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Sample records for anastomosis surgical

  1. Nasogastric tube placement into the hepaticojejunostomy anastomosis in pancreaticoduodenectomy: a simple surgical technique for prevention of bile leak.

    Science.gov (United States)

    Kaya, Bulent; Ozcabi, Yetkin; Tasdelen, Iksan; Onur, Ender; Memisoglu, Kemal

    2016-05-01

    Hepaticojejunostomy is an important part of many surgical procedures including pancreaticoduodenectomy. Biliary leakage from hepaticojejunostomy may be associated with intraabdominal abscess formation, biliary peritonitis, and even mortality. A 72-year-old female patient was admitted to our hospital with obstructive jaundice. After initial evaluation, she was diagnosed with distal common bile duct obstruction without accurate diagnosis. Before planned pancreaticoduodenectomy, biliary drainage with a T-tube was performed due to the presence of cholangitis. After the first operation, pancreaticoduodenectomy was performed. Postinflammatory changes around the hilar region made the hepaticojejunostomy risky. A bilio-digestive anastomosis was performed using a new technique. A nasogastric tube was placed into the common bile duct proximal to the anastomosis. The postoperative course of the patient was uneventful. The use of a nasogastric tube as a stent in risky hepaticojejunostomies is a simple technique that can be beneficial.

  2. Nasogastric tube placement into the hepaticojejunostomy anastomosis in pancreaticoduodenectomy: a simple surgical technique for prevention of bile leak.

    Science.gov (United States)

    Kaya, Bulent; Ozcabi, Yetkin; Tasdelen, Iksan; Onur, Ender; Memisoglu, Kemal

    2016-05-01

    Hepaticojejunostomy is an important part of many surgical procedures including pancreaticoduodenectomy. Biliary leakage from hepaticojejunostomy may be associated with intraabdominal abscess formation, biliary peritonitis, and even mortality. A 72-year-old female patient was admitted to our hospital with obstructive jaundice. After initial evaluation, she was diagnosed with distal common bile duct obstruction without accurate diagnosis. Before planned pancreaticoduodenectomy, biliary drainage with a T-tube was performed due to the presence of cholangitis. After the first operation, pancreaticoduodenectomy was performed. Postinflammatory changes around the hilar region made the hepaticojejunostomy risky. A bilio-digestive anastomosis was performed using a new technique. A nasogastric tube was placed into the common bile duct proximal to the anastomosis. The postoperative course of the patient was uneventful. The use of a nasogastric tube as a stent in risky hepaticojejunostomies is a simple technique that can be beneficial. PMID:27212998

  3. Robotic Tubal Anastomosis: Technical Aspects

    OpenAIRE

    Bedaiwy, Mohamed A.; Barakat, Ehab M.; Falcone, Tommaso

    2011-01-01

    Objectives: To describe the surgical technique of robotic tubal anastomosis. Methods: Retrospective chart and video review of the instrumentation and methodology used for robotically assisted tubal anastomosis. Results: All tubal anastomoses were performed with the use of 3 or 4 robotic arms, 3 or 4 robotic instruments, and 1 assistant trocar. Conclusions: Robotic technology facilitates the performance of robotic tubal anastomosis.

  4. Biodegradable scaffold with built-in vasculature for organ-on-a-chip engineering and direct surgical anastomosis

    Science.gov (United States)

    Zhang, Boyang; Montgomery, Miles; Chamberlain, M. Dean; Ogawa, Shinichiro; Korolj, Anastasia; Pahnke, Aric; Wells, Laura A.; Massé, Stéphane; Kim, Jihye; Reis, Lewis; Momen, Abdul; Nunes, Sara S.; Wheeler, Aaron R.; Nanthakumar, Kumaraswamy; Keller, Gordon; Sefton, Michael V.; Radisic, Milica

    2016-06-01

    We report the fabrication of a scaffold (hereafter referred to as AngioChip) that supports the assembly of parenchymal cells on a mechanically tunable matrix surrounding a perfusable, branched, three-dimensional microchannel network coated with endothelial cells. The design of AngioChip decouples the material choices for the engineered vessel network and for cell seeding in the parenchyma, enabling extensive remodelling while maintaining an open-vessel lumen. The incorporation of nanopores and micro-holes in the vessel walls enhances permeability, and permits intercellular crosstalk and extravasation of monocytes and endothelial cells on biomolecular stimulation. We also show that vascularized hepatic tissues and cardiac tissues engineered by using AngioChips process clinically relevant drugs delivered through the vasculature, and that millimetre-thick cardiac tissues can be engineered in a scalable manner. Moreover, we demonstrate that AngioChip cardiac tissues implanted with direct surgical anastomosis to the femoral vessels of rat hindlimbs establish immediate blood perfusion.

  5. Biodegradable scaffold with built-in vasculature for organ-on-a-chip engineering and direct surgical anastomosis

    Science.gov (United States)

    Zhang, Boyang; Montgomery, Miles; Chamberlain, M. Dean; Ogawa, Shinichiro; Korolj, Anastasia; Pahnke, Aric; Wells, Laura A.; Massé, Stéphane; Kim, Jihye; Reis, Lewis; Momen, Abdulah; Nunes, Sara S.; Wheeler, Aaron; Nanthakumar, Kumaraswamy; Keller, Gordon; Sefton, Michael V.; Radisic, Milica

    2016-01-01

    We report the fabrication of a scaffold (hereafter referred to as AngioChip) that supports the assembly of parenchymal cells on a mechanically tunable matrix surrounding a perfusable, branched, three-dimensional microchannel network coated with endothelial cells. The design of AngioChip decouples the material choices for the engineered vessel network and for cell seeding in the parenchyma, enabling extensive remodelling while maintaining an open-vessel lumen. The incorporation of nanopores and micro-holes in the vessel walls enhances permeability, and permits intercellular crosstalk and extravasation of monocytes and endothelial cells on biomolecular stimulation. We also show that vascularized hepatic tissues and cardiac tissues engineered by using AngioChips process clinically relevant drugs delivered through the vasculature, and that millimeter-thick cardiac tissues can be engineered in a scalable manner. Moreover, we demonstrate that AngioChip cardiac tissues implanted via direct surgical anastomosis to the femoral vessels of rat hindlimbs establish immediate blood perfusion. PMID:26950595

  6. Late surgical complications of subtotal colectomy with antiperistaltic caeco-rectal anastomosis for slow transit constipation A critical analysis.

    Science.gov (United States)

    Marchesi, Federico; Rapacchi, Chiara; Cecchini, Stefano; Sarli, Leopoldo; Tartamella, Francesco; Roncoroni, Luigi

    2016-01-01

    La stipsi grave da rallentato transito è stata negli ultimi anni definitivamente riconosciuta come una condizione potenzialmente chirurgica, e nuove varianti tecniche sono state proposte in alternativa alla colectomia totale con ileo-retto anastomosi con l’obiettivo di minimizzare il rapporto rischi-benefici per il paziente. In quest’ottica la colectomia subtotale con anastomosi ceco-rettale (SCCRA) rappresenta nella nostra esperienza una valida alternativa, riducendo, a parità di efficacia, l’incontinenza e l’urgency postoperatoria, grazie alla preservazione della valvola ileo-cecale e del reservoir cecale. Tuttavia, a fronte di una buona percentuale di successi, legati soprattutto al miglioramento della selezione dei pazienti, la chirurgia della stipsi da rallentato transito presenta tuttora un non trascurabile numero di insuccessi e di complicanze tardive, spesso imprevedibili, e correlate alle varianti tecniche adottate. Nello specifico caso della SCCRA, la preservazione di un segmento colico verosimilmente malfunzionante (il ceco) è stata imputata come possibile causa di recidiva di stipsi cosiccome origine di complicanze chirurgiche tardive (distensione cecale, volvolo). L’obiettivo di questo studio è di analizzare in maniera critica le complicanze tardive di SCCRA, esaminando i rischi specifici della procedura per identificare possibili misure di prevenzione. A tal fine sono stati valutati i dati di 43 pazienti aderenti al follow-up sottoposti a SCCRA presso il nostro Istituto. Sono stati inclusi i pazienti sottoposti a re-intervento per complicanza tardiva chiaramente correlata a SCCRA presso il nostro centro. Sono state identificate 3 complicanze tardive (7%): una distensione cecale, un volvolo ileo-cecale, un volvolo ileale. Tutti i pazienti sono stati trattati chirurgicamente con successo. Solo nel primo caso è stata identificata una evidente condizione predisponente: la presenza di una defecazione ostruita non risolta associata ad un

  7. Proctocolectomy and ileal J-pouch anal anastomosis on the surgical treatment of familial adenomatous polyposis and ulcerative colitis: analysis of 49 cases

    Directory of Open Access Journals (Sweden)

    Bruno Amaral Medeiros

    2012-09-01

    Full Text Available OBJECTIVE: To evaluate the results of ileal J-pouch anal anastomosis in ulcerative colitis and familial adenomatous polyposis. METHOD: Retrospective analysis of medical records of 49 patients submitted to ileal J-pouch anal anastomosis. RESULTS: Ulcerative colitis was diagnosed in 65% and familial adenomatous polyposis in 34%. Mean age was 39.5 years. 43% were male. Among familial adenomatous polyposis, 61% were diagnosed with colorectal cancer. Thirty-one percent of patients with ulcerative colitis was submitted to a previous surgical approach and 21% of these had toxic megacolon. Average hospital stay was 10 days. Post-operative complications occurred in 50% of patients with ulcerative colitis and 29.4% with familial adenomatous polyposis. Intestinal diversion was performed in 100% of ulcerative colitis and 88% of familial adenomatous polyposis. Pouchitis occurred in eight cases (seven ulcerative colitis and one FAP, requiring excision of the pouch in three ulcerative colitis. Mortality rate was 7.6%: two cases of carcinoma on the pouch and two post-operative complications. Late post-operative complications occurred in 22.4%: six familial adenomatous polyposis and five ulcerative colitis. Two patients had erectile dysfunction, and one retrograde ejaculation. One patient with severe perineal dermatitis was submitted to excision of the pouch. Incontinence occurred in four patients and two reported soil. Mean bowel movement was five times a day. CONCLUSION: Ileal J-pouch anal anastomosis is a safe surgery with acceptable morbidity and good functional results, if well indicated and performed in referral centers.OBJETIVO: Avaliar resultados da anastomose íleo-anal com bolsa ileal em J na colite ulcerativa e na polipose adenomatosa familiar. MÉTODO: Análise retrospectiva dos prontuários de 49 pacientes submetidos a anastomose íleo-anal com bolsa ileal em J. RESULTADOS: 65% de colite ulcerativa e 34% de polipose adenomatosa familiar. Idade m

  8. Techniques for colorectal anastomosis

    OpenAIRE

    Ho, Yik-Hong; Ashour, Mohamed Ahmed Tawfik

    2010-01-01

    Colorectal anastomotic leak remains one of the most feared post-operative complications, particularly after anterior resection of the rectum with, the shift from abdomino-peritoneal resections to total mesorectal excision and primary anastomosis. The literature fails to demonstrate superiority of stapled over hand-sewn techniques in colorectal anastomosis, regardless of the level of anastomosis, although a high stricture rate was noted in the former technique. Thus, improvements in safety asp...

  9. Surgical treatment of familial adenomatous polyposis: ileoretal anastomosis or restorative proctolectomy? Tratamento cirúrgico da polipose adenomatosa familiar: anastomose íleo-retal ou bolsa ileal?

    Directory of Open Access Journals (Sweden)

    Fábio Guilherme Campos

    2009-12-01

    Full Text Available CONTEXT: Controversy regarding the best operative choice for familial adenomatous polyposis lays between the morbidity of restorative proctocolectomy and the supposed mortality due to rectal cancer after ileorectal anastomosis. OBJECTIVES: To evaluate operative complications and oncological outcome after ileorectal anastomosis and restorative proctocolectomy. METHODS: Charts from patients treated between 1977 and 2006 were retrospectively analyzed. Clinical and endoscopic data, results of treatment, pathological reports and information regarding early and late outcome were recorded. RESULTS: Eighty-eight patients - 41 men (46.6% and 47 women (53.4% - were assisted. At diagnosis, 53 patients (60.2% already had associated colorectal cancer. Operative complications occurred in 25 patients (29.0 %, being 17 (19.7% early and 8 (9.3% late complications. There were more complications after restorative proctocolectomy (48.1% compared to proctocolectomy with ileostomy (26.6% and ileorectal anastomosis (19.0% (P = 0,03. There was no operative mortality. During the follow-up of 36 ileorectal anastomosis, cancer developed in the rectal cuff in six patients (16,6%. Cumulative cancer risk after ileorectal anastomosis was 17.2% at 5 years, 24.1% at 10 years and 43.1% at 15 years of follow-up. Age-dependent cumulative risk started at 30 years (4.3%, went to 9.6% at 40 years, 20.9% at 40 years and 52% at 60 years. Among the 26 patients followed after restorative proctocolectomy, it was found cancer in the ileal pouch in 1 (3.8%. CONCLUSIONS: 1. Operative complications occurred in about one third of the patients, being more frequently after the confection of ileal reservoir; 2. greater age and previous colonic carcinoma were associated with the development of rectal cancer after ileorectal anastomosis; 3. patients treated by restorative proctocolectomy are not free from the risk of pouch degeneration; 4. the disease complexity and the various risk factors

  10. Treatment of Crohn's disease recurrence after ileoanal anastomosis by azathioprine.

    Science.gov (United States)

    Berrebi, W; Chaussade, S; Bruhl, A L; Pariente, A; Valleur, P; Hautefeuille, P; Couturier, D

    1993-08-01

    Ileoanal anastomosis is a surgical procedure performed in patients with ulcerative colitis. In a small number of patients operated on for ulcerative colitis, Crohn's disease occurs in the reservoir, mimicking pouchitis, and may lead to pouch excision and to a permanent terminal ileostomy. Two patients with recurrent Crohn's disease in the reservoir after ileoanal anastomosis were treated with azathioprine for 18 and 24 months, respectively. Azathioprine induced a complete clinical and endoscopic remission. These two observations suggested that immunosuppressive drugs were a good option for permanent ileostomy in cases of recurrence of Crohn's disease in the reservoir after ileoanal anastomosis. PMID:8344116

  11. Clinical repercussions of Martin-Gruber anastomosis: anatomical study☆

    Science.gov (United States)

    Cavalheiro, Cristina Schmitt; Filho, Mauro Razuk; Pedro, Gabriel; Caetano, Maurício Ferreira; Vieira, Luiz Angelo; Caetano, Edie Benedito

    2016-01-01

    Objective The main objective of this study was to describe Martin-Gruber anastomosis anatomically and to recognize its clinical repercussions. Method 100 forearms of 50 adult cadavers were dissected in an anatomy laboratory. The dissection was performed by means of a midline incision along the entire forearm and the lower third of the upper arm. Two flaps including skin and subcutaneous tissue were folded back on the radial and ulnar sides, respectively. Results Nerve communication between the median and ulnar nerves in the forearm (Martin-Gruber anastomosis) was found in 27 forearms. The anastomosis was classified into six types: type I: anastomosis between the anterior interosseous nerve and the ulnar nerve (n = 9); type II: anastomosis between the anterior interosseous nerve and the ulnar nerve at two points (double anastomosis) (n = 2); type III: anastomosis between the median nerve and the ulnar nerve (n = 4); type IV: anastomosis between branches of the median nerve and ulnar nerve heading toward the flexor digitorum profundus muscle of the fingers; these fascicles form a loop with distal convexity (n = 5); type V: intramuscular anastomosis (n = 5); and type VI: anastomosis between a branch of the median nerve to the flexor digitorum superficialis muscle and the ulnar nerve (n = 2). Conclusion Knowledge of the anatomical variations relating to the innervation of the hand has great importance, especially with regard to physical examination, diagnosis, prognosis and surgical treatment. If these variations are not given due regard, errors and other consequences will be inevitable. PMID:27069892

  12. Persistent carotid-vertebrobasilar anastomosis: radiologic findings

    International Nuclear Information System (INIS)

    To evaluate the radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies. Thirteen pateints with fourteen cases of carotid-vertebrobasilar anastomosis collected from January 1992 to December 1997 were reviewed. Clinical diagnosis refered for cerebral angiography were cerebral infarction (n=3D3), intracranial hemorrhage (n=3D2), subarachnoid hemorrhage (n=3D1), brain tumor (n=3D3), arteriovenous malformation (n=3D3) and trigeminal neuralgia (n=3D1). Cerebral angiograms and clinical symptoms were retrospectively analyzed. The fourteen carotid-vertebrobasilar anastomsis consisted of eleven cases of persistent trigeminal artery and three cases of type I proatantal intersegmental artery. Persistent trigeminal arteries were associated with anterior communicating artery aneurysm(n=3D1), posterior fossa arteriovenous malformation(n=3D2) and persistent trigeminal artery variant(n=3D5). Type I proatantal intersegmental arteries were associated with hypoplastic vertebral arteries(n=3D2): only proximal segment in one, and proximal and distal segments in one case. Only one patient had clinical symptom related to the carotid-vertebrobasilar anastomosis which was trigeminal neuralgia. Knowledge of the anatomical and radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies will aid in the accurate diagnosis of neurovascular disease and prevent possible complications during surgical and interventional procedures.=20

  13. Persistent carotid-vertebrobasilar anastomosis: radiologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Il; Kim, Dong Ik; Jun, Pyoung; Yoon, Pyeong Ho; Hwang, Geum Ju; Cheon, Young Jik; Lim, Joon Seok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1998-11-01

    To evaluate the radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies. Thirteen pateints with fourteen cases of carotid-vertebrobasilar anastomosis collected from January 1992 to December 1997 were reviewed. Clinical diagnosis refered for cerebral angiography were cerebral infarction (n=3D3), intracranial hemorrhage (n=3D2), subarachnoid hemorrhage (n=3D1), brain tumor (n=3D3), arteriovenous malformation (n=3D3) and trigeminal neuralgia (n=3D1). Cerebral angiograms and clinical symptoms were retrospectively analyzed. The fourteen carotid-vertebrobasilar anastomsis consisted of eleven cases of persistent trigeminal artery and three cases of type I proatantal intersegmental artery. Persistent trigeminal arteries were associated with anterior communicating artery aneurysm(n=3D1), posterior fossa arteriovenous malformation(n=3D2) and persistent trigeminal artery variant(n=3D5). Type I proatantal intersegmental arteries were associated with hypoplastic vertebral arteries(n=3D2): only proximal segment in one, and proximal and distal segments in one case. Only one patient had clinical symptom related to the carotid-vertebrobasilar anastomosis which was trigeminal neuralgia. Knowledge of the anatomical and radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies will aid in the accurate diagnosis of neurovascular disease and prevent possible complications during surgical and interventional procedures.=20.

  14. Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models

    OpenAIRE

    Miguel Angel Maluf; Walter José Gomes; Ademir Massarico Bras; Thiago Cavalcante Vila Nova de Araújo; André Lupp Mota; Caio Cesar Cardoso; Rafael Viana dos S. Coutinho

    2015-01-01

    ABSTRACT OBJECTIVE: Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. METHODS: First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was compr...

  15. Magnetic compression anastomosis as a nonsurgical treatment for esophageal atresia

    Energy Technology Data Exchange (ETDEWEB)

    Zaritzky, Mario [Hospital de Ninos de La Plata, Department of Radiology, Buenos Aires (Argentina); University of Chicago Medical Center, Department of Radiology, Chicago, IL (United States); Ben, Ricardo [Hospital de Ninos de La Plata, Department of Gastroenterology, Buenos Aires (Argentina); Zylberg, Gaston I.; Yampolsky, Brian [Hospital de Ninos de La Plata, Department of Radiology, Buenos Aires (Argentina)

    2009-09-15

    We describe a unique technique to promote a nonsurgical esophageal anastomosis with magnets in children with esophageal atresia. To evaluate the efficacy of magnetic lengthening of atretic esophageal ends to produce an anastomosis and to communicate our results after more than 2 years of follow-up. Between September 2001 and March 2004, five children were selected for treatment. Two of the children had esophageal atresia without fistula (type A) and three had atresia with fistula converted to type A surgically; however, surgeons failed to achieve an anastomosis because of the width of the gap. Neodymium-iron-boron magnets were used. Daily chest radiographs were taken until union of the magnets was observed. They were then replaced with an orogastric tube. Anastomosis was achieved in all patients in an average of 4.8 days. One patient, with signs of early sepsis, was successfully treated with antibiotics. In four of the five patients, esophageal stenosis developed. At the time of this report, two patients were free of treatment and on an oral diet (after 26 months), two patients required periodic balloon dilatation, and one patient had recently undergone surgery due to recurrent esophageal stenosis not amenable to balloon dilatation. Magnetic esophageal anastomosis is a feasible method in selected patients with esophageal atresia. Esophageal anastomosis was achieved in all patients. The only observed complication of significance was esophageal stenosis. One patient needed surgery because of stenosis. (orig.)

  16. Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis

    NARCIS (Netherlands)

    Ali, Usama Ahmed; Keus, Frederik; Heikens, Joost T.; Bemelman, Willem A.; Berdah, Stephane V.; Gooszen, H. G.; van Laarhoven, Cees J. H. M.

    2009-01-01

    Background Restorative proctocolectomy with ileo pouch anal anastomosis (IPAA) is the main surgical treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). With the advancements of minimal-invasive surgery this demanding operation is increasingly being performed

  17. Surgery for necrotising enterocolitis : primary anastomosis or enterostomy?

    NARCIS (Netherlands)

    Hofman, FN; Bax, NMA; van der Zee, DC

    2004-01-01

    The ideal surgical management of neonates with necrotising enterocolitis (NEC) is still a matter of debate. The purpose of this study was to compare the results of bowel resection with primary anastomosis with the results of bowel resection with enterostomy. Sixty-three neonates with NEC had a bowel

  18. Usefulness of continuous suture using short-thread double-armed micro-suture for cerebral vascular anastomosis

    Directory of Open Access Journals (Sweden)

    Sei Haga

    2014-01-01

    Full Text Available Background: When microvascular anastomosis is performed in a deep, narrow operating field, securing space to throw knots is difficult. To simplify the procedure and avoid obstruction of the anastomosis, we use a continuous suturing with short-thread double-armed micro-suture. Methods: Sixty-four patients (38 cerebral revasculazation, 16 moyamoya disease, and 10 aneurysm surgery undergoing microvaucular anastomosis were included. During anastomosis, a continuous suture was placed with short-thread double-armed micro-suture. Results: During 64 microanastomosis procedures, 64 consecutive continuous sutures were performed with 1-year follow up. All patients showed patency of anastomosis with long-term follow up. Conclusions: This technique is especially useful for anastomosis in a deep, narrow surgical field, such as in superior cerebellar artery anastomosis.

  19. Correlation between bursting pressure and breaking strength in colonic anastomosis

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    Leonardo de Castro Durães

    2013-06-01

    Full Text Available PURPOSE: To investigate the correlation between bursting pressure and breaking strength on the 7th postoperative day following left colonic anastomosis in rats. METHODS: Seventy rats were randomly divided into seven groups of ten animals each. All of the animals underwent segmental resection of the left colon and end-to-end anastomosis. The animals in groups I to VI underwent surgical laparoscopies with pneumoperitoneums using carbon dioxide or helium at pressures of 5, 12 or 20 mmHg. In Group VII, open laparotomy was performed. The animals were reoperated on postoperative day 7 to measure the bursting pressure and the breaking strength of the anastomosis. RESULTS: The anastomosis bursting pressure in 70 animals was 193.10±55.56 mmHg. There was no significant difference between the groups (p=0.786. The breaking strength of the anastomosis was 0.26±0.12 N. There was no significant difference between the groups (p=0.356. Pearson's correlation test showed a low correlation (r=0.231 lacking statistical significance (p=0.054. CONCLUSION: There was no correlation between the bursting pressure and breaking strength of left colonic anastomoses in rats on the 7th postoperative day.

  20. J-pouch Ileoanal Anastomosis in Children and Adolescents with Ulcerative Colitis: Functional Outcome, Satisfaction and Impact on Social Life

    DEFF Research Database (Denmark)

    Wewer, V; Hesselfeldt, Peter; Qvist, N;

    2005-01-01

    OBJECTIVES: The aim of this study was to evaluate, over a 10-year period, severe surgical complications, functional outcome, patient satisfaction and impact on social life after colectomy and J-pouch ileoanal anastomosis for children and adolescents

  1. LEAKAGE OF COLONIC ANASTOMOSIS AFTER COLON RESECTION

    Institute of Scientific and Technical Information of China (English)

    Kanellos I; Pramateftakis MG

    2004-01-01

    Objective To present the diagnosis and management of anastomotic leakage after colon resection. Methods Early diagnosis and urgent therapeutic intervention are required in order to avert life-threatening conditions that may be caused by anastomotic leakage. Results The diagnosis of anastomotic leakage is based on clinical features, peripheral blood investigations and abdominal computed tomography (CT) scan. Major leaks are defined by symptoms of peritonitis and septicaemia due to leakage. Major leaks should be managed operatively. Minor leaks can be managed conservatively with successful outcomes. Conclusion Leakage of colonic anastomosis remains the most serious complication after colon resection. It is a major cause of postoperative morbidity and mortality. A high index of suspicion is required in order to detect early, nonspecific signs of a leakage and urgent surgical intervention is usually required to avert life-threatening events.

  2. Is a drain necessary after colonic anastomosis?

    OpenAIRE

    Johnson, C.D.; Lamont, P. M.; Orr, N; Lennox, M

    1989-01-01

    To date, there have been no clinical investigations of the usefulness of drains following colonic anastomosis in elective operations. We report a prospective study in which 49 patients were randomized to have a corrugated silastic drain (Portex) placed next to the colonic anastomosis. These patients were compared with a control group of 57 patients who had no drain. The two groups were similar in age, sex, diagnosis and site of anastomosis. There was no difference in outcome between the two g...

  3. J-pouch ileoanal anastomosis in children and adolescents with ulcerative colitis

    DEFF Research Database (Denmark)

    Wewer, Vibeke; Hesselfeldt, Peter; Qvist, Niels;

    2005-01-01

    OBJECTIVES: The aim of this study was to evaluate, over a 10-year period, severe surgical complications, functional outcome, patient satisfaction and impact on social life after colectomy and J-pouch ileoanal anastomosis for children and adolescents colitis. METHODS: Data...

  4. Infliximab treatment reduces tensile strength in intestinal anastomosis

    DEFF Research Database (Denmark)

    Jensen, Jonas Sanberg; Petersen, Nacie Bello; Biagini, Matteo;

    2015-01-01

    BACKGROUND: The antitumor necrosis factor (infliximab [IFX]) has gained widespread use in the treatment of inflammatory bowel disease. However, several patients must undergo surgical treatment due to treatment failure and there is a potential risk that preoperative IFX treatment may have a negative...... and should be investigated further as a potential risk factor of anastomotic dehiscence in inflammatory bowel disease surgery....... effect on the healing process in intestinal anastomosis. The objective of this study was to examine the effect of repeated IFX treatment on anastomotic strength and degree of inflammation in the anastomotic line in the small intestine of rabbits. METHODS: Thirty-two rabbits were randomized (2...

  5. Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models

    Directory of Open Access Journals (Sweden)

    Miguel Angel Maluf

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVE: Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. METHODS: First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. RESULTS: The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. CONCLUSION: 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

  6. Comparison of proctocolectomy and ileal pouch-anal anastomosis to colectomy and ileorectal anastomosis in familial adenomatous polyposis.

    Science.gov (United States)

    Koskenvuo, L; Mustonen, H; Renkonen-Sinisalo, L; Järvinen, H J; Lepistö, A

    2015-06-01

    Prophylactic surgical options for familial adenomatous polyposis (FAP) are either colectomy and ileorectal anastomosis (IRA) or proctocolectomy and ileal pouch-anal anastomosis (IPAA). The aim of this study was to analyse the short-term and long-term outcomes of these two operative techniques. All patients with FAP in Finland have been prospectively recorded in a database since 1963 were retrospectively reviewed in this analysis. Altogether 140 (61%) colectomies with IRA and 88 (39%) proctocolectomies with IPAA have been performed. Complications occurred in 28 (21%) patients after IRA and in 26 (30%) patients after IPAA. There were 15 (11%) severe complications for IRA and 5 (6%) for IPAA. Twenty-one (15%) patients of the IRA group ended up in conventional ileostomy whereas 3 (3.4%) patients of the IPAA group had their ileal reservoir converted to an ileostomy (p = 0.01). Cumulative survival for IRA was lower than for the IPAA (p = 0.03), but if accounting only for operations made after the IPAA era had commenced, there was no significant difference. IPAA was associated with improved long-term survival without an increase in postoperative complications. The risk of death after colectomy and IRA seemed to be predominantly related to the remaining risk of rectal cancer. Therefore, we favour proctocolectomy with IPAA as the prophylactic surgical procedure for FAP with intermediate or severe polyposis. PMID:25504366

  7. Single- versus two- layer intestinal anastomosis: a meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Taji Yoshinori

    2006-01-01

    Full Text Available Abstract Background To compare single- with two- layer intestinal anastomosis after intestinal resection: a meta-analysis of randomized controlled trials. Methods Randomized controlled trials comparing single- with two-layer intestinal anastomosis were identified using a systematic search of Medline, Embase and the Cochrane Library Databases covering articles published from 1966 to 2004. Outcome of primary interest was postoperative leak. A risk ratio for trial outcomes and weighted pooled estimates for data were calculated. A fixed-effect model weighted using Mantel-Haenszel methods and a random-effect model using DerSimonian-Laird methods were employed. Results Six trials were analyzed, comprising 670 participants (single-layer group, n = 299; two-layer group, n = 371. Data on leaks were available from all included studies. Combined risk ratio using DerSimonian-Laird methods was 0.91 (95% CI = 0.49 to 1.69, and indicated no significant difference. Inter-study heterogeneity was significant (χ2 = 10.5, d.f. = 5, p = 0.06. Conclusion No evidence was found that two-layer intestinal anastomosis leads to fewer post-operative leaks than single layer. Considering duration of the anastomosis procedure and medical expenses, single-layer intestinal anastomosis appears to represent the optimal choice for most surgical situations.

  8. One anastomosis gastric bypass: a simple, safe and efficient surgical procedure for treating morbid obesity El bypass gástrico de una anastómosis: un procedimiento simple, seguro y eficaz para tratar la obesidad mórbida

    Directory of Open Access Journals (Sweden)

    M. García-Caballero

    2004-11-01

    Full Text Available The One Anastomosis Gastric Bypass has been developed from the Mini Gastric Bypass procedure as originally described by Robert Rutledge. The modification of the original procedure consists of making a latero-lateral gastro-jejunal anastomosis instead of a termino-lateral anastomosis, as is carried out as described in the original procedure. The rationale for these changes is to try to reduce exposure of the gastric mucosa to biliopancreatic secretions because of their potentially carcinogenic effects with longer term exposure, which is the major criticism of the original technique. If we fix the jejunal loop to the gastric pouch some centimetres up to the gastro-jejunal anastomosis the biliopancreatic secretions have less possibility of coming into the gastric cavity (gravity force. Furthermore, if the anastomosis is latero-lateral this possibility is reduced even more. In addition, the intestinal loop reinforces the staple line against disruption, and also the gastric pouch against dilatation.El Bypass Gástrico de Una Anastomosis se ha desarrollado a partir del Mini Bypass Gástrico descrito por Robert Rutledge. La modificación del procedimiento original consiste en hacer una anastomosis latero-lateral en lugar de termino-lateral como se hace en la técnica original. Este cambio intenta reducir la exposición de la mucosa gástrica a la secreción bilio-pancreática, evitando así el posible efecto carcinogénico de la exposición crónica que constituye la más importante crítica del procedimiento original. Al fijar el asa de yeyuno a la nueva bolsa gástrica unos centímetros por encima de la anastomosis gastro-yeyunal, la secreción bilio-pancreática tiene menos posibilidades de entrar en la cavidad gástrica (fuerza de gravedad. Al ser la anastomosis latero-lateral esta posibilidad se reduce aún más. Además, el asa de yeyuno refuerza la línea de grapas contra su disrupción y previene la posible dilatación de la bolsa gástrica.

  9. Recent Advancement on Surgical Treatments for Lymphedema

    OpenAIRE

    Koshima, Isao; Narushima, Mitsunaga; Yamamoto, Yusuke; Mihara, Makoto; Iida, Takuya

    2012-01-01

    Treatment for limb lymphedema is challenging. The recent development of the super-microsurgical technique has made lymphaticovenular (LV) anastomosis an easier and more accurate surgical method for lymphedema. A summary of our experience as well as recent developments in surgical treatments for lymphedema are described.

