients. Perioperative 30-day mortality was 6.5% (n=30). Seventeen patients had early bile leaks (3.7%) and 17 had late strictures (3.7%) at a median of 12 months. On univariable logistic regression analysis, younger age was a significant risk factor for biliary anastomotic leak. However, on multivariable analysis only biliary reconstruction following biliary injury (odds ratio [OR]=6.84; p=0.002) and anastomosis above the biliary confluence (OR=4.62; p=0.03) were significant. Younger age and biliary reconstruction following injury appeared to be significant risk factors for biliary strictures but multivariable analysis showed that only younger age was significant. CONCLUSIONS Biliary-enteric anastomoses have a low incidence of early and late complications. Biliary reconstruction following injury and a high anastomosis (above the confluence) are significant risk factors for anastomotic leak. Younger patients are significantly more likely to develop an anastomotic stricture over the longer term.
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Shestakov, A. L., I. M. Tadzhibova, A. I. Cherepanin, A. A. Bezaltynnykh und M. E. Shakhbanov. „MECHANICAL ESOPHAGEAL ANASTOMOSES“. Surgical practice, Nr. 3 (04.12.2020): 29–35. http://dx.doi.org/10.38181/2223-2427-2020-3-29-35.
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This article gives an overview of mechanical esophageal anastomosis. The results of the esophageal anastomoses formation by using circular and linear stitching devices (staplers) by Russian and foreign authors are presented in chronological order. The faults of staplers, complications associated with them are described. The importance of the problem related to the choice of anastomotic technique to reduce the risks of specific complications such as leakage and stricture of esophageal anastomosis was remarked by authors. The advantages and disadvantages of the currently known esophageal anastomotic methods have been analyzed. It was noted that mechanical side-to-side anastomoses are associated with low frequency of leakage, stricture, postoperative mortality, that’s why they have become preferable, especially in the mini-invasive reconstructive surgery. The authors concluded that the question about the feasibility of mechanical esophageal anastomoses formation is not answered, the evaluation of the properties of modern staplers and the search for the best esophageal anastomotic method are relevant for modern surgery.
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Chobey, S. M., und O. O. Dutko. „METHODS OF ILEO-TRANSVERSE AND COLON INVAGINATIONAL ANASTOMOSES CREATING“. Kharkiv Surgical School, Nr. 1 (20.03.2021): 96–101. http://dx.doi.org/10.37699/2308-7005.1.2021.18.
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Summary. The aim of the study. To improve the results of patients with tumors and non-neoplastic diseases of the colon treatment, to introduce into clinical practice the original surgical technique and methods of creating of colon anastomoses, which were tested in experiment.
Materials and methods. Original methods of invaginational ileo-transverse and colon anastomoses creating were developed in the experiment on rabbits. Taking into account the obtained positive results, the methods of anastomoses formation were transferred to the surgical clinic and patents of Ukraine were obtained.
In 2020, ileo-transverse and colonic anastomoses were formed in 134 patients on the basis of Transcarpathian Antitumor Center: one-row invaginational anastomosis according to the developed method in 22 patients (16.4 %), two-row manual — in 58 (43.3 %), circular stapler — in 36 (26.9 %), linear stapler anastomosis — in 4 (3 %), laparoscopic (linear stapler) — in 14 (10.4 %).
Results and discussion. The most of complications occurred in the group with manual two-row anastomosis (16), in two cases the anastomotic leakage was recorded. When using a circular stapler suture, anastomotic leakage was observed in 1 patient, and anastomositis — in 4. When using linear stapler anastomoses, postoperative wound suppuration was observed in 1 patient.
Conclusions. The most of early postoperative complications was observed after using a two-row manual colonic anastomosis (27.5 %). When using a circular stapler suture, the number of early postoperative complications was less than with a two-row manual anastomosis (22.2 % vs. 27.5 %, respectively). The least number of complications was recorded after the creation of a one-row invaginational anastomosis in the proposed original technique.
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Head, Linden, und Douglas McKay. „Economic Comparison of Hand-Sutured and Coupler-Assisted Microvascular Anastomoses“. Journal of Reconstructive Microsurgery 34, Nr. 01 (25.09.2017): 071–76. http://dx.doi.org/10.1055/s-0037-1606540.
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Background Compared with hand-sewn anastomoses, microvascular anastomotic coupling devices (MACDs) provide equivalent flap survival and reduced operative time. To date, an economic analysis of MACDs has not been reported. The objective of this study was to evaluate the economics of a venous anastomosis performed using a coupling device compared with a hand-sewn anastomosis. Methods Economics were modeled for a single free tissue transfer (FTT) requiring one venous anastomosis performed with either hand-sewn sutures or with a coupler-assisted anastomosis using the GEM COUPLER. Fixed and variable costs incurred with each anastomotic technique were identified with an activity-based cost analysis. Price lists were retrieved from suppliers to quantify disposable costs and capital expenditures. Two literature reviews were executed to identify microsurgical operating room (OR) costs and operating time reductions with coupler-assisted anastomoses. Results For each venous anastomosis, the use of the anastomotic coupler increased disposable costs by $284.40 compared with a hand-sutured anastomosis. Total fixed and variable OR costs were $30.82 per minute. Operating time was reduced by a mean of 16.9 minutes with a coupler-assisted anastomosis, decreasing OR costs by $519.29. Total savings of $234.89 were generated for each coupler-assisted anastomosis, recuperating the device's capital expenditure after 13 uses. Conclusion Compared with a hand-sewn venous anastomosis, an MACD produces savings with each case and quickly recoups the device's capital expenditure. Despite its limitations and simplicity, this study provides a practical economic analysis that can help inform purchasing decisions, particularly for smaller volume centers where the economic rationale may be less clear.
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Pribil, Stefan, und Stephen K. Powers. „Carotid artery end-to-end anastomosis in the rat using the argon laser“. Journal of Neurosurgery 63, Nr. 5 (November 1985): 771–75. http://dx.doi.org/10.3171/jns.1985.63.5.0771.
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✓ Microvascular end-to-end anastomoses of rat common carotid arteries measuring 0.6 to 0.7 mm in diameter were performed using an argon surgical laser system. Vascular bonding with the argon laser was accomplished in all cases. The anastomosed carotid artery segments were evaluated both angiographically and histologically at 1 day, 1 week, and 1 month after laser bonding. With increasing time after anastomosis, there was a trend toward increasing angiographically proven stenosis of the anastomotic segment and histologically demonstrated pseudoaneurysm formation of the vessel wall at the bonded site. Pseudoaneurysm formation was associated with a dense inflammatory response in the anastomotic vessel segment. In spite of excellent initial tissue bonding and vessel patency, the delayed results of progressive vessel wall disruption and segmental stenosis indicate that further experience in using the argon laser for vessel welding is needed before this method can be accepted as an alternative to current microvascular suture technique.