  10. Neoadjuvant radiotherapy and anastomosis dehiscence after total mesorectal excision for stage II and III rectal cancer

    International Nuclear Information System (INIS)

    Background: Anterior resection is nowadays the preferred option of surgical treatment for rectal cancer without sphincter involvement. However, this operation is associated with the risk of anastomosis dehiscence (AD). Aim: The aim of this study was to estimate the influence of neoadjuvant radiotherapy and other factors on the risk of anastomosis dehiscence after total mesorectal excision for stage II and III rectal cancer. Materials/Methods: One hundred and thirty consecutive patients operated on due to histologically confirmed rectal carcinoma were studied with prospective data collection. Elective surgery with curative intent was administered. All patients underwent sphincter sparing anterior resection with total mesorectal excision. End-to-end anastomosis with double stapled technique was performed. Impact of patient-, tumour- and treatment-related variables on anastomosis dehiscence rate was evaluated in univariate and multivariate analysis. Results: Incidence of AD was 10.6 %. There was no leakage-related mortality. Univariate analysis showed that patients age and gender, presence of lymph node metastases and irradiation setting (pre- vs post-operative) did not significantly influence dehiscence rate (P>0.05). Tumour level at or below 7 cm from the anal verge was related to increased AD risk with statistical importance (P=0.0438). Neither pelvic drainage nor omentoplasty effectively protected the anastomosis. Proximal diversion with protective stoma resulted in significantly decreasing AD risk (P=0.0012). In multivariate analysis the presence of transversostomy was found as the most important independently associated with significantly lower incidence of AD. Conclusions: Neoadjuvant radiotherapy does not seem to be a significant risk factor for anastomosis dehiscence, even after resection of low-sited tumours, but proximal diversion with temporary stoma needs to be considered. (authors)

  11. Pregnancy outcomes and prognostic factors from tubal sterilization reversal by sutureless laparoscopical re-anastomosis: a retrospective cohort study

    NARCIS (Netherlands)

    J.J.B.F.G. Schepens; B.W.J. Mol; M.A.H.M. Wiegerinck; S. Houterman; C.A.M. Koks

    2011-01-01

    BACKGROUND: Female sterilization is a widely used contraceptive method but in a small group of women, post-sterilization regret occurs. A dilemma for these women is the choice between surgical re-anastomosis and IVF. We evaluated the factors that affected pregnancy rate after laparoscopic tubal re-a

  12. Pouchitis-Associated Iritis (Uveitis Following Total Proctocolectomy and Ileal Pouch-to-Anal Anastomosis in Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Hugh James Freeman

    2001-01-01

    Full Text Available A 26-year-old woman with ulcerative colitis treated with a proctocolectomy and ileal pouch-to-anal anastomosis developed an erosive and ulcerative pouchitis. Although no ophthalmological manifestations were present before the staged surgical procedures, iritis developed after appearance of the pouchitis. Both conditions subsequently resolved with oral corticosteroids and metronidazole.

  13. Unmasking of the trigemino-accessory reflex in accessory facial anastomosis

    OpenAIRE

    Esteban, A.; Prieto, J.

    1999-01-01

    OBJECTIVE—To evaluate the possible blink reflex responses in facial muscles reinnervated by the accessory nerve.
METHOD—Eleven patients with a complete facial palsy were submitted to a surgical repair by an accessory facial nerve anastomosis (AFA). In this pathological group, blink reflex was studied by means of percutaneous electrical stimulation of the supraorbital nerve and recording from the orbicularis oculi muscle. A control group comprised seven normal people an...

  14. Real-time 3D Fourier-domain optical coherence tomography guided microvascular anastomosis

    Science.gov (United States)

    Huang, Yong; Ibrahim, Zuhaib; Lee, W. P. A.; Brandacher, Gerald; Kang, Jin U.

    2013-03-01

    Vascular and microvascular anastomosis is considered to be the foundation of plastic and reconstructive surgery, hand surgery, transplant surgery, vascular surgery and cardiac surgery. In the last two decades innovative techniques, such as vascular coupling devices, thermo-reversible poloxamers and suture-less cuff have been introduced. Intra-operative surgical guidance using a surgical imaging modality that provides in-depth view and 3D imaging can improve outcome following both conventional and innovative anastomosis techniques. Optical coherence tomography (OCT) is a noninvasive high-resolution (micron level), high-speed, 3D imaging modality that has been adopted widely in biomedical and clinical applications. In this work we performed a proof-of-concept evaluation study of OCT as an assisted intraoperative and post-operative imaging modality for microvascular anastomosis of rodent femoral vessels. The OCT imaging modality provided lateral resolution of 12 μm and 3.0 μm axial resolution in air and 0.27 volume/s imaging speed, which could provide the surgeon with clearly visualized vessel lumen wall and suture needle position relative to the vessel during intraoperative imaging. Graphics processing unit (GPU) accelerated phase-resolved Doppler OCT (PRDOCT) imaging of the surgical site was performed as a post-operative evaluation of the anastomosed vessels and to visualize the blood flow and thrombus formation. This information could help surgeons improve surgical precision in this highly challenging anastomosis of rodent vessels with diameter less than 0.5 mm. Our imaging modality could not only detect accidental suture through the back wall of lumen but also promptly diagnose and predict thrombosis immediately after reperfusion. Hence, real-time OCT can assist in decision-making process intra-operatively and avoid post-operative complications.

  15. The efficacy of intraoperative methylene blue enemas to assess the integrity of a colonic anastomosis

    OpenAIRE

    Kozol Robert A; McGeehin William; Smith Stanton; Giles David

    2007-01-01

    Abstract Background Intraoperative testing of colonic anastomoses is routine in assuring anastamotic integrity. We sought to determine the efficacy of the methylene blue enema (MBE) as an intraoperative test for anastomotic leaks. Methods This study is a retrospective review of consecutive colonic operations performed from January 2001 to December 2004 in a community hospital setting by a general surgical group that uses the MBE exclusively. All operations featuring a colonic anastomosis and ...

  16. Improved technique of vascular anastomosis for small intestinal transplantation in rats

    Institute of Scientific and Technical Information of China (English)

    Yuan Xin Li; Jie Shou Li; Ning Li

    2000-01-01

    AIM To establish a new improved vascular anastomotic technique to simplify the surgical technique and increase the survivsl rate of small intestinal transplantation in rats. METHODS The graft removed en bloc consisted of entire small intestine, portal vein and aortic segment with superior mesenteric artery. The graft was perfused in situ and the gut lumen was irrigated during the operation.Heterotopic small bowel transplantation was performed by microvascular end-to-side anastomosis between the donor aortic segment with superior mesenteric artery and the recipient abdominal aorta, and by the formation of a "Cuff" anastomosis between the donor portal vein and the recipient left renal vein. Both ends of the grafts were exteriorized as stomas. RESULTS A total of 189 intestinal transplantations were performed in rats, 33 of which were involved in the formal experimental group, with a survival rate of 84.8%. The average time for the donor surgery was 80min ±10min; for graft repair 10min ± 3min; and for recipient surgery 95min ± 15min. The average time for the arterial anastomosis and the vein anastomosis was 18min ± 5min and imin,respectively. The warm ischemic time and cold ischemic time were 22min ± 5min and less than 60min, respectively. The whole operation was completed by a single surgeon, the operative time being about 3 hours. CONCLUSION The vascular anastomosis used in this study could simplify surgical technique,reduce the operative time and elevate the survival rate of small intestinal transplantation in rats.

  17. Autologous nerve anastomosis versus human amniotic membrane anastomosis A rheological comparison following simulated sciatic nerve injury

    Institute of Scientific and Technical Information of China (English)

    Guangyao Liu; Qiao Zhang; Yan Jin; Zhongli Gao

    2011-01-01

    The sciatic nerve is biological viscoelastic solid, with stress relaxation and creep characteristics. In this study, a comparative analysis of the stress relaxation and creep characteristics of the sciatic nerve was conducted after simulating sciatic nerve injury and anastomosing with autologous nerve or human amniotic membrane. The results demonstrate that, at the 7 200-second time point, both stress reduction and strain increase in the human amniotic membrane anastomosis group were significantly greater than in the autologous nerve anastomosis group. Our findings indicate that human amniotic membrane anastomosis for sciatic nerve injury has excellent rheological characteristics and is conducive to regeneration of the injured nerve.

  18. A novel colonic anastomosis technique involving fixed polyglycolic acid mesh

    OpenAIRE

    Aysan, Erhan; Bektas, Hasan; Ersoz, Feyzullah; Sari, Serkan; Kaygusuz, Arslan

    2010-01-01

    Background: Polyglycolic acid mesh (PAM) reinforcement of colonic anastomoses were evaluated. Methods: Twenty female albino rabbits were divided into two groups. Each rabbit underwent segmental colonic resection with single-layer anastomosis. In one group of rabbits, PAM of length equal to the circumference of the anastomosis was applied. Rabbits were sacrificed on postoperative day 10 and peritoneal adhesions, anastomosis burst pressure, and anastomosis histopathological characteristics were...

  19. Ultrastructural view of colon anastomosis under propolis effect by transmission electron microscopy

    Institute of Scientific and Technical Information of China (English)

    Sibel Serin Kilicoglu; Bulent Kilicoglu; Esra Erdemli

    2008-01-01

    AIM: To evaluate the effect of propolis administration on the healing of colon anastomosis with light and transmission electron microscopes.METHODS: Forty-eight Wistar-Albino female rats were divided into two groups and had colon resection and anastomosis.In group Ⅰ,rats were fed with standard rat chow pre- and postoperatively.The rats in group Ⅱ were fed with standard rat chow and began receiving oral supplementation of propolis 100 mg/kg per day beginning 7 d before the operation and continued until they were sacrificed.Rats were sacrificed 1,3,7 and 14 d after operation,and anastomotic bursting pressures measured.After the resection of anastomotic segments,histopathological examination was performed with light and transmission electron microscopes by two blinded histologists and photographed.RESULTS: The colonic bursting pressures of the propolis group were statistically significantly better than the control group.Ultrastructural histopathological analysis of the colon anastomosis revealed that propolis accelerated the phases of the healing process and stimulated mature granulation tissue formation and collagen synthesis of fibroblasts.CONCLUSION: Bursting pressure measurements and ultra structural histopathological evaluation showed that administration of propolis accelerated the healing of colon anastomosis following surgical excision.

  20. [Surgical treatment of chronic idiopathic constipation].

    Science.gov (United States)

    Menguy, R; Chey, W

    We review current experience with surgical treatment of severe constipation due to primary inertia of the colon. Over the last 10 years, we have operated 18 patients (14 females and 4 males) with severe constipation. The surgical procedure was either nearly total colonectomy with ascending colon/rectum anastomosis (8 cases) or total colonectomy with ileorectal anastomosis (9 cases). In one patient, coloproctectomy was performed with an ileoanal anastomosi. Indications for surgery were based on results of barium emena and functional evaluation of defecation. Results were satisfactory in all patients. In several patients however, we noted that the motility of other levels of the digestive tract was also impaired. Colonectomy was introduced as a treatment for chronic constipation nearly a century ago and although very few indications have been retained in the recent this procedure has now become an acceptable surgical approach in a limited number of well-though-out cases. PMID:7729199

  1. Primary small bowel anastomosis in generalised peritonitis

    NARCIS (Netherlands)

    deGraaf, JS; van Goor, Harry; Bleichrodt, RP

    1996-01-01

    Objective: To find out if primary small bowel anastomosis of the bowel is safe in patients with generalised peritonitis who are treated by planned relaparotomies. Design: Retrospective study. Setting: University hospital, The Netherlands. Subjects. 10 Patients with generalised purulent peritonitis c

  2. Surgical techniques in type A dissection.

    Science.gov (United States)

    Hussain, Syed T; Svensson, Lars G

    2016-05-01

    Acute aortic dissection is a surgical emergency that must be urgently managed, with the primary goal of restoring flow to the dominant true lumen in the downstream aorta. Our preference at the Cleveland Clinic is for an open distal anastomosis technique without aortic clamping, as it permits more accurate approximation of dissected layers and more homeostatically secure anastomosis. During this procedure we employ right axillary end-to-side graft perfusion, followed by deep hypothermic circulatory arrest and antegrade brain perfusion. The distal anastomosis is performed without felt strips or glue. Critical to achieving a successful outcome is meticulous de-airing of the arch, diligent myocardial protection, and a water-tight anastomosis prior to discontinuing cardiopulmonary bypass. PMID:27386412

  3. Pressure drops in a distensible model of end-to-side anastomosis in systemic-to-pulmonary shunts.

    Science.gov (United States)

    Migliavacca, Francesco; Pennati, Giancarlo; Di Martino, Elena; Dubini, Gabriele; Pietrabissa, Riccardo

    2002-06-01

    The modified Blalock-Taussig shunt is a surgical procedure used as a palliation to treat complex congenital heart defects. It consists of an interposing prosthetic tube between the innominate/subclavian artery and the right pulmonary artery. Previous experience indicates that the pressure drop across the shunt is affected by the pulmonary pressure at the distal anastomosis combined with the distensibility of the anastomosis. In this study, a computational fluid-structure interaction approach is presented to investigate the haemodynamic behaviour. Steady-state fluid dynamics and structural analyses were carried out using commercial codes based on the finite element method (FIDAP and ABAQUS) coupled by means of a purposely-developed procedure to transfer boundary conditions. Both prosthetic tube and artery walls were characterised by non-linear material properties. Three different pulmonary pressures (2, 5 and 15 mmHg) and two volume flow rates (0.4 and 0.8 l/min) were investigated. Results indicate that the effects of distensibility at the distal anastomosis on the shunt pressure drop are relevant only when the distal anastomosis on the shunt pressure drop are relevant only when the distal anastomosis is not fully distended, which occurs when the pulmonary pressure is lower than 5 mmHg.

  4. Randomized trial on the application of biofragmentable anastomosis ring in intestinal anastomosis

    Institute of Scientific and Technical Information of China (English)

    CHEN Shuang; YANG Bin; HE Jia-hui; ZHANG Yu-chao; LAI Dong-ming

    2009-01-01

    Background The biofragmentable anastomosis ring(BAR)is a simple alternative device to create intestinal anastomosis.Our study was designed to evaluate the clinical value of BAR in intestinal anastomosis.Methods A total of 167 patients performed intestinal anastomosis from January 2002 to February 2006 were randomized to BAR group(n=82)and manual suture group(n=85)as control.They were equally allocated to the two groups regarding sex,age,site of anastomosis,emergent or elective surgery and contaminant diseases.The results of postoperative complications and recovery were recorded in each group.Results Eighty-seven intraperitoneal BAR anastomoses were completed in 82 patients.Two and one postoperative deaths were recorded in BAR and suture group,respectively,no deaths were directly related to anastomotic technique.In suture group,anastomotic leakage and early bleeding both occurred in two patients respectively,no anastomotic bleeding occurred in BAR group,one patient in BAR group developed enterocutaneous fistulae.Perioperative bleeding,operation time and length of hospitalization were similar in two groups(P>0.05).Time for return of bowel function was significantly shortened in BAR group than that in suture group(P<0.05).Conclusion The BAR appears to be a standard,easy,safe and effective altemative either in elective or emergent intraperitoneal intestinal anastomotic surgery.

  5. Anal transition zone in the surgical management of ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Jennifer Holder-Murray; Alessandro Fichera

    2009-01-01

    Preservation of the anal transition zone has long been a significant source of controversy in the surgical management of ulcerative colitis. The two techniques for restorative proctocolectomy and ileal pouch anal anastomosis (RPC IPAA) in common practice are a stapled anastomosis and a handsewn anastomosis;these techniques differ in the amount of remaining rectal mucosa and therefore the presence of the anal transition zone following surgery. Each technique has advantages and disadvantages in long-term functional outcomes, operative and postoperative complications, and risk of neoplasia. Therefore, we propose a selective approach to performing a stapled RPC IPAA based on the presence of dysplasia in the preoperative endoscopic evaluation.

  6. Occipital artery-to-posterior inferior cerebellar artery anastomosis with multiple-layer dissection of suboccipital muscles under a reverse C-shaped skin incision.

    Science.gov (United States)

    Katsuno, Makoto; Tanikawa, Rokuya; Uemori, Genki; Kawasaki, Kazutsune; Izumi, Naoto; Hashimoto, Masaaki

    2015-06-01

    Although occipital artery (OA)-to-posterior inferior cerebellar artery (PICA) anastomosis is the most familiar reconstruction for posterior cerebral circulation, the procedure is considered difficult because of the anatomical complex course of OA and the depth of the operative field at the anastomosis site. Therefore, we attempted a safe and reliable method for OA-to-PICA anastomosis under multiple-layer dissection of suboccipital muscles and a reverse C-shaped skin incision. We reviewed the clinical records of patients who underwent OA-to-PICA anastomosis in our institute, and report the outcome with special emphasis on graft patency and surgical complications. Nine patients are described. In one patient the bypass was accomplished at the cortical segment of the PICA and in all others at the caudal loop. The average time for de-clamping the PICA was 29 min and 29 s. Although the overall graft patency rate was 100%, one patient showed a new medulla infarction at the time of post-operatory three-dimensional computed tomography angiography. Besides a secure OA-to-PICA anastomosis, this technique allows safe harvest of the OA and the creation of a shallow and wide anastomosis field. PMID:25633907

  7. Evaluation of a novel thermosensitive heparin-poloxamer hydrogel for improving vascular anastomosis quality and safety in a rabbit model.

    Directory of Open Access Journals (Sweden)

    Ying-Zheng Zhao

    Full Text Available Despite progress in the design of advanced surgical techniques, stenosis recurs in a large percentage of vascular anastomosis. In this study, a novel heparin-poloxamer (HP hydrogel was designed and its effects for improving the quality and safety of vascular anastomosis were studied. HP copolymer was synthesized and its structure was confirmed by Fourier transform infrared spectroscopy (FTIR and nuclear magnetic resonance spectroscopy ((1H-NMR. Hydrogels containing HP were prepared and their important characteristics related to the application in vascular anastomosis including gelation temperature, rheological behaviour and micromorphology were measured. Vascular anastomosis were performed on the right common carotid arteries of rabbits, and the in vivo efficiency and safety of HP hydrogel to achieve vascular anastomosis was verified and compared with Poloxamer 407 hydrogel and the conventional hand-sewn method using Doppler ultrasound, CT angiograms, scanning electron microscopy (SEM and histological technique. Our results showed that HP copolymer displayed special gel-sol-gel phase transition behavior with increasing temperature from 5 to 60 °C. HP hydrogel prepared from 18 wt% HP solution had a porous sponge-like structure, with gelation temperature at approximately 38 °C and maximum elastic modulus at 10,000 Pa. In animal studies, imaging and histological examination of rabbit common jugular artery confirmed that HP hydrogel group had similar equivalent patency, flow and burst strength as Poloxamer 407 group. Moreover, HP hydrogel was superior to poloxamer 407 hydrogel and hand-sewn method for restoring the functions and epithelial structure of the broken vessel junctions after operation. By combining the advantages of heparin and poloxamer 407, HP hydrogel holds high promise for improving vascular anastomosis quality and safety.

  8. [DESCRIPTION OF A RETROPERITONEAL ACCESS ROUTE TO THE VESSELS OF THE SPLEEN FOR SPLENORENAL ARTERIAL AND VENOUS ANASTOMOSIS].

    Science.gov (United States)

    Gil-Vernet Vila, José María

    2014-01-01

    To perform arterial or venous spleno-renal anastomoses, surgeons have so far systematically used the transperitoneal way whic is burdened by a high mortality an morbility percentage. On the basis of anatomo-surgical considerations, a retroperitoneal approach has been found reaching the hilus of the spleen via the lumbar region; the first arterial spleno-renal anastomosis by this way was performed in 1972 and the first venous spleno-renal anastomosis due to portal hipertension also by this way was performed in 1974, the alter proving to be the least aggresive by avoiding damaging the páncreas, the most surgical and direct for reaching the splenic vessels thereby enabling a better exposure and an easier performing of the anastomoses. By being retroperitoneal, the loss or infección of the ascitic liquid in the cirrhotic patient is prevented.

  9. Robotically Assisted Single Anastomosis Duodenoileal Bypass after Previous Sleeve Gastrectomy Implementing High Valuable Technology for Complex Procedures

    Directory of Open Access Journals (Sweden)

    Ramon Vilallonga

    2015-01-01

    Full Text Available Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve. We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed.

  10. In vivo perfusion assessment of an anastomosis surgery on porcine intestinal model (Conference Presentation)

    Science.gov (United States)

    Le, Hanh N. D.; Opferman, Justin; Decker, Ryan; Cheon, Gyeong W.; Kim, Peter C. W.; Kang, Jin U.; Krieger, Axel

    2016-04-01

    Anastomosis, the connection of two structures, is a critical procedure for reconstructive surgery with over 1 million cases/year for visceral indication alone. However, complication rates such as strictures and leakage affect up to 19% of cases for colorectal anastomoses and up to 30% for visceral transplantation anastomoses. Local ischemia plays a critical role in anastomotic complications, making blood perfusion an important indicator for tissue health and predictor for healing following anastomosis. In this work, we apply a real time multispectral imaging technique to monitor impact on tissue perfusion due to varying interrupted suture spacing and suture tensions. Multispectral tissue images at 470, 540, 560, 580, 670 and 760 nm are analyzed in conjunction with an empirical model based on diffuse reflectance process to quantify the hemoglobin oxygen saturation within the suture site. The investigated tissues for anastomoses include porcine small (jejunum and ileum) and large (transverse colon) intestines. Two experiments using interrupted suturing with suture spacing of 1, 2, and 3 mm and tension levels from 0 N to 2.5 N are conducted. Tissue perfusion at 5, 10, 20 and 30 min after suturing are recorded and compared with the initial normal state. The result indicates the contrast between healthy and ischemic tissue areas and assists the determination of suturing spacing and tension. Therefore, the assessment of tissue perfusion will permit the development and intra-surgical monitoring of an optimal suture protocol during anastomosis with less complications and improved functional outcome.

  11. Tratamento cirúrgico do megacólon chagásico: retocolectomia abdominal com anastomose colorretal mecânica término-lateral Surgical treatment of chagasic megacolon: abdominal rectocolectomy with mechanical colo-rectal end- to-side anastomosis

    Directory of Open Access Journals (Sweden)

    José Hyppolito da Silva

    1999-10-01

    Full Text Available Trinta e cinco doentes portadores de megacólon chagásico foram operados pela técnica da retocolectomia abdominal com anastomose colorretal mecânica término-lateral durante o período de 1993 a 1997. Vinte (57,14% doentes eram do sexo feminino e 15 (42,85% do masculino. A idade variou de 27 a 76 anos, com média de 51 anos. A operação constou de ressecção do segmento dilatado, sepultamento do coto retal na altura da reflexão peritoneal com grampeador, dissecção do espaço retrorretal até o plano dos músculos elevadores e anastomose colorretal mecânica término-lateral posterior. Em quatro (11,42% doentes a anastomose foi anterior. Em três (8,57% doentes, o teste de escape da anastomose foi positivo, o que obrigou a complementação manual da sutura em dois (5,71 % e sutura e ostomia derivativa em um (2,85%. Ocorreram sete (20,00% complicações pós-operatórias precoces, sendo quatro consideradas relevantes (11,42% e quatro (11,42% complicações tardias. Houve um (2,85% óbito por complicação clínica. Os doentes submetidos a colostomia foram reoperados para fechamento da mesma sem intercorrências. A totalidade dos doentes apresenta hábito intestinal normal. Não houve referências a alterações gênito-urinárias, nem a incontinência fecal. A anastomose foi tocada ou visibilizada em todos os pacientes examinados, durante o seguimento ambulatorial. Não houve casos de fecaloma no coto retal. Embora os resultados iniciais sejam bastante satisfatórios, é necessário maior tempo de observação para se avaliar a possibilidade de recidiva.Thirty five patients with chagasic megacolon were operated on by the technique of recto-colectomy with colo-rectal mechanical end-to-side anastomosis, anterior or posterior during the period of 1993 to 1997. Twenty (57.14% patients were female and 15 (42.85% male. The age ranged from 27 to 76 years, with a mean of 51years. The operation consisted of resection of the dilated colon, closure

  12. EUS-Guided Antegrade Transhepatic Placement of a Self-Expandable Metal Stent in Hepatico-Jejunal Anastomosis

    OpenAIRE

    Everson LA Artifon; Adriana Vaz Safatle-Ribeiro; Flávio Coelho Ferreira; Luiz Poli-de-Figueiredo; Samir Rasslan; Francisco Carnevale; José Pinhata Otoch; Paulo Sakai; Michel Kahaleh

    2011-01-01

    Context To demonstrate an EUS-guided biliary drainage in patient with gastrointestinal tract modified surgically. Case report An EUS guided access to the left intra hepatic duct, followed by an antegrade passage of a partially self-expandable metal stent that was removed by using an enteroscope, in one patient with hepatico-jejunal anastomosis. There were no early or delayed complications and the procedure was effective in relieving jaundice until the self-expandable metal stent was removed, ...

  13. Modified end-to-end anastomosis for the treatment of congenital tracheal stenosis with a bridging bronchus.

    Science.gov (United States)

    Stock, Cameron; Nathan, Meena; Murray, Ryan; Rahbar, Reza; Fynn-Thompson, Francis

    2015-01-01

    An infant with a ventricular septal defect; Vertebral anomalies, Anal atresia, Cardiac anomalies, Tracho Esophageal fistula (TEF), Renal anomalies, Limb anomalies syndrome; and tracheal stenosis with a bridging bronchus underwent repair of the ventricular septal defect and trachea-bronchial reconstruction at age 11 months. Herein we describe our surgical approach to resection of the bridging bronchus and a technique using a modified end-to-end tracheal anastomosis for the correction of this complex anomaly. PMID:25555968

  14. CLINICAL ADVANTAGES OF TOTAL CAVOPULMONARY ANASTOMOSIS WITHOUT CARDIOPULMONARY BYPASS

    Institute of Scientific and Technical Information of China (English)

    Jun-min Chu; Qing-yu Wu; Jian-ping Xu

    2005-01-01

    Objective To evaluate surgical methods and results of extracardiac conduit total cavopulmonary anastomosis (ECTCPA) without cardiopulmonary bypass (CPB).Methods From May 2000 to April 2003, 11 patients with functional univentricle underwent off-pump EC-TCPA (noCPB group). Their postoperative outcome was retrospectively compared with a 17-patient group who underwent EC-TCPA with cardiopulmonary bypass (CPB group) over a concurrent time period.Results There was 1 operative death in no-CPB group and 2 in CPB group; early postoperative hemodynamics appeared to significantly improve in no-CPB group. Blood and platelet transfusions decreased and blood plasma transfusion significantly lowered in no-CPB group compared with CPB group (P = 0.036). Postoperative courses of patients in no-CPB group were smooth and event free, and extubation time was substantially short. Intensive cares unit stay (P=0.04) and hospital stay (P= 0.02) postoperation were significantly shorter, hospital costs were significantly reduced (P= 0.004) in no-CPB group compared with CPB group.Conclusions EC-TCPA without use of CPB is not a difficult procedure; the procedure results in improvement in postoperative hemodynamics, and decreased use of blood and blood products. It is a more efficient operation with more short recovery time and reduced hospital stay.

  15. The Effects of Systemic IGF-I on the Arterial Anastomosis in Rats

    Directory of Open Access Journals (Sweden)

    Baris Keklik

    2014-04-01

    Full Text Available Objective: In this study, we aimed to document the effects of a well-known agent and mdash; and ldquo;insulin-like growth factor (IGF-I and rdquo; and mdash; on the microvascular anastomosis site. Methods: Sixteen Sprague-Dawley rats were used in this study. The rats were classified randomly into two equally numbered groups (eight rats each: the control (Group 1 and the experiment group (Group 2. The femoral artery was dissected completely in all rats. Following division of the artery, anastomoses were conducted with microvascular techniques. Forty-five minutes after the anastomoses, an Acland milking test was performed in order to check the patency and the first surgical session was terminated. In the second stage, LONG and reg; R3 IGF-I human (Sigma-Aldrich, St. Louis, Missouri, United States solution was introduced to Group 2 (experimental group intraperitoneally in doses of 2 mg/kg on the day of the surgery in addition to the third and seventh days postoperatively. On the 4th postoperative week, the patency of the anastomoses was evaluated with the Acland milking test. In addition, one centimeter of a vascular segment including the anastomosis site was excised and stained with hematoxylin-eosin. They were evaluated for edema, inflammation, vascular wall injury, intimal hyperplasia, medial atrophy, thrombus, calcification, foreign body reactions, and the endothelial proliferation. Results: The Acland milking test showed a 100% vascular patency in both groups. A statistically significant difference was found between the experimental and control groups in terms of edema and vascular wall injury (p0.05. Conclusion: Under the light of the obtained data, IGF-I was effective in preventing the edema and vascular wall injury at the anastomosis site. However, the net positive clinical effect on anastomosis patency necessitates further studies. [Arch Clin Exp Surg 2014; 3(2.000: 87-93

  16. An effect of wrapping peripheral nerve anastomosis with pedicled muscle flap on nerve regeneration in experiment

    Directory of Open Access Journals (Sweden)

    Naumenko L.Yu.

    2010-01-01

    Full Text Available Despite intrinsic capacity of peripheral nerves to regenerate, functional outcomes of peripheral nerves injury remain poor. Nerve ischemia, intra-/perineurial fibrosis and neuroma formation contribute a lot to that. Several authors demonstrated beneficial effects of increased vascularization at the site of injury on peripheral nerves regeneration. The use of highly vascularized autologous tissues (greater omentum as a source of peripheral nerves neovascularization shows promising re-sults. We proposed a surgical technique in which injured peripheral nerves anastomosis was wrapped in a pedicled muscular flap and performed morphological assessment of the efficacy of such technique with the aid of immunohistochemistry. 14 rats (which underwent sciatic nerve transection were operated according to proposed technique. Another 14 rats, in which only end-to-end nerve anastomosis (without muscular wrapping was performed served as controls. Morphological changes were evaluated at 3 weeks and 3 months periods. Higher blood vessel and axon counts were observed in experimental groups at both checkpoints. There was also an increase in Schwann cells and macrophages counts, and less collagen content in pe-ripheral nerves of experimental groups. Axons in neuromas of experimental groups showed a higher degree of arrangement. We conclude that proposed surgical technique provides better vascularisation of injured peripheral nerves, which is beneficial for nerve regeneration.

  17. Effect of Microvascular Anastomosis Technique on End Product Outcome in Simulated Training: A Prospective Blinded Randomized Controlled Trial.

    Science.gov (United States)

    Kim, Eunsol; Singh, Masha; Akelina, Yelena; Shurey, Sandra; Myers, Simon R; Ghanem, Ali M

    2016-09-01

    Background The aim of this article is to evaluate the difference in skills acquisition of two end-to-end microvascular anastomosis techniques-the triangulation and biangulation-in early microsurgery training. Method In this study, 32 candidates ranging from medical students to higher surgical trainees underwent a 5-day basic microsurgery course. On days 3 and 5 of the course, candidates performed two end-to-end anastomoses on cryopreserved rat aortas. One anastomosis was performed using the biangulation technique and the other using the triangulation technique. Candidates were randomized to the order of technique performed. Structural patency, errors performed, and suture distribution were evaluated randomly by a blinded reviewer using the anastomosis lapse index score and ImageJ (U.S. National Institutes of Health, Bethesda, MD) Software. Results A total of 128 anastomoses were evaluated during the study period. A total of six anastomoses performed with the biangulation technique, and four anastomoses with the triangulation technique, were physically occluded on day 3 of the course. On day 5, two biangulation technique anastomoses and one triangulation technique produced a nonpatent outcome. There was a statistically significant difference of patency rate between the 2 days of evaluation confirming evidence of skill acquisition but no statistically significant difference between the two techniques in relation to anastomotic patency, errors performed, or suture placement quality. Conclusion The biangulation and triangulation techniques of microvascular anastomosis produce similar outcomes in relation to vessel structural patency and quality of anastomosis when taught in early stages of microsurgery training. Our results suggest that both techniques are equally suitable in training novices, basic microsurgical skills. PMID:27303937

  18. [Low colorectal anastomosis by the anterior perineal approach. 29 cases].

    Science.gov (United States)

    Bricot, R; Le Treut, Y P; Kadji, C A; Bardot, J; Rodde, J M

    1985-12-14

    Using the combined abdominoperineal approach to the rectum through the recto-genital space, very low colo-rectal anastomosis can be performed without damaging the anal sphincter. Twenty-nine patients were operated upon by this procedure for malignant or benign disease of the lower two-thirds of the rectum: there was 2 failure; 6 patients developed transient perineal fistula; 27 patients now have normal anal continence. This technique has been considerably facilitated, notably in males, by stapled anastomosis. PMID:2934722

  19. Motility of the jejunum after proctocolectomy and ileal pouch anastomosis.

    OpenAIRE

    Chaussade, S; Merite, F; Hautefeuille, M; Valleur, P; Hautefeuille, P.; Couturier, D

    1989-01-01

    Proctocolectomy with ileal pouch anastomosis could modify motility of the small intestine through two mechanisms: obstruction or bacterial overgrowth. Motility of the jejunum was measured in 11 patients with ileoanal anastomosis six (n = 6), or 12 (n = 5) months after closure of the loop ileostomy. Manometric recording from the jejunum were made during fasting (four hours) and after a liquid meal (one hour). These findings were compared with those of six healthy volunteers. Motor events were ...

  20. Management of low colorectal anastomotic leak: Preservingthe anastomosis

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Anastomotic leak continues to be a dreaded complicationafter colorectal surgery, especially in the lowcolorectal or coloanal anastomosis. However, therehas been no consensus on the management of the lowcolorectal anastomotic leak. Currently operative proceduresare reserved for patients with frank purulentor feculent peritonitis and unstable vital signs, and varyfrom simple fecal diversion with drainage to resectionof the anastomosis and closure of the rectal stump withend colostomy (Hartmann's procedure). However, ifthe patient is stable, and the leak is identified days oreven weeks postoperatively, less aggressive therapeuticmeasures may result in healing of the leak and salvageof the anastomosis. Advances in diagnosis and treatmentof pelvic collections with percutaneous treatments, andnewer methods of endoscopic therapies for the acutelyleaking anastomosis, such as use of the endosponge,stents or clips, have greatly reduced the need for surgicalintervention in selected cases. Diverting ileostomy, ifnot already in place, may be considered to reduce fecalcontamination. For subclinical leaks or those that persistafter the initial surgery, endoluminal approaches suchas injection of fibrin sealant, use of endoscopic clips, ortransanal closure of the very low anastomosis may beutilized. These newer techniques have variable successrates and must be individualized to the patient, with thegoal of treatment being restoration of gastrointestinalcontinuity and healing of the anastomosis. A reviewof the treatment of low colorectal anastomotic leaks ispresented.

  1. A novel colonic anastomosis technique involving fixed polyglycolic acid mesh

    Science.gov (United States)

    Aysan, Erhan; Bektas, Hasan; Ersoz, Feyzullah; Sari, Serkan; Kaygusuz, Arslan

    2010-01-01

    Background: Polyglycolic acid mesh (PAM) reinforcement of colonic anastomoses were evaluated. Methods: Twenty female albino rabbits were divided into two groups. Each rabbit underwent segmental colonic resection with single-layer anastomosis. In one group of rabbits, PAM of length equal to the circumference of the anastomosis was applied. Rabbits were sacrificed on postoperative day 10 and peritoneal adhesions, anastomosis burst pressure, and anastomosis histopathological characteristics were evaluated. Results: The average burst pressure for the control and PAM groups was 149±15.95 mmHgand 224±124.5 mmHg, respectively (p=0.578). All control anastomoses burst, whereas only five (50%) PAM anastomoses burst (p<0.03). There was no anastomotic leakage in the control group, whereas three PAM group anastomoses leaked (p=0.210). The collagen fiber density and amount of neovascularization were lower in the PAM than the control group (p=0.001 and p=0.002, respectively). The average peritoneal adhesion value was 1.6±0.51 in the control group and 2.9±0.31 in the PAM group (p<0.0001). Conclusion: The new fixed PAM-reinforced anastomosis technique resulted in an increased risk of anastomosis leakage and peritoneal adhesion, but also higher in non-burst anastomoses. PMID:21072268

  2. Restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: A narrative review.

    Science.gov (United States)

    Sofo, Luigi; Caprino, Paola; Sacchetti, Franco; Bossola, Maurizio

    2016-08-27

    Restorative proctocolectomy with ileal pouch-anal anastomosis (RP-IPAA) is the gold standard surgical treatment for ulcerative colitis. However, despite the widespread use of RP-IPAA, many aspects of this treatment still remain controversial, such as the approach (open or laparoscopic), number of stages in the surgery, type of pouch, and construction type (hand-sewn or stapled ileal pouch-anal anastomosis). The present narrative review aims to discuss current evidence on the short-, mid-, and long-term results of each of these technical alternatives as well as their benefits and disadvantages. A review of the MEDLINE, EMBASE, and Ovid databases was performed to identify studies published through March 2016. Few large, randomized, controlled studies have been conducted, which limits the conclusions that can be drawn regarding controversial issues. The available data from retrospective studies suggest that laparoscopic surgery has no clear advantages compared with open surgery and that one-stage RP-IPAA may be indicated in selected cases. Regarding 2- and 3-stage RP-IPAA, patients who underwent these surgeries differed significantly with respect to clinical and laboratory variables, making any comparisons extremely difficult. The long-term results regarding the pouch type show that the W- and J-reservoirs do not differ significantly, although the J pouch is generally preferred by surgeons. Hand-sewn and stapled ileal pouch-anal anastomoses have their own advantages, and there is no clear benefit of one technique over the other. PMID:27648159

  3. The Comparison Between the Complications after Two Surgical Techniques of Esophageal Cancer

    OpenAIRE

    Mohamad Taghi Rajabi Mashhadi; Ghodratollah Maddah; Reza Bagheri; Ghasem Faghanzadeh Ganji; Reza Shojaeian; Sajad Nurshafiee; Masoumeh Gharib; Maryam Salehi

    2014-01-01

    Introduction: Esophageal cancer is a common gastro intestinal malignancy. One of the most common techniques of surgery in esophageal cancer is transhiatal esophagectomy with esophagogastric anastomosis in the neck. This technique is accompanied by complications like chronic gastero-esophegeal reflux and late stenosis. This study was designed to compare the risk of complications after two surgical techniques for esophageal cancer: esophagogastric anastomosis with partial fundoplication and eso...

  4. Effect of omentum graft on esophageal anastomosis in dogs

    Directory of Open Access Journals (Sweden)

    A. K. Mahdi

    2011-01-01

    Full Text Available The aim of this study was to evaluate the complications and final function outcome of wrapping nonvascularized omentum graft around the suture line of esophageal anastomosis. Twelve adult local breed dogs were used in this study. The animals were divided into two equal groups (control and treated, all animal induced into general anesthesia by injection of atropen sulphate in a dose 0.04 mg/kg B.W, intramuscularly then after 15 minute given mixture of ketamine hydrochloride and xylazine hydrochloride in doses 15 mg/kg and 5 mg/kg B.W intramuscularly respectively. An oblique resection of about 1cm of the esophageal length and anastomosis by double layer of simple interrupted pattern by 2.0 cat gut suture (control group, same procedure was done in treated group except the wrapping the anastomosis site with patch of omentum tissue after lapratomy operation in the left flank region procedure. The clinical signs of treated animal revealed signs of dysphagia and regurgitation in treated group while this signs disappear in the control group. Radiological and histopathological examination of the anastomosis site performed at 15 and 30 days post operation. Radiological study recorded high degree of stenosis in the anastomosis site in treated group at 15 and 30 days post operation in compared with animals in control group that record mean degree of stenosis in treated group at 15 day (57.61±0.2 and at 30 day (55.78±0.2 while it recorded in control group at 15 day (39.34±1.04 and at 30 day (36.0.6 ±0.9, histopathological results recorded enhanced healing of anastomosis site in treated animals more than control animals. In conclusion we found that non vascularized omental graft prevent leak when used around the anastomosis line in esophageal and enhanced healing of anastomosis line but it increase the stenosis, fibrosis and adhesion of anastomosis site with surrounding muscle and this interferes with the swallowing as well as dysphagia and regurgitation

  5. Transdiaphragnatic exposure for direct atrioatrial anastomosis in liver transplantation

    Institute of Scientific and Technical Information of China (English)

    CHEN Zhe-yu; YAN Lü-nan; ZENG Yong; WEN Tian-fu; LI Bo; ZHAO Ji-chun; WANG Wen-tao; YANG Jia-yin; XU Ming-qing

    2010-01-01

    Background Liver transplantation in Budd-Chiari syndrome remains controversial; however, some improved techniques lead to better results. We report medium-term follow-up results of liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome and explore the indications of liver transplantation with atrioatrial anastomosis for patients with end stage liver disease.Methods Nine patients (six Budd-Chiari syndromes, one end stage hepatolithiasis, one hepatocellular carcinoma and one incurable alveolar echinococcosis) underwent liver transplantation with atrioatrial anastomosis in West China Hospital of Sichuan University from 1999 to 2006. Eight liver transplants used cadaveric orthotopic livers and one a living donor liver. The operative technique was transdiaphragmatic exposure for direct atrioatrial anastomosis and replacement of inferior vena cava by cryopreserved vena cava graft with the help of venovenous bypass.Results All liver transplantations were successful. Two patients contracted pulmonary infection and acute rejection took place in another case. With proper treatment, all patients recovered well and had good quality of life. To date, they have been followed up for more than 24 months. The only death followed recurrence of hepatic carcinoma three years after liver transplantation.Conclusions Transdiaphragmatic exposure for direct atrioatrial anastomosis and the cryopreserved vena cava graftreplacement of inferior vena cava are possible for patients with end stage liver disease thus extending the indications of liver transplantation.

  6. Tissue vitality monitoring system and method and surgical technique

    NARCIS (Netherlands)

    French, P.J.; Jeekel, J.; Lange, J.F.

    2007-01-01

    Tissue vitality is monitored by means of a sensor attached to the tissue. Preferably, the sensor is attached to the tissue at the end of a surgical intervention, for example after anastomosis of the colon. The sensor is attached to the tissue with a sensitive surface facing the tissue, e.g. at a poi

  7. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  8. Ulnar neuropathy with prominent proximal Martin-Gruber anastomosis.

    Science.gov (United States)

    Burakgazi, Ahmet Z; Russo, Mary; Bayat, Elham; Richardson, Perry K

    2014-07-01

    Martin-Gruber anastomosis (MGA) is the most common nerve anastomosis in the upper extremities and it crosses from the median nerve to the ulnar nerve. Proximal MGA is an under recognized anastomosis between the ulnar and median nerves at or above the elbow and should not be missed during nerve conduction studies. We presented two patients with ulnar neuropathy mimicking findings including numbness and tingling of the 4th and 5th digits and mild weakness of intrinsic hand muscles. However, both cases had an apparently remarkable conduction block between the below- and above-elbow sites that was disproportionate to their clinical findings. To explain this discrepancy, a large MGA was detected with stimulation of the median nerve at the elbow. Thus, proximal MGA should be considered in ulnar neuropathy at the elbow when apparent conduction block or/and discrepancy between clinical and electrodiagnostic findings is found. PMID:24147570

  9. Giant serpentine aneurysm arising from the middle cerebral artery successfully treated with trapping and anastomosis: case report.

    Science.gov (United States)

    Abiko, Masaru; Ikawa, Fusao; Ohbayashi, Naohiko; Mitsuhara, Takafumi; Nosaka, Ryo; Inagawa, Tetsuji

    2009-02-01

    A 56-year-old man presented with a giant serpentine aneurysm arising from the middle cerebral artery (MCA) manifesting as right hemiparesis and motor aphasia. Magnetic resonance imaging and digital subtraction angiography identified the giant serpentine aneurysm arising from the MCA. The patient was treated surgically. Temporary clipping of the distal channel induced thrombosis in the vascular channel, and the thrombosis was aspirated with an ultrasonic suction device after superficial temporal artery-MCA anastomosis. This case shows that initial occlusion of the distal channel is effective to treat giant serpentine aneurysm. PMID:19246869

  10. Sigmoid Resection with Primary Anastomosis for Uncomplicated Giant Colonic Diverticulum : a Report of two Cases.

    Science.gov (United States)

    Mahieu, J; Mansvelt, B; Veys, E

    2014-01-01

    Giant colonic diverticulum (GCD) is a rare complication of colonic diverticulosis. A small number of cases has been reported in the literature. Patients with GCD have often few non-specific symptoms. Unfortunately, severe complications exist and may lead to surgical acute abdomen. Therefore, this complication of the diverticular disease must be known and properly treated. There is no gold standard diagnostic test, but an air-fluid or air-filled, rounded, pseudocystic image in relation with the colonic wall in a patient with colonic diverticula should suggest this diagnosis to the clinician. We report two cases of a 70-year-old male patient and a 44-year-old female patient having a giant sigmoid diverticulum. The treatment of choice of an uncomplicated GCD is an elective colonic resection, including the giant -diverticulum, with primary anastomosis ; while in case of complicated GCD (peritonitis, abscess or complex fistula), a two-stage resection should be considered.

  11. Colorectal Anastomoses: Surgical outcome and prevention of anastomotic leakage

    OpenAIRE

    Bakker, Ilsalien

    2016-01-01

    Colorectal surgery is a frequently performed procedure with more than 10.000 annual resections in the Netherlands. The majority of resections are performed for colorectal cancer. The first part of this thesis focused on outcome of colorectal cancer surgery in the Netherlands based on the nationwide data of the Dutch Surgical Colorectal Audit. Surgical resection with creation of bowel continuance is the primary goal in uncomplicated procedures. An anastomosis however, bears the risk of anastom...

  12. The Comparison Between the Complications after Two Surgical Techniques of Esophageal Cancer

    Directory of Open Access Journals (Sweden)

    Mohamad Taghi Rajabi Mashhadi

    2014-08-01

    Full Text Available Introduction: Esophageal cancer is a common gastro intestinal malignancy. One of the most common techniques of surgery in esophageal cancer is transhiatal esophagectomy with esophagogastric anastomosis in the neck. This technique is accompanied by complications like chronic gastero-esophegeal reflux and late stenosis. This study was designed to compare the risk of complications after two surgical techniques for esophageal cancer: esophagogastric anastomosis with partial fundoplication and esophagogastric anastomosis without it. Materials and Methods: In this retrospective cohort study, 100 patients with distal two thirds of esophageal cancer who underwent transhiatal esophagectomy in Ghaem and Omid hospitals Mashhad University of Medical Sciences from 2005 to 2010 were included. Esophagogastric anastomosis to the posterior gastric wall was performed with a partial gastric fundoplication in the first group but simple routine anastomosis was done to the posterior gastric wall in the second group. Results: In a retrospective cohort study 100 patients entered the study with 59 male & 41 female and with a mean age 54.6±6.4 years. Squamous cell carcinoma was observed in 77% of the patients and adenocarcinoma was reported in 23% of them. Seventy-two percent of tumours were located in distal third and 28% were in middle third of esophagus. Esophagogastric anastomotic leakage was observed in 3 cases of fundoplication group and 7 cases of simple anastomosis technique (P=0.182 so there was no significant difference between the two groups. Benign anastomosis stricture was reported in one of the patients who underwent esophagogastric anastomosis with fundoplication, but it was observed in 8 cases with simple anastomosis technique (P=0.03 so there was a significant difference between the two groups. Conclusion: Esophagogastric anastomosis with partial fundal fundoplication is a safe technique with low incidence of anatomic leakage and late stenosis.

  13. Anastomosis in minimally invasive Ivor lewis esophagectomy via two ports provides equivalent perioperative outcomes to open

    Directory of Open Access Journals (Sweden)

    Y Zhao

    2014-01-01

    Full Text Available Objective: Minimally invasive esophagectomy (MIE is becoming a selective treatment of esophageal cancer; however, it′s a complex and technically demanding surgical operation. MIE can be performed in high volume centers in a variety of ways using different techniques. Transthoracic staplers have traditionally been used in open transthoracic Ivor Lewis Esophagectomy (ILE with good success. An investigation of the safety and utility of transthoracic stapler via two ports on thorax for esophageal anastomosis in minimally invasive ILE is reviewed. Methods: Patients of esophageal cancer were selected between November 2012 and July 2014. All the patients received minimally invasive (MIE or open transthoracic ILE. Transthoracic stapler for MIE anastomosis was performed through the major port located at subaxillary region. Patients′ demographics, indications for esophagectomy, perioperative treatments, intraoperative data, postoperative complications, hospital length of stay, 7 and in-hospital mortality were evaluated. Results: Totally, 63 consecutive patients underwent MIE or ILE. All the patients were Han with a mean age of 60 years (52-74. The indication of surgery is esophageal cancer, and squamous cell carcinoma was defined by pathologist before operation. None of the patients had neoadjuvant chemotherapy or radiation. All the MIE patients were no conversions to open thoracotomy or laparotomy. Mean operative time was 4.5 h. One patient (3.03% suffered postoperative pneumonia, no leak from the gastric conduit staple line or esophageal anastomoses, no postoperative complication required surgical intervention was observed. The median hospital length of stay was 13 days (range 7-18. There were no in-hospital mortalities. Conclusions: In our study, transthoracic stapler through the major port at subaxillary seems technically feasible and safe for minimally invasive ILE with comparable morbidity and oncologic data to open.

  14. Diagnostic and interventional radiology in the post-operative period and follow-up of patients after rectal resection with coloanal anastomosis.

    Science.gov (United States)

    Severini, A; Civelli, E M; Uslenghi, E; Cozzi, G; Salvetti, M; Milella, M; Gallino, G; Bonfanti, G; Belli, F; Leo, E

    2000-01-01

    Surgical treatment of carcinoma of the distal third of the rectum with anal sphincter preservation is increasingly used in accredited cancer centers. This study aimed to evaluate the diagnostic usefulness of radiological investigations in the management of patients who had undergone resection with coloanal anastomosis for carcinoma of the rectum, in the immediate post-operative period, during closure of the protective colostomy and in the follow-up of symptomatic recanalized patients. A total of 175 patients who had undergone total rectal resection with end-to-side anastomosis for carcinoma of the distal third of the rectal ampulla, most of whom had received postoperative radiotherapy, were evaluated radiologically. In the postoperative period radiological investigation was ordered only for symptomatic patients to detect pathology of the anastomosis and the pouch sutures and was used direct film abdominal radiography and contrast-enhanced radiography of the rectal stump with a water-soluble radio-opaque agent. Before closure of the colostomy, 2 months after rectal excision or approximately 4 months after if postoperative radiotherapy was given, the anastomosis and pouch of all patients, even asymptomatic ones, were studied with water-soluble contrast enema to check for normal canalization. In the follow-up after recanalization radiological examinations were done to complete the study of the large intestine if the endoscopist was not able to examine it up to the cecum. Of the 175 patients examined radiologically during the postoperative period and/or subsequent follow-up, 95 showed no pathological findings. Seventy-nine patients had fistulas of the coloanal anastomosis or the pouch, 23 of which supplied a presacral collection. In the absence of severe sepsis, the only therapeutic measures were systemic antibiotics and washing of the surgical catheters to maintain efficient operation. In 2 patients in whom transanal drainage was performed radiologically the fistula

  15. Diagnostic and interventional radiology in the post-operative period and follow-up of patients after rectal resection with coloanal anastomosis

    Energy Technology Data Exchange (ETDEWEB)

    Severini, A.; Civelli, E.M.; Uslenghi, E.; Cozzi, G.; Salvetti, M.; Milella, M. [Department of Radiology, National Cancer Institute of Milan, via Venezian 1, I-23100 Milan (Italy); Gallino, G.; Bonfanti, G.; Belli, F.; Leo, E. [Department of Surgery, National Cancer Institute of Milan, via Venezian 1, I-23100 Milan (Italy)

    2000-07-01

    Surgical treatment of carcinoma of the distal third of the rectum with anal sphincter preservation is increasingly used in accredited cancer centers. This study aimed to evaluate the diagnostic usefulness of radiological investigations in the management of patients who had undergone resection with coloanal anastomosis for carcinoma of the rectum, in the immediate post-operative period, during closure of the protective colostomy and in the follow-up of symptomatic recanalized patients. A total of 175 patients who had undergone total rectal resection with end-to-side anastomosis for carcinoma of the distal third of the rectal ampulla, most of whom had received postoperative radiotherapy, were evaluated radiologically. In the postoperative period radiological investigation was ordered only for symptomatic patients to detect pathology of the anastomosis and the pouch sutures and was used direct film abdominal radiography and contrast-enhanced radiography of the rectal stump with a water-soluble radio-opaque agent. Before closure of the colostomy, 2 months after rectal excision or approximately 4 months after if postoperative radiotherapy was given, the anastomosis and pouch of all patients, even asymptomatic ones, were studied with water-soluble contrast enema to check for normal canalization. In the follow-up after recanalization radiological examinations were done to complete the study of the large intestine if the endoscopist was not able to examine it up to the cecum. Of the 175 patients examined radiologically during the postoperative period and/or subsequent follow-up, 95 showed no pathological findings. Seventy-nine patients had fistulas of the coloanal anastomosis or the pouch, 23 of which supplied a presacral collection. In the absence of severe sepsis, the only therapeutic measures were systemic antibiotics and washing of the surgical catheters to maintain efficient operation. In 2 patients in whom transanal drainage was performed radiologically the fistula

  16. ["Pouchitis" after ileo-anal anastomosis with reservoir].

    Science.gov (United States)

    Chaussade, S; Bouzard, D; Denizot, Y; Valleur, P; Hautefeuille, P; Couturier, D

    1991-01-01

    Pouchitis is the most poorly understood complication of ileoanal anastomosis. The incidence reported in the literature ranges from 7 to 42% as there are no diagnostic criteria. The various clinical symptoms and endoscopic findings raise the possibility that pouchitis is a heterogenous disease, in which the role of bacterial overgrowth and recurrence of inflammatory bowel disease must be clarified. PMID:1929161

  17. Motility of the jejunum after proctocolectomy and ileal pouch anastomosis.

    Science.gov (United States)

    Chaussade, S; Merite, F; Hautefeuille, M; Valleur, P; Hautefeuille, P; Couturier, D

    1989-01-01

    Proctocolectomy with ileal pouch anastomosis could modify motility of the small intestine through two mechanisms: obstruction or bacterial overgrowth. Motility of the jejunum was measured in 11 patients with ileoanal anastomosis six (n = 6), or 12 (n = 5) months after closure of the loop ileostomy. Manometric recording from the jejunum were made during fasting (four hours) and after a liquid meal (one hour). These findings were compared with those of six healthy volunteers. Motor events were classified as follows: migrating motor complex (MMC), propagated contractions, or discrete clustered contractions. All patients were investigated for bacterial overgrowth (D-glucose breath test). Only two patients had bacterial overgrowth. The frequency of MMC remained unchanged after ileo-anal anastomosis (2.83 (0.37)/four hours) compared with normal volunteers (2.81 (0.29)/four hours). During fasting, four patients had numerous propagated contractions in the jejunum. This condition was associated in two with bacterial overgrowth and in two with intubation of the reservoir. Discrete clustered contractions were found in the seven patients studied postprandially (7.6 (2.5)/h), but not in volunteers. These seven patients emptied their pouch spontaneously and bacterial overgrowth was found in only one. As this motility pattern was previously described in partial small intestinal obstruction, it is postulated that discrete clustered contractions could be the consequence of a functional obstruction as a result of anastomosis of the small intestine to the high pressure zone of the anal sphincters. Images Fig. 1 Fig. 2 PMID:2707637

  18. Tratamento cirúrgico do câncer da porção distal do têrço inferior do reto pela ressecção anterior ultrabaixa e interesfinctérica com anastomose coloanal por videolaparoscopia Surgical treatment of ultra-low rectal cancer by laparoscopic coloanal anastomosis and intersphincteric resection

    Directory of Open Access Journals (Sweden)

    José Reinan Ramos

    2009-09-01

    definitiva em 92,3% dos doentes; d A utilização dessa técnica não comprometeu os resultados oncológicos num período médio de 30 meses de seguimento.PURPOSES: The main purpose of this study was to evaluate the postoperative complications, the length of the hospital stay, the clinic functional results, and the oncological outcome at 2,5 years follow-up of patients with very low rectal cancer treated by laparoscopic coloanal anastomosis and intersphincteric resection. PATIENTS AND METHODS: 491 patients were treated by laparoscopic colorectal surgery, 13 of 172 with rectal cancer were selected and prospectively evaluated. All with very low rectal cancer, 9 female. No patient T4 or with complete response to quimioirradiation was selected. Quimioirradiation was used in 8 patients. RESULTS: The postoperative complication rate was 23,1% and the anastomotic fistulas rate was 7,7%. No patients died postoperatively. 61,5% of the patients were discharged before 7 days of hospital stay. The median number of harvested lymphnodes was 13. Mean distal tumor-free margin was 1,5 cm. Circumferential margin was positive in 1 case (7,7%. Fecal incontinence was related in 41% of the patients and fracionned evacuations in 91%. Eleven patients (84% have related good quality of life. One patient is with definitive stoma (7,7%. With median follow-up of 30 months, there were one local recurrence (7,7% and two cases of lung metastases (15,4 %. All, the three patients died of the diseases. Ten patients are survived (77% without disease. CONCLUSIONS: Analysis of results led to the following conclusions: a The technique employed is safe and have presented low rate of complication and no mortality; b The use of this technique have permited short length of the hospital stay; c Functional results were regular , but colostomy was avoid in 92,3% of the patients; d The use of this technique does not compromise the oncological outcome at a median follow-up of 30 months.

  19. FORMATION OF VESICOURETHRAL ANASTOMOSIS DURING ENDOVIDEOSURGICAL EXTRAPERITONEAL RADICAL PROSTATECTOMY: СOMPARATIVE STUDY OF THREE DIFFERENT PROCEDURES

    Directory of Open Access Journals (Sweden)

    S. V. Popov

    2014-07-01

    Full Text Available Extraperitoneoscopic (endovideosurgical extraperitoneal radical prostatectomy (ERPE is one of the current surgical treatment procedures in patients with localized prostate cancer. Failure of vesicourethral anastomosis (VUA and the development of its stricture are common surgi-cal complications. This investigation compares the efficiency and safety of different procedures to form VUA during ERPE: an interrupted suture (n = 24, a MVAC suture (n = 23, and a MVAC suture using self-locking suture material (n = 24. The performed comparative analysis of different procedures for forming VUA during ERPE may conclude that there are a number of advantages of the MVAC suture ap-plying the self-locking suture material. These advantages include less time taken to form VUA with the low frequency of complications, such as leakages occurring during control cystography or the development of delayed VUA strictures. 

  20. FORMATION OF VESICOURETHRAL ANASTOMOSIS DURING ENDOVIDEOSURGICAL EXTRAPERITONEAL RADICAL PROSTATECTOMY: СOMPARATIVE STUDY OF THREE DIFFERENT PROCEDURES

    Directory of Open Access Journals (Sweden)

    S. V. Popov

    2014-01-01

    Full Text Available Extraperitoneoscopic (endovideosurgical extraperitoneal radical prostatectomy (ERPE is one of the current surgical treatment procedures in patients with localized prostate cancer. Failure of vesicourethral anastomosis (VUA and the development of its stricture are common surgi-cal complications. This investigation compares the efficiency and safety of different procedures to form VUA during ERPE: an interrupted suture (n = 24, a MVAC suture (n = 23, and a MVAC suture using self-locking suture material (n = 24. The performed comparative analysis of different procedures for forming VUA during ERPE may conclude that there are a number of advantages of the MVAC suture ap-plying the self-locking suture material. These advantages include less time taken to form VUA with the low frequency of complications, such as leakages occurring during control cystography or the development of delayed VUA strictures. 

  1. Splenic autotransplantation and oesophageal transection anastomosis in patients with portal hypertension(26 years clinical observation)

    Institute of Scientific and Technical Information of China (English)

    CHEN Jisheng; HUO Jinshan; ZHANG Hongwei; SHANG Changzhen; CHEN Rufu; ZHANG Jie; Obetien Mapudengo; CHEN Yajin; ZHANG Lei

    2007-01-01

    The surgical treatment methods for cirrhosis patients complicated with portal hypertension are complicated.In this study,we evaluated the effectiveness of a new treatment strategy:splenic auto-transplantation and oesophageal transection anastomosis on 274 patients from three aspects:clinical observation,splenic immunology and portal dynamics.From 1979 to 2005,274 cirrhosis patients with portal hypertension who underwent the new treatment strategy were followed up to observe different clinical indexes,which were then compared with those of the traditional surgery treatment.From 1999 to 2002,a randomized control trial (RCT) was performed on 40 patients to compare their immune function after operation.From 1994 to 2004,another RCT.was carried out on 28 patients to compare the portal dynamics through three-dimensional dynamic contrast enhanced MR angiography (3D DEC MR.A) investigation after operation.Among 274 patients (mean age 41.8 years),the emergency operative mortality (4.4%),selective operative mortality (2.2%),complication rate (17.9%),morbidity of hepatic encephalopathy ( < 1%),bleeding rate of portal hypertension gastritis (PHG) (9.1%),and morbidity of hepatic carcinoma (8%) were similar to those under traditional operation;the spleen immunology function (Tuftsin,IgM)decreased among the groups 2 months after operation.Through 3D DCE MRA,the cross section area,the velocity and volume of blood flow of main portal vein decrease significantly after operation in both groups,the auto transplantation group was significantly lower in velocity and volume of blood flow than in the control group.Splenic auto transplantation and esophageal transection anastomosis are a safe,effective,and reasonable treatment strategy for portal hypertension with varicial bleeding.It can not only correct hypersplenism but also completely stanch blood,and auto transplanted spleen in the retroperitoneal space can preserve immune function and establish abroad collateral circulation.

  2. Blind loop perforation after side-to-side ileocolonic anastomosis.

    Science.gov (United States)

    Valle, Raffaele Dalla; Zinicola, Roberto; Iaria, Maurizio

    2014-08-27

    Blind loop syndrome after side-to-side ileocolonic anastomosis is a well-recognized entity even though its incidence and complication rates are not clearly defined. The inevitable dilation of the ileal cul-de-sac leads to stasis and bacterial overgrowth which eventually leads to mucosal ulceration and even full-thickness perforation. Blind loop syndrome may be an underestimated complication in the setting of digestive surgery. It should always be taken into account in cases of acute abdomen in patients who previously underwent right hemicolectomy. We herein report 3 patients who were diagnosed with perforative blind loop syndrome a few years after standard right hemicolectomy followed by a side-to-side ileocolonic anastomosis.

  3. Blind loop perforation after side-to-side ileocolonic anastomosis

    Institute of Scientific and Technical Information of China (English)

    Raffaele; Dalla; Valle; Roberto; Zinicola; Maurizio; Iaria

    2014-01-01

    Blind loop syndrome after side-to-side ileocolonic anas-tomosis is a well-recognized entity even though its in-cidence and complication rates are not clearly defined. The inevitable dilation of the ileal cul-de-sac leads to stasis and bacterial overgrowth which eventually leads to mucosal ulceration and even full-thickness perfora-tion. Blind loop syndrome may be an underestimated complication in the setting of digestive surgery. It should always be taken into account in cases of acute abdomen in patients who previously underwent right hemicolectomy. We herein report 3 patients who were diagnosed with perforative blind loop syndrome a few years after standard right hemicolectomy followed by a side-to-side ileocolonic anastomosis.

  4. DISTAL SPLENORENAL VENOUS ANASTOMOSIS IN TREATMENT OF DIABETES MELLITUS

    Directory of Open Access Journals (Sweden)

    T. I. Shraer

    2010-01-01

    Full Text Available We studied the outcomes of the operations for distal splenorenal venous anastomosis of 134 patients with type 1 diabetes mellitus. We have noticed the significant improvement of patient’s general condition due to spasmolytic effect of glucagon, bypassed to blood circulation without coming through liver and also a stabilization of glyce- mia because of a restoration of insulin-glucagon ratio in systemic circulation. The effect of a surgery depends on a stage of microangiopathy and nephrosclerosis. 

  5. Sutureless colon anastomosis with fibrin glue in the rat.

    Science.gov (United States)

    Haukipuro, K A; Hulkko, O A; Alavaikko, M J; Laitinen, S T

    1988-08-01

    The only technique available for creating an intestinal anastomosis without tissue strangulation is gluing. Theoretically, this could lead to a higher hydroxyproline content and greater mechanical strength than in a sutured anastomosis. To test the hypothesis, 83 rats underwent left colon resection and inverted primary anastomosis with either one layer of sutures (NG group) or fibrin glue (FG group). Seven-day FG anastomoses showed less adhesions (P = .02) but one subclinical leakage and a further radiologic one, compared with a greater amount of adhesions but no leakages in the NG group. The mean bursting pressures (mmHg) in the FG and NG groups, respectively, were 25 +/- 20 (SD) and 63 +/- 23 (N.S.) 30 minutes after surgery, 107 +/- 33 and 115 +/- 30 after one day, 81 +/- 31 and 133 +/- 26 (P less than .001) after four days, and 161 +/- 36 and 175 +/- 24 after seven days. The somewhat earlier rise in hydroxyproline content in the glued anastomoses did not lead to significant intergroup differences. The glued anastomoses were thus weak during the critical lag period of healing. Also, by preventing adhesion formation, the glue may reduce the extra blood supply from perianastomotic vessels. The outcomes might have differed more under demanding experimental or clinical situations. PMID:2456902

  6. Straight ileo-anal anastomosis with myectomy as an alternative to ileal pouch-anal anastomosis in restorative proctocolectomy.

    Science.gov (United States)

    Landi, E; Landa, L; Fianchini, A; Marmorale, C; Piloni, V

    1994-04-01

    Restorative proctocolectomy with various types of reservoir is widely used in the elective surgery of ulcerative colitis and familial adenomatous polyposis. Both, advantages and disadvantages of this procedure are well known and documented. Straight ileo-anal anastomosis (IAA) yields unsatisfactory clinical results due to the lack of storage capacity of the distal ileum and the frequency of bowel movements related to high pressure ileal waves. In an attempt to create an alternative to the above procedures, we have performed a straight ileo-anal anastomosis with two rectangular (10 cm x 1 cm) myectomies down to 2 cm, above the anastomotic line. The two myectomies are spaced at 120 degrees to each other and to the mesenteric border of the ileal loop. The rationale of this approach is to reduce the peristaltic drive of the ileum by weakening the muscular wall. This study presents the results in three patients operated on with this new method in the last year.

  7. Halstedian technique revisited. Innovations in teaching surgical skills.

    Science.gov (United States)

    Barnes, R W; Lang, N P; Whiteside, M F

    1989-07-01

    This paper reviews the laboratory models used to teach fundamental surgical skills in our general surgery residency. The laboratory modules allow supervision and self-instruction, practice, and videotape monitoring of the following techniques: skin incision, suturing, knot tying, hemostasis, vascular anastomosis, and intestinal anastomosis. Pigs' feet simulate human skin for exercises in skin incision, lesion excision, suturing, and basic plastic surgical techniques. Latex tubing and penrose drains allow experience in suturing, knot tying, and hemostasis. Polytetrafluoroethylene vascular prostheses permit quantification of the precision of needle passage and suturing by measurement of leakage of water through a vascular anastomosis. Reconstituted, lyophilized, irradiated bovine arteries and ileum provide models of biologic tissue for creating handsewn vascular anastomoses and sutured or stapled gastrointestinal anastomoses. A headlamp videocamera allows unobstructive recording of the resident's technical performance and provides subsequent visual feedback for self-improvement when compared to reference instructional videotapes. We feel that these innovations may enhance surgical dexterity of residents without the need for animal sacrifice. Our goal is to foreshorten the learning curve for basic surgical skills and improve performance in the clinical operating room.