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Trotter, J., L. Onos, C. McNaught, M. Peter, M. Gatt, K. Maude und J. MacFie. „The use of a novel adhesive tissue patch as an aid to anastomotic healing“. Annals of The Royal College of Surgeons of England 100, Nr. 3 (März 2018): 230–34. http://dx.doi.org/10.1308/rcsann.2018.0003.
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Introduction One of the most feared complications of colorectal surgery is anastomotic leak. Numerous techniques have been studied in the hope of decreasing leakage. This study was designed to assess the handling characteristics of a novel adhesive tissue patch (TissuePatch™; Tissuemed, Leeds, UK) applied to colorectal anastomoses in a pilot study. This was with a view to assessing its potential role in aiding anastomotic healing in subsequent trials. Methods A patch was applied to colorectal anastomoses after the surgeon had completed the anastomosis and prior to abdominal closure. Handling characteristics and patient outcomes were recorded prospectively. Results Nine patients were recruited before the study was prematurely terminated. In one patient, the patch fell off and in another patient, the surgeon omitted to apply it. Six patients had significant postoperative problems (1 confirmed leak necessitating return to theatre and excision anastomosis, 3 suspicious of leak on computed tomography delaying discharge, 2 perianastomotic collections). One patient had an uneventful recovery. Conclusions Although the handling characteristics of this novel tissue patch were deemed satisfactory, it appears that wrapping a colorectal anastomosis with an adhesive hydrophilic patch has significant deleterious effects on anastomotic healing. This could be a consequence of the creation of a microenvironment between the patch and the anastomosis that impairs healing. Further research is required to better understand the mechanisms involved. At present, the use of such patches on colorectal anastomoses should be discouraged outside the confines of a well monitored trial.
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Geevarghese, Sunil K., Anne L. Bradley, James Atkinson, J. Kelly Wright, William C. Chapman, David H. Van Buren, K. Taylor Blair et al. „Comparison of Arcuate-Legged Clipped versus Sutured Hepatic Artery, Portal Vein, and Bile Duct Anastomoses“. American Surgeon 65, Nr. 4 (April 1999): 311–16. http://dx.doi.org/10.1177/000313489906500404.
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Attempts at improving anastomoses have included the development of stapling techniques. Our purpose was to evaluate arcuate-legged clipped versus standard sutured anastomoses of the hepatic artery (HA), portal vein (PV), and bile duct in a porcine liver transplantation model. Two groups of pigs were studied intraoperatively and 1 day after liver transplantation. A control group underwent sutured anastomosis of PV and HA with polypropylene and of bile duct with polydioxanone (n = 8). An experimental group underwent anastomoses with arcuate-legged clips (n = 8). We analyzed the time to perform anastomosis and flows before and at various time points after anastomosis. In addition, patency and histology of the anastomoses were evaluated 1 day after operation, including a fibrin-thrombosis score, medial injury, and inflammation score. Times to complete HA and PV anastomoses were not different between clipped and sutured groups. However, the time was shorter to complete bile duct anastomosis with clips than with sutures (6.3 ± 1.1 minutes and 13.3 ± 2.0 minutes, respectively). Flows through HA anastomoses were not different between groups, but flow through the PV was higher in clipped compared with sutured anastomosis (P = 0.06). Patency was 100 per cent with no leaks for all three anastomoses in both groups. Histologic data were similar between vascular anastomotic groups. Sutured bile duct anastomoses revealed mild smooth muscle injury in 75 per cent whereas clipped bile duct anastomoses displayed no smooth muscle injury. We conclude that arcuate-legged clipped anastomosis represents a viable option to sutured anastomoses of the PV, HA, and bile duct anastomoses. Bile duct anastomoses were completed in less than half the time and with less tissue damage documented histologically.
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Cossu, Maria Laura, Massimiliano Coppola, Enrico Fais, Matteo Ruggiu, Claudio Spartà, Stefano Profili, Vincenzo Bifulco, Giovanni B. Meloni und Giuseppe Noya. „The Use of the Valtrac Ring in the Upper and Lower Gastrointestinal Tract, for Single, Double, and Triple Anastomoses: A Report of 50 Cases“. American Surgeon 66, Nr. 8 (August 2000): 759–62. http://dx.doi.org/10.1177/000313480006600815.
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The Valtrac biofragmentable anastomotic ring (V-BAR) technique has been widely used in clinical practice, particularly in anastomoses of the colon. The success of this method encouraged some surgeons to use it also in anastomosis of the small intestine. We are convinced that the method can be used successfully also in anastomosis of the small intestine and the upper gastrointestinal tract, particularly in cases of technically difficult and high-risk anastomoses. Between 1995 and 1998, we used the V-BAR in 35 patients, performing a total of 50 anastomoses. In 13 patients a double anastomosis was created in the same operation, and in one patient a triple anastomosis was created. In all we performed one end-to-end esophagojejunostomy, one gastrojejunostomy, six gastroileostomies, two duodenojejunal anastomoses, 13 end-to-end duodenoileostomies, one jejuno-jejunal anastomosis, 18 end-to-side ileoileal anastomoses, one ileocolic anastomosis, and seven colocolic anastomoses. Follow-up at between 2 and 36 months showed good overall results with regard to resumption of intestinal transit and canalization, even in those cases in which a double and triple suture was performed using the Valtrac ring. In our experience, the V-BAR can be used in upper gastrointestinal surgery with excellent results. Compared with manual sutures, the ring allows better and faster resumption of transit and canalization.
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Tang, Ze, Hongfei Cai und Youbin Cui. „Influence of Early Postoperative Feeding in Gastrointestinal Anastomotic Fistula Formation and Healing Time in Rabbits“. BioMed Research International 2018 (2018): 1–6. http://dx.doi.org/10.1155/2018/8258096.
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Objectives. To determine whether early postoperative feeding attenuates the inhibitory effects of intestinal anastomosis in rabbits. Methods. After undergoing gastrointestinal anastomosis, 48 rabbits were randomly divided into experimental and control groups. The rabbits in the experimental group were fed a liquid diet beginning 24 h postoperatively, while the control rabbits received only total parenteral nutrition after the operation. Exploratory laparotomies were performed on four rabbits in each group 3, 5, 7, 10, and 15 days postoperatively, and the healing rate of the anastomosis, anastomotic bursting pressure, anastomotic breaking strength, and hydroxyproline content at the anastomosis were determined. Results. The anastomoses healed in 91.6% (22/24) of the control group and 95.8% (23/24) of the experimental group. The anastomotic bursting pressure decreased remarkably in both groups 3 days postoperatively, reaching the lowest value. The anastomotic breaking strength did not differ between the two groups 3 days postoperatively, when both reached their lowest points, and both groups increased markedly and peaked 10 days postoperatively. The hydroxyproline content of the anastomosis was slightly lower in the experimental group 3 days postoperatively, although both groups peaked 7 days postoperatively. Conclusions. Early postoperative feeding does not increase the anastomosis healing time or rate of gastrointestinal anastomosis leakage.
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ZHAO, XI, YOUJUN LIU, JINLI DING, XIAOCHEN REN, FAN BAI, MINGZI ZHANG, LIANCAI MA, WENXIN WANG, JINSHENG XIE und AIKE QIAO. „HEMODYNAMIC EFFECTS OF THE ANASTOMOSES IN THE MODIFIED BLALOCK–TAUSSIG SHUNT: A NUMERICAL STUDY USING A 0D/3D COUPLING METHOD“. Journal of Mechanics in Medicine and Biology 15, Nr. 01 (Februar 2015): 1550017. http://dx.doi.org/10.1142/s0219519415500177.
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The modified Blalock–Taussig (BT) shunt is a palliative surgery which can help the tetralogy of Fallot (TOF) patient increase the blood oxygen saturation by interposing a systemic-to-pulmonary artery shunt. Two typical anastomotic shapes are frequently used in clinical practice: the end-to-side (ETS) and the side-to-side (STS) anastomosis. This paper examines the hemodynamic influence of the anastomotic shape in the modified BT shunt. Three models with different anastomotic shapes were reconstructed. The ETS anastomoses were applied in the first model. For the innominate artery (IA) and the pulmonary artery (PA) in the second model, the ETS and the STS anastomosis were applied, respectively. Finally, the STS anastomoses were applied in the third model. The 0D/3D coupling method was used to perform a numerical simulation by coupling the three-dimensional (3D) artery model with a zero-dimensional (0D) lumped parameter model for the cardiovascular system. The simulation results showed that the perfusion into the left and right PA in Model 1 was unbalanced. Swirling flow appeared in the shunt in Model 3, but the shunt flow rate in Model 3 was lower. The ETS anastomosis at the PA may cause unbalanced blood perfusion into the left and right PA. Conversely, the STS anastomosis can make the blood perfusion more balanced. Otherwise, the STS anastomosis at the IA could generate a swirling flow in the shunt which may provide a better hemodynamic environment while decreasing the pulmonary perfusion.
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Tozzi, Piergiorgio, Antonio F. Corno und Ludwig K. von Segesser. „Intravascular Ultrasound: Potential Tool to Assess Coronary Anastomosis Quality“. Asian Cardiovascular and Thoracic Annals 11, Nr. 2 (Juni 2003): 143–46. http://dx.doi.org/10.1177/021849230301100212.
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Coronary angiography and Doppler flow measurements are most commonly used to assess the patency of anastomoses in the operating theater. Intravascular ultrasound might be another means of monitoring the surgical procedure during coronary artery bypass. Five sheep underwent off-pump bypass of the left anterior descending coronary artery using the left internal mammary artery. The running suture was evaluated by intraoperative fluoroscopy and a coronary intravascular ultrasound probe inserted into the target artery proximal to the anastomosis. Macroscopic examination of the anastomosis was performed to validate the angiographic and intravascular ultrasound images. The diameter, cross-sectional area, and compliance of each anastomosis were calculated in systole and diastole. All anastomoses were patent without signs of stenosis. In one case, intravascular ultrasound showed an intimal flap, which was confirmed by macroscopic examination. The mean major anastomotic diameter was 4.5 ± 0.5 mm on angiography and 4.0 ± 0.5 mm on intravascular ultrasound. From the ultrasound data, the mean cross-sectional anastomotic area was calculated as 6.21 ± 0.1 mm2 in systole and 5.49 ± 0.1 mm2 in diastole, and these data were used to calculate the cross-sectional anastomosis compliance. Coronary intravascular ultrasound can visualize intima-to-intima apposition and provide reliable calculations of anastomosis compliance.
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Полуэктов und V. Poluektov. „Treatment of patients with anastomotic stricture scar gastrointestinal (scientific report)“. Journal of New Medical Technologies. eJournal 8, Nr. 1 (05.11.2014): 0. http://dx.doi.org/10.12737/7372.
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A large number of operations on the gastrointestinal anastomoses various superimposed ends. Unfortunately, in some cases, the healing anastomosis stricture formation ends. Over the past years there have been an effective minimally invasive treatments anastomotic stricture based on the violent, mechanical expansion narrowing of the anastomosis. And when they are used may occur serious complications.
This article presents the different ways to improve treatments for anastomotic stricture of the gastrointes-tinal tract by means of endoscopic tools that will improve the safety of these methods.
The results of treatment of cicatricial strictures anastomoses on advanced techniques in 42 patients.
In particular, in all patients, the technique used to ensure the removal of scar strictures. In one case, prob-ing, there was bleeding from the area of the anastomosis, which was verified during the procedure, allowing for a timely endoscopic hemostasis with a favorable outcome. Other complications.
The article concluded that improved methods of treating scar stricture of anastomosis of the gastrointes-tinal tract, applied in the clinic are highly have a minimum number of complications and are the method of choice in this pathology.
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Pathak, A., MD Aklakhur Rahaman und SM Mishra. „Single-Layer Versus Double Layer Intestinal Anastomosis of Small Bowel at Nepalgunj Teaching Hospital“. Journal of Nepalgunj Medical College 12, Nr. 1 (17.09.2015): 35–38. http://dx.doi.org/10.3126/jngmc.v12i1.13405.