  8. Surgical treatment of radiation enteritis

    International Nuclear Information System (INIS)

    Radiation enteritis is a progressive, disease process that causes intestinal fibrosis and obliterative endarteritis, which results in significant morbidity and mortality. The authors' clinical experience involving 20 patients over a 22-year period from 1967 through 1989 who underwent various surgical procedures to alleviate chronic symptoms secondary to radiation enteritis is described. Eight men and 12 women with a mean age of 52 years (24 to 81 years) underwent a total of 27 procedures for complications of radiation enteritis. Radiation therapy was delivered for treatment of gynecologic malignancies (55%), colorectal cancer (20%), prostate malignancies (10%), and others (15%). The mean average dose of radiation delivered was 5,514 rads with a range of 2,613 to 7,000 rads. The interval from radiation treatment to time of surgery averaged 9 years. Operative procedures consisted of 12 resection and primary anastomosis procedures and 15 resections with stoma creation. Formation of a stoma was used in patients with more severe disease. The 30-day operative mortality was 0% and morbidity was 55%. There were no anastomotic leaks or intra-abdominal abscesses. The authors conclude that resection and primary anastomosis can safely be performed in selected patients but that judicious use of stoma formation can avoid major mortality and morbidity associated with surgery in this setting

  9. [Rectal resection with colo-anal anastomosis for ergotamine-induced rectal stenosis].

    Science.gov (United States)

    Panis, Y; Valleur, P; Kleinmann, P; Willems, G; Hautefeuille, P

    1990-01-01

    Anorectal ulcers due to ergotamine suppositories are extremely rare. We report the first case of rectal stenosis following regular abuse of ergotamine suppositories which required rectal resection and coloanal anastomosis, despite stopping the intoxication 1 year previously. The rectal eversion during the perineal procedure allowed a low anastomosis to be performed, on the dentate line. One year later, the functional result was considered to be good, demonstrating the place of coloanal anastomosis in benign rectal pathology. PMID:2100123

  10. [The time of proctectomy during ileo-anal anastomosis].

    Science.gov (United States)

    Hautefeuille, P

    1993-01-01

    Proctectomy is one of the most important operative phases of ileal pouch-anal anastomosis. It allows complete resection of the rectal mucosa and determines the quality of the postoperative course and the functional results. Two procedures are described, either with a distal rectal mucosectomy or complete resection of the rectal wall as far as the pectinate line. Functional results are identical. The second procedure leads to a complete resection of the rectal mucosa and therefore will be indicated in cases of low rectal cancer of dysplasia when the anus can be preserved. PMID:8161140

  11. Polarization-sensitive multispectral tissue characterization for optimizing intestinal anastomosis

    Science.gov (United States)

    Cha, Jaepyeong; Triana, Brian; Shademan, Azad; Krieger, Axel; Kim, Peter C. W.; Kang, Jin U.

    2014-03-01

    A novel imaging system that recommends potential suture placement for anastomosis to surgeons is developed. This is achieved by a multispectral imaging system coupled with polarizers and image analysis software. We performed preliminary imaging of ex vivo porcine intestine to evaluate the system. Vulnerable tissue regions including blood vessels were successfully identified and segmented. Thickness of different tissue areas is visualized. Strategies towards optimal points for suture placements have been discussed. Preliminary data suggest our imaging platform and analysis algorithm may be useful in avoiding blood vessels, identifying optimal regions for suture placements to perform safer operations in possibly reduced time.

  12. Gastrojejunal Anastomosis Perforation after Gastric Bypass on a Patient with Underlying Pancreatic Cancer: A Case Report and Review of the Literature.

    Science.gov (United States)

    Bellorin, Omar; Kundel, Anna; Ramirez-Valderrama, Alexander; Castro, Armando

    2015-01-01

    Introduction. We describe a case of gastrojejunal anastomosis perforation after gastric bypass on a patient with underlying pancreatic cancer. Case Description. A 54-year-old female with past surgical history of gastric bypass for morbid obesity and recent diagnosis of unresectable pancreatic cancer presents with abdominal pain, peritonitis, and sepsis. Computerized axial tomography scan shows large amount of intraperitoneal free air. The gastric remnant is markedly distended and a large pancreatic head mass is seen. Intraoperative findings were consistent with a perforated ulcer located at the gastrojejunal anastomosis and a distended gastric remnant caused by a pancreatic mass invading and obstructing the second portion of the duodenum. The gastrojejunal perforation was repaired using an omental patch. A gastrostomy for decompression of the remnant was also performed. The patient had a satisfactory postoperative period and was discharged on day 7. Discussion. Perforation of the gastrojejunal anastomosis after Roux-en-Y gastric bypass is an unusual complication. There is no correlation between the perforation and the presence of pancreatic cancer. They represent two different conditions that coexisted. The presence of a gastrojejunal perforation made the surgeon aware of the advanced stage of the pancreatic cancer.

  13. Gastrojejunal Anastomosis Perforation after Gastric Bypass on a Patient with Underlying Pancreatic Cancer: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Omar Bellorin

    2015-01-01

    Full Text Available Introduction. We describe a case of gastrojejunal anastomosis perforation after gastric bypass on a patient with underlying pancreatic cancer. Case Description. A 54-year-old female with past surgical history of gastric bypass for morbid obesity and recent diagnosis of unresectable pancreatic cancer presents with abdominal pain, peritonitis, and sepsis. Computerized axial tomography scan shows large amount of intraperitoneal free air. The gastric remnant is markedly distended and a large pancreatic head mass is seen. Intraoperative findings were consistent with a perforated ulcer located at the gastrojejunal anastomosis and a distended gastric remnant caused by a pancreatic mass invading and obstructing the second portion of the duodenum. The gastrojejunal perforation was repaired using an omental patch. A gastrostomy for decompression of the remnant was also performed. The patient had a satisfactory postoperative period and was discharged on day 7. Discussion. Perforation of the gastrojejunal anastomosis after Roux-en-Y gastric bypass is an unusual complication. There is no correlation between the perforation and the presence of pancreatic cancer. They represent two different conditions that coexisted. The presence of a gastrojejunal perforation made the surgeon aware of the advanced stage of the pancreatic cancer.

  14. Clinical outcome of ileal pouch-anal anastomosis for chronic ulcerative colitis in China

    Institute of Scientific and Technical Information of China (English)

    Liu Gang; Han Hongqiu; Liu Tong; Fu Qiang; Lyu Yongcheng

    2014-01-01

    Background The incidence of chronic ulcerative colitis (CUC) in China is remarkably increasing,while little information on surgical treatment has been reported.This study aimed to completely describe and analyze the clinical outcome of restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for CUC in China.Methods Ninety-five consecutive patients,who suffered CUC and had surgical indications,were carefully selected.All patients underwent IPAA.Data on patient characteristics,surgical indications,surgical details,postoperative complications,functional outcome,and quality of life were collected.Results The mean patient age at the time of the operation was 32 years.Twenty-nine (31%) patients underwent an emergency operation,and 66 (69%) underwent elective procedures.Four patients with severe dysplasia underwent operations,but no carcinoma was histologically confirmed.A two-stage operation was performed in 87 (92%) patients,and a hand-sewn technique was applied in 88 (93%) patients.Sixteen patients (17.0%) experienced early complications,and there was a significant difference between the emergency surgery group and the elective group (31.0% vs.10.6%,respectively; P <0.01).Five (5.3%) patients developed pouchitis as a late complication.The mean stool frequency after the operation was 4.6 (2-11) during the first 24 hours and 1.5 (0-4) overnight.According to the Kirwan grading scale,87 (91.8%) patients showed satisfactory anal continence function.The quality of life improved significantly from a preoperative mean value of 0.28-0.61 before ileostomy closure to 0.78 after ileostomy closure (P <0.01) according to the Cleveland Global Quality of Life index.Conclusions IPAA is an effective and safe surgical procedure for patients with CUC in China.However,some characteristics,such as the low incidence of pouchitis,require further study.

  15. Pancreaticoduodenectomy with Roux—Y Anastomosis to Reconstruct the Digestive Tract:A Report of 30 Cases

    Institute of Scientific and Technical Information of China (English)

    MAYougang; LIXiaosong; 等

    2002-01-01

    Objective To explore the ways how to decrease the morbidity and mortality of pancreaticoduodenectomy(PD).Medthods In 30 cases of PD,a free vascularized jejunal loop was used to pefform single loop Roux-Y anastomosis to reconstruct the digestive tract.Results The morality rate was xero and there were no cases of leakage at the pancraticojejunostomy and choledocojejunostomy.All patients were discharged from hospita 10-14 days after operation.Postoperative follow-up of long-term choronic complications showed only one patient(3.33%)suffered from chronic steatorrhea and malnutrition,the remaining 29 cases(96.67%)had a good function of digestion and normal nutrition.There were no cases of biler reflux gastric disease,retrograde infection,anastomostic ulcer of gastrojejunostomy,and dumping syndrome.Conclusion This surgical procedure can effectively reduce the morbidity and the mortality of PD.

  16. Angiographic results of retinal-retinal anastomosis and retinal-choroidal anastomosis after treatments in eyes with retinal angiomatous proliferation

    Directory of Open Access Journals (Sweden)

    Saito M

    2012-08-01

    Full Text Available Masaaki Saito,1 Tomohiro Iida,1,2 Mariko Kano,1 Kanako Itagaki11Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, 2Department of Ophthalmology, Tokyo Women's Medical University School of Medicine, Tokyo, JapanBackground: The purpose of this study was to evaluate the angiographic results of retinal-retinal anastomosis (RRA and retinal-choroidal anastomosis (RCA for eyes with retinal angiomatous proliferation (RAP after treatment with intravitreal bevacizumab injections as monotherapy or intravitreal bevacizumab combined with photodynamic therapy.Methods: In this interventional, consecutive case series, we retrospectively reviewed five naïve eyes from four patients (mean age 80 years treated with three consecutive monthly intravitreal bevacizumab (1.25 mg/0.05 mL injections as initial treatment, and followed up for at least 3 months. In cases with over 3 months of follow-up and having recurrence of RAP or leakage by fluorescein angiography, retreatment was performed with a single intravitreal bevacizumab injection and photodynamic therapy.Results: Indocyanine green angiography showed RRA in three eyes with subretinal neovascularization and RCA in two eyes with choroidal neovascularization at baseline. At 3 months after baseline (month 3, neither the RRA nor RCA was occluded in any eye on indocyanine green angiography. Retreatment with intravitreal bevacizumab plus photodynamic therapy was performed in three eyes at months 3 (persistent leakage on fluorescein angiography, 6, and 7 (recurrence of RAP lesion, which achieved obvious occlusion of the RRA and RCA. Mean best-corrected visual acuity improved from 0.13 to 0.21 at month 3 (P = 0.066. No complications or systemic adverse events were noted.Conclusion: Although intravitreal bevacizumab for RAP was effective in improving visual acuity during short-term follow-up, intravitreal bevacizumab could not achieve complete occlusion of RRA and RCA, which could

  17. Smart tissue anastomosis robot (STAR): a vision-guided robotics system for laparoscopic suturing.

    Science.gov (United States)

    Leonard, Simon; Wu, Kyle L; Kim, Yonjae; Krieger, Axel; Kim, Peter C W

    2014-04-01

    This paper introduces the smart tissue anastomosis robot (STAR). Currently, the STAR is a proof-of-concept for a vision-guided robotic system featuring an actuated laparoscopic suturing tool capable of executing running sutures from image-based commands. The STAR tool is designed around a commercially available laparoscopic suturing tool that is attached to a custom-made motor stage and the STAR supervisory control architecture that enables a surgeon to select and track incisions and the placement of stitches. The STAR supervisory-control interface provides two modes: A manual mode that enables a surgeon to specify the placement of each stitch and an automatic mode that automatically computes equally-spaced stitches based on an incision contour. Our experiments on planar phantoms demonstrate that the STAR in either mode is more accurate, up to four times more consistent and five times faster than surgeons using state-of-the-art robotic surgical system, four times faster than surgeons using manual Endo360(°)®, and nine times faster than surgeons using manual laparoscopic tools. PMID:24658254

  18. Smart tissue anastomosis robot (STAR): a vision-guided robotics system for laparoscopic suturing.

    Science.gov (United States)

    Leonard, Simon; Wu, Kyle L; Kim, Yonjae; Krieger, Axel; Kim, Peter C W

    2014-04-01

    This paper introduces the smart tissue anastomosis robot (STAR). Currently, the STAR is a proof-of-concept for a vision-guided robotic system featuring an actuated laparoscopic suturing tool capable of executing running sutures from image-based commands. The STAR tool is designed around a commercially available laparoscopic suturing tool that is attached to a custom-made motor stage and the STAR supervisory control architecture that enables a surgeon to select and track incisions and the placement of stitches. The STAR supervisory-control interface provides two modes: A manual mode that enables a surgeon to specify the placement of each stitch and an automatic mode that automatically computes equally-spaced stitches based on an incision contour. Our experiments on planar phantoms demonstrate that the STAR in either mode is more accurate, up to four times more consistent and five times faster than surgeons using state-of-the-art robotic surgical system, four times faster than surgeons using manual Endo360(°)®, and nine times faster than surgeons using manual laparoscopic tools.

  19. Ventricular Assist Device in Single-Ventricle Heart Disease and a Superior Cavopulmonary Anastomosis.

    Science.gov (United States)

    Niebler, Robert A; Shah, Tejas K; Mitchell, Michael E; Woods, Ronald K; Zangwill, Steven D; Tweddell, James S; Berger, Stuart; Ghanayem, Nancy S

    2016-02-01

    Our objective is to describe the use of a ventricular assist device (VAD) in single-ventricle patients with circulatory failure following superior cavopulmonary anastomosis (SCPA). We performed a retrospective chart review of all single-ventricle patients supported with a VAD following SCPA. Implantation techniques, physiologic parameters while supported, medical and surgical interventions postimplant, and outcomes were reviewed. Four patients were supported with an EXCOR Pediatric (Berlin Heart Inc., The Woodlands, TX, USA) following SCPA for a median duration of 10.5 days (range 9-312 days). Selective excision of trabeculae and chords facilitated apical cannulation in all patients without inflow obstruction. There were two pump exchanges in the one patient supported for 312 days. Two patients were evaluated by cardiac catheterization while supported. Three of four patients were successfully bridged to transplantation. One patient died while supported. All patients had significant bleeding at the time of transplantation, and one required posttransplant extracorporeal membrane oxygenation with subsequent full recovery. VAD support can provide a successful bridge to transplantation in patients with single-ventricle circulation following SCPA. A thorough understanding of the challenges encountered during this support is necessary for successful outcomes.

  20. Gastrojejunal Anastomosis Complications and Their Management after Laparoscopic Roux-en-Y Gastric Bypass

    Directory of Open Access Journals (Sweden)

    Yannick Fringeli

    2015-01-01

    Full Text Available Background. Complications at the gastrojejunal anastomosis after laparoscopic Roux-en-Y gastric bypass (LRYGB are challenging in terms of diagnosis, therapy, and prevention. This study aims at identifying these complications and discussing their management. Methods. Data of 228 patients who underwent a LRYGB between October 2008 and December 2011 were reviewed retrospectively to evaluate the frequency and treatment of complications such as stenoses, marginal ulcers, perforated marginal ulcers, or anastomotic leaks related to the operation. Results. Follow-up information was available for 209 patients (91.7% with a median follow-up of 38 months (range 24–62 months. Of these patients 16 patients (7.7% experienced complications at the gastrojejunostomy. Four patients (1.9% had stenoses and 12 patients (5.7% marginal ulcers, one of them with perforation (0.5%. No anastomotic leaks were reported. One case with perforated ulcer and one with recurrent ulcers required surgical revision. Conclusion. Gastrojejunal anastomotic complications are frequent and occur within the first few days or up to several years after surgery. Stenoses or marginal ulcers are usually successfully treated nonoperatively. Laparoscopic repair, meanwhile, is an appropriate therapeutic option for perforated ulcers.

  1. The Immediate Results of Surgical Treatment of Bladder Cancer

    Directory of Open Access Journals (Sweden)

    Alexei L. Charyshkin

    2016-06-01

    Full Text Available The objective of this study was to evaluate the immediate results of the use of ureterointestinal anastomosis according to the Bricker technique at radical cystectomy (RC for bladder cancer (BC. Materials and Results: The study included 96 patients (11.5% women and 88.5% men with bladder cancer (BC, aged from 31 to 74 years (mean age 63.8±7.2, who underwent RC in the Lipetsk Regional Oncology Center, in the period from 2005 to 2014. Among the early postoperative complications, we identified dynamic ileus (16.7%, inflammatory complications of the surgical wound (12.5%, acute pyelonephritis (10.4%, and failure of ureterointestinal anastomosis (4.2%. The frequency of postoperative acute pyelonephritis corresponded to the findings of other authors. Two (2.1% patients died from early postoperative complications because of concomitant diseases (ischemic heart disease, myocardial infarction; thus, postoperative mortality in the early postoperative period was 4.2%. Chronic pyelonephritis with chronic renal failure detected in 15(15.6% patients after one year after surgery was the most frequent late postoperative complication. The stricture of ureterointestinal anastomosis in 9(9.4% patients has been eliminated through relaparotomy and resection of anastomosis. The development of urolithiasis in 12(12.5% patients after one year after surgery has required the implementation of contact lithotripsy and litholytic therapy.

  2. Caudal shif ting of hepatic vein anastomosis inright liver living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Sheung Tat Fan

    2008-01-01

    BACKGROUND: In right liver living donor liver trans-plantation, hepatic venous anastomosis is performed using the recipient's right hepatic vein oriifce. There may be situations that the portal vein is short or the right liver graft is small, leading to dififculty in portal vein, hepatic artery or duct-to-duct anastomosis. METHODS: The recipient's right hepatic vein oriifce is closed partially for 2 cm at the cranial end or totally, and a new venotomy is made caudal to the right hepatic vein oriifce. Hepatic vein anastomosis is performed with the new venotomy. RESULTS: The distance between the liver graft hilum and hepatoduodenal ligament is reduced. Portal vein, hepatic artery and biliary anastomosis could be performed without tension or conduit. CONCLUSION: Caudal shifting of hepatic vein anasto-mosis facilitates implantation of a right liver living donor graft.

  3. 改良胃空肠Roux-en-Y吻合术在胃肠手术中的应用%Modified gastrojejunostomy Roux-en-Y anastomosis in gastrointestinal surgery

    Institute of Scientific and Technical Information of China (English)

    孙劲松; 施开德; 朱际飚; 杜俊

    2011-01-01

    目的:探讨改良胃空肠Roux-en-Y吻合术在胃肠手术中的临床应用价值,选择理想的胃空肠吻合术式.方法:2006年11月~2010年2月我科选择20例胃肠手术患者采用改良Roux-en-Y吻合术(在不切断空肠的前提下行胃空肠吻合加Brown吻合,同时阻断输入襻空肠)完成重建消化道,并进行回顾性分析.结果:全组无手术死亡和吻合口漏、出血、狭窄并发症出现,且未发现有明显症状的碱性反流性胃炎,无Roux潴留综合征发生.结论:改良胃空肠Roux-en-Y吻合术既具有标准Roux-en-Y吻合术的优点,又比标准Roux-en-Y吻合术操作简单、手术时间减少、并发症少,可以作为胃空肠吻合的首选术式.%Objective: To evaluate the modified gastrojejunostomy Roux-en-Y anastomosis in gastrointestinal surgery clinical value, to select the ideal surgical gastrojejunostomy. Methods: From Nov. 2006 to Feb. 2010, our department of gastrointestinal surgery in 20 patients with the modified Roux-en-Y anastomosis (jejunum, without cutting down the premise of Brown anastomosis plus gastrojejunostomy, while blocking the input loop of jejunum ) completed the reconstruction of digestive tract, and analyzed retrospectively. Results: There was no operative mortality and anastomotic leakage, bleeding, stricture complications, and did not show obvious symptoms of alkaline reflux gastritis, no occurrence of Roux stasis syndrome. Conclusion: Modified gastrojejunostomy Roux-en-Y anastomosis with both the standard Roux-en-Y anastomosis advantage off than the standard Roux-en-Y anastomosis is simple, to reduce operation time, fewer complications, can be used as Gastrojejunostomy the preferred surgical anastomosis.

  4. Outflow distribution at the distal anastomosis of infrainguinal bypass grafts.

    Science.gov (United States)

    Fisher, R K; How, T V; Bakran, A; Brennan, J A; Harris, P L

    2004-03-01

    Outflow distribution at the distal anastomosis of infrainguinal bypass grafts remains unquantified in vivo, but is likely to influence flow patterns and haemodynamics, thereby impacting upon graft patency. This study measured the ratio of distal to proximal outflow in 30 patients undergoing infrainguinal bypass for lower limb ischaemia, using a flow probe and a transit-time ultrasonic flow meter. The mean outflow distribution was approximately 75% distal to 25% proximal, with above knee anastomoses having a greater proportion of distal flow (84%) compared to below knee grafts (73%). These in vivo flow characteristics differ significantly from those used in theoretical models studying flow phenomena (50:50 and/or 100:0), and should be incorporated into future research. PMID:14757463

  5. A new endoscopic therapeutic method for acute obstructive suppurative cholangitis post Roux-en-Y anastomosis: endoscopic retrograde cholangiography through jejunostomy

    Directory of Open Access Journals (Sweden)

    Zhuo YANG

    2012-01-01

    Full Text Available  Objective  To probe the value of endoscopic retrograde cholangiography (ERC through jejunostomy in patients in whom ERC could not be performed via the mouth after Roux-en-Y anastomosis on the upper gastrointestinal tract. Methods  In two patients suffering from acute obstructive suppurative cholangitis after a radical operation for cholangiocarcinoma, ERC could not be performed through the mouth due to the presence of a long non-functional jejunal loop. A jejunostomy was first done in the afferent loop of the jejunum, and a gastroscope was then inserted via the jejunostomy and passed retrogradely, to find the stoma of the cholangiointestinal anastomosis. ERC was then successfully performed, and followed by endoscopic retrograde biliary drainage (ERBD. Results  The operation was successful. It was found that cholangio-jejunostomy stoma was narrow, and a large amount of purulent mucus was present in the enlarged intrahepatic duct. ERC was done to enlarge the stoma, and a stent was placed into the main branch of the intrahepatic duct. Two patients achieved surgical success and smooth recovery after the operation. Conclusion  ERC through a jejunostomy in the patients who had Roux-en-Y cholangiojejunostomy following radical resection for cholangiocarcinoma, is a safe and effective surgical procedure.

  6. Operação de Glenn bidirecional Bidirectional Glenn anastomosis

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    Paulo Chaccur

    1992-09-01

    complex heart defects, in those patients that doesn't meet the necessary criteria for prosecution of an atriopulmonary anastomosis. The surgery consists on anastomosing the superior caval vein (end to side anastomoses, in a way that the venous blood is distributed to both the right and left lungs. Between January and February, 1992, 20 patients have undergone the bidirectional anastomosis at the Instituto Dante Pazzanese de Cardiologia. Eight patients were female. Their ages ranged from 5 months to 8 years (mean age 37.7 months and their weights ranged from 6.3 to 18.8 kg (means 12.4 kg. The surgical indication was considered primary in 10 cases. There were 8 patients with tricuspid atresia and 3 double inlet ventricles with highly diminished pulmonary blood flow considered not ideal candidates to a complete rapair. The other patients were considered secundary surgical indication. They had previous palliative operations such as systemic pulmonary shunts; pulmonary banding and atrialseptectomy (6 with tricuspid atresia, 3 double inlet ventricle with pulmonary stenosis or banding and 1 double intlet right ventricle with superior inferior ventricle. The surgery was performed with direction of the caval vein to right atrium in 12 cases and by means of cardiopulmonary bypass in 8. During the operation, the patients were monitored with a pulsatile oximeter. The mean preoperative arterial oxygen saturation was 75.5% (range 71 % to 86% and postoperative 95% (range 91 % to 98%. No hospital death occurred. There was one late death caused by pulmonary infection two months after the surgery. We believe that the bidirectional Glenn anastomosis has its place as a first stage to a complete correction, because it doesn't increase cardiac work and pulmonary vascular resistence and is not associated with pulmonary arterial and anastomotic distortions as Blalock-Taussig does.

  7. Surgical Assisting

    Science.gov (United States)

    ... specific training over and above a degree in science, nursing, physician assisting, or another health profession. Prerequisites . Recommended eligibility requirements for admission into a surgical assisting program are: Bachelor of Science degree (or higher) Associate degree in an allied ...

  8. Healing of Stoma After Magnetic Biliary-Enteric Anastomosis in Canine Peritonitis Models

    Institute of Scientific and Technical Information of China (English)

    Jian-hui Li; Long Guo; Wei-jie Yao; Zhi-yong Zhang; Shan-pei Wang; Shi-qi Liu; Zhi-min Geng; Xiao-ping Song; Yi Lv

    2014-01-01

    Objective To assese the healing of stoma after magnetic anastomosis for the reconstruction of biliary-enteric continuity under severe inflammation. Methods Acute bile duct injury was constructed as a bile peritonitis model in mongrel dogs (n=32). Magnetic anastomosis (group A, n=16) and traditional suture anastomosis (group B, n=16) were performed to reconstruct the biliary-enteric continuity in one stage. Half of the dogs in each group were euthanized on the 30th postoperative day, and the other half on the 90th postoperative day to harvest the stoma region. The healing conditions of the stoma after the 2 anastomotic approaches were observed with naked eyes, under light microscope and scanning electron microscope. Results The stoma leakage rate (50%versus 0%on the 30th postoperative day, 37.5%versus 12.5%on the 90th postoperative day, both P Conclusions Magnetic anastomosis stent ensures better healing of the stoma even under the circumstance of severe inflammation.

  9. CROSSING ANASTOMOSIS OF NERVE BUNDLES NEAR INNERVATED ORGANS TO TREAT IRREPARABLE NERVE INJURIES

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To study the therapeutical effects of crossing anastomosis of nerve on the peripheral and central nerve injuries.Methods Twelve kinds of central and peripheral nerve disorders and their complications were treated with 11 kinds of crossing anastomosis of nerve bundles near the innervated organs. After nerve injury and repair, somatosensory evoked potentials (SEPs) and horseradish peroxidase (HRP) retrograde tracing studies were used to investigate the rabbit's nerve function and morphology.Results The ulcers of all patients healed. Sensation, voluntary movement, and joint function recovered. Four weeks after the anastomosis of distal stump of radialis superficialis nerve and median nerve, pain sensation regained and SEPs appeared. HRP retrograde tracing studies demonstrated sensory nerve ending of medial nerve formed new connection with the body of neuron.Conclusion Crossing anastomosis of nerve is an effective method to treat peripheral and central nerve injuries.

  10. In vivo laser assisted end-to-end anastomosis with ICG-infused chitosan patches

    Science.gov (United States)

    Rossi, Francesca; Matteini, Paolo; Esposito, Giuseppe; Scerrati, Alba; Albanese, Alessio; Puca, Alfredo; Maira, Giulio; Rossi, Giacomo; Pini, Roberto

    2011-07-01

    Laser assisted vascular repair is a new optimized technique based on the use of ICG-infused chitosan patch to close a vessel wound, with or even without few supporting single stitches. We present an in vivo experimental study on an innovative end-to-end laser assisted vascular anastomotic (LAVA) technique, performed with the application of ICGinfused chitosan patches. The photostability and the mechanical properties of ICG-infused chitosan films were preliminary measured. The in vivo study was performed in 10 New Zealand rabbits. After anesthesia, a 3-cm segment of the right common carotid artery was exposed, thus clamped proximally and distally. The artery was then interrupted by means of a full thickness cut. Three single microsutures were used to approximate the two vessel edges. The ICG-infused chitosan patch was rolled all over the anastomotic site and welded by the use of a diode laser emitting at 810 nm and equipped with a 300 μm diameter optical fiber. Welding was obtained by delivering single laser spots to induce local patch/tissue adhesion. The result was an immediate closure of the anastomosis, with no bleeding at clamps release. Thus animals underwent different follow-up periods, in order to evaluate the welded vessels over time. At follow-up examinations, all the anastomoses were patent and no bleeding signs were documented. Samples of welded vessels underwent histological examinations. Results showed that this technique offer several advantages over conventional suturing methods: simplification of the surgical procedure, shortening of the operative time, better re-endothelization and optimal vascular healing process.

  11. Significance and specificity of vascular anastomosis in liver transplantation: Our experience

    OpenAIRE

    Nenezić Dragoslav; Tasić Nebojša; Ilijevski Nenad; Radak Đorđe

    2007-01-01

    Introduction Transplantation is the method of choice in the treatment of terminal liver diseases with acute and structural damage of liver tissue and congenital liver diseases. Objective The aim of our study was to determine specificity and significance of vascular anastomosis in liver transplantation by postoperative evaluation of vascular anastomosis function. Method The study included 16 patients with 16 liver transplantations and one re-do liver transplantation. In all patients, preoperat...

  12. HAND-SEWN VERSUS STAPLER ESOPHAGOGASTRIC ANASTOMOSIS AFTER ESOPHAGEAL RESSECTION: SISTEMATIC REVIEW AND META-ANALYSIS

    OpenAIRE

    Castro, Paula Marcela Vilela; RIBEIRO, Felipe Piccarone Gonçalves; ROCHA, Amanda de Freitas; Mônica MAZZURANA; ALVAREZ, Guines Antunes

    2014-01-01

    Introduction Postoperative anastomotic leak and stricture are dramatic events that cause increased morbidity and mortality, for this reason it's important to evaluate which is the best way to perform the anastomosis. Aim To compare the techniques of manual (hand-sewn) and mechanic (stapler) esophagogastric anastomosis after resection of malignant neoplasm of esophagus, as the occurrence of anastomotic leak, anastomotic stricture, blood loss, cardiac and pulmonary complications, mortality and ...

  13. Hypoglossal-facial nerve anastomosis: a clinical and electrophysiological follow-up.

    OpenAIRE

    Iansek, R.; Harrison, M. J.; Andrew, J

    1986-01-01

    Eight patients with acoustic neuroma and five patients with hemifacial spasm, who had undergone hypoglossal-facial nerve anastomosis 1-14 years previously, were reviewed clinically and electrophysiologically with an electrically elicited blink reflex. Functional recovery from the anastomosis, as rigorously judged on a scale of good, fair and poor, was fair to poor. Electrically it was found that the blink reflex was present in eight patients, suggesting facial nerve re-innervation of the faci...

  14. Completely obstructed colorectal anastomosis: A new non-electrosurgical endoscopic approach before balloon dilatation

    Institute of Scientific and Technical Information of China (English)

    Gabriele; Curcio; Marco; Spada; Fabrizio; di; Francesco; Ilaria; Tarantino; Luca; Barresi; Gaetano; Burgio; Mario; Traina

    2010-01-01

    Benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection. On occasion, the anastomosis may close completely. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials as to the optimal approach. Through-the-scope balloon dilatation is well known and easy to perform. Some case reports describe different endoscopic approaches, including endoscopic electrocision with a papillotomy knife or hook knife...

  15. Role of water-soluble enema before takedown of diverting ileostomy for low pelvic anastomosis.

    Science.gov (United States)

    Karsten, Benjamin J; King, Justin B; Kumar, Ravin R

    2009-10-01

    The integrity of a low pelvic anastomosis is often studied radiographically before takedown of a diverting ileostomy. The aim of this study is to determine the impact of routine water-soluble enema studies (WSE) in our patient population with low pelvic anastomosis. We retrospectively reviewed the operative database for a county teaching hospital from 1998 to 2008. All patients with low pelvic anastomosis (ultralow colorectal, coloanal, and ileoanal pouch anastomosis) with diverting ileostomy who underwent subsequent takedown were identified. Fifty patients met inclusion criteria. Thirty-eight patients were evaluated by WSE and 12 were not. Twenty-five patients (66%) were noted to have normal WSE studies before ostomy takedown. Thirteen patients (26%) were noted to have abnormalities on WSE. Two stenoses were clinically significant. Water-soluble enema study was 100 per cent sensitive and 69 per cent specific for detecting significant pathology. Digital rectal examination (DRE), colonoscopy, and flexible sigmoidoscopy were also 100 per cent sensitive in detecting substantial pathology. Routine use of WSE failed to demonstrate a significant impact on patients with low pelvic anastomosis undergoing ileostomy takedown. Routine DRE and rigid proctoscopy can be used to evaluate low pelvic anastomosis. WSE can be used selectively on patients with abnormal findings. PMID:19886140

  16. Clinical applications of magnetic rings in colorectal anastomosis.

    Science.gov (United States)

    Jansen, A; Brummelkamp, W H; Davies, G A; Klopper, P J; Keeman, J N

    1981-10-01

    Based upon experiments on animals, an anastomotic apparatus, consisting of two magnetic rings of polymer bonded, rare earth cobalt magnets embedded in polyester, was developed. There are three types of polyester device with diameters of 25, 28, and 30 millimeters, respectively. The force between the magnets varied between 2.5 Newtons at 4 centimer separation and 11.8 Newtons at union. For the low colorectal anastomosis, a magnet holder, connecting rod and spherical cap were developed. The aim of the technique is a quick restoration of the underbroken submucosal intestinal cylinder by optimal circular apposition of the submucosal layer. The working mechanism is based upon progressive compression, leading to necrosis of the intermediate mucosal and submucosal layers by increasing the magnetic force while intestinal healing takes place. After seven to 12 days, the magnets cut through the disappear from the anastomotic region by intestinal peristalsis. From the initial series of 21 patients, 11 resections of the sigmoid colon and nine low anterior resections were performed. Dehiscence of the suture line was noted in two instances. One patient required reoperation. The other patient had a small area of dehiscence at the suture line after evacuation of an infected hematoma with a further uncomplicated course. One patient died on the third postoperative day of recurrent myocardial infarction. In the other 18 patients, primary intestinal healing was demonstrated roentgenologically and sigmoidoscopically. PMID:7280943

  17. CO2 vascular anastomosis of atherosclerotic and calcified arteries

    Science.gov (United States)

    White, John V.; Leefmans, Eric; Stewart, Gwendolyn J.; Katz, Mira L.; Comerota, Anthony J.