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Background: Resection and anastomosis of small bowel is one of the common surgical procedure encountered in routine and emergency cases. There are various techniques of anastomosing the resected intestine.Objectives: To know the efficacy of single layer anastomosis over double layer anastomosis in terms of anastomotic leakage, wound infection, mortality and time consumed.Methods: A comparative cross sectional analytical study was carried out at department of General Surgery at Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal from January 2013 to December 2013. Altogether 62 patients who underwent resection and anastomosis of small bowel were considered for this study. Patients who were included in this study were equally divided into two groups. Group A (n=32) underwent single layer anastomosis and group B (n=30) were subjected to double layer anastomosis. In both the groups anastomotic leakage, wound infection, mortality and time consumed were recorded and compared.Results: Altogether 62 patients were included in the study. The study showed anastomotic leakage 3 (9.37%) in Group A and 2 (6.67%) in Group B. Wound infection was 6 (18.75%) in Group A and 4(13.33%) in Group B and mortality was observed in only 1(3.12%) patient in Group A due to uncontrolled sepsis. There was no statistical difference between the two groups in anastomotic leakage, wound infection and mortality as shown by respective p (0.696, 0.562, 0.329) values. However the time required for single layer bowel anastomosis was less in comparison to double layer bowel anastomosis.Conclusion: Based on our data, the technique of single layer of bowel anastomosis does not increase the rate of anastomotic leakage, wound infection and mortality however time required for anastomosis is less as compared to double layer anastomosis. Therefore this study concludes that there is no added benefit of double layer of anastomosis over single layer bowel anastomosis.Journal of Nepalgunj Medical College Vol.12(1) 2014: 35-38
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Nerstrøm, Malene, Peter-Martin Krarup, Lars Nannestad Jorgensen und Magnus S. Ågren. „The Effect of a Synthetic Heparan Sulfate on the Healing of Colonic Anastomoses“. Gastroenterology Research and Practice 2017 (2017): 1–6. http://dx.doi.org/10.1155/2017/1078062.
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Background. The mimetic compound OTR4120 may replace endogenous-degraded heparan sulfates that normally maintain the bioactivity of growth factors that are important for tissue repair. Herein, we investigated the effect of OTR4120 on the healing of normal colonic anastomoses. Methods. We evaluated the following two treatment groups of male Sprague Dawley rats (220–256 g): control-treated colonic anastomoses (n=25) and OTR4120-treated colonic anastomoses (n=25). We resected 10 mm of the left colon and then applied either saline alone (control) or OTR4120 (100 μg/mL) in saline to the colonic ends before an end-to-end single-layer anastomosis was constructed and again on the anastomosis before the abdomen and skin were closed. Results. On postoperative day 3, the anastomotic breaking strengths were 1.47 ± 0.32 N (mean ± SD) in the control group and 1.52 ± 0.27 N in the OTR4120-treated animals (P=0.622). We also found that the hydroxyproline concentration (indicator of collagen) in the anastomotic wounds did not differ (P=0.571) between the two groups. Conclusions. Our data demonstrate that a single local application of OTR4120 intraoperatively did not increase the biomechanical strength of colonic anastomoses at the critical postoperative day 3 when the anastomoses are the weakest.
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Ahmadi, Iraj, Pradyumna Herle, David Hunter-Smith, James Leong, Warren Rozen und George Miller. „End-to-End versus End-to-Side Microvascular Anastomosis: A Meta-analysis of Free Flap Outcomes“. Journal of Reconstructive Microsurgery 33, Nr. 06 (04.03.2017): 402–11. http://dx.doi.org/10.1055/s-0037-1599099.
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Background Optimal outcomes in microsurgery have been attributed to a range of factors, with performing of end-to-end (ETE) versus end-to-side (ETS) influencing anastomotic complications and flap outcomes. Methods A systematic review of the literature and meta-analysis was undertaken to evaluate the relative risks of anastomotic complications with ETE versus ETS approaches, for arterial and venous anastomoses looking at risk ratios (RRs) for thrombosis and overall flap failure. Results RRs of thrombosis and flap failure in ETS versus ETE venous anastomosis groups were 1.30 (95% confidence interval [CI]: 0.53–3.21) and 1.50 (95% CI: 0.85–2.67), respectively. The RRs of thrombosis and flap failure in ETS versus ETE arterial anastomosis groups were 1.04 (95% CI: 0.32–3.35) and 1.04 (95% CI: 0.72–1.48), respectively. Conclusion Differences in rates of thrombosis and flap failure between ETE and ETS venous and arterial anastomoses are marginal and nonsignificant. As such, the type of anastomotic technique is best decided on a case-by-case basis, dependent on anatomical, surgical, and patient factors.
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Pieruzzi, Federico, und Federica Mescia. „Nuovo Approccio nel Trattamento Dell'ipertensione Arteriosa Resistente Mediante Anastomosi Artero-venosa“. Giornale di Clinica Nefrologica e Dialisi 27, Nr. 2 (11.05.2015): 67–69. http://dx.doi.org/10.33393/gcnd.2015.798.
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Pieruzzi, Federico, und Federica Mescia. „Nuovo Approccio nel Trattamento Dell'ipertensione Arteriosa Resistente Mediante Anastomosi Artero-venosa“. Giornale di Tecniche Nefrologiche e Dialitiche 27, Nr. 2 (April 2015): 67–69. http://dx.doi.org/10.5301/gtnd.2015.14654.
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Wildeboer, Aurelia, Wido Heeman, Arne van der Bilt, Christiaan Hoff, Joost Calon, E. Christiaan Boerma, Mahdi Al-Taher und Nicole Bouvy. „Laparoscopic Laser Speckle Contrast Imaging Can Visualize Anastomotic Perfusion: A Demonstration in a Porcine Model“. Life 12, Nr. 8 (16.08.2022): 1251. http://dx.doi.org/10.3390/life12081251.
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Background: Intestinal resection causes inevitable vascular damage, which cannot always be seen during an intraoperative clinical assessment of local intestinal perfusion. If left unaltered, impaired perfusion can lead to complications, such as anastomotic leakage (AL). Therefore, we demonstrate the use of a novel laparoscopic laser speckle contrast imaging (LSCI)-based approach in order to assess local intestinal perfusion during the construction of intestinal anastomoses. Methods: Three segments were isolated from the small intestine of a pig, while the perfusion of each was compromised by coagulating 7–8 mesenteric arteries. Both clinical assessments and LSCI were used to detect the induced perfusion deficits and to subsequently guide a transection in either a well perfused, marginally perfused, or poorly perfused tissue area within the segment. Bowel ends were then utilized for the creation of three differently perfused anastomoses: well perfused/well perfused (anastomosis segment 1), well perfused/poorly perfused (anastomosis segment 2), and poorly perfused/poorly perfused (anastomosis segment 3). After construction of the anastomoses, a final perfusion assessment using both clinical assessment and LSCI was executed in order to evaluate the vascular viability of the anastomosis. Results: Laparoscopic LSCI enabled continuous assessment of local intestinal perfusion and allowed for detection of perfusion deficits in real time. The imaging feedback precisely guided the surgical procedure, and, when evaluating the final anastomotic perfusion, LSCI was able to visualize the varying degrees of perfusion, whereas standard clinical assessment yielded only minor differences in visual appearance of the tissue. Conclusions: In this technical note, we demonstrate a novel LSCI-based approach for intraoperative perfusion assessment. With its ability to continuously visualize perfusion in real time, laparoscopic LSCI has significant potential for the optimization of anastomotic surgery in the near future.
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Li, Xinju, Zhe Wang, Guangjian Zhang, Junke Fu und Qifei Wu. „T-shaped linear-stapled cervical esophagogastric anastomosis for minimally invasive esophagectomy: a pilot study“. Tumori Journal 106, Nr. 6 (20.01.2020): 506–9. http://dx.doi.org/10.1177/0300891619898531.
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Background: Minimally invasive esophagectomy (MIE) has become a good option in the surgical treatment of esophageal cancer. Cervical esophagogastric anastomoses (CEGA) are widely used during esophagectomy. However, CEGA are related with a higher incidence of anastomotic complications. In the present study, a new procedure of T-shaped linear-stapled cervical esophagogastric anastomosis was used during MIE and the short-term outcomes are presented. Methods: From May 2014 to December 2018, 32 consecutive patients with esophageal cancer who underwent total MIE followed by T-shaped linear-stapled cervical esophagogastric anastomosis were included. Postoperative outcomes were analyzed. Results: Fifteen men and 17 women were included this pilot study. The histology of all cases was squamous cell carcinoma. Mean operation time of T-shaped linear-stapled cervical esophagogastric anastomosis was 17.6 minutes. There were no early or late mortalities. A minor cervical anastomotic leakage occurred in 1 patient. No complications of anastomotic stenosis occurred in this study. Conclusion: The T-shaped linear-stapled cervical esophagogastric anastomosis is efficient, reliable, easy to perform, and associated with lower postoperative complication rate.
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Kapischke, Matthias, Dietmar Gerhard und Alexandra Pries. „Sutureless open vascular anastomosis connector: An experimental study“. Vascular 25, Nr. 1 (24.09.2016): 101–4. http://dx.doi.org/10.1177/1708538116669065.
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The objective of this study was to assess the safety of a new developed sutureless vascular adapter system in a porcine model. In five pigs, 4-cm-long polyester prosthesis (6 mm diameter) were implanted and anastomosed with the newly developed adapter proximally and suture anastomosis distally. The integration of the adapter was investigated in comparison to the suture anastomosis. These investigations were performed by light microscopy and scanning electron microscopy. Median operative time for performing the adapter anastomosis was significantly shorter compared to suture anastomosis (66 s vs. 246 s, p < 0.05). Median estimated blood loss during adapter anastomosis implementation was 22.5 mL (range 19.0–25.0 mL) compared to 48.2 mL (range 45.4–63.5 mL, p < 0.05). In five hand-sewn anastomoses, overall eight additional stitches were necessary whereas all adapter anastomoses showed primary leak tightness. This in vivo study shows the technical feasibility of the newly developed adapter.
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Stecher, David, Pierfrancesco Agostoni, Gerard Pasterkamp, Imo E. Hoefer, Lex A. van Herwerden und Marc P. Buijsrogge. „Six-Month Healing of the Nonocclusive Coronary Anastomotic Connector in an Off-Pump Porcine Bypass Model“. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 9, Nr. 2 (März 2014): 130–36. http://dx.doi.org/10.1097/imi.0000000000000055.
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Objective This pilot study evaluates the anastomotic healing of the Excimer Laser Assisted Nonocclusive Anastomosis coronary connector at 6 months in a porcine off-pump coronary artery bypass (OPCAB) model. Methods Left internal thoracic artery to left anterior descending coronary artery bypass in two animals and left internal thoracic artery to left anterior descending coronary artery and right internal thoracic artery to right coronary artery bypasses in one animal were evaluated intraoperatively and at 6 months. The anastomoses (n = 4) were examined by angiography, intravascular ultrasound, optical coherence tomography, scanning electron microscopy, and histology. Results At follow-up, all anastomoses (n = 4) were fully patent (FitzGibbon grade A). Scanning electron microscopy demonstrated complete endothelial coverage of the anastomotic surface, and histology showed minimal streamlining intimal hyperplasia. The in vivo intravascular ultrasound and optical coherence tomography acquisitions confirmed histologic findings. Optical coherence tomography demonstrated 0.06-mm intimal coverage of the intraluminal part of the connector along the full circumference of the anastomosis. Conclusions In this pilot study, the Excimer Laser Assisted Non-occlusive Anastomosis coronary connector showed an excellent healing response on the long-term in the porcine OPCAB model. Hence, this new concept might be a potential alternative to hand-sutured anastomosis in (minimally invasive) OPCAB surgery.
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Ekici, Yahya, Eda Yılmaz Akcay und Gokhan Moray. „Effect of the Bioadhesive, BioGlue, on Impaired Colonic Anastomose Healing in Rats“. International Surgery 100, Nr. 11-12 (01.11.2015): 1375–81. http://dx.doi.org/10.9738/intsurg-d-15-00085.1.
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Colonic anastomotic leakage is still a problem in general surgery practice. We sought to investigate the effect of a new tissue adhesive, BioGlue, on the healing of normal and impaired colonic anastomoses. Sixty-four rats were randomized into 4 groups. In all animals, a 1-cm segment of the left colon was resected, and an end-to-end sutured anastomosis was created. Animals were then divided into 2 groups: normal and impaired anastomosis. These 2 groups were further subdivided into 2 additional groups: animals that received BioGlue and those that did not. All rats received intraperitoneal injections of either 0.9% NaCl or 5-fluorouracil (5-FU). Anastomotic evaluation was done 7 days after surgery. Macroscopic healing, mechanical strength, and histopathologic healing parameters were evaluated. Leakage of the anastomosis was significantly higher in rats in the impaired group compared with those in the BioGlue groups (P = 0.043). The adhesion formation score was significantly higher in rats in the impaired anastomosis group compared with the other groups. Bursting pressures were significantly lower in the impaired anastomosis group than in the other ones (P = 0.001). Neoangiogenesis and fibroblast activity were different among the groups (P = 0.001). Inflammatory cell infiltration and collagen deposition did not differ among the groups (P = 0.07). Immediate postoperative intraperitoneal administration of 5-FU after colonic anastomosis inhibits intestinal wound healing. Covering colon anastomoses with BioGlue after suturing conferred beneficial effect on healing.