    1990-06-01

    The technique for CO2 laser fusion vascular anastomosis in normal vessels has been well established. Normal arterial wall has a predictable thermal response to the incident laser energy, with rapid heating and cooling of collagen within the arterial wall. Since atherosclerosis involves subendothelial cellular proliferation, lipid and calcium deposition, it may modify the thermal responsiveness of the arterial wall. To this study, CO2 laser fusion anastomoses were attempted in rabbits with non-calcific atherosclerosis and humans with calcific atherosclerosis. All anastomoses were successfully completed without alteration in technique despite the presence of plaque at the site of laser fusion. Histology of rabbit vessels revealed the classic laser fusion cap within the adventitia and persistent atherosclerotic plaque at the flow surface. Duplex imaging of patients post-operatively demonstrated long term anastomotic patency in 2 of 3 fistulae. These results suggest that neither non-calcified or calcified atherosclerosis significantly alters the arterial wall thermal responsiveness to CO2 laser energy or inhibits creation of laser fusion anastomoses. Therefore, this technique may be applicable to the treatment of patients with atherosclerotic occlusive disease.

  18. The relationship between suture number and the healing process of end-to-end arterial anastomosis

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    Winston B Yoshida

    1997-06-01

    Full Text Available In spite of the grate experience accumulated in vascular repairing, the ideal number of sutures for vascular anastomosis remains controversial. It is generally thought that the more stitches applied in a vascular anastomosis, the lesser resistant the anastomosis will be. The purpose of this study was to test this hypothesis in 20 rabbits, in which both carotid arteries were cross sectioned and repaired by end-to-end anastomosis with 8 interrupted sutures in one side (G1 and 16 in the other side (G2. After 3 and 15 days, the animals were randomly allocated for tensile strength, hydroxyproline determination (7 animals and for histologic analysis of the anastomosis (3 animals. Conventional staining procedures (hematoxylin-eosin and Masson methods and the picrosirius red polarization (PSP technique for collagen type determination were used. From 3 to 15 days, the tensile strength increased in both groups, from 265.0±-44.4g to 391.2±-49.0g in G1 and from 310.0±-71.5g to 348.7±-84.0g in G2 (p<0.005, with no statistical difference between the groups in each period of study. The hydroxyproline content, expressed as hydroxyproline/protein ratio, varied from 0.04±-0.01 to 0.05±-0.02 in G1 and from 0.05±-0.01 to 0.05±-0.02 in G2, with no significant difference between periods and groups. The histology showed similar inflammatory and reparative aspects in both groups. In both groups and periods the PSP technique demonstrated predominantly type I collagen in relation to type III collagen in the anastomosis. We concluded that even doubling the number of stitches, the healing process and strength did not change in the arterial anastomosis.

  19. OUTCOME OF EARLY ORAL FEEDING AFTER ELECTIVE COLONIC ANASTOMOSIS

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    Sushant

    2015-08-01

    Full Text Available OBJECTIVE: Outcome of early oral feeding after elective colonic anastomosis . STUDY DESI G N: Descriptive case series . PLACE & DURATION OF STUDY : Department of Surgery Mata Gujari Medical C ollege, Kishanganj, Bihar, India. From June 2012 - March 2014. METHODOLOGY: De tailed preoperative ev aluation of the selected patients was done. Patients with malignancies, heart disease, poor general conditions, distal loop obstructions were excluded from the series. In selected patient’s proper history, physical examination and base line investigations were done. Limited bowel preparation was done in all the patients. Postope ratively 15 - 50 ml of sips was allowed 2 hourly after recovery form anesthesia . Free oral fluid intake was allowed on postoperative day - 1 , semisolids on day - 2 and day - 3 as tolerated and full oral diet allowed on day - 4. In case of two episodes of vomiting and absence of bowel sounds , patients were kept nil by mouth and nasogastric tube was inserted . RESULTS : Total 68 pat ients were selected, out of which 46(67.64% were males and 22(32.36% females (M.F2.09 : 1 . The age range was from 28 year to 76 year wi th mean age of 47.5 +2.4 year . Passage of first flatus was observed between 2 to 6 days (mean 2.8 days , and the time of first passage of stool was 3 - 8 days (mean 4.6 days. Twelve (17.64% patients did not tolerate feeding . Intolerance to feed results into vomiting and abdominal distension. Postoperative complications included wound infection (10.29% , electrolyte imbalance (4.41%, respiratory tract infections (2.94%, anastigmatic leaks (1.47% and wound dehiscence (1.47% . The hospital stay was 3 - 8 day ( M ean 5.4 day . CONCLUSION : Early oral feeding after elective colonic surgery was safe and well tolerated by majority of the patients.

  20. Significance and specificity of vascular anastomosis in liver transplantation: Our experience

    Directory of Open Access Journals (Sweden)

    Nenezić Dragoslav

    2007-01-01

    Full Text Available Introduction Transplantation is the method of choice in the treatment of terminal liver diseases with acute and structural damage of liver tissue and congenital liver diseases. Objective The aim of our study was to determine specificity and significance of vascular anastomosis in liver transplantation by postoperative evaluation of vascular anastomosis function. Method The study included 16 patients with 16 liver transplantations and one re-do liver transplantation. In all patients, preoperative angiography and postoperative duplex sonographic and angiographic evaluation of vascular anastomosis were performed. Results Preoperative angiographic evaluation did not reveal anomalies in liver blood vessels of transplant candidates. In one patient, we identified and angiographically confirmed stenosis on anastomosis of the hepatic artery on the 7th postoperative day. In another patient, we had artificial thrombosis of the hepatic artery branch due to the liver biopsy. Conclusion The successful performance of vascular anastomosis in liver transplantation is significant for adequate liver graft perfusion, good postoperative graft function and overall outcome of the liver transplantation.

  1. Carotid-anterior cerebral artery anastomosis on MR angiography: a university hospital-based study

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, Akira; Saito, Naoko; Okada, Yoshitaka; Inoue, Kaiji [Saitama Medical University International Medical Center, Department of Diagnostic Radiology, Hidaka, Saitama (Japan)

    2012-01-15

    Rarely in the anterior circulation, an anastomosis of the carotid and anterior cerebral arteries occurs when an anomalous branch arises from the ophthalmic segment of the internal carotid artery and anastomoses with the A1-A2 junction of the anterior communicating artery. Right-side predominance is known. To our knowledge, the incidence of carotid-anterior cerebral artery anastomosis has not been reported, so we researched cases in our institution records to determine incidence and investigated characteristic features of the condition on magnetic resonance (MR) angiography. To isolate such cases, we retrospectively reviewed cranial MR angiographic images of 3,491 consecutive patients in our institution. We found three cases with carotid-anterior cerebral artery anastomosis (two men, one woman), representing an incidence of 0.086%. The anastomosis was on the right in all three cases. A normal A1 segment of the anterior cerebral artery (ACA) was present in two cases but could not be identified in the remaining case on MR angiographic images that included source images. Two of the three patients demonstrated associated arterial variations in their carotid systems. On MR angiography, we observed a 0.086% incidence of carotid-anterior cerebral artery anastomosis in our institution and reaffirmed the right-side predominance of this anomaly. We found a high frequency of other associated arterial variations in the carotid system. (orig.)

  2. Radiological evaluation of the patency of duodenal-esophageal anastomosis during a long postoperative follow-up: effectiveness of an alkaline reflux model in rats

    Directory of Open Access Journals (Sweden)

    Cavazzola L

    2011-08-01

    Full Text Available André Vicente Bigolin1, João Vicente Grossi2, Juliano Hermes Maeso Montes1, Roberto Nicola1, Leandro Totti Cavazzola11School of Medicine, Lutheran University of Brazil, Canoas; 2Hospital de Pronto Socorro de Porto Alegre, Department of Surgery, Porto Alegre, Rio Grande do Sul, BrazilBackground: Performing experimental studies has played an important role in acquiring knowledge about esophageal carcinogenesis. In this context, the choice of a more reliable experimental model requires proof of its effectiveness in order to lend greater credibility to the results. The objective of this study was to evaluate the patency of duodenal-esophageal anastomosis during long-term postoperative follow-up in rats.Methods: This was an experimental study in which 45 female Wistar rats were used. A side-to-side anastomosis was performed, going from the anterior side of the esophagus to the second duodenal portion. A standardized radiological technique was used to carry out a contrasted radiological study of the esophagus, stomach, and duodenum during weeks 4, 12, 20, and 30 after surgery. Different contrast media were used, and the animals were divided into groups, ie, group 1 (100% barium sulfate, group 2 (50% barium sulfate, and group 3 (60% aqueous iodinated contrast media. Contrast radiographs were taken in each group at weeks 4, 12, 20, and 30 after the surgical procedure. The radiographic images were evaluated by two radiologists who were blinded regarding the contrast groups. Macroscopic evaluation of each animal was compared with the radiological findings.Results: Postoperative mortality was 13.33%. The remaining animals were divided into study groups. All the contrast radiological examinations showed evidence of the location of the esophagus, stomach, and proximal portion of the intestine, and demonstrated the laterolateral relationship of the distal esophagus and the duodenum in the epigastric region. Patency of the anastomosis was observed at each

  3. Outcome of surgical treatment of intestinal perforation in typhoid fever

    Institute of Scientific and Technical Information of China (English)

    Aziz; Sümer; zgür; Kemik; Ahmet; Cumhur; Dülger; Aydemir; Olmez; Ismail; Hasirci; Erol; Kisli; Vedat; Bayrak; Gulay; Bulut; etin; Kotan

    2010-01-01

    AIM:To represent our clinical experience in the treatment of intestinal perforation arising from typhoid fever.METHODS:The records of 22 surgically-treated patients with typhoid intestinal perforation were evaluated retrospectively.RESULTS:There were 18 males and 4 females,mean age 37 years(range,8-64 years).Presenting symptoms were fever,abdominal pain,diarrhea or constipation.Sixteen cases were subjected to segmental resection and end-to-end anastomosis,while 3 cases received 2-layered primary repair foll...

  4. [Surgery for pancreatic cancer: Evidence-based surgical strategies].

    Science.gov (United States)

    Sánchez Cabús, Santiago; Fernández-Cruz, Laureano

    2015-01-01

    Pancreatic cancer surgery represents a challenge for surgeons due to its technical complexity, the potential complications that may appear, and ultimately because of its poor survival. The aim of this article is to summarize the scientific evidence regarding the surgical treatment of pancreatic cancer in order to help surgeons in the decision making process in the management of these patients .Here we will review such fundamental issues as the need for a biopsy before surgery, the type of pancreatic anastomosis leading to better results, and the need for placement of drains after pancreatic surgery will be discussed.

  5. Interintestinal Anastomoses With New Generation Of Circular - Stapling Instrument Supporting At Surgical Treatment Of Inflammatory-Ulcer Diseases Of The Colon.

    Directory of Open Access Journals (Sweden)

    B Navruzov

    2010-04-01

    Full Text Available Surgical treatment of inflammatory diseases of intestine remains actual problem, despite the progress of conservative therapy. In our research it was etablished,  applying low and ultralow ileorectal anastomosis with circular - stapling apparatus allows to reach reliability of the generated anastomoses, it is essential reduce operation time, reduce number of postoperative complications and reduce duration of patients stay in hospital.

  6. Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer.

    Science.gov (United States)

    Zhong, Min-Er; Niu, Bei-Zhan; Ji, Wu-Yang; Wu, Bin

    2016-06-14

    We report on a patient diagnosed with Peutz-Jeghers syndrome (PJS) with synchronous rectal cancer who was treated with laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). PJS is an autosomal dominant syndrome characterized by multiple hamartomatous polyps in the gastrointestinal tract, mucocutaneous pigmentation, and increased risks of gastrointestinal and nongastrointestinal cancer. This report presents a patient with a 20-year history of intermittent bloody stool, mucocutaneous pigmentation and a family history of PJS, which together led to a diagnosis of PJS. Moreover, colonoscopy and biopsy revealed the presence of multiple serried giant pedunculated polyps and rectal adenocarcinoma. Currently, few options exist for the therapeutic management of PJS with synchronous rectal cancer. For this case, we adopted an unconventional surgical strategy and ultimately performed laparoscopic restorative proctocolectomy with IPAA. This procedure is widely considered to be the first-line treatment option for patients with ulcerative colitis or familial adenomatous polyposis. However, there are no previous reports of treating PJS patients with laparoscopic IPAA. Since the operation, the patient has experienced no further episodes of gastrointestinal bleeding and has demonstrated satisfactory bowel control. Laparoscopic restorative proctocolectomy with IPAA may be a safe and effective treatment for patients with PJS with synchronous rectal cancer. PMID:27298573

  7. EUS-Guided Antegrade Transhepatic Placement of a Self-Expandable Metal Stent in Hepatico-Jejunal Anastomosis

    Directory of Open Access Journals (Sweden)

    Everson LA Artifon

    2011-11-01

    Full Text Available Context To demonstrate an EUS-guided biliary drainage in patient with gastrointestinal tract modified surgically. Case report An EUS guided access to the left intra hepatic duct, followed by an antegrade passage of a partially self-expandable metal stent that was removed by using an enteroscope, in one patient with hepatico-jejunal anastomosis. There were no early or delayed complications and the procedure was effective in relieving jaundice until the self-expandable metal stent was removed, 3 months later. A cholangiogram was obtained via enteroscopy, after removal of self-expandable metal stent, and found to be normal. The patient had an uneventful evaluation afterwards. Conclusion The indication of these procedures must be made under a multidisciplinary view while sharing information with the patient or legal guardian. EUS-guided biliary drainage is feasible when performed by professionals with expertise in biliopancreatic endoscopy and advanced echo-endoscopy and should be performed currently under rigorous protocol in educational institutions.

  8. The surgical management of necrotising enterocolitis (NEC).

    Science.gov (United States)

    Thakkar, Hemanshoo Sudhir; Lakhoo, Kokila

    2016-06-01

    Necrotising enterocolitis (NEC) is a neonatal surgical emergency. At its early stages, the management of NEC is largely medical using broad-spectrum antibiotics, gut rest and total parental nutrition. The only absolute indication for surgery is an intra-abdominal perforation. There are several relative indications for surgery based on clinical, biochemical and radiological parameters. Once the decision to intervene is made, several approaches may be taken. Peritoneal lavage can be used as a salvage procedure or definitive management in some cases. The most common approach taken is bowel resection with enterostomy formation. There is a role for primary anastomosis of bowel in limited NEC. In severe, multi-focal NEC a high diverting jejunostomy or "clip and drop technique" can be used. Laparoscopy has a limited role and is not widespread. The surgical complications of NEC include stoma related morbidity, anastomotic leak/stricture and short-bowel syndrome. Long-term data on neurodevelopmental outcomes is sparse but the present literature is suggestive of a negative impact in cases of surgically managed NEC. PMID:27032753

  9. A 26-year clinical observation of splenic auto-transplantation and oesophageal transection anastomosis: a new treatment strategy in patients with portal hypertension

    Institute of Scientific and Technical Information of China (English)

    ZHANG Lei; CHEN Ji-sheng; HUO Jin-shan; ZHANG Hong-wei; CHEN Ru-fu; ZHANG Jie; Obetien Mapudengo; FANG Tian-lin; CHEN Ya-jin; OU Qing-jia

    2007-01-01

    Background Surgical treatment options for patients with cirrhosis and portal hypertension are complicated. In this study,we evaluated the effectiveness of a new treatment strategy, splenic auto-transplantation and oesophageal transection anastomosis. We report results from clinical observations, splenic immune function and portal dynamics in 274 patients.Methods From 1979 to 2005, 274 cirrhosis patients with portal hypertension underwent the new treatment strategy, and were followed up to compare results with those patients who underwent traditional surgical treatment. From 1999 to 2002,a randomized controlled trial (RCT) was performed on 40 patients to compare their post-operative immune function. From 1994 to 2006, another RCT enrolled 28 patients to compare portal dynamics using three-dimensional dynamic contrast-enhanced magnetic resonance angiography (3D DEC MRA) investigation post operation.Results Among 274 patients (mean age 41.8 years), the emergency operative mortality (4.4%), selective operative mortality (2.2%), complication rate (17.9%), prevalence of hepatic encephalopathy (<1%), rate of portal hypertension gastritis (PHG) bleeding (9.1%), and morbidity of hepatic carcinoma (8%) were similar to those patients undergoing traditional operation; the spleen immunology function (Tuftsin, IgM) decreased in both groups 2 months post operation,but this decrease did not reach statistical significance. Through 3D DCE MRA, the cross sectional area and the velocity and volume of blood flow of the main portal vein decreased significantly after operation in both groups. The velocity and volume of blood flow in the auto-transplantation group was significantly lower than that in the control group.Conclusions Splenic auto-transplantation and esophageal transection anastomosis is a safe, effective, and reasonable treatment strategy for patients with portal hypertension with varicial bleeding. It not only can correct hypersplenism, but may also achieve complete

  10. SURGICAL NUTRITION

    Directory of Open Access Journals (Sweden)

    Danny Kurniawan Darianto

    2015-07-01

    Full Text Available A patient undergoing surgery faces great physiologic and psychologic stress. so nutritional demands are greatly increased during this period and deficiencies can easily develop. If these deficiencies are allowed to develop and are not in screening, serious malnutrition and clinical problem can occur. Therefore careful attention must be given to a patient's nutritional status in preparation of surgery, as well as to the individual nutritional needs. If these needs are met, complications are less likely developing. Natural resources provide for rapid recovery. Proper nutrition can speed healing in surgical patients with major trauma, severe malnutition, burns, and other severe illnesses. New techniques for tube feeding, intravenous nutrition for patients with serious weight loss due to gastrointestinal disorders, and use of supplements can hasten wound healing and shorten recovery times.

  11. Heart-shaped anastomosis for Hirschsprung's disease: Operative technique and long-term follow-up

    Institute of Scientific and Technical Information of China (English)

    Guo Wang; Xiao-Yi Sun; Ming-Fa Wei; Yi-Zhen Weng

    2005-01-01

    AIM: To study the long-term therapeutic effect of "heartshaped" anastomosis for Hirschsprung's disease.METHODS: From January 1986 to October 1997, we performed one-stage "heart-shaped" anastomosis for 193 patients with Hirschsprung's disease (HD). One hundred and fiftytwo patients were followed up patients (follow-up rate 79%).The operative outcome and postoperative complications were retrospectively analyzed.RESULTS: Early complications included urine retention in 2patients, enteritis in 10, anastomotic stricture in 1, and intestinal obstruction in 2. No infection of abdominal cavity or wound and anastomotic leakage or death occurred in any patients. Late complications were present in 22 cases,including adhesive intestinal obstruction in 2, longer anal in 5, incision hernia in 2, enteritis in 6, occasional stool stains in 7 and 6 related with improper diet. No constipation or incontinence occurred in any patient.CONCLUSION: The early and late postoperative complication rates were 7.8% and 11.4% respectively in our "heartshaped anastomosis" procedure. "Heart-shaped"anastomosis procedure for Hirschsprung's disease provides a better therapeutic effect compared to classic procedures.

  12. Sutureless end-to-end bowel anastomosis in rabbit using Iow-power CO2 laser

    Institute of Scientific and Technical Information of China (English)

    Zhong Rong Li; Yong Long Chi; Run Cong Ke

    2000-01-01

    The use of laser energy to weld biological tissues and produce sutureless anastomosis has its advantages over conventional silk-sutured anastomosis since it was reported in small vessels[1] and fallopian tubes[2], in the late 1970s. Since then, more investigators have welded a larger variety of tissues[3-13] and have expanded its application to welding trials of entertomies of rabbit and rat small intestine[14-17] Sauer et al[18] reported results from Nd: YAG laser in reconstruction of end-to-end welding in rabbit small intestine. Recently, controlled temperature during YAG and argon laser-assisted welding of entertomies of rabbit and rat was implemented to eliminate exponential increases in the rate of denaturation associated with rapidly increasing temperature[19,20]. Yet there was no report of sutureless end-to-end bowel anastomosis using low-power CO2 laser. This is a report of a circumferential end-to-end laser welding bowel anastomosis in rabbit by using 3 different CO2 laser powers to explore the feasibility of CO2 laser welding of a circumferential intestinal tissue and to determine the optimal laser-welding parameter. Then the appropriate CO2 laser power was chosen to weld bowels in rabbit and its long-term healing effect was evaluated.

  13. Evaluation and further development of the Excimer Laser Assisted Non-occlusive Anastomosis (ELANA) technique

    NARCIS (Netherlands)

    van Doormaal, T.P.C.

    2010-01-01

    The research described in this thesis had 2 main goals. The first goal was to evaluate the clinical results of the Excimer Laser Assisted Non-occlusive Anastomosis (ELANA) technique. The most important subgroups of patients were separately evaluated in the first part of this thesis (chapters 2 to 5)

  14. Heterogeneity in electrophoretic karyotype within and between anastomosis groups of Rhizoctonia solani

    NARCIS (Netherlands)

    Keijer, J.; Houterman, P.M.; Dullemans, A.M.; Korsman, M.G.

    1996-01-01

    Isolates of the soil borne basidiomycete Rhizoctonia solani vary in cultural appearance, in growth characteristics and in pathogenicity towards plants. Isolates of R. solani can be divided into anastomosis groups (AGs) and this division accommodates part of the observed diversity. However, a clear l

  15. Biomedical Engineering Approach to Evaluate Anastomosis Methods for Coronary Artery Bypass Grafting

    Institute of Scientific and Technical Information of China (English)

    M.Umezu; J.Kawai; J.Suehiro; M.Arita; Y.Shiraishi; K.Iwasaki; T.Tanaka; H.Niinami

    2004-01-01

    There are two different methods for coronary artery bypass grafting: end-to-side and side-to-side anastomosis. In vitro mock test, flow visualization and animal experiments were performed in parallel to compare the hemodynamic effect between two methods. Thus, bioengineers can provide practical useful information to the clinical team.

  16. Impact of top end anastomosis design on patency and flow stability in coronary artery bypass grafting.

    Science.gov (United States)

    Koyama, Sachi; Kitamura, Tadashi; Itatani, Keiichi; Yamamoto, Tadashi; Miyazaki, Shohei; Oka, Norihiko; Nakashima, Kouki; Horai, Tetsuya; Ono, Minoru; Miyaji, Kagami

    2016-05-01

    For coronary artery bypass grafting (CABG), free grafts such as a saphenous vein or radial artery are often used for grafts to the lateral and posterior walls. However, the relationship between top-end anastomosis design and long-term patency remains unknown. Because coronary artery blood flow is dominant during diastole, top-end anastomosis may work better if the graft is directed towards the apex, whereas the shortest graft pathway appears to be most efficient. Using computational fluid dynamic models, we evaluated the hemodynamic variables that were affected by the angle of the top-end anastomosis. We created three-dimensional geometries of the aortic root with coronary arteries that involved 75 % stenosis in the obtuse marginal and postero-lateral branches. Two bypass models under vasodilator administration were created: in a"Model A", the top-end anastomosis is parallel to the long axis of the ascending aorta and the graft passed over the conus directed towards the apex; in a "Model B", the top-end anastomosis is directed toward the shortest pathway, and form near the right angles to the long axis of the ascending aorta. Wall shear stress (WSS) and its fluctuation, an oscillatory shear index (OSI) were evaluated to predict fibrosis progression at the anastomosis site and graft flow. Graft flow was 197.3 ml/min and 207.3 ml/min in the "Model A" and "Model B", respectively. The minimal WSS value inside the graft with the "Model A" and "Model B" was 0.53 Pa and 4.09 Pa, respectively, and the OSI value was 0.46 and 0.04, respectively. The top-end anastomosis of a free graft should be directed vertically towards the aorta to achieve the shortest graft pathway to maintain a high graft flow rate and to avoid the risks of endothelial fibrosis and plaque progression over the long-term after CABG. PMID:25910614

  17. SIMPLIFIED LAPAROSCOPIC GASTRIC BYPASS WITH GASTROJEJUNAL LINEAR MECHANICAL ANASTOMOSIS: TECHNICAL ASPECTS

    Science.gov (United States)

    PALERMO, Mariano; SERRA, Edgardo

    2016-01-01

    ABSTRACT Background: Gastric bypass is a restrictive and malabsorptive surgery. The restrictive part consists in the creation of a small gastric pouch. The gastrointestinal bypass serves as the malabsorptive element. Aim: To describe a simplified gastric bypass approach for morbid obese patients, showing our results, and also remarking the importance of this technique for reducing the learning curve. Method: The patient is positioned in a split legs position and carefully strapped to the operating room table, with the surgeon between the patient's legs. Five trocars are inserted after pneumoperitoneum at the umbilicus. Dissection of the esophagogastric angle and lesser curvature is mandatory before the gastric pouch manufacturing. This pouch is done with two blue load staplers. Using a blue load linear stapler inserted only half way into the hole in the pouch is used to perform the gastrojejunal anastomosis and in order to create an anastomosis that is about 2 cm in length. A side-to-side jejunojejunostomy is done with a white load linear stapler. The last step of the gastric bypass consists in the cut of the jejunum between the two anastomosis with a white load linear stapler. Blue test is performed in order to detect leaks. Results: From January 2012 to December 2015, 415 simplified RYGB were performed. Gender: 67% female and 33 % males. Average of BMI 44.7. Mean age was 42 years old. Mean operative time 79 min. 39 % of this sample had T2 diabetes. Regarding complications were observed, one fistula, one gastrojejunal stenosis and one obstruction due to a bezoar. Conclusion: The described technique is a simplified approach in which all the anastomosis are performed in the upper part of the abdomen, allowing the surgeons to be more systematized and avoiding them to make mistakes in the confection of the Roux-en-Y anastomosis. This simplified gastric bypass is a safe and reproducible technique. PMID:27683785

  18. Surgical techniques of arterialized orthotopic liver transplantation in rats

    Institute of Scientific and Technical Information of China (English)

    MA Yi; WANG Guo-dong; GUO Zhi-yong; GUO Zhi-gang; HE Xiao-shun; CHEN Gui-hua

    2007-01-01

    Background Recently, much attention has been paid to hepatic artery reconstruction in rat liver transplantation, which can prevent bile duct ischemia and preserve better liver structure. In this study, three methods of graft arterialization,including sleeve, cuff, and stent anastomosis, were conducted and the results were compared.Methods Orthotopic liver transplantation (OLT) with rearterialization was conducted in 90 rats, which were divided into sleeve, cuff, and stent groups (n=30 in each). Ninety-six rats received OLTs with standardized two-cuff technique without rearterialization as a control. The sleeve technique included an end-to-end anastomosis between the donor common hepatic artery and recipient proper hepatic artery, or between the donor celiac artery and recipient common hepatic artery.Cuff technique involved an anastomosis between the donor common hepatic artery and recipient common hepatic artery.In the stent technique, the recipient hepatic artery and donor hepatic artery were connected using an intraluminal polyethylene stent. The arterial anastomosis time and arterial patency rate in each group were recorded. The liver graft survival and bile duct complication rates were measured.Results The total surgical time of OLT with rearterialization was (118.3±12.9) minutes in the sleeve group, (106.2±11.6)minutes in the cuff, (93.8±10.2) minutes in the stent, and (88.2±9.6) minutes in the control. The corresponding anhepatic phase was (19.6±2.8), (19.2±2.2), (18.6±1.8), and (20.0±2.5) minutes respectively in the sleeve, cuff, stent, and control groups. One-week survival rate was 86.5% in the control, and 86.7% in the groups with rearterialization. No significant difference was detected in the survival rate between them (P>0.05). The incidence of biliary complications in non-rearterialized group (17.7%) was significantly higher than that in the rearterialized group (6.7%, P<0.05). No significant difference was found in the incidence of biliary

  19. Surgical treatment of complicated traumatic aneurysm and arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    乔正荣; 时德

    2003-01-01

    Objective: To evaluate the surgical methods and the outcome of management for traumatic arterial aneurysm (TAA) and traumatic arteriovenous fistula (TAVF). Methods: A total of 121 patients with TAA or TAVF were treated by surgery. Clinical, operative and postoperative data were collected and analyzed retrospectively. Results: The surgical techniques included aneurysmectomy and arterial end-to-end anastomosis or vascular grafting or artery ligation, aneurysm ligation and bypass, vascular repair, fistula excision and vascular ligation or vascular grafting or repair and so on. One patient died (0.83%). The follow-up rates of TAA and TAVF were 65.7% and 60% respectively. Conclusions: Complicated TAA and TAVF in different sites should be treated with different methods.

  20. Improved Health-Related Quality of Life After Surgical Management of Severe Refractory Constipation-Dominant Irritable Bowel Syndrome

    OpenAIRE

    Lam, Jennifer Y.; Kidane, Biniam; Manji, Farouq; Taylor, Brian M.

    2015-01-01

    Irritable bowel syndrome (IBS) is the most common of the functional gastrointestinal disorders (FGIDs). Despite its prevalence and health-care costs, there are few effective therapies for patients with severe symptoms. Our objective was to determine whether surgical management would improve health-related quality of life (HRQOL) in severe refractory constipation-dominant FGIDs. From 2003 to 2005, 6 patients underwent total colectomy with end ileostomy or primary anastomosis. They completed Sh...

  1. Surgical indication in Schistosomiasis mansoni portal hypertension: follow-up from 1985 to 2001

    Directory of Open Access Journals (Sweden)

    Maria José Conceição

    2002-10-01

    Full Text Available The study had the objective to evaluate the benefits of surgical indication for portal hypertension in schistosomiasis patients followed from 1985 to 2001. Schistosoma mansoni eggs were confirmed by at least six stool examinations or rectal biopsy. Clinical examination, abdominal ultrasonography, and digestive endoscopy confirmed the diagnosis of esophageal varices. A hundred and two patients, 61.3% male (14-53 years old were studied. Digestive hemorrhage, hypersplenism, left hypochondrial pain, abdominal discomfort, and hypogonadism were, in a decreasing order, the major signs and symptoms determining surgical indication. Among the surgical techniques employed, either splenectomy associated to splenorenal anastomosis or azigoportal desvascularization, esophageal gastric descompression and esophageal sclerosis were used. Follow-up of patients revealed that, independent on the technique utilized, a 9.9% of death occurred, caused mainly by digestive hemorrhage due to the persistence of post-treatment varices. The authors emphasize the benefits of elective surgical indication allowing a normal active life.

  2. Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension (the ROX CONTROL HTN study): a randomised controlled trial.

    LENUS (Irish Health Repository)

    Lobo, Melvin D

    2015-01-22

    Hypertension contributes to cardiovascular morbidity and mortality. We assessed the safety and efficacy of a central iliac arteriovenous anastomosis to alter the mechanical arterial properties and reduce blood pressure in patients with uncontrolled hypertension.

  3. Surgical approach to right colon cancer: From open technique to robot. State of art.

    Science.gov (United States)

    Fabozzi, Massimiliano; Cirillo, Pia; Corcione, Francesco

    2016-08-27

    This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical

  4. Surgical approach to right colon cancer: From open technique to robot. State of art.

    Science.gov (United States)

    Fabozzi, Massimiliano; Cirillo, Pia; Corcione, Francesco

    2016-08-27

    This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical

  5. Transanal Pull-Through Procedure with Delayed versus Immediate Coloanal Anastomosis for Anus-Preserving Curative Resection of Lower Rectal Cancer: A Case-Control Study.

    Science.gov (United States)

    Xiong, Yong; Huang, Ping; Ren, Qing-Gui

    2016-06-01

    This case-control study compared the effectiveness and safety of transanal pull-through procedure (TPP) with delayed or immediate coloanal anastomosis (CAA) for anus-preserving curative resection of lower rectal cancer. Lower rectal cancer patients (n = 128) were hospitalized between January 2003 and December 2013 for elective anus-preserving curative resection through a TPP with delayed (n = 72) or immediate (n = 56) CAA. Main outcome measures including surgical safety, resection radicality, and defecation function were assessed. The two groups were comparable in age, sex, gross pathology, histology, and tumor-node-metastasis staging. Both the delayed and immediate CAA TPPs had similar resection radicality and safety profiles. The immediate CAA was associated with a significantly higher risk of anastomotic leakage and defecation impairment. None of patients in the delayed CAA group experienced anastomotic leakage. In conclusion, TPP with delayed CAA may be superior to immediate CAA in minimizing the risk of anastomotic leakage and relevant surgical morbidities, and does not require a temporary ileostomy and second-look restoration of ostomy. PMID:27305886

  6. The thrill of success: central arterial-venous anastomosis for hypertension.

    Science.gov (United States)

    Fudim, Marat; Stanton, Alice; Sobotka, Paul A; Dolan, Eamon; Krum, Henry

    2014-12-01

    Excess blood pressure remains the most important risk factor for cardiovascular and renal disease. Poly pharmacy has been proved safe and effective under clinical trial circumstances; however, the majority of patients fail to sustain pharmaceutical persistence and adherence. The opportunity to offer patients a treatment or device in addition or perhaps instead of drug therapy alone may significantly broaden the options for patients and allow greater success in hypertensive therapy. In this review, we examine the potential of a fixed-volume central arterial-venous anastomosis to reduce blood pressure in hypertensive patients, review possible mechanisms by which the anastomosis may reduce blood pressure, and consider the unique clinical trial opportunities posed by this therapy.

  7. Functional and oncologic results after coloanal anastomosis for low rectal carcinoma.

    Science.gov (United States)

    Hautefeuille, P; Valleur, P; Perniceni, T; Martin, B; Galian, A; Cherqui, D; Hoang, C

    1988-01-01

    Thirty-five patients who had adenocarcinoma of the middle third of the rectum were treated by resection and coloanal anastomosis. The aim of this study was to assess functional and oncologic results of an original technique of coloanal anastomosis. There was no operative mortality, and operative morbidity consisted of seven anastomotic leaks with two failures. Among 31 patients assessed for functional results only one had unsatisfactory results. Good continence was obtained within a few weeks for the 30 patients who had satisfactory results. No patients were lost to follow-up, which was over 5 years in 24 patients (68%). The 5-year survival rate was 64%, identical to that for other series. PMID:3337562

  8. A meta-analysis of aneurysm formation in laser assisted vascular anastomosis (LAVA)

    Science.gov (United States)

    Chen, Chen; Peng, Fei; Xu, Dahai; Cheng, Qinghua

    2009-08-01

    Laser assisted vascular anastomosis (LAVA) is looked as a particularly promising non-suture method in future. However, aneurysm formation is one of the main reasons delay the clinical application of LAVA. Some scientists investigated the incidence of aneurysms in animal model. To systematically analyze the literature on reported incidence of aneurysm formation in LAVA therapy, we performed a meta-analysis comparing LAVA with conventional suture anastomosis (CSA) in animal model. Data were systematically retrieved and selected from PUBMED. In total, 23 studies were retrieved. 18 studies were excluded, and 5 studies involving 647 animals were included. Analysis suggested no statistically significant difference between LAVA and CSA (OR 1.24, 95%CI 0.66-2.32, P=0.51). Result of meta analysis shows that the technology of LAVA is very close to clinical application.

  9. Significance of the Intraoperative Methylene Blue Test for Postoperative Evaluation of the Vesicourethral Anastomosis

    Directory of Open Access Journals (Sweden)

    J. N. Nyarangi-Dix

    2012-01-01

    Full Text Available We prospectively investigated whether routine evaluation of the vesicourethral anastomosis (VUA after radical prostatectomy can be waived. Primary integrity of the VUA was analysed by an intraoperative methylene-blue test (IMBT and postoperatively by conventional cystography. Data on the IMBT, contrast extravasation and prostate volume as well as pad usage were collected prospectively. Significantly more patients with a primary watertight anastomosis demonstrated by the MBT had no leakage in the postoperative cystography (<0.001. In a multivariate logistic regression with adjustment for prostate size and surgeon, the positive correlation between IMBT and postoperative cystography remained statistically significant (=0.001. The IMBT is easy to perform, inexpensive, and timesaving. With it postoperative evaluation of VUA for integrity can be waived in a significant number of patients. Following our algorithm, the Foley can be removed without further testing of the VUA, whenever the IMBT detected no leakage.

  10. Electronic surgical record management.

    Science.gov (United States)

    Rockman, Justin

    2010-01-01

    This paper explores the challenges surgical practices face in coordinating surgeries and how the electronic surgical record management (ESRM) approach to surgical coordination can solve these problems and improve efficiency. Surgical practices continue to experience costly inefficiencies when managing surgical coordination. Application software like practice management and electronic health record systems have enabled practices to "go digital" for their administrative, financial, and clinical data. However, surgical coordination is still a manual and labor-intensive process. Surgical practices need to create a central and secure record of their surgeries. When surgical data are inputted once only and stored in a central repository, the data are transformed into active information that can be outputted to any form, letter, calendar, or report. ESRM is a new approach to surgical coordination. It enables surgical practices to automate and streamline their processes, reduce costs, and ensure that patients receive the best possible care. PMID:20480775

  11. Exteriorized colon anastomosis for unprepared bowel: An alternative to routine colostomy

    Institute of Scientific and Technical Information of China (English)

    Sami K Asfar; Hilal M Al-Sayer; Talib H Juma

    2007-01-01

    AIM: To see the possibility of avoiding routine colostomy in patients presenting with unprepared bowel.METHODS: The cohort is composed of 103 patients,of these, 86 patients presented as emergencies (selfinflected and iatrogenic colon injuries, stab wounds and blast injury of the colon, volvulus sigmoid, obstructing left colon cancer, and strangulated ventral hernia).Another 17 patients were managed electively for other colon pathologies. During laparotomy, the involved segment was resected and the two ends of the colon were brought out via a separate colostomy wound.One layer of interrupted 3/0 silk was used for colon anastomosis. The exteriorized segment was immediately covered with a colostomy bag. Between the 5th and 7th postoperative day, the colon was easily dropped into the peritoneal cavity. The defect in the abdominal wall was closed with interrupted nonabsorbable suture. The skin was left open for secondary closure.RESULTS: The mean hospital stay (± SD) was 11.5 ±2.6 d (8-20 d). The exteriorized colon was successfully dropped back into the peritoneal cavity in all patients except two. One developed a leak from oesophagojejunostomy and from the exteriorized colon. She subsequently died of sepsis and multiple organ failure(MOF). In a second patient the colon proximal to the exteriorized anastomosis prolapsed and developed severe serositis, an elective ileo-colic anastomosis (to the left colon) was successfully performed.CONCLUSION: Exteriorized colon anastomosis is simple, avoids the inconvenience of colostomy and can be an alternative to routine colostomy. It is suitable where colostomy is socially unacceptable or the facilities and care is not available.

  12. Internal carotid-cerebellar artery anastomosis. So-called persistent trigeminal artery variant

    Energy Technology Data Exchange (ETDEWEB)

    Tanohata, Kazunori; Maehara, Tadayuki; Noda, Masanobu; Katoh, Hiromi

    1987-09-01

    Five cases of internal carotid-cerebellar artery anastomosis are presented. These anomalous vessels are identical to the so-called persistent trigeminal artery variant (PTAV). In our cases, two superior cerebellar arteries (SCAs), two anterior inferior cerebellar arteries (AICAs) and one posterior inferior cerebellar artery (PICA) arose from the precavernous segment of the internal carotid artery. We discuss the embryolgical and neuroradiological aspects of this anomaly.

  13. Assessment of pulmonary veins after atrio-pericardial anastomosis by cardiovascular magnetic resonance

    OpenAIRE

    Greenway Steven C; Yoo Shi-Joon; Baliulis Giedrius; Caldarone Christopher; Coles John; Grosse-Wortmann Lars

    2011-01-01

    Abstract Background The atrio-pericardial anastomosis (APA) uses a pericardial pouch to create a large communication between the left atrium and the pulmonary venous contributaries in order to avoid direct suturing of the pulmonary veins during the repair of congenital cardiac malformations. Post-operative imaging is routinely performed by echocardiography but Cardiovascular Magnetic Resonance (CMR) offers excellent anatomical imaging and quantitative information about pulmonary blood flow. W...

  14. Partial recovery of respiratory function and diaphragm reinnervation following unilateral vagus nerve to phrenic nerve anastomosis in rabbits.

    Directory of Open Access Journals (Sweden)

    Junxiang Wen

    Full Text Available Respiratory dysfunction is the leading cause of mortality following upper cervical spinal cord injury (SCI. Reinnervation of the paralyzed diaphragm via an anastomosis between phrenic nerve and a donor nerve is a potential strategy to mitigate ventilatory deficits. In this study, anastomosis of vagus nerve (VN to phrenic nerve (PN in rabbits was performed to assess the potential capacity of the VN to compensate for lost PN inputs. At first, we compared spontaneous discharge pattern, nerve thickness and number of motor fibers between these nerves. The PN exhibited a highly rhythmic discharge while the VN exhibited a variable frequency discharge pattern. The rabbit VN had fewer motor axons (105.3±12.1 vs. 268.1±15.4. Nerve conduction and respiratory function were measured 20 weeks after left PN transection with or without left VN-PN anastomosis. Compared to rabbits subjected to unilateral phrenicotomy without VN-PN anastomosis, diaphragm muscle action potential (AP amplitude was improved by 292%, distal latency by 695%, peak inspiratory flow (PIF by 22.6%, peak expiratory flow (PRF by 36.4%, and tidal volume by 21.8% in the anastomosis group. However, PIF recovery was only 28.0%, PEF 28.2%, and tidal volume 31.2% of Control. Our results suggested that VN-PN anastomosis is a promising therapeutic strategy for partial restoration of diaphragm reinnervation, but further modification and improvements are necessary to realize the full potential of this technique.

  15. The outcome of surgical treatment in patients with obstructive colorectal cancer

    Directory of Open Access Journals (Sweden)

    Abdullah Kısaoğlu

    2013-01-01

    Full Text Available orectal cancer obstructions are responsible for about 85% of colonic emergencies. The aim of this study was to investigate the results of urgent surgical intervention that applied in acute colonic obstructions related to cancer. Methods: In this study, 86 cases presenting with acute colonic obstruction who were operated with the diagnosis of colonic tumor between January 2010 and December 2010 were assessed retrospectively. Age, gender, symptoms on presentation, presence of concomitant disease, surgical methods applied, complication and mortality rates were recorded.Results: Fifty of the cases were male, 36 were female. The mean age was 63.6 years. Twenty cases had undergone emergency colonoscopic examination at diagnosis and an obstructive lesion had been observed. The surgical operations performed were right hemicolectomy in 18, sigmoid resection in 34, left hemicolectomy in 10, abdomino-perineal resection in 2, subtotal colectomy in 4, transverse colectomy in two. Primary anastomosis was performed in thirty-four cases. Mortality was observed in 12 cases. Conclusions: In selected cases of left colon cancers with obstruction, resection and primary anastomosis is generally possible. Those over 70, presence of co-morbidities, albumin level under 3 g/dl, ASA score 3 and higher, blood loss of more than 500 ml, and preoperative blood transfusion were related to the high postoperative morbidity.Key words: Colorectal cancer, obstruction, surgical treatment, outcome.

  16. Coronary artery bypass grafting hemodynamics and anastomosis design: a biomedical engineering review.

    Science.gov (United States)

    Ghista, Dhanjoo N; Kabinejadian, Foad

    2013-01-01

    In this paper, coronary arterial bypass grafting hemodynamics and anastomosis designs are reviewed. The paper specifically addresses the biomechanical factors for enhancement of the patency of coronary artery bypass grafts (CABGs). Stenosis of distal anastomosis, caused by thrombosis and intimal hyperplasia (IH), is the major cause of failure of CABGs. Strong correlations have been established between the hemodynamics and vessel wall biomechanical factors and the initiation and development of IH and thrombus formation. Accordingly, several investigations have been conducted and numerous anastomotic geometries and devices have been designed to better regulate the blood flow fields and distribution of hemodynamic parameters and biomechanical factors at the distal anastomosis, in order to enhance the patency of CABGs. Enhancement of longevity and patency rate of CABGs can eliminate the need for re-operation and can significantly lower morbidity, and thereby reduces medical costs for patients suffering from coronary stenosis. This invited review focuses on various endeavors made thus far to design a patency-enhancing optimized anastomotic configuration for the distal junction of CABGs.

  17. Immediate primary anastomosis for isolated oesophageal atresia: A single-centre experience

    Directory of Open Access Journals (Sweden)

    Ibrahim Uygun

    2015-01-01

    Full Text Available Background: Isolated oesophageal atresia without tracheo-oesophageal fistula represents a major challenge for most paediatric surgeons. Here, we present our experience with six neonates with isolated oesophageal atresia who successfully underwent immediate primary anastomosis using multiple Livaditis circular myotomy. Materials and Methods: All six neonates were gross type A isolated oesophageal atresia (6%, from among 102 neonates with oesophageal atresia, treated between January 2009 and December 2013. Five neonates were female; one was male. The mean birth weight was 2300 (range 1700-3100 g. Results: All six neonates successfully underwent immediate primary anastomosis using multiple myotomies (mean 3; range 2-4 within 10 (median 3 days after birth. The gap under traction ranged from 6 to 7 cm. One neonate died of a major cardiac anomaly. Another neonate was lost to follow-up after being well for 3 months. Three anastomotic strictures were treated with balloon dilatation, and four anastomotic leaks were treated conservatively. The mean duration of follow-up was 33 months. Conclusions: To treat isolated oesophageal atresia, an immediate primary anastomosis can be achieved using multiple myotomies. Although, this approach is associated with high complication rates, as are other similar approaches, these complications can be overcome.

  18. Inhibitory effects of alkaloids from Sophora alopecuroids on feeding,development and reproduction of Clostera anastomosis

    Institute of Scientific and Technical Information of China (English)

    Yang Zhende; Zhao Boguang; Zhu Lin; Fang Jie; Xia Luqing

    2006-01-01

    Alkaloids from Sophora alopecuroids were bioassayed with Clostera anastomosis for their antifeedant and growth inhibitory effects.The antifeedant rate in choice test reached 62%-86% at the dose 2.5 mg/mL,while in non-choice bioassay the rate was only 20%-29%.In choice bioassay,the anfifeedant rate increased with larval instars of C anastomosis and did not in non-choice experiment.The alkaloids also imposed a strong influence on the growth of C anastomosis larvae,i.e.,after feeding on the leaves treated with alkaloid,the larvae lost their weight,weight gain,and relative growth rate (RGR) significantly when compared with the controls.In the second day after treatment with the dose at 10 mg/mL of the alkaloid,the RGR reduced by 39.8%,and the food intake and the feces weight were respectively 57.7% and 57.4% of the controls.The approximate digestibility (AD) increased significantly,and the efficiency in converting digested food (ECD),and the efficiency in converting ingested food (ECI) decreased greatly after feeding the treated leaves.Moreover,the eggs laid per female were also inhibited by this alkaloid.The significance and prospect of the alkaloids in controlling forest insect pests were also discussed.

  19. Surgical innovation as sui generis surgical research.

    Science.gov (United States)

    Lotz, Mianna

    2013-12-01

    Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.

  20. Uso do adesivo de fibrina na anastomose esôfago-esofágica cervical, em cães The use of fibrin adhesive in the esophagus-esophageal cervical anastomosis, in dogs

    Directory of Open Access Journals (Sweden)

    Orlando Ribeiro Prado Filho

    2004-08-01

    Full Text Available OBJETIVO: Estudar os efeitos da associação do adesivo cirúrgico de fibrina à técnica operatória da invaginação submucosa, em anastomoses esofagianas. MÉTODO: Trinta e dois cães submetidos à anastomose esôfago-esofágica foram alocados em dois grupos: I com sutura em doze pontos e II com sutura em quatro pontos e vedação com adesivo de fibrina. Os animais foram avaliados no sétimo e décimo-quarto dias de pós-operatório. Foram analisados: a evolução ponderal, o índice de estenose, a incidência de deiscências e fístulas, a presença de secreções na tela subcutânea, a presença de líquido intersticial, matriz protêica, celularidade, fibroblastos, fibras de colágeno e concentração de hidroxiprolina. RESULTADOS: O índice de estenose foi menor para os animais do grupo I no sétimo dia de observação. Nos animais do grupo II a incidência de deiscências, secreção serosa e purulenta foram signitivamente maiores aos sete e quatorze dias, enquanto a presença de fístulas foi maior no sétimo dia. Quanto à concentração tecidual de hidroxiprolina não houve diferença estatística entre os grupos. Os fibroblastos e fibras de colágeno tiveram presença mais acentuada no grupo II no décimo-quarto dia. Ocorreram quatro óbitos em animais do grupo II. CONCLUSÕES: A anastomose por invaginação submucosa-mucosa com vedação com adesivo de fibrina apresentou piores resultados que a anastomose convencional de doze pontos circunferenciais.BACKGROUND: The aim of this research was to study the effects of the use of fibrin adhesive with the surgical technique of submucosa invagination, in esophageal anastomosis. METHODS: Thirty two dogs operated on for esophageal anastomosis, were distributed in two groups: group I with encircling suture of twelve stitches, and group II with encircling suture of four stitches and fibrin sealant. The anastomosis was evaluated in the 7th and 14th post-operative day. Weight evolution, stenosis

  1. Penile fracture with disruption of both cavernosal bodies and complete urethral rupture in a 15-years-old male: Delayed surgical approach

    Directory of Open Access Journals (Sweden)

    Carolina Talini

    2016-09-01

    Full Text Available Penile fracture is defined as the traumatic rupture of the tunica albuginea of the corpus cavernosa usually associated to trauma during sexual intercourse or masturbation. Historically penile fracture has been managed conservatively, but contemporary management includes early surgical exploration. The case presents a 15-year-old male who suffered a blunt penile trauma and was first managed with cystostomy and no penile exploration. Five months after trauma was submitted to definitive surgical correction of both, urethral rupture and bilateral corporal fracture. The proposed surgical techinique was a diamond-shape corpora anastomosis. Surgery did well and after 3 years he presented no late complications.

  2. MEMS-based handheld fourier domain Doppler optical coherence tomography for intraoperative microvascular anastomosis imaging.

    Directory of Open Access Journals (Sweden)

    Yong Huang

    Full Text Available To demonstrate the feasibility of a miniature handheld optical coherence tomography (OCT imager for real time intraoperative vascular patency evaluation in the setting of super-microsurgical vessel anastomosis.A novel handheld imager Fourier domain Doppler optical coherence tomography based on a 1.3-µm central wavelength swept source for extravascular imaging was developed. The imager was minimized through the adoption of a 2.4-mm diameter microelectromechanical systems (MEMS scanning mirror, additionally a 12.7-mm diameter lens system was designed and combined with the MEMS mirror to achieve a small form factor that optimize functionality as a handheld extravascular OCT imager. To evaluate in-vivo applicability, super-microsurgical vessel anastomosis was performed in a mouse femoral vessel cut and repair model employing conventional interrupted suture technique as well as a novel non-suture cuff technique. Vascular anastomosis patency after clinically successful repair was evaluated using the novel handheld OCT imager.With an adjustable lateral image field of view up to 1.5 mm by 1.5 mm, high-resolution simultaneous structural and flow imaging of the blood vessels were successfully acquired for BALB/C mouse after orthotopic hind limb transplantation using a non-suture cuff technique and BALB/C mouse after femoral artery anastomosis using a suture technique. We experimentally quantify the axial and lateral resolution of the OCT to be 12.6 µm in air and 17.5 µm respectively. The OCT has a sensitivity of 84 dB and sensitivity roll-off of 5.7 dB/mm over an imaging range of 5 mm. Imaging with a frame rate of 36 Hz for an image size of 1000(lateral×512(axial pixels using a 50,000 A-lines per second swept source was achieved. Quantitative vessel lumen patency, lumen narrowing and thrombosis analysis were performed based on acquired structure and Doppler images.A miniature handheld OCT imager that can be used for intraoperative evaluation of

  3. Hypoglossal-facial nerve anastomosis in the rabbits using laser welding.

    Science.gov (United States)

    Hwang, Kun; Kim, Sun Goo; Kim, Dae Joong

    2008-10-01

    The aim of this study is to compare laser nerve welding of hypoglossal-facial nerve to microsurgical suturing and a result of immediate and delayed repair, and to evaluate the effectiveness of laser nerve welding in reanimation of facial paralysis of the rabbit models. The first group of 5 rabbits underwent immediate hypoglossal-facial anastomosis (HFA) by microsurgical suturing and the second group of 5 rabbits by CO2 laser welding. The third group of 5 rabbits underwent delayed HFA by microsurgical suturing and the fourth group of 5 rabbits by laser nerve welding. The fifth group of 5 rabbits sustained intact hypoglossal and facial nerve as control. In all rabbits of the 4 different groups, cholera toxin subunit B (CTb) was injected in the epineurium distal to the anastomosis site on the postoperative sixth week and in normal hypoglossal nerve in the 5 rabbits of control group. Neurons labeled CTb of hypoglossal nuclei were positive immunohistochemically and the numbers were counted. In the immediate HFA groups, CTb positive neurons were 1416 +/- 118 in the laser welding group (n = 5) and 1429 +/- 90 in the microsurgical suturing group (n = 5). There was no significant difference (P = 0.75). In the delayed HFA groups, CTb positive neurons were 1503 +/- 66 in the laser welding group (n = 5) and 1207 +/- 68 in the microsurgical suturing group (n = 5). Difference was significant (P = 0.009). There was no significant difference between immediate and delayed anastomosis in the laser welding group (P = 0.208), but some significant difference was observed between immediate and delayed anastomosis in the microsurgical suturing group (P = 0.016). Injected CTb in intact hypoglossal neurons (n = 5) were labeled 1970 +/- 165. No dehiscence was seen on the laser welding site of nerve anastomosis in all the rabbits as re-exploration was done for injection of CTb. This study shows that regeneration of the anastomosed hypoglossal-facial nerve was affected similarly by either

  4. Influence of the surgical manipulation of the colon in colonic induced carcinogenesis in rats Influencia de la manipulación quirúrgica del colon en la carcinogénesis cólica inducida en ratas

    Directory of Open Access Journals (Sweden)

    J. F. Noguera Aguilar

    2004-05-01

    Full Text Available Aim: to investigate the influence of different experimental manipulations in a model of colonic experimental carcinogenesis with pharmacological induction in the rat. Experimental design: a total of 90 Sprague-Dawley male rats, divided into three groups, were used: non-surgical (n = 30; surgical with colonic trauma (n = 20, and surgical with colo-colonic anastomosis (n = 40. Carcinogenic induction was carried out with 1-2 dimethylhydrazine dihydrochloride. Colonic adenocarcinomas were identified and the number of tumors, as well as tumoral surface and percentage of tumoral surface was established. One-way ANOVA and Chi-square were employed for the statistical analysis. Results: the number of tumors was greater in the surgical group than in the control group, and tumors preferentially develop-ed around the manipulated colon. Surface and tumoral percentage were greater in the surgical group than in the control group, being also greater in the anastomosis group than in the group with colonic trauma. Within anastomosis groups, a greater tumor surface and percentage was found in the group with titanium than in the group with reabsorbable material. Conclusions: the experimental manipulation of the colon in rats enhances drug-induced colon carcingenesis. The creation of an anastomosis further increases the carcinogenic process compared with simulated anastomosis. This process is also enhanced by the quantity of suture material included in the anastomosis, and by the non-reabsorbable nature of the materials used in the anastomotic line.Objetivo: valorar la influencia de las distintas manipulaciones experimentales en un modelo de carcinogénesis cólica experimental con inducción farmacológica en la rata. Diseño experimental: se emplearon 90 ratas Sprague-Dawley macho, divididas en tres grupos: no quirúrgico (n=30; quirúrgico con traumatismo cólico (n=20, y quirúrgico con anastomosis colocólica (n=40. La inducción carcinogénica se realizó con

  5. T-Stenting-and-Small-Protrusion Technique for Bifurcation Stenoses After End-to-Side Anastomosis of Transplant Renal Artery and External Iliac Artery: Report of Two Cases

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Yong, E-mail: cheny102@163.com; Ye, Peng, E-mail: thomas19871223@163.com [Southern Medical University, Department of Interventional Radiology, Nanfang Hospital (China); Jiang, Wen-jin, E-mail: 18653501187@163.com [Yantai Yuhuangding Hospital (China); Ma, Shuo-yi, E-mail: mazelong123456789@126.com; Zhao, Jian-bo, E-mail: zhaojianbohgl@163.com; Zeng, Qing-le, E-mail: doctorzengqingle@126.com [Southern Medical University, Department of Interventional Radiology, Nanfang Hospital (China)

    2015-10-15

    Bifurcation stenoses after end-to-side anastomosis of transplant renal artery (TRA) and external iliac artery (EIA), including stenoses at the anastomosis and the iliac artery proximal to the TRA, are rare. In the present article, we report two successfully managed cases of bifurcation stenoses after end-to-side anastomosis of the TRA and EIA using the technique of T-stenting and small protrusion (TAP stenting)

  6. [Motor nerves of the face. Surgical and radiologic anatomy of facial paralysis and their surgical repair].

    Science.gov (United States)

    Vacher, C; Cyna-Gorse, F

    2015-10-01

    Motor innervation of the face depends on the facial nerve for the mobility of the face, on the mandibular nerve, third branch of the trigeminal nerve, which gives the motor innervation of the masticator muscles, and the hypoglossal nerve for the tongue. In case of facial paralysis, the most common palliative surgical techniques are the lengthening temporalis myoplasty (the temporal is innervated by the mandibular nerve) and the hypoglossal-facial anastomosis. The aim of this work is to describe the surgical anatomy of these three nerves and the radiologic anatomy of the facial nerve inside the temporal bone. Then the facial nerve penetrates inside the parotid gland giving a plexus. Four branches of the facial nerve leave the parotid gland: they are called temporal, zygomatic, buccal and marginal which give innervation to the cutaneous muscles of the face. Mandibular nerve gives three branches to the temporal muscles: the anterior, intermediate and posterior deep temporal nerves which penetrate inside the deep aspect of the temporal muscle in front of the infratemporal line. The hypoglossal nerve is only the motor nerve to the tongue. The ansa cervicalis, which is coming from the superficial cervical plexus and joins the hypoglossal nerve in the submandibular area is giving the motor innervation to subhyoid muscles and to the geniohyoid muscle.

  7. Abortion - surgical - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  8. Optimizing surgical f

    Directory of Open Access Journals (Sweden)

    Sabry Mohamed Amin

    2016-07-01

    Conclusions: In our study both dexmedetomidine and esmolol were effective in reducing MABP, and lowering the heart rate providing dry surgical field and ensured good surgical condition during cochlear implant surgery in pediatric patients.

  9. Urogynecologic Surgical Mesh Implants

    Science.gov (United States)

    ... be used for urogynecologic procedures, including repair of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). It is ... associated with surgical mesh for transvaginal repair of pelvic organ prolapse 513(e) Proposed Order for Reclassification of Surgical ...

  10. Robotic surgery in gynecologic oncology: evolution of a new surgical paradigm.

    Science.gov (United States)

    Boggess, John F

    2007-01-01

    Robotic surgical platforms were first developed with telesurgery in mind. Conceptualized by NASA and the military to provide surgical expertise to remote locations, some telesurgical success has been documented, but progress has been held back by communication bandwidth limitations. Telepresence surgery, where the surgeon is in proximity to the patient but is provided with an ergonomic console equipped with three-dimensional vision and autonomous control of wristed laparoscopic surgical instruments and energy sources, has shown efficacy first in cardiac and then urologic cancer surgery. Interest is currently focused on the application of this technology in the field of gynecology, with techniques being described to perform simple hysterectomy, myomectomy, tubal anastomosis, and pelvic reconstruction procedures. This article will review the application of robotic- and computer-assisted surgery in the specialty of gynecologic oncology. PMID:25484936

  11. Robotic surgery in gynecologic oncology: evolution of a new surgical paradigm.

    Science.gov (United States)

    Boggess, John F

    2007-01-01

    Robotic surgical platforms were first developed with telesurgery in mind. Conceptualized by NASA and the military to provide surgical expertise to remote locations, some telesurgical success has been documented, but progress has been held back by communication bandwidth limitations. Telepresence surgery, where the surgeon is in proximity to the patient but is provided with an ergonomic console equipped with three-dimensional vision and autonomous control of wristed laparoscopic surgical instruments and energy sources, has shown efficacy first in cardiac and then urologic cancer surgery. Interest is currently focused on the application of this technology in the field of gynecology, with techniques being described to perform simple hysterectomy, myomectomy, tubal anastomosis, and pelvic reconstruction procedures. This article will review the application of robotic- and computer-assisted surgery in the specialty of gynecologic oncology.

  12. Staged microvascular anastomosis training program for novices:transplantation of both kidneys from one rat donor

    Institute of Scientific and Technical Information of China (English)

    Zhou Shoujun; Li Enchun; He Jun; Weng Guobin; Yuan Hexing; Hou Jianquan

    2014-01-01

    Background Rat renal transplantation is an essential experimental model and requires greater microsurgical skills.Thus,training novices to perform quick and reliable microvascular anastomosis is of vital importance for rat renal transplantation.In this study,we developed and evaluated a staged microvascular anastomosis training program for novices,harvesting and transplanting both kidneys from one rat donor.Methods Five trainees without any prior microsurgical experience underwent a training program in which the goals were staged according to difficulty.Each trainee had to achieve satisfactory results as evaluated by a mentor before entering the next stage.Rat renal transplantation was accomplished by end-to-end technique with a bladder patch.In the intensive rat renal transplantation stage,the trainees required an average of 20 independent attempts at isotransplantation as final training assessment.Results After 2 months of intensive practice,all trainees had achieved stable and reproducible rat renal transplantation,with a satisfactory survival rate of 85.9% at postoperative Day 7.The total mean operative time was 78.0 minutes and the mean hot ischemia time was 26.2 minutes.With experience increasing,the operative time for each trainee showed a decreasing trend,from 90-100 minutes to 60-70 minutes.After 20 cases,the mean operative time of the trainees was not statistically significantly different from that of the mentor.Conclusion Harvesting and transplanting both kidneys from one rat donor after a staged microvascular anastomosis training program is feasible for novices without any prior microsurgical skills.

  13. A clinical application of laser direction in anastomosis for inferior canalicular laceration

    Institute of Scientific and Technical Information of China (English)

    LIANG Tao; ZHAO Ke-xiao; ZHANG Ling-yun

    2006-01-01

    Objective:To study the therapeutic efficiency and effecacy of laser-directing approach on searching for the nasal broken end of lacerated lacrimal canaliculus in anastomosis for canalicular laceration.Methods: Forty-nine patients ( 49 eyes ) suffering from traumatic inferior canalicular laceration were divided into control group and laser-directing group. The distance between the lacrimal punctum and the nasal broken end of lacerated lacrimal canaliculus was more than 6 mm. During the course of management of eyelid trauma, the patients were treated by canalicular anastomosis operation with traditional method and laser-directing method in searching for the nasal broken end of lacerated lacrimal canaliculus respectively. The silicone tube of 1 mm diameter was intubated in the lacrimal passage as a stent for 4 to 6months.Results: In the laser-directing group, the mean time in searching for the nasal broken end of lacerated lacrimal canaliculus was (5.75 ± 1.49) minutes and the mean time of operation was (49.21±3.37) minutes; both were significantly shorter than that of the control group(P <0.01). The cure rate of the laser-directing group was96.55 %, higher than that of the control group but without statistical significance (P > 0.05).Conclusions: The laser-directing method is much quicker and more convenient to searching for the nasal broken end of the lacerated lacrimal canaliculus than the traditional approach, and patients suffer less pain and damaging in canalicular anastomosis operation.

  14. Flow structures at the proximal side-to-end anastomosis. Influence of geometry and flow division.

    Science.gov (United States)

    Hughes, P E; How, T V

    1995-05-01

    Flow structures were visualized in transparent polyurethane models of proximal side-to-end vascular anastomoses, using planar illumination of suspended tracer particles. Both the effects of geometry and flow division were determined under steady and pulsatile flow conditions, for anastomosis angles of 15, 30, and 45 degrees. The flow patterns were highly three-dimensional and were characterized by a series of vortices in the fully occluded distal artery and two helical vortices aligned with the axis of the graft. In steady flow, above a critical Reynolds number, the flow changed from a laminar regime to one displaying time-dependent behavior. In particular, significant fluctuating velocity components were observed in the distal artery and particles were shed periodically from the occluded artery into the graft. Pairs of asymmetric flow patterns were also observed in the graft, before the onset of the time-dependent flow regime. The critical Reynolds number ranged from 427 to 473 and appeared to be independent of anastomosis angle. The presence of a patent distal artery had a significant effect on the overall flow pattern and led to the formation of a large recirculation region at the toe of the anastomosis. The main structures observed in steady flow, such as vortices in the distal artery and helical flow in the graft, were also seen during the pulsatile cycle. However, the secondary flow components in the graft were more pronounced in pulsatile flow particularly during deceleration of the flow waveform. At higher mean Reynolds numbers, there was also a greater mixing between fluid in the occluded arterial section and that in the graft. PMID:7666660

  15. Results of the use of autotransplantation of the intraabdominal testis using microsurgical vascular anastomosis.

    Science.gov (United States)

    MacMahon, R A; O'Brien, B M; Aberdeen, J; Richardson, W; Cussen, L J

    1980-02-01

    This study indicates that where facilities are available, the use of autotransplantation of the intraabdominal testis with microsurgical anastomosis to vessels of the groin is an acceptable, and possibly the best, alternative to orchidectomy for the intraabdominal testis. It is certainly justifiable in the case of the bilateral intraabdominal testis but in the case of the unilateral intraabdominal testis with a normally descended and apparently normal testis in the opposite hemiscrotum, the incresed incidence of neoplasia in intraabdominal testes should be taken into account in the decision on the method of treatment. PMID:6102597

  16. Ovarian cancer mimicking recurrence at colorectal anastomosis: report of a case.

    LENUS (Irish Health Repository)

    Reardon, C M

    2012-02-03

    PURPOSE: The aim of this article is to emphasize the increased risk of developing metachronous ovarian tumors after resection of rectal cancer. METHOD AND RESULTS: We report the case of a postmenopausal female patient who, five years after anterior resection, developed a primary ovarian malignancy that invaded a rectal anastomosis and in so doing mimicked a recurrence of a Dukes A rectal cancer. To our knowledge, such an occurrence has not been described previously in the literature. CONCLUSION: This case illustrates the possible benefits of routine prophylactic oophorectomy at the time of colorectal cancer resection.