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Kryzauskas, Marius, Matas Jakubauskas, Neda Gendvilaite, Vilius Rudaitis und Tomas Poskus. „Bowel Rest with Total Parenteral Nutrition as an Alternative to Diverting Ileostomy in High-Risk Colorectal Anastomosis: A Pilot Study“. Medicina 58, Nr. 4 (02.04.2022): 510. http://dx.doi.org/10.3390/medicina58040510.
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Anastomotic leakage remains the most feared complication in colorectal surgery. Various intraoperative tests evaluate bowel perfusion and mechanical integrity of the colorectal anastomosis. These tests reduce the risk of postoperative anastomotic leakage; however, the incidence remains high. Diverting loop ileostomy mitigates the damage if anastomotic leakage occurs. Nevertheless, ileostomy has a significant rate of complications, reducing patients’ quality of life, and requiring an additional operation. We evaluated six consecutive cases where bowel rest with total parenteral nutrition was used instead of diverting loop ileostomy. All colorectal anastomoses were at high risk of postoperative anastomotic leakage. Total parenteral nutrition was administered for the first seven days postoperatively. There were no serious complications during the recovery period, and no clinical postoperative anastomotic leakage was detected. All patients tolerated total parenteral nutrition. Bowel rest with total parenteral nutrition may be a feasible option in high-risk left-sided colorectal anastomosis and a possible alternative to a preventive loop ileostomy. Further studies are necessary to evaluate it on a larger scale.
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Batıoğlu, Figen, Özge Yanık, Ferhad Özer, Sibel Demirel und Emin Özmert. „A Comparative Study of Choroidal Vascular and Structural Characteristics of Typical Polypoidal Choroidal Vasculopathy and Polypoidal Choroidal Neovascularization: OCTA-Based Evaluation of Intervortex Venous Anastomosis“. Diagnostics 13, Nr. 1 (31.12.2022): 138. http://dx.doi.org/10.3390/diagnostics13010138.
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Background: The aim of this study was to compare the choroidal characteristics of typical polypoidal choroidal vasculopathy (T-PCV) and polypoidal choroidal neovascularization (P-CNV) cases, and to investigate the presence of intervortex venous anastomoses in these PCV subtypes by using en face optical coherence tomography angiography (OCTA). Methods: A total of 35 eyes of 33 PCV cases were included. The PCV cases were divided into T-PCV and P-CNV groups. The choroidal vascularity index (CVI) was calculated. En face OCTA images were evaluated for the presence of intervortex venous anastomoses. The diameter of the largest anastomotic Haller vessel was measured. Results: T-PCV cases had significantly higher mean CVI values (73.9 ± 3.7 vs. 70.8 ± 4.5%) than P-CNV cases (p = 0.039). Intervortex venous anastomoses were observed in 85.7% of T-PCV eyes and in 91.7% of P-CNV eyes on en face OCTA (p = 1.000). In the cases with intervortex venous anastomosis, the mean diameter of the largest anastomotic vessel on en face OCTA was 341.2 ± 109.1 µm in the T-PCV and 280.4 ± 68.4 µm in the P-CNV group (p = 0.048). Conclusions: The higher CVI value in T-PCV may be an important feature concerning the pathogenesis and classification of PCV. Although there was no difference between the two subtypes in terms of intervortex anastomosis, more dilated anastomotic vessels were observed in the T-PCV.
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Könneker, Sören, G. F. Broelsch, J. W. Kuhbier, T. Framke, N. Neubert, K. Dastagir, T. Mett, P. M. Vogt und A. Jokuszies. „Outcome Analysis of End-to-End and End-to-Side Anastomoses in 131 Patients Undergoing Microsurgical Free Flap Reconstruction of the Lower Extremity“. Journal of Reconstructive Microsurgery Open 02, Nr. 01 (27.10.2016): e7-e14. http://dx.doi.org/10.1055/s-0036-1593815.
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Background End-to-end and end-to-side anastomoses remain the most common techniques in microsurgical free flap reconstruction. Still, there is an ongoing effort to optimize established techniques and develop novel techniques. Numerous comparative studies have investigated flow dynamics and patency rates of microvascular anastomoses and their impact on flap survival. In contrast, few studies have investigated whether the type of anastomosis influences the outcome of microvascular free flap reconstruction of a lower extremity. Patients and Methods Retrospectively, we investigated the outcome of 131 consecutive free flaps for lower extremity reconstruction related to the anastomotic technique. Results No statistical significance between arterial or venous anastomoses were found regarding the anastomotic techniques (p = 0.5470). However, evaluated separately by vessel type, a trend toward statistical significance for anastomotic technique was observed in the arterial (p = 0.0690) and venous (p = 0.1700) vessels. No thromboses were found in arterial end-to-end anastomoses and venous end-to-side anastomoses. More venous (n = 18) than arterial thromboses (n = 9) occurred in primary anastomoses undergoing microsurgical free flap reconstruction (p = 0.0098). Flap survival rate was 97.37% in the end-to-end arterial group versus 86.36% in the end-to-side group. No thromboses were found in five arterial anastomoses using T-patch technique. Conclusion For lower extremities, there is a connate higher risk for venous thrombosis in anastomotic regions compared with arterial thrombosis. We observed divergent rates for thromboses between end-to-end and end-to-side anastomoses.However, if thrombotic events are explained by anastomotic technique and vessel type, the latter carries more importance.
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Käser, Samuel Andreas, Irina Hofmann, Niels Willi, Felix Stickel und Christoph Andreas Maurer. „Liver Cirrhosis/Severe Fibrosis Is a Risk Factor for Anastomotic Leakage after Colorectal Surgery“. Gastroenterology Research and Practice 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/1563037.
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Purpose. Liver cirrhosis associated with high perioperative morbidity/mortality. This retrospective study determines whether liver cirrhosis represents a risk factor for anastomotic leakage after colonic anastomosis or not. Methods. Based on a prospective database with all consecutive colorectal resections performed at the authors’ institution from 07/2002 to 07/2012 (n=2104) all colonic and rectal anastomoses were identified (n=1875). A temporary loop ileostomy was constructed in 257 cases (13.7%) either due to Mannheimer Peritonitis-Index > 29 or rectal anastomosis below 6 cm from the anal verge. More than one-third of the patients (n=691) had postoperative contrast enema, either at the occasion of another study or prior to closure of ileostomy. The presence of liver cirrhosis and the development of anastomotic leakage were assessed by chart review. Results. The overall anastomotic leakage rate was 2.7% (50/1875). In patients with cirrhosis/severe fibrosis, the anastomotic leakage rate was 12.5% (3/24), while it was only 2.5% (47/1851) in those without (p=0.024). The difference remained statistically significant after correction for confounding factors by multivariate analysis. Conclusion. Patients with liver cirrhosis/severe fibrosis have an increased risk of leakage after colonic anastomosis.