  17. Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis?

    Institute of Scientific and Technical Information of China (English)

    Paulo; Herman; Marcos; V; Perini; Vincenzo; Pugliese; Julio; Cesar; Pereira; Marcel; Autran; C; Machado; William; A; Saad; Luiz; AC; D; Albuquerque; Ivan; Cecconello

    2010-01-01

    AIM:To evaluate the long-term results of liver resection for the treatment of primary intrahepatic lithiasis.Prognostic factors,especially the impact of bilioenteric anastomosis on recurrence of symptoms were assessed.METHODS:Forty one patients with intrahepatic stones and parenchyma fibrosis/atrophy and/or biliary stenosis were submitted to liver resection.Resection was associated with a Roux-en-Y hepaticojejunostomy in all patients with bilateral stones and in those with unilateral disease and dilation of...

  18. Persistent primitive trigeminal artery associated with monocular blindness and external carotid-vertebral artery anastomosis

    Science.gov (United States)

    Yin, Suo; Zhang, Hong T.; Zhang, Dao P.; Zhang, Shu L.

    2015-01-01

    In this paper, we present 2 rare cases of persistent embryonic anastomoses. In one case, the patient presented with persistent trigeminal artery along with multiple foci of cerebral infarction as well as central retinal artery thrombosis. In the other case, the patient had direct anastomosis of the vertebral artery with ipsilateral external carotid artery as well as pontine infarction, aneurysm, and unilateral hypoplasia of the vertebral artery. The findings in these cases may shed light on the clinical presentation of such persistent anastomoses and aid their detection in clinical settings. PMID:25935186

  19. Persistent primitive trigeminal artery associated with monocular blindness and external carotid-vertebral artery anastomosis.

    Science.gov (United States)

    Yin, Suo; Zhang, Hong T; Zhang, Dao P; Zhang, Shu L

    2015-05-01

    In this paper, we present 2 rare cases of persistent embryonic anastomoses. In one case, the patient presented with persistent trigeminal artery along with multiple foci of cerebral infarction as well as central retinal artery thrombosis. In the other case, the patient had direct anastomosis of the vertebral artery with ipsilateral external carotid artery as well as pontine infarction, aneurysm, and unilateral hypoplasia of the vertebral artery. The findings in these cases may shed light on the clinical presentation of such persistent anastomoses and aid their detection in clinical settings. PMID:25935186

  20. Effect of thymoquinone on the healing of left colon anastomosis: an experimental study

    OpenAIRE

    Kızıltan, Remzi; Yılmaz, Özkan; Çelik, Sebahattin; Yıldırm, Serkan; Alp, Hamit Hakan; Aras, Abbas; Kotan, Çetin

    2016-01-01

    Aim To evaluate the effect of thymoquinone on the healing of experimental left colon anastomosis in rats. Methods Forty Wistar albino rats weighing 250–300 g were randomly divided into four groups (10 rats/group). Group 1 (control group) rats were not administered Thymoquinone (TQ) for 3 days after the operation. Group 2 was administered daily TQ for 3 days starting from the first day after the operation. Group 3 was not administered TQ for 7 days after the operation. Group 4 was administered...

  1. Factors affecting anastomotic leak after colorectal anastomosis in patients without protective stoma in tertiary care hospital

    International Nuclear Information System (INIS)

    Objective: To determine the factors associated with clinically significant anastomotic leak in patients having undergone large intestinal anastomosis. Method: The retrospective study at the Aga Khan University Hospital, Karachi, comprised data between January 2000 and March 2010, related to patients who underwent colorectal anastomosis. Demographic details of the patients, as well as preop, intraop and postop risk factors were recorded. Anastomotic leak was identified as per the defined criteria. Outcome of patients was recorded as postop hospital stay and mortality. Univariate and Multivariate analyses were applied to identify risk factors for anastomotic leakage. Results: Among the total 127 patients in the study, anastomotic leak occurred in 19 (15%) patients (Group 1), while there was no clinical leak in 108 (85%) patients (Group 2). Univariate analysis showed 8 factors to be affecting the anastomotic leak: operation time (p=0.003), intraoperative blood loss (p=0.006), intraoperative blood transfusion (p=0.013), indication of surgery malignancy vs. benign (p=0.049), type of surgery elective vs. emergency (p=0.037), intraop use of vasopressor (p=0.019), segment of bowel anastomosed left side vs. right side (p=0.012), and drain placement vs. no drain placed (p=0.035). Preop immunosuppressive therapy was borderline significant (p=0.089). Multivariate analysis showed that left vs. right sided anastomosis (p=0.068), blood transfusion >2 pack cells (p=0.028), smoker vs. non-smoker (p=0.049), elective vs. emergency surgery (p=0.012) were the independent risk factors which significantly affected the outcome of bowel anastomosis. Mortality rate was 15.79% (n=3/19) in Group 1, while it was 1.85% (n=2/108) in Group 2 (p=0.02). The postop hospital stay was 15+-5.44 days in Group 1, while it was 7.51+-4.04 days in Group 2 (p>0.001). Conclusion: In colorectal anastomotic surgeries temporary diversion stoma formation needs to be considered on the basis of risk factors to

  2. Bricker's ileal conduit urinary diversion with a simple non-refluxing uretero ileal anastomosis

    DEFF Research Database (Denmark)

    Bernstein, I T; Bennicke, K; Rørdam, P;

    1991-01-01

    Fifty consecutive patients had ileal conduits constructed with a technically and quick simple antireflux ureteroileal anastomosis. Complications related to the ureteral implantation were studied retrospectively, and at follow-up (8 months-12 years later, median 3 years) conduit dysfunction and ur...... from 300 to 420 mumol/l. Partial ureteral reflux was present in three (2 patients) of 33 ureters studied and minimal conduit dysfunction was found in 8 patients. In conclusion we find this method of urinary diversion to be quick, easy, and safe....

  3. Outcome of 132 consecutive reconstructive operations for intestinal fistula--staged operation without primary anastomosis improved outcome in retrospective analysis

    DEFF Research Database (Denmark)

    Runström, B; Hallböök, O; Nyström, P O;

    2013-01-01

    AIM: To study factors that influenced healing and survival after attempted closure of enterocutaneous fistula. MATERIAL AND METHODS: Retrospective analysis of prospective data concerning 101 patients operated on 132 instances for 110 enterocutaneous fistulae at two hospitals. RESULTS: In all, 96...... (87%) of the 110 fistulae healed and 92 (91%) patients survived. A total of 9 patients with unhealed fistula died. Multivariate analysis revealed jaundice as an independent factor for both death and failed closure and operation without anastomosis as an independent positive factor for healing. Failure...... rate was lower after an operation with stoma without anastomosis (6 of 43, 14%) than after an operation with anastomosis (30 of 89, 34%) p = 0.0213. Of the 36 instances with unhealed fistula, 13 (36%) could be ascribed to inadvertent bowel lesions at the reconstructive operation. In addition...

  4. Preoperative irradiation combined with chemotherapy impairs healing of bronchial anastomosis during the early postoperative period in rats

    International Nuclear Information System (INIS)

    The effect of preoperative irradiation and antineoplastic agents on healing at the site of bronchial anastomosis was investigated using rats. The bursting pressure in irradiation group and combined irradiation and chemotherapy group was significantly lower than in control and chemotherapy group at day 5 after operation. There was no significant difference in bursting pressure in all groups at day 7. The histologic finding of the anastomosis with hematoxyline and eosin (H and E) stain showed that submucosal connective tissue had not regenerated, and defects were seen in the submucosal tissue in irradiation and combined therapy group at day 3 and day 5. But, the connective tissue had matured in irradiation group at day 7 compared with control group. In conclusion, this study demonstrated that the healing of bronchial anastomosis was markedly delayed in early postoperative days in the rats receiving irradiation and combined therapy. (author)

  5. Comparative evaluation of entero-anastomosis by inversion techniques with different suturing materials in bovine [Water buffalo

    International Nuclear Information System (INIS)

    Single layer end-to-end inverted and everted techniques of entero-anastomosis were evaluated in sixteen male buffalo calves using silk and catgut sutures. All the animals of everting group showed areas of adhesion grossly, whereas it was only in three animals of inverting group. Histological evidences revealed a more uniform healing pattern in inversion group and radiography suggested comparatively greater degree of stenosis, but without functional impairment of intestinal lumen, than everting anastomosis. Connective tissue proliferation and mononuclear cell infiltrations were very minimal with silk suture whereas these were pronounced with catgut, irrespective of anastomotic technique. Thus inversion technique of anastomosis accomplished by single layer suturing with silk thread was ideal for enteroanastomosis in cattle

  6. The effect of peritoneal lavage on the postoperative course after colonic anastomosis and perforation in the rat.

    Science.gov (United States)

    Arnesjö, B; Breland, U; Petersson, B G

    1975-01-01

    Peritoneal lavage was given during four days to rats subjected either to transection and re-anastomosis or perforation of the descending part of the colon or caecum. Control rats were treated in the smae way but did not receive peritoneal lavage. The rats which were treated with a colonic anastomosis and peritoneal lavage had significantly less abdominal adhesions, peritonitis and peritoneal fluid observed at autopsy 11 or 60 days after surgery. No rats developed anastomosis insufficiency and all survived. Peritoneal lavage in rats subjected to colonic or caecal perforation increased the survival time and reduced the mortality rate, the frequency of adhesions and the signs of peritonitis. An increased frequency of peritoneal adhesions was observed after extensive mobilization of the colon during operation when no peritoneal lavage had been given. The peritoneal lavage catheter per se did not cause adhesions.

  7. Comparison of Modifications in Flap Anastomosis Patterns and Skin Incision Types for External Dacryocystorhinostomy: Anterior-Only Flap Anastomosis with W Skin Incision versus Anterior and Posterior Flap Anastomosis with Linear Skin Incision

    Directory of Open Access Journals (Sweden)

    Burcu Dirim

    2015-01-01

    Full Text Available Purpose. To compare the outcomes of external dacryocystorhinostomy (E-DCR by using two different flap anastomosis patterns and skin incision types. Methods. This study included 79 patients (88 eyes with lacrimal drainage system disorders who underwent E-DCR surgery. Fifty eyes of 44 patients (group A underwent E-DCR by suturing anterior and posterior flaps (H-flap of the lacrimal sac with curvilinear skin incision whereas in 38 eyes of 35 patients (group B DCR was performed by suturing only anterior flaps (U-flap with W skin incision. Results. The success rate was evaluated according to lacrimal patency and scar assessment scores. Patency was achieved in 78 patients (88.6%. In terms of groups, patency was 44 eyes (88.0% in group A and 34 eyes (89.5% in group B. There was no statistically significant difference in the success rates of lacrimal patency between the two groups. Further, there was no statistically significant difference concerning cutaneous scar scores. Conclusion. Our study suggests that anastomoses of only anterior flaps or both anterior and posterior flaps have similar success rates; suturing only anterior flaps is easier to perform and shortens the operative time. In addition, W skin incision is a reasonable alternative to curvilinear incision for reducing scar formation.

  8. Colonic J-pouch anal anastomosis after ultralow anterior resection with upper sphincter excision for low-lying rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Jae-Gahb Park; Min Ro Lee; Seok-Byung Lim; Chang Won Hong; Sang Nam Yoon; Sung-Bum Kang; Seung Chul Heo; Seung-Yong Jeong; Kyu Joo Park

    2005-01-01

    AIM: There is some evidence of functional superiority of colonic J-pouch over straight coloanal anastomosis (CAA)in ultralow anterior resection (ULAR) or intersphincteric resection. On the assumption that colonic J-pouch anal anastomosis is superior to straight CAA in ULAR with upper sphincter excision (USE: excision of the upper part of the internal sphincter) for low-lying rectal cancer, we compare functional outcome of colonic J-pouch vs the straight CAA.METHODS: Fifty patients of one hundred and thirty-three rectal cancer patients in whom lower margin of the tumors were located between 3 and 5 cm from the anal verge received ULAR including USE from September 1998 to January 2002. Patients were randomized for reconstruction using either a straight (n = 26) or a colonic J-pouch anastomosis (n = 24) with a temporary diverting-loop ileostomy. All patients were followed-up prospectively by a standardized questionnaire [Fecal Inco-ntinence Severity Index (FISI) scores and Fecal Incontinence Quality of Life (FIQL) scales].RESULTS: We found that, compared to straight anastomosis patients, the frequency of defecation was significantly lower in J-pouch anastomosis patients for 10 mo afterileostomy takedown. The FISI scores and FIQL scales were significantly better in J-pouch patients than in straight patients at both 3 and 12 mo after ileostomy takedown.Furthermore, we found that FISI scores highly correlated with FIQL scales.CONCLUSION: This study indicates that colonic J-pouch anal anastomosis decreases the severity of fecal incontinence and improves the quality of life for 10 mo after ileostomy takedown in patients undergoing ULAR with USE forlow-lying rectal cancer.

  9. Plastic Changes of Synapses and Excitatory Neurotransmitter Receptors in Facial Nucleus Following Facial-facial Anastomosis

    Institute of Scientific and Technical Information of China (English)

    Pei CHEN; Jun SONG; Linghui LUO; Shusheng GONG

    2008-01-01

    The remodeling process of synapses and eurotransmitter receptors of facial nucleus were observed. Models were set up by facial-facial anastomosis in rat. At post-surgery day (PSD) 0, 7, 21 and 60, synaptophysin (p38), NMDA receptor subunit 2A and AMPA receptor subunit 2 (GIuR2) were observed by immunohistochemical method and emi-quantitative RT-PCR, respectively. Meanwhile, the synaptic structure of the facial motorneurons was observed under a transmission electron microscope (TEM). The intensity of p38 immunoreactivity was decreased, reaching the lowest value at PSD day 7, and then increased slightly at PSD 21. Ultrastructurally, the number of synapses in nucleus of the operational side decreased, which was consistent with the change in P38 immhnoreactivity. NMDAR2A mRNA was down-regulated significantly in facial nucleus after the operation (P000.05). The synapses innervation and the expression of NMDAR2A and AMPAR2 mRNA in facial nucleus might be modified to suit for the new motor tasks following facial-facial anastomosis, and influenced facial nerve regeneration and recovery.

  10. Engineering anastomosis between living capillary networks and endothelial cell-lined microfluidic channels.

    Science.gov (United States)

    Wang, Xiaolin; Phan, Duc T T; Sobrino, Agua; George, Steven C; Hughes, Christopher C W; Lee, Abraham P

    2016-01-21

    This paper reports a method for generating an intact and perfusable microvascular network that connects to microfluidic channels without appreciable leakage. This platform incorporates different stages of vascular development including vasculogenesis, endothelial cell (EC) lining, sprouting angiogenesis, and anastomosis in sequential order. After formation of a capillary network inside the tissue chamber via vasculogenesis, the adjacent microfluidic channels are lined with a monolayer of ECs, which then serve as the high-pressure input ("artery") and low pressure output ("vein") conduits. To promote a tight interconnection between the artery/vein and the capillary network, sprouting angiogenesis is induced, which promotes anastomosis of the vasculature inside the tissue chamber with the EC lining along the microfluidic channels. Flow of fluorescent microparticles confirms the perfusability of the lumenized microvascular network, and minimal leakage of 70 kDa FITC-dextran confirms physiologic tightness of the EC junctions and completeness of the interconnections between artery/vein and the capillary network. This versatile device design and its robust construction methodology establish a physiological transport model of interconnected perfused vessels from artery to vascularized tissue to vein. The system has utility in a wide range of organ-on-a-chip applications as it enables the physiological vascular interconnection of multiple on-chip tissue constructs that can serve as disease models for drug screening. PMID:26616908

  11. Ectopic Varices Rupture in the Gastroduodenal Anastomosis Successfully Treated with N-butyl-2-cyanoacrylate Injection

    Directory of Open Access Journals (Sweden)

    Takagi,Hitoshi

    2007-12-01

    Full Text Available The term "ectopic varices" is used to describe dilated portosystemic collateral veins in unusual locations other than the gastroesophageal region. We recently experienced a rare case of ectopic varices that developed in the gastroduodenal anastomosis after subtotal gastrectomy. A 70-year-old male with liver cirrhosis due to hepatitis C virus infection was admitted for hematemesis and tarry stool. He had received a subtotal gastrectomy with the Billroth-I method for gastric ulcer at 46 years of age. Although emergency endoscopy revealed esophageal and gastric fundal varices, there were no obvious bleeding points. After removal of the coagula, ectopic varices and a fibrin plug were observed on the gastroduodenal anastomosis. During the observation, blood began to spurt from the fibrin plug. N-butyl-2-cyanoacrylate with lipiodol injection succeeded in hemostasis. Splenic angiography showed gastric varices feeding from a short gastric vein and the posterior gastric vein. The blood flow around the bleeding point, as indicated by lipiodol deposition, had decreased, and no feeding vein was observed. Endoscopic and angiographic findings are shown and the treatment for such lesions is discussed.

  12. Eficacitatea combaterii larvelor de Clostera anastomosis L. la ieșirea din hibernare [Treatment efficacy of Clostera anastomosis L. caterpillars control in postdormancy phase

    Directory of Open Access Journals (Sweden)

    Duduman Mihai-Leonard

    2015-12-01

    Full Text Available Clostera anastomosis is an important poplar and willow defoliator which, especially since 1950, caused important damages to intensive hybrid poplar crops in Europe and Asia. The need to reduce the loss caused by this insect, often led to radical control tactics, consisting in spraying chemical insecticides with low specificity and high impact on biodiversity. Other control methods (biological control had not the expected effect. Considering the above mentioned aspects and the fact that C. anastomosis overwinters as larvae, mainly in bark crevices of the stems of infested trees, it was tested the possibility of controlling this pest, by chemical control of the larvae, early in spring. There were designed two trials in lab and in field, in order to test the efficacy of 5 insecticides [Proteus (thiacloprid + deltamethrin, Ovipron (horticultural oil, Nuprid (imidacloprid, Confidor (imidacloprid and Karate Zeon (lambda-cyhalothin], sprayed directly on the stem of the poplar trees colonized with overwintering larvae nests. The treatment efficacy was assessed based on the survival rate of larvae after chemical spraying, by comparing it to the control samples. All surviving larvae were trapped in sticky barriers placed around the stems, above the sprayed area. Of the tested insecticides, the most efficient was Confidor, causing mortality of the 90.2 ± 1.8% of the larvae, significantly higher than the rest of the tested insecticides (Proteus, Ovipron, Nuprid. In field conditions, Confidor caused the decrease of the larvae population with 78.2 ± 7.4% for poplar clone AF2, and with 92.9 ± 6.4% for poplar clone AF8, and Karate Zeon caused 100% mortality. Control of the larvae in spring was efficient. It is a matter of course that this control method will have a lower environmental impact due to both the application moment (early spring, before poplars flush, and high control of the sprayed area (only the lower section of the infested tree stems

  13. Safer intestinal invagination for a solid pancre-atico-jejunal anastomosis in presence of a soft texture pancreatic remnant and non-dilated duct

    Institute of Scientific and Technical Information of China (English)

    Francesco Giudici; Benedetta Pesi; Daniela Zambonin; Stefano Scaringi; Paolo Bechi; Giacomo Batignani

    2015-01-01

    Pancreatico-jejunal anastomosis after pancreato-duodenectomy still represents the Achilles’ heel of the proce-dure: the failure of this anastomosis is relatively common and it is the main cause of post-operative morbidity and mortality. Studies have described different reconstruction strategies for the control of the development of post-operative pancreatic ifstula, but the strategy to obtain a safer pancreatico-jejunal anastomosis is still far from satisfaction. We report a novel variation of the invagination technique based on preliminary clinical experience in 8 patients who underwent pancreatico-jejunal anastomosis after pancreatoduodenectomy in our hepatobiliopancreatic center from 2008 to 2014. The varia-tion could obtain a safer intestinal invagination for a solid pancreatico-jejunal anastomosis even in the presence of soft pancreatic remnant.

  14. Safer intestinal invagination for a solid pancre-atico-jejunal anastomosis in presence of a soft texture pancreatic remnant and non-dilated duct

    Institute of Scientific and Technical Information of China (English)

    Francesco Giudici; Benedetta Pesi; Daniela Zambonin; Stefano Scaringi; Paolo Bechi; Giacomo Batignani

    2016-01-01

    Pancreatico-jejunal anastomosis after pancreato-duodenectomy still represents the Achilles’ heel of the proce-dure: the failure of this anastomosis is relatively common and it is the main cause of post-operative morbidity and mortality. Studies have described different reconstruction strategies for the control of the development of post-operative pancreatic ifstula, but the strategy to obtain a safer pancreatico-jejunal anastomosis is still far from satisfaction. We report a novel variation of the invagination technique based on preliminary clinical experience in 8 patients who underwent pancreatico-jejunal anastomosis after pancreatoduodenectomy in our hepatobiliopancreatic center from 2008 to 2014. The varia-tion could obtain a safer intestinal invagination for a solid pancreatico-jejunal anastomosis even in the presence of soft pancreatic remnant.

  15. Manual of Surgical Instruments

    Directory of Open Access Journals (Sweden)

    Olga Lidia Sánchez Sarría

    2014-10-01

    Full Text Available Surgical instruments are the group of tools used in surgical procedures. They are very expensive and sophisticated. Consequently, a standardized and meticulous care is essential; they should go through the decontamination, cleaning and sterilization process. These instruments are designed in order to provide surgeons with tools that help them to perform a basic surgical procedure; there are multiple variations and the design depends on their function. This paper aims at showing all surgical instruments that can be used in an operating room during surgery and are not generally included in the medical literature.

  16. 不同肠管吻合方式对吻合口愈合的影响%Comparison of single-layer anastomosis and double-layer anastomosis of small intestine in dogs

    Institute of Scientific and Technical Information of China (English)

    沈凯; 周刚; 叶颖江; 梁斌

    2012-01-01

    目的 观察不同吻合方法对犬小肠手术后吻合口愈合的影响,探讨其有效性及安全性.方法 成年犬12条,根据吻合部位不同随机分为A、B2组,A组距离屈式韧带100 cm小肠采用双层吻合,距离屈式韧带200 cm小肠采用单层吻合;B组反之.术中记录2种吻合方式的操作时间.术后7d再次手术,找到吻合口并评价吻合口周围粘连分级,测量吻合破裂压(ABP)、小肠浆肌层破裂压.结果 单层吻合与双层吻合后局部粘连分级末见明显差异;单层吻合与双层吻合的ABP分别为(325.83±88.03)和(331.25±70.33) cmH2O(1 cm H2O=0.098 kPa,P>0.05);单层吻合与双层吻合的浆肌层破裂压分别为(185.42±40.87)和(182.08±20.72) cm H2O(P>0.05);单层吻合和双层吻合时间分别为(17.08±3.20)和(23.50±2.50) min(P <0.01).结论 单层吻合法是一种安全、有效的小肠吻合方法.%Objective To evaluate the effectiveness and safety of single-layer anastomosis and double-layer anastomosis of small intestine.Methods Twelve dogs were divided into two groups:group A ( single-layer anastomosis at small intestine 100 cm after Treitz ligament and double-layer anastomosis at small intestine 200 cm after Treitz ligament,n =6) ; group B (double-layer anastomosis at small intestine 100 cm after Treitz ligament and single-layer anastomosis at small intestine 200 cm after Treitz ligament,n =6).The time used for each anastomosis were recorded.The second operations were performed on postoperative day 7 on all the dogs to determine in situ anastomostic bursting pressures (ABP) and the pressures while the serosa layer was tom.Results No anastomosis leak was found in twenty-four stoma of the twelve dogs.There was no significant difference between the stoma created by single-layer anastomosis and double-layer anastomosis on intraperitoneal adhesions.The averaged ABP in the single-layer anastomosis group and the double-layer anastomosis group was (325.83 ± 88

  17. Surgical ethics and the challenge of surgical innovation.

    Science.gov (United States)

    Angelos, Peter

    2014-12-01

    Surgical ethics as a specific discipline is relatively new to many. Surgical ethics focuses on the ethical issues that are particularly important to the care of surgical patients. Informed consent for surgical procedures, the level of responsibility that surgeons feel for their patients' outcomes, and the management of surgical innovation are specific issues that are important in surgical ethics and are different from other areas of medicine. The future of surgical progress is dependent on surgical innovation, yet the nature of surgical innovation raises specific concerns that challenge the professionalism of surgeons. These concerns will be considered in the following pages.

  18. [Interintestinal anastomoses formation using permanent magnet in surgical treatment of children with intestinal stomas].

    Science.gov (United States)

    Gatkin, E Ya; Razumovsky, A Yu; Korsunsky, A A; Konovalov, A K; Sergeev, A V; Vinogradov, A Ya; Sein, V A

    2015-01-01

    It was analyzed the results of treatment of 48 children aged from 1 month to 14 years. In these observations by the 6th - 7th days after doubleintestinalstoma formation magnetic dies with inductance from 300 to 360 mTl and energy force at least 255 kJ/m3 were introduced into lumen of afferent and efferent intestinal loops. Attractive or compression force between dies was 600 g, i.e. force per 1 cm2 was 200 g according to dies' surface 1.12.83.0 cm. Magnets are not only surgical instruments but also physiotherapeutic devices improving microcirculation and stimulating regeneration in the area of anastomosis. Interintestinal anastomosis has been completely formed for 5-7 days. Thereafter magnetic dies have been removed. Stool was normalized in 45 of 48 observations after surgery (1-3 times daily). Intestinal discharge from ileostomy reduced to minimal amount. In 2 patients irregular bowel movements was observed due to adhesive stenosis of interintestinal anastomosis. Magnetic dies can't be established in 1 case due to adhesive process. Hospital stay was from 10 to 25 days in 41 children. 7 patients were discharged for outpatient treatment later. All children were under observation for the period 2-4 months after discharge. Signs of hypotrophy including body weight deficit within 10% of age norm were diagnosed only in 3 children with prematurity degree I-II. Hereafter children were repeatedly hospitalized; intestinal stomas were surgically removed using conventional technique. Thus complete convalescence was obtained. PMID:26271323

  19. Sir Charles Alfred Ballance (1856-1936) and the introduction of facial nerve crossover anastomosis in 1895

    NARCIS (Netherlands)

    Van de Graaf, Robert C.; Ijpma, Frank F. A.; Nicolai, Jean-Philippe A.

    2009-01-01

    Sir Charles Ballance (1856-1936) was the first surgeon in history to perform a facial nerve crossover anastomosis in 1895. Although, recently, several papers on the history of facial nerve surgery have been published, little is known about this historically important operation, the theoretical reaso

  20. Combined resection of aberrant right hepatic artery without anastomosis in panceaticoduodenectomy for pancreatic head cancer: A case report

    Directory of Open Access Journals (Sweden)

    Atsushi Nanashima

    2016-01-01

    Conclusion: By the preoperative and intraoperative imaging managements conducted, combined resection of the aberrant right hepatic artery without anastomosis was achieved by pancreaticoduodenectomy for pancreas head cancer. However, improvements in imaging diagnosis and careful management of R0 resection are important.

  1. Influence of irradiation and hyperthermia on the wound healing of the intestinal anastomosis and the skin suture in rat

    International Nuclear Information System (INIS)

    The influence of irradiation and/or hyperthermia on the wound healing in the rats was studied. In this study, an exteriorized segment of the small intestine or the skin of the right foot was exposed to single doses of irradiation(15 Gy), local hyperthermia (44deg C, 30 minutes), or irradiation plus hyperthermia. After the treatment, intestinal anastomosis or skin suture was performed. The wound healing was assessed by the bursting pressure of the anastomosis, by the tensile strength of suture of the skin, by the hydroxyproline concentration of the tissue around the anastomosis or the skin suture. The wound healing was significantly deteriorated in the group of irradiation. On the other hand, there was no difference in wound healing between the group of hyperthermia and the control group. In the group of combined irradiation and hyperthermia, depressed wound healing was observed. However in this group further deterioration of wound healing was not observed compared to the irradiation group. It was concluded that under the conditions of this experimental model, hyperthermia did not cause any significant deterioration of wound healing of the intestinal anastomosis and the skin suture. (author)

  2. Early Mobilization after Free-flap Transfer to the Lower Extremities: Preferential Use of Flow-through Anastomosis

    Directory of Open Access Journals (Sweden)

    Shimpei Miyamoto, MD

    2014-03-01

    Conclusions: This study demonstrates that early mobilization after free-flap transfer to the lower extremity is made possible by flow-through anastomosis for both arteries and veins. Flow-through flaps have stable circulation from the acute phase and can tolerate early dangling and ambulation.

  3. Role of interventional therapy in hepatic artery stenosis and non-anastomosis bile duct stricture after orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Da-Bing Zhao; Jie-Sheng Qian; Hong Shan; Zai-Bo Jiang; Ming-Sheng Huang; Kang-Shun Zhu; Gui-Hua Chen; Xiao-Chun Meng; Shou-Hai Guan; Zheng-Ran Li

    2007-01-01

    AIM: To analyze the clinical manifestations and the effectiveness of therapy in patients with orthotopic liver transplantation (OLT)-associated hepatic artery stenosis (HAS) and non-anastomosis bile duct stricture.METHODS: Nine cases were diagnosed as HAS and non-anastomosis bile duct stricture. Percutaneous transluminal angioplasty (PTA) was performed in four HAS cases, and expectant treatment in other five HAS cases; percutaneous transhepatic bile drainage, balloon dilation, stent placement were performed in all nine cases.RESULTS: Diffuse intra- and extra-bile duct stricture was observed in nine cases, which was associated with bile mud siltation and biliary infection. Obstruction of the bile duct was improved obviously or removed. Life span/ follow-up period was 13-30 mo after PTA of four HAS cases, 6-23 mo without PTA of other five cases.CONCLUSION: Progressive, non-anastomosis, and diffuse bile duct stricture are the characteristic manifestations of HAS and non-anastomosis bile duct stricture after OLT. These are often associated with bile mud siltation, biliary infection, and ultimate liver failure. Interventional therapy is significantly beneficial.

  4. Application of side-to-side anastomosis of the lesser curvature of stomach and jejunum in gastric bypass

    Science.gov (United States)

    Bai, Ri-Xing; Yan, Wen-Mao; Li, You-Guo; Xu, Jun; Zhong, Zhi-Qiang; Yan, Ming

    2016-01-01

    AIM To evaluate the feasibility of side-to-side anastomosis of the lesser curvature of stomach and jejunum in laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS Seventy-seven patients received side-to-side anastomosis of the lesser curvature of stomach and jejunum by utilization of linear stapler in LRYGB from April 2012 to July 2015 were retrospectively analyzed. RESULTS All patients were successfully completed laparoscopic gastric bypass with the side-to-side anastomosis of the lesser curvature of stomach and jejunum. No patient was switched to laparotomy during operation. No early complications including gastrointestinal anastomotic bleeding, fistula, obstruction, deep vein thrombosis, incision infections, intra-abdominal hernia complications were found. One patient complicated with stricture of gastrojejunal anastomosis (1.3%) and six patients complicated with incomplete intestinal obstruction (7.8%). BMI and HbA1c determined at 3, 6, 12, 24 mo during follow up period were significantly reduced compared with preoperative baselines respectively. The percentage of patients who maintain HbA1c (%) < 6.5% without taking antidiabetic drugs reached to 61.0%, 63.6%, 75.0%, and 63.6% respectively. The outcome parameters of concomitant diseases were significantly improved too. CONCLUSION Present surgery is a safety and feasibility procedure. It is effective to lighten the body weight of patients and improve type 2 diabetes and related complications. PMID:27729746

  5. Laser solder repair technique for nerve anastomosis: temperatures required for optimal tensile strength

    Science.gov (United States)

    McNally-Heintzelman, Karen M.; Dawes, Judith M.; Lauto, Antonio; Parker, Anthony E.; Owen, Earl R.; Piper, James A.