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Man, Jeannette, und Jennifer Hrabe. „Anastomotic Technique—How to Optimize Success and Minimize Leak Rates“. Clinics in Colon and Rectal Surgery 34, Nr. 06 (November 2021): 371–78. http://dx.doi.org/10.1055/s-0041-1735267.
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AbstractDetermining when to perform a bowel anastomosis and whether to divert can be difficult, as an anastomosis made in a high-risk patient or setting has potential for disastrous consequences. While the surgeon has limited control over patient-specific characteristics, the surgeon can control the technique used for creating anastomoses. Protecting and ensuring a vigorous blood supply is fundamental, as is mobilizing bowel completely, and employing adjunctive techniques to attain reach without tension. There are numerous ways to create anastomoses, with variations on the segment and configuration of bowel used, as well as the materials used and surgical approach. Despite numerous studies on the optimal techniques for anastomoses, no one method has prevailed. Without clear evidence on the best anastomotic technique, surgeons should focus on adhering to good technique and being comfortable with several configurations for a variety of conditions.
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Watanabe, Go, Hiroshi Ohtake und Shigeyuki Tomita. „Rapid Novel Aortic Arch Replacement for Thoracic Aortic Aneurysm Using Three Continuous Sutures and a Felt Cylindrical Collar“. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 6, Nr. 5 (September 2011): 344–46. http://dx.doi.org/10.1097/imi.0b013e318235a819.
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This report describes the novel parachute technique of open distal anastomosis at the aortic arch replacement. Two Teflon felt cylindrical collars were initially placed on the anastomotic site of the descending aorta. All four to five outer loops of the stitches used in the parachute technique were tracked by the gathering suture. The anastomotic sutures and three gathering sutures were finally pulled simultaneously. The prosthetic graft and the aortic stump with Teflon felt were safely and completely anastomosed. Surgical or hospital death and serious complications were not found. The mean anastomotic duration (circulatory arrest duration) in 16 patients was 23 minutes. Our novel technique using a Teflon felt cylindrical collar and modified continuous suturing was not only safe but also reduced the duration of anastomosis and minimized blood loss. This technique is simple and can be applied to aortic valve replacement.
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Simmons, Jon D., Joseph W. Gunter, Justin D. Manley, David E. Sawaya und Christopher J. Blewett. „Stapled Intestinal Anastomosis in Neonates: Validation of Safety and Efficacy“. American Surgeon 76, Nr. 6 (Juni 2010): 644–46. http://dx.doi.org/10.1177/000313481007600632.
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The safety and effectiveness of a stapled intestinal anastomosis in adults and children is well documented. However, the role of this technique in neonates is not well validated. We report our experience with stapled intestinal anastomoses in the neonate at the University of Mississippi Medical Center. All patients from the neonatal intensive care unit who had a stapled intestinal anastomosis between February 2007 and May 2008 were identified. A stapled side-to-side functional end-to-end intestinal anastomosis was performed in all patients using a gastrointestinal anastomosis stapler. Demographic, management, and outcome data were collected via chart review. Variables collected included: birth weight, estimated gestational age at birth and surgery, weight at surgery, the use of vasopressors, associated diagnoses, location of the anastomosis, and postoperative clinic visits. A total of 18 patients were identified during the study period. Nine had small bowel to small bowel, eight had ileum to colon, and one had a colon to colon anastomosis. The average weight at time of operation was 2.8 kilograms (Kg) and the average estimated gestational age at surgery was 38.7 weeks. The only complication reported was a partial small bowel obstruction on postoperative day 12, which was successfully treated nonoperatively. Two patients died from problems not associated with the anastomosis. There were no anastomotic leaks or strictures. The literature regarding the use of stapled bowel anastomoses in neonates is scant. Stapled intestinal anastomoses can be performed safely in neonates without a high rate of complication. The long term effects of stapled intestinal anastomoses in the neonate are unknown. Future areas of interest would include effects on postoperative feeding and operative time.
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Bittolo Bon, Silvia, Michele Rapi, Riccardo Coletta, Antonino Morabito und Luca Valentini. „Plasticised Regenerated Silk/Gold Nanorods Hybrids as Sealant and Bio-Piezoelectric Materials“. Nanomaterials 10, Nr. 1 (20.01.2020): 179. http://dx.doi.org/10.3390/nano10010179.
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Manual and mechanical suturing are currently the gold standard for bowel anastomosis. If tissue approximation fails, anastomotic leaks occur. Anastomotic leaks may have catastrophic consequences. The development of a fully absorbable, biocompatible sealant material based on a bio-ink silk fibroin can reduce the chance of anastomotic leaks. We have produced a Ca-modified plasticised regenerated silk (RS) with gold nanorods sealant. This sealant was applied to anastomosed porcine intestine. Water absorption from wet tissue substrate applied compressive strains on hybrid RS films. This compression results in a sealant effect on anastomosis. The increased toughness of the hybrid plasticised RS resulted in the designing of a bio-film with superior elongation at break (i.e., ≈200%) and bursting pressure. We have also reported structure-dependent piezoelectricity of the RS film that shows a piezoelectric effect out of the plane. We hope that in the future, bowel anastomosis can be simplified by providing a multifunctional bio-film that makes feasible the mechanical tissue joint without the need for specific tools and could be used in piezoelectric sealant heads.
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Nishikimi, Kyoko, Shinichi Tate, Ayumu Matsuoka, Satoyo Otsuka und Makio Shozu. „Surgical Techniques and Outcomes of Colorectal Anastomosis after Left Hemicolectomy with Low Anterior Rectal Resection for Advanced Ovarian Cancer“. Cancers 13, Nr. 16 (23.08.2021): 4248. http://dx.doi.org/10.3390/cancers13164248.
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Extended colon resection is often performed in advanced ovarian cancer. Restoring intestinal continuity and avoiding stoma creation improve patients’ quality of life postoperatively. We tried to minimize the number of anastomoses, restore intestinal continuity, and avoid stoma creation for 295 patients with stage III/IV ovarian cancer who underwent low anterior rectal resection (LAR) with or without colon resection during cytoreductive surgery. When the remaining colon could not reach the rectal stump after left hemicolectomy with LAR, we used the following techniques for tension-free anastomosis: right colonic transposition, retro-ileal anastomosis through an ileal mesenteric defect, or an additional colic artery division. Rates of stoma creation and rectal anastomotic were 3% (9/295) and 6.6% (19/286), respectively. Among 21 patients in whom the remaining colon did not reach the rectal stump after left hemicolectomy with LAR, 20 underwent tension-free anastomosis, including eight, six, and six patients undergoing right colonic transposition, retro-ileal anastomosis through an ileal mesenteric defect, and an additional colic artery division, respectively. Colorectal anastomosis is feasible for patients with extended colonic resection. Low anastomotic leakage and stoma rates can be achieved with careful attention to colonic mobilization and tension-free anastomosis.