    1998-01-01

    Laser-assisted repair of nerves is often unsatisfactory and has a high failure rate. Two disadvantages of laser assisted procedures are low initial strength of the resulting anastomosis and thermal damage of tissue by laser heating. Temporary or permanent stay sutures are used and fluid solders have been proposed to increase the strength of the repair. These techniques, however, have their own disadvantages including foreign body reaction and difficulty of application. To address these problems solid protein solder strips have been developed for use in conjunction with a diode laser for nerve anastomosis. The protein helps to supplement the bond, especially in the acute healing phase up to five days post- operative. Indocyanine green dye is added to the protein solder to absorb a laser wavelength (approximately 800 nm) that is poorly absorbed by water and other bodily tissues. This reduces the collateral thermal damage typically associated with other laser techniques. An investigation of the feasibility of the laser-solder repair technique in terms of required laser irradiance, tensile strength of the repair, and solder and tissue temperature is reported here. The tensile strength of repaired nerves rose steadily with laser irradiance reaching a maximum of 105 plus or minus 10 N.cm-2 at 12.7 W.cm-2. When higher laser irradiances were used the tensile strength of the resulting bonds dropped. Histopathological analysis of the laser- soldered nerves, conducted immediately after surgery, showed the solder to have adhered well to the perineurial membrane, with minimal damage to the inner axons of the nerve. The maximum temperature reached at the solder surface and at the solder/nerve interface, measured using a non-contact fiber optic radiometer and thermocouple respectively, also rose steadily with laser irradiance. At 12.7 W.cm-2, the temperatures reached at the surface and at the interface were 85 plus or minus 4 and 68 plus or minus 4 degrees Celsius respectively

  6. Presence of PAF-acether in stool of patients with pouch ileoanal anastomosis and pouchitis.

    Science.gov (United States)

    Chaussade, S; Denizot, Y; Valleur, P; Nicoli, J; Raibaud, P; Guerre, J; Hautefeuille, P; Couturier, D; Benveniste, J

    1991-06-01

    Platelet-activating factor is an endogenous phospholipid produced by a wide variety of inflammatory cells. Platelet-activating factor induces severe pathological changes in various organs and, among numerous potent effects, causes bowel necrosis. Pouchitis is a poorly understood complication of ileoanal pouch anastomosis which occurs in patients who undergo surgery for ulcerative colitis. The aim of this study was to measure ileal or fecal platelet-activating factor and lyso platelet-activating factor contents in normal volunteers (n = 12), in patients with terminal ileostomy (n = 7), and in patients with ileoanal anastomosis (n = 15) (8 patients have pouchitis defined by the presence of ulcerations on the reservoir). Fecal samples were processed and assessed for platelet-activating factor by platelet aggregation assay. The aggregating material was further characterized as platelet-activating factor by the following: inhibition of the platelet aggregation it induced by specific platelet-activating factor receptor antagonist (BN 52021; IHB, Le Plessis Robinson, France); abolition of platelet aggregation after incubation with phospholipase A2 but not with lipase A1; and retention time on high-performance liquid chromatography. Stool platelet-activating factor content (in nanograms per gram of stool, mean +/- 1SD) was significantly increased in patients with pouchitis (22.2 +/- 16 ng/g) compared with patients with normal reservoir (1.59 +/- 0.63 ng/g, P less than 0.01), terminal ileostomy (0.59 +/- 0.43 ng/g, P less than 0.01), and healthy controls (0 +/- 0 ng/g of stool, P less than 0.001). Lyso platelet-activating factor (nanograms per gram of stool) was increased in patients with pouchitis (10,704 +/- 5499 ng/g) compared with patients with normal reservoir (4721 +/- 4549 ng/g of stool, P less than 0.05), terminal ileostomy (3042 +/- 4019 ng/g, P less than 0.02), and healthy volunteers (128 +/- 107 ng/g, P less than 0.001). In patients with ileoanal anastomosis and

  7. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.

    2012-01-01

    In the Netherlands, each year over 1700 patients die from preventable surgical errors. Numerous initiatives to improve surgical practice have had some impact, but problems persist. Despite the introduction of checklists and protocols, patient safety in surgery remains a continuing challenge. This is

  8. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.

    2008-01-01

    A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15......A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15...

  9. Combined pancreatic and kidney transplantation: en bloc retrieval and transplantation--a new surgical technique.

    Science.gov (United States)

    De Pauw, L; Ickx, B; Fery, F; Doutrelepont, J M; Abramowicz, D; Vereerstraeten, P; Kinnaert, P

    1994-01-01

    We designed and performed on two patients a new surgical procedure of en bloc kidney and pancreatic transplantation. The liver, pancreas and kidneys were removed en bloc in the donor. On the bench, the liver and the left kidney were separated from the bloc, leaving the pancreas and the right kidney for combined kidney and pancreatic transplantation. The portal vein was divided near to the emergence of the splenic vein. The coeliac axis was taken with an aortic patch. The left renal vein was cut at its entrance to the inferior vena cava (IVC) and the left renal artery was taken with an aortic patch. Reconstruction of the pancreatic vessels was performed with a double anastomosis: the portal vein was anastomosed to the hole in the IVC resulting from the section of the left renal vein and the splenic artery was anastomosed to the hole in the aorta resulting from the section of the left renal artery. The proximal ends of the aorta and IVC were closed with running sutures. In the recipient, the iliac vessels on the right side were dissected. Anastomosis of the distal part of the aorta and the IVC was performed with the right iliac vessels. Duodenocystostomy and reimplantation of the ureter were done according to the usual techniques. This new surgical technique allowed an easy vascular reconstruction of the pancreatic vessels. In the recipient, only one side was used for renal and pancreatic transplantation. Moreover, the length of the transplant procedure was significantly reduced. PMID:11271270

  10. Surgical Anatomy of the Gastrointestinal Tract and Its Vasculature in the Laboratory Rat

    Directory of Open Access Journals (Sweden)

    Katarína Vdoviaková

    2016-01-01

    Full Text Available The aim of this study was to describe and illustrate the morphology of the stomach, liver, intestine, and their vasculature to support the planning of surgical therapeutic methods in abdominal cavity. On adult Wistar rats corrosion casts were prepared from the arterial system and Duracryl Dental and PUR SP were used as a casting medium and was performed macroscopic anatomical dissection of the stomach, liver, and intestine was performed. The rat stomach was a large, semilunar shaped sac with composite lining. On the stomach was very marked fundus, which formed a blind sac (saccus cecus. The rat liver was divided into six lobes, but without gall bladder. Intestine of the rat was simple, but cecum had a shape as a stomach. The following variations were observed in the origin of the cranial mesenteric artery. On the corrosion cast specimens we noticed the presence of the anastomosis between middle colic artery (a. colica media and left colic artery (a. colica sinistra. We investigated the second anastomosis between middle colic artery and left colic artery. The results of this study reveal that the functional anatomical relationship between the rat stomach, liver and intestine is important for the development of surgical research in human and veterinary medicine.

  11. An improved algorithm for coronary bypass anastomosis segmentation in epicardial ultrasound sequences

    DEFF Research Database (Denmark)

    Jørgensen, Alex Skovsbo; Schmidt, Samuel Emil; Staalsen, Niels-Henrik;

    2016-01-01

    Epicardial ultrasound (EUS) can be used for intra-operative quality assessment of coronary artery bypass anastomoses. To quantify the anastomotic quality from EUS images, the area of anastomotic structures has to be extracted from EUS sequences. Currently, this is done manually as no objective...... methods are available. We used an automatic anastomosis segmentation algorithm to extract the area of anastomotic structures from in vivo EUS sequences obtained from 16 porcine anastomoses. The algorithm consists of four major components: vessel detection, vessel segmentation, segmentation quality control...... and inter-frame contour alignment. The segmentation accuracy was assessed using m-fold cross-validation based on 830 manual segmentations of the anastomotic structures. A Dice coefficient of 0.879 (±0.073) and an absolute area difference of 16.95% (±17.94) were obtained. The proposed segmentation algorithm...

  12. Repair of esophageal atresia with proximal fistula using endoscopic magnetic compression anastomosis (magnamosis) after staged lengthening.

    Science.gov (United States)

    Dorman, Robert M; Vali, Kaveh; Harmon, Carroll M; Zaritzky, Mario; Bass, Kathryn D

    2016-05-01

    We describe the treatment of a patient with long-gap esophageal atresia with an upper pouch fistula, mircogastria and minimal distal esophageal remnant. After 4.5 months of feeding via gastrostomy, a proximal fistula was identified by bronchoscopy and a thoracoscopic modified Foker procedure was performed reducing the gap from approximately 7-5 cm over 2 weeks of traction. A second stage to ligate the fistula and suture approximate the proximal and distal esophagus resulted in a gap of 1.5 cm. IRB and FDA approval was then obtained for endoscopic placement of 10-French catheter mounted magnets in the proximal and distal pouches promoting a magnetic compression anastomosis (magnamosis). Magnetic coupling occurred at 4 days and after magnet removal at 13 days an esophagram demonstrated a 10 French channel without leak. Serial endoscopic balloon dilation has allowed drainage of swallowed secretions as the baby learns bottling behavior at home. PMID:27012861

  13. An augmented reality system in lymphatico-venous anastomosis surgery.

    Science.gov (United States)

    Nishimoto, Soh; Tonooka, Maki; Fujita, Kazutoshi; Sotsuka, Yohei; Fujiwara, Toshihiro; Kawai, Kenichiro; Kakibuchi, Masao

    2016-01-01

    Indocyanine green lymphography, displayed as infrared image, is very useful in identifying lymphatic vessels during surgeries. Surgeons refer the infrared image on the displays as they proceed the operation. Those displays are usually placed on the walls or besides the operation tables. The surgeons cannot watch the infrared image and the operation field simultaneously. They have to move their heads and visual lines. An augmented reality system was developed for simultaneous referring of the infrared image, overlaid on real operation field view. A surgeon wore a see-through eye-glasses type display during lymphatico-venous anastomosis surgery. Infrared image was transferred wirelessly to the display. The surgeon was able to recognize fluorescently shining lymphatic vessels projected on the glasses and dissect them out. PMID:27154749

  14. Decellularized extracellular matrix microparticles as a vehicle for cellular delivery in a model of anastomosis healing.

    Science.gov (United States)

    Hoganson, David M; Owens, Gwen E; Meppelink, Amanda M; Bassett, Erik K; Bowley, Chris M; Hinkel, Cameron J; Finkelstein, Eric B; Goldman, Scott M; Vacanti, Joseph P

    2016-07-01

    Extracellular matrix (ECM) materials from animal and human sources have become important materials for soft tissue repair. Microparticles of ECM materials have increased surface area and exposed binding sites compared to sheet materials. Decellularized porcine peritoneum was mechanically dissociated into 200 µm microparticles, seeded with fibroblasts and cultured in a low gravity rotating bioreactor. The cells avidly attached and maintained excellent viability on the microparticles. When the seeded microparticles were placed in a collagen gel, the cells quickly migrated off the microparticles and through the gel. Cells from seeded microparticles migrated to and across an in vitro anastomosis model, increasing the tensile strength of the model. Cell seeded microparticles of ECM material have potential for paracrine and cellular delivery therapies when delivered in a gel carrier. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 1728-1735, 2016. PMID:26946064

  15. Radiologic evaluation of the continent (S-pouch) ileal reservoir with anal anastomosis

    Energy Technology Data Exchange (ETDEWEB)

    Hennild, V.; Kjaergaard, H.; Kuld Hansen, L.

    A radiologic investigation was performed in 26 patients subjected to colectomy, mucosal proctectomy and endorectal ileo-anal anastomosis after the creation of an ileal reservoir. The patients had suffered from ulcerative colitis or familial polyposis. The reservoir and its efferent leg was best demonstrated by contrast enema. The size and position of the reservoir and the efferent leg was demonstrated, and stenoses, abscesses and fistulae could be identified. Examination of the small bowel with a contrast medium showed slight dilatation of the ileum orally to the reservoir in all instances and one patient had a stenosis at the junction of the afferent leg of the reservoir. Erect and supine projections of the abdomen showed gas in the intestine and fluid levels in the reservoir. These radiographic findings should not be confused with ileus or pelvic abscess. Radiology was of great value in disclosing postoperative complications.

  16. FIRST NATIONAL EXPERIENCE OF RETROPERITONEAL PANCREAS TRANSPLANTATION WITH THE FORMATION OF DUODENO-DUODENAL ANASTOMOSIS

    Directory of Open Access Journals (Sweden)

    A. V. Pinchuk

    2013-01-01

    Full Text Available Simultaneous pancreas-kidney transplantation is a valid therapeutic option for patients with type 1 diabetes mel- litus (DM and secondary diabetic nephropathy, which enables to achieve an insulin-independent euglycemic state with normalization of glycosylated hemoglobin levels, prevent the secondary complications of diabetes and consequently improve patients, quality of life. There are various transplantation procedures exist. Although pancreas is transplanted because of its endocrine function, one of the main issues, which prevent the successful development of pancreas transplantation, is an exocrine drainage. The aim of this paper was to summarize our first experience of retroperitoneal pancreas transplantation with the formation of duodeno-duodenal anastomosis for enteric drainage. 

  17. Late results of mucosal proctectomy and colo-anal sleeve anastomosis for chronic irradiation rectal injury

    International Nuclear Information System (INIS)

    Ten patients with severe chronic irradiation injury to the rectum were treated by mucosal proctectomy and colo-anal sleeve anastomosis. The indications were: recurrent rectal bleeding (five), stricture (three), fistula (one) and intractable pain (one). Overall follow-up has ranged from 8 to 77 months (mean 40 months). In the present survivors (n=7) the follow-up ranges from 18 to 77 months (mean 52 months). Six patients have been followed up for more than 3 years and four for more than 5 years. There was no operative mortality. Three anastomotic strictures occurred but the protecting stoma could be closed in all but one patient. Continence was acceptable although urgency and frequency of defaecation were troublesome symptoms. The operation is recommended for life-threatening, haemorrhagic chronic irradiation injury to the rectum. (author)

  18. Surgical treatment of postintubation tracheal stenosis: Iranian experience of effect of previous tracheostomy

    Directory of Open Access Journals (Sweden)

    Hashemzadeh S

    2012-01-01

    Full Text Available Shahryar Hashemzadeh1, Khosrow Hashemzadeh2, Farzad Kakaei3, Raheleh Aligholipour4, Kamyar Ghabili51Tuberculosis and Lung Disease Research Center, 2Department of Cardiovascular Surgery, Shahid Madani Hospital, 3Department of General Surgery, 4Students Research Committee, 5Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Postintubation tracheal stenosis remains the most common indication for tracheal surgery. In the event of a rapid and progressive course of the disease after extubation, surgical approaches such as primary resection and anastomosis or various methods of tracheoplasty should be selected. We report our experience with surgical management of moderate to severe postintubation tracheal stenosis. We also compared intraoperative variables in postintubation tracheal stenosis between those with and without previous tracheostomy.Methods: Over a 5-year period from June 2005 to July 2010, 50 patients aged 14–64 years with moderate (50%–70% of the lumen to severe (>70% postintubation tracheal stenosis underwent resection and primary anastomosis. Patients were followed up to assess the surgical outcome. To study the effect of previous tracheostomy on treatment, surgical variables were compared between patients with previous tracheostomy (group A, n = 27 and those without previous tracheostomy (group B, n = 23.Results: Resection and primary anastomosis was performed via either cervical incision (45 patients or right thoracotomy (five patients. In two patients with subglottic stenosis, complete resection of the tracheal lesion and anterior portion of cricoid cartilage was performed, and the remaining trachea was anastomosed to the thyroid cartilage using a Montgomery T-tube. There was only one perioperative death in a patient with a tracheo-innominate fistula. The length of the resected segment, number of resected rings, and subsequent duration of surgery were significantly

  19. Intrathoracic versus Cervical Anastomosis after Resection of Esophageal Cancer: A matched pair analysis of 72 patients in a single center study

    Directory of Open Access Journals (Sweden)

    Klink Christian D

    2012-08-01

    Full Text Available Abstract Background The aim of this study was to analyze the early postoperative outcome of esophageal cancer treated by subtotal esophageal resection, gastric interposition and either intrathoracic or cervical anastomosis in a single center study. Methods 72 patients who received either a cervical or intrathoracic anastomosis after esophageal resection for esophageal cancer were matched by age and tumor stage. Collected data from these patients were analyzed retrospectively regarding morbidity and mortality rates. Results Anastomotic leakage rate was significantly lower in the intrathoracic anastomosis group than in the cervical anastomosis group (4 of 36 patients (11% vs. 11 of 36 patients (31%; p = 0.040. The hospital stay was significantly shorter in the intrathoracic anastomosis group compared to the cervical anastomosis group (14 (range 10–110 vs. 26 days (range 12 – 105; p = 0.012. Wound infection and temporary paresis of the recurrent laryngeal nerve occurred significantly more often in the cervical anastomosis group compared to the intrathoracic anastomosis group (28% vs. 0%; p = 0.002 and 11% vs. 0%; p = 0.046. The overall In-hospital mortality rate was 6% (4 of 72 patients without any differences between the study groups. Conclusions The present data support the assumption that the transthoracic approach with an intrathoracic anastomosis compared to a cervical esophagogastrostomy is the safer and more beneficial procedure in patients with carcinoma of the lower and middle third of the esophagus due to a significant reduction of anastomotic leakage, wound infection, paresis of the recurrent laryngeal nerve and shorter hospital stay.

  20. [Clinico-morphological assessment of early and late results of laser therapy of the anastomosis area after radical surgeries for stomach cancer].

    Science.gov (United States)

    Zyrianov, B N; Vusik, M V; Kritskaia, N G

    2003-01-01

    The study included 52 patients after gastrectomy for carcinoma of the proximal part of the stomach. Endoscopic laser therapy was made in 32 patients to reduce inflammation in the anastomosis zone 2-3 weeks after surgery. Drug therapy was made in 20 patients within the same time period. Histochemical study of the biopsy material of esophageal and intestinal part of the anastomosis was carried out. It is revealed that application of copper vapor laser early after surgery reduces edema and inflammation in the anastomosis zone for 2 weeks as well as accelerates the growth of granulation tissue forming a delicate scar thus preventing formation of scar stenosis.

  1. Multiscale Surgical Telerobots

    Energy Technology Data Exchange (ETDEWEB)

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  2. Living donor liver hilar variations:surgical approaches and implications

    Institute of Scientific and Technical Information of China (English)

    Onur Yaprak; Tolga Demirbas; Cihan Duran; Murat Dayangac; Murat Akyildiz; Yaman Tokat; Yildiray Yuzer

    2011-01-01

    BACKGROUND: Varied vascular and biliary anatomies are common in the liver. Living donor hepatectomy requires precise recognition of the hilar anatomy. This study was undertaken to study donor vascular and biliary tract variations, surgical approaches and implications in living liver transplant patients. METHODS: Two hundred living donor liver transplantations were performed at our institution between 2004 and 2009. All donors were evaluated by volumetric computerized tomography (CT), CT angiography and magnetic resonance cholangiography in the preoperative period. Intraoperative ultrasonography and cholangiography were carried out. Arterial, portal and biliary anatomies were classified according to the Michels, Cheng and Huang criteria. RESULTS: Classical hepatic arterial anatomy was observed in 129 (64.5%) of the 200 donors. Fifteen percent of the donors had variation in the portal vein. Normal biliary anatomy was found in 126 (63%) donors, and biliary tract variation in 70% of donors with portal vein variations. In recipients with single duct biliary anastomosis, 16 (14.4%) developed biliary leak, and 9 (8.1%) developed biliary stricture; however more than one biliary anastomosis increased recipient biliary complications. Donor vascular variations did not increase recipient vascular complications. Variant anatomy was not associated with an increase in donor morbidity. CONCLUSIONS: Living donor liver transplantation provides information about variant hilar anatomy. The success of the procedure depends on a careful approach to anatomical variations. When the deceased donor supply is inadequate, living donor transplantation is a life-saving alternative and is safe for the donor and recipient, even if the donor has variant hilar anatomy.

  3. Ambulatory Surgical Measures - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  4. Ambulatory Surgical Measures - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  5. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  6. Surgical Critical Care Initiative

    Data.gov (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  7. Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Assfalg, Volker; Hüser, Norbert; Michalski, Christoph; Gillen, Sonja; Kleeff, Jorg; Friess, Helmut, E-mail: friess@chir.med.tu-muenchen.de [Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, D-81675 Munich (Germany)

    2011-02-14

    Palliative treatment concepts are considered in patients with non-curatively resectable and/or metastasized pancreatic cancer. However, patients without metastases, but presented with marginally resectable or locally non-resectable tumors should not be treated by a palliative therapeutic approach. These patients should be enrolled in neoadjuvant radiochemotherapy trials because a potentially curative resection can be achieved in approximately one-third of them after finishing treatment and restaging. Within the scope of best possible palliative care, resection of the primary cancer together with excision of metastases represents a therapeutic option to be contemplated in selected cases. Comprehensive palliative therapy is based on treatment of bile duct or duodenal obstruction for certain locally unresectable or metastasized advanced pancreatic cancer. However, endoscopic or percutaneous stenting procedures and surgical bypass provide safe and highly effective therapeutic alternatives. In case of operative drainage of the biliary tract (biliodigestive anastomosis), the prophylactic creation of a gastro-intestinal bypass (double bypass) is recommended. The decision to perform a surgical versus an endoscopic procedure for palliation depends to a great extent on the tumor stage and the estimated prognosis, and should be determined by an interdisciplinary team for each patient individually.

  8. The role of surgical neuroangiography in the treatment of epistaxis

    International Nuclear Information System (INIS)

    The potential benefit of embolization procedures has not been fully recognized by North American otolaryngologists, who often choose surgical ligation over embolization. Complications associated with improper endovascular treatment further interfere with the demand for this treatment modality. The authors suggest that embolization for epistaxis is safe and reliable if performed by well-trained teams. A thorough understanding of vascular anatomy, anatomic variations, and the dangerous anastomosis is mandatory. They have performed (combined experience) surgical neuroangiography in more than 70 patients with persistent and recurrent epistaxis. The underlying pathology in the patients treated by embolization was quite varied. The nasal packings could always be removed in the angiography room immediately after the embolization procedure. A protocol approach to angiography as proposed by one of the authors (P. L.) is strongly recommended. Superselective catheterization allows the safe deposition of embolic material. Proper embolization will lead to early mobilization of the patient. The vascular supply to the nasal fossa and the pitfalls associated with embolization of this area are discussed in detail, as are the goals and results that can be expected with proper embolization of the various disease processes associated with epistaxis

  9. Clinical spectrum of internal hernia. A surgical emergency

    International Nuclear Information System (INIS)

    The purpose of this study was to define the indicators of bowel ischemia caused by congenital or acquired internal hernia, based on our 10-year experience in one center. We reviewed the medical records, imaging studies, and operative findings of 20 patients who underwent surgery for an internal hernia at our medical center between 1995 and 2005. The clinical characteristics and related indicators of the patients with, and those without bowel ischemia were compared and analyzed statistically. The subtypes of congenital internal hernia (CIH) included transmesenteric (n=6, 60%), paraduodenal (n=2, 20%), and pericecal (n=2, 20%) hernia. The abdominal surgical procedures preceding acquired internal hernia (AIH) were Roux-en-Y anastomosis (n=6, 60%) and appendectomy (n=3, 30%). Transmesenteric hernia was the most prevalent type of CIH in children. Abdominal rebound tenderness, advanced leukocytosis (>18000/mm3), or a high level of manual band form (>6%) were the positive predictive factors for bowel ischemia, whereas a history of chronic intermittent abdominal pain was a negative indicator. No recurrence was noted during the 10-year study period. The overall mortality rate was 20%, attributable to enteral bacteria sepsis in all cases. Internal hernia is a rare but lethal condition. Early diagnosis and prompt surgical intervention provide the only chance of a successful outcome. (author)

  10. Surgical treatment for rabbits' femoral arteries subjected to gunshot wounds combining with seawater immersion

    Institute of Scientific and Technical Information of China (English)

    LIU Peng; PENG Xue-liang; LIU Jin-cai; LAI Xi-nan; ZHANG Liang-chao; WU Guo-ping; WANG Li-li

    2005-01-01

    Objective: To investigate the surgical treatment methods and evaluate the outcome of gunshot wounds combining with seawater immersion in rabbits' femoral arteries.Methods: One hundred healthy New Zealand white rabbits (either sex, 3.14 kg±0.61 kg in weight) were randomly divided into a seawater immersion group (n=50) and a simple injury group (n=50). The unilateral femoral arteries of all the rabbits were injured by 0.38 g steel spheres with velocity of 600-800 m/s fired by a 7.62 mm rifle. The rabbits in the seawater immersion group were immersed in seawater (saline content of 2.54%, pH 8.2-8.4, and at 21℃) for 60 minutes but those in the simple injury group were not. After the injured segment (observed by naked eyes) of the femoral artery was excised, the blood flow restoration was reconstructed by direct end-to-end anastomosis, reversed autogenous venous grafting or cryopreserved arterial allografting, according to the length of the arterial defects. At 24 hours, and 7, 14 and 21 days after operation, the blood flow was examined. Operative exploration was performed for the animals with partly or fully obstructed blood flow. The tissues around the anastomosis sites and the grafts were harvested for pathological observation under a light microscope and an electron microscope.Results: In the rabbits with completely transected injury, the unobstructed rates in the first 3 weeks after operation were 80.00% in the seawater immersion group and 86.67% in the single injury group, and no significant difference was found between the two groups (P>0.1). In the rabbits with arterial contusion injury, the unobstructed rates in the first 3 weeks after operation were 86.67% in the seawater immersion group and 82.35% in the single injury group, and no significant difference was found between the two groups (P>0.1). Most thrombosis occurred in the first operative week. Atypical endothelial cells were detected at the anastomosis sites at the first operative week, and the

  11. [Dextrocardia with situ solitus, ventricular loop, double outlet hypoplastic right ventricle and L-malposition of the great arteries. Description and surgical treatment of a rare and complex cardiopathy].

    Science.gov (United States)

    Fraisse, A; Ghez, O; Ligi, I; Laporte-Giugliano, V; Chetaille, P; Bonnet, J L; Aubert, F; Metras, D

    2002-05-01

    Despite the cardiac surgery improvements allowing the correction of the majority of congenital heart diseases with ventricle-great vessels discontinuity, some abnormalities increase the risk of bi-ventricular reparation. We herein report the case of a patient presenting a rare form of double outlet right ventricle with a ventricular loop, with moderate right ventricle hypoplasia. L-malposition of great vessels and pulmonary artery stenosis, and for whom we opted for a palliative surgical treatment including a systemic-pulmonary anastomosis followed by a upper right bi-directional cavo-pulmonary derivation. The last surgery was followed by recurrent right pleural effusions disappearing after the embolization of the systemic-pulmonary anastomosis by catheterism as it probably obstructed the draining of the cavo-pulmonary anastomosis. The relevance of this clinical case reported is, firstly the description of this ventricle loop resulted from a marked ventricular malposition which is a rare heart disease, and secondly the discussion about the surgical treatment, especially about the choice between palliative and curative surgery. Only comparative studies on long term morbidity and mortality between the bi-ventricular reparation and mono-ventricular palliation will allow the selection of the most appropriate surgical treatment.

  12. The Single-Knot Running Vesicourethral Anastomosis after Minimally Invasive Prostatectomy: Review of the Technique and Its Modifications, Tips, and Pitfalls.

    Science.gov (United States)

    Albisinni, Simone; Aoun, Fouad; Peltier, Alexandre; van Velthoven, Roland

    2016-01-01

    The vesicourethral anastomosis represents a step of major difficulty at the end of minimally invasive radical prostatectomy. Over 10 years ago, we have devised the single-knot running vesicourethral anastomosis, which has been widely adopted in urologic departments worldwide. Aim of the current paper is to review the technique, its adaptability in complex situations, its complications, and possible modifications, including the use of barbed sutures. PMID:27340567

  13. Management of Super-super Obese Patients: Comparison Between Mini (One Anastomosis) Gastric Bypass and Sleeve Gastrectomy.

    Science.gov (United States)

    Madhok, Brijesh; Mahawar, Kamal K; Boyle, Maureen; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K

    2016-07-01

    Management of super-super obese patients poses a particular challenge for bariatric surgeons. Many staged algorithms exist for these patients. Essentially all of these involve a lower-risk procedure like sleeve gastrectomy first before a definitive second-stage procedure like gastric bypass or duodenal switch. This study compares our results with 19 mini (one anastomosis) gastric bypass and 56 sleeve gastrectomy in super-super obese patients. Sleeve gastrectomy patients were significantly older. There was no mortality or major complication in either group. There was no minor complication in mini (one anastomosis) gastric bypass group compared to two in the sleeve gastrectomy group. Mini (one anastomsosis) gastric bypass patients experienced significantly higher weight loss compared to sleeve gastrectomy patients at 6 months, 1 year, and 2 years after surgery.

  14. Application of a three-dimensional microsurgical video system for a rat femoral vessel anastomosis

    Institute of Scientific and Technical Information of China (English)

    Liu Jianfeng; Chen Bin; Ni Yong; Zhan Yongqiang; Gao Haibin

    2014-01-01

    Background The operating microscopes have been applied to modern surgery for nearly a century.However,generations of microsurgeons have to flex their necks and fix their eyes on the eyepieces of a microscope continually that leads to physical and mental fatigue during a long operation.Stereoscopic three-dimensional (3D) media provides more ergonomic working environment,subsequently,resulting better performance in tasks and more accurate judgment.In this study,an alternative method of magnification was analyzed using a three-dimensional microsurgical video system and compared with the traditional method under microscopy to evaluate the availability and feasibility of a 3D microsurgical video system for microvascular anastomosis.Methods Forty Sprague-Dawley rats were randomly divided into four groups with each of 10.In 20 rats,10 femoral artery anastomoses with a conventional microscope (arterial microscope group) were compared with that of 10 femoral artery anastomoses with a 3D microsurgical video system (arterial 3D group).For the other 20 rats,10 femoral vein anastomoses using a conventional microscope (venous microscope group) were compared with that of 10 femoral vein anastomoses using a 3D microsurgical video system (venous 3D group).The arterial and venous microscope groups were considered to be the control groups.The arterial and venous 3D groups were the experimental groups.The examined criteria were as follows:anastomotic time,patency right after the procedure and 10 days later,number of sutures,vessel caliber,and pathological features.Results There were no differences between the operating equipment with respect to vessel caliber,anastomotic time,patency rate,number of sutures,and pathological changes in either the small arteries or veins.The average arterial anastomotic time of the arterial microscope group and arterial 3D group was 34.21 and 33.87 minutes,respectively (P >0.05).The average venous anastomotic time of the venous microscope group and

  15. Outcomes of Prosthetic Hemodialysis Grafts after Deployment of Bare Metal versus Covered Stents at the Venous Anastomosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Charles Y., E-mail: charles.kim@duke.edu; Tandberg, Daniel J.; Rosenberg, Michael D.; Miller, Michael J.; Suhocki, Paul V.; Smith, Tony P. [Duke University Medical Center, Division of Vascular and Interventional Radiology (United States)

    2012-08-15

    Purpose: To compare postintervention patency rates after deployment of bare metal versus covered stents across the venous anastomosis of prosthetic arteriovenous (AV) grafts. Methods: Review of our procedural database over a 6 year period revealed 377 procedures involving stent deployment in an AV access circuit. After applying strict inclusion criteria, our study group consisted of 61 stent deployments in 58 patients (median age 58 years, 25 men, 33 women) across the venous anastomosis of an upper extremity AV graft circuit that had never been previously stented. Both patent and thrombosed AV access circuits were retrospectively analyzed. Within the bare metal stent group, 20 of 32 AV grafts were thrombosed at initial presentation compared to 18 of 29 AV grafts in the covered stent group. Results: Thirty-two bare metal stents and 29 covered stents were deployed across the venous anastomosis. The 3, 6, and 12 months primary access patency rates for bare metal stents were not significantly different than for covered stents: 50, 41, and 22 % compared to 59, 52, and 29 %, respectively (p = 0.21). The secondary patency rates were also not significantly different: 78, 78, and 68 % for bare metal stents compared to 76, 69, and 61 % for covered stents, respectively (p = 0.85). However, covered stents demonstrated a higher primary stent patency rate than bare metal stents: 100, 85, and 70 % compared to 75, 67, and 49 % at 3, 6, and 12 months (p < 0.01). Conclusion: The primary and secondary access patency rates after deployment of bare metal versus covered stents at the venous anastomosis were not significantly different. However, bare metal stents developed in-stent stenoses significantly sooner.

  16. Feasibility of Neurovascular Antropylorus Perineal Transposition With Pudendal Nerve Anastomosis Following Anorectal Excision: A Cadaveric Study for Neoanal Reconstruction

    OpenAIRE

    Chandra, Abhijit; Kumar, Ashok; Noushif, M; Gupta, Nitish; Kumar, Vijay; Chauhan, Navneet Kumar; Gupta, Vishal

    2013-01-01

    Purpose Perineal transposition of the antropyloric valve following an anorectal excision as a substitute for a permanent colostomy has recently been reported in humans. However, the problem of neural control still remains in these patients. Our aim herein was to study the anatomical feasibility of an anastomosis between the pudendal nerve branches (inferior rectal nerve) innervating the external anal sphincter and the anterior vagal branches of the perineally-transposed antropyloric segment i...

  17. A novel biodegradable biliary stent in the normal duct hepaticojejunal anastomosis: an 18-month follow-up in a large animal model.

    Science.gov (United States)

    Laukkarinen, Johanna M; Sand, Juhani A; Chow, Pierce; Juuti, Hanne; Kellomäki, Minna; Kärkkäinen, Päivi; Isola, Jorma; Yu, Sidney; Somanesan, Satchithanantham; Kee, Irene; Song, In Chin; Ng