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Valverde, A. „Principi e tecniche delle anastomosi digestive: particolarità in chirurgia laparoscopica e robotica“. EMC - Tecniche Chirurgiche Addominale 21, Nr. 3 (September 2015): 1–10. http://dx.doi.org/10.1016/s1283-0798(15)72334-x.
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Kovács, T., T. Németh, Zs Orosz und I. Köves. „Endoscopy and autopsy follow-up of biodegradable oesophageal anastomoses in dogs“. Acta Veterinaria Hungarica 49, Nr. 4 (November 2001): 451–63. http://dx.doi.org/10.1556/004.49.2001.4.9.
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The Biofragmentable Anastomosis Ring (BAR) is a mechanical device composed of absorbable material and creates an inverting, atraumatic compressive anastomosis with no foreign material at the anastomotic site after healing. The aim of the present experimental study was to assess the safety of oesophagoscopy in early days after oesophageal anastomoses performed with the BAR and to follow-up the healing of BAR anastomoses by in vivo endoscopy and autopsy examination. Thirty mongrel dogs divided into subgroups according to the timepoints of endoscopy and autopsy (4th, 7th, 14th, 28th day) were used. There was no significant difference in the healing of anastomoses performed under or above the tracheal bifurcation. Pleural adhesions helped to cover and seal small subclinical leaks. The mortality was 13.3% (4 dogs) and the overall leakage rate 14.3%. We looked for bleeding, haematoma, erosion, ulceration and granulation tissue in the anastomosis. Due to the high mechanical strength of these anastomoses, oesophagoscopy was a safe, easy and feasible method for follow-up BAR intrathoracic anastomoses, with no significant difference between the number of lesions found with endoscopy as compared to the autopsy data. The overall sensitivity of oesophagoscopy to discover mucosal lesions was 73.1%. Endoscopy had no complications, therefore it is a useful method of follow-up and may help predict the normal or compromised healing of oesophageal anastomoses.
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Aghayev, E. K., T. E. Mamedov, E. M. Gasimov und Z. E. Ismayilova. „Efficacy of application of a human placenta hydrolysate in prophylaxis of the intestinal anastomoses sutures insufficiency“. Klinicheskaia khirurgiia 86, Nr. 7 (07.07.2019): 9–12. http://dx.doi.org/10.26779/2522-1396.2019.07.09.
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Objective. Studying of impact of a human placenta hydrolysate on regeneration of intestinal anastomosis and prophylaxis of their sutures insufficiency.
Materials and methods. Experimental investigations were conducted on two groups of rabbits. In every group a simulation model of an acute strangulation ileus was created. In a one day a relaparotomy, resection of necrotized intestinal segments with anastomosing in a “side-to-side” fashion were done in rabbits of both groups. After the operation the control group rabbits have obtained a standard treatment, while in the main group the rabbits together with a standard treatment have obtained a human placenta hydrolysate preparation «Laennec». On the days 3, 5, 7 and 15th the according intestinal segments were probed for morpho-histochemical investigations.
Clinical investigations were conducted in 122 patients, consisting of resection of intestinal segments with formation of anastomoses. The control group consisted of 60 patients, and the main one – in 62. The data of the control group were studied retrospectively. In the main group the patients, together with a standard treatment, a human placenta hydrolysate in a form of preparation “Laennec” was applied for prophylaxis of insufficiency of the intestinal anastomoses sutures.
Results. Basing on experimental results it may be stressed, that application of preparation «Laennec» strengthens regeneration and angiogenesis in zone of anastomosis, because in animals of the main group, comparing with a control one, high mitotic index, good angiogenesis and the motor-evacuation function integrity were noted.
In clinical practice the anastomotic sutures insufficiency in the control group have occurred in 13.3% of observations, and in the main group – in 1.6% of observations.
Conclusion. Application of the human placenta hydrolysate for prophylaxis of the sutures insufficiency in intestinal anastomoses is affordable due to successive clinical and experimental data obtained.
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Rossi, Heather L., Marc I. Brand und Theodore J. Saclarides. „Anal Complications after Restorative Proctocolectomy (J-Pouch)“. American Surgeon 68, Nr. 7 (Juli 2002): 628–30. http://dx.doi.org/10.1177/000313480206800715.
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A prospective assessment was performed to determine the incidence of anal complications after ileoanal J-pouch anastomosis procedures for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). From 1989 to 2000, 75 patients (50 male and 25 female) underwent proctocolectomy and ileal pouch-anal anastomosis with temporary loop ileostomy for UC (N = 68) and FAP (N = 7). Overall 33 patients (44%) developed anal complications postoperatively. Nineteen patients (25%) had mild anal stenosis amenable to digital dilatation in the office. Ten patients (13%) had severe anal stenosis requiring operative dilatation. Ileostomy closure was delayed longer than 3 months in four patients because of anal stenosis. One patient never had his ileostomy closed secondary to severe anal stenosis. Anal fissures developed in one patient that resolved with conservative treatment. Three patients developed fistula-in-ano and one patient developed a pouch-vaginal fistula. Of these four patients two later manifested signs of Crohn's disease. Four patients developed perirectal abscesses (three without fistulas) that were treated with incision and drainage. Two patients had presacral (anastomotic) abscesses; one patient was treated with temporary anastomotic diversion and the other underwent a permanent ileostomy and pouch resection. Both of these patients were later diagnosed with Crohn's disease. Anal complications developed in 17 of 41 (41%) handsewn anastomoses, 16 of 34 (47%) stapled anastomoses, three of seven (43%) patients with FAP, and 30 of 68 (44%) patients with UC. Operative technique and disease type did not significantly correlate with the type of anal complication. However, hand-sewn anastomoses had a higher incidence of severe strictures and FAP patients did not develop anal abscesses, fistulas, or fissures. Forty-five per cent of our patients with abscesses/fistulas and all of our patients with presacral abscesses from anastomotic dehiscence were later diagnosed with Crohn's disease. Anal complications after ileoanal J-pouch anastomosis are relatively common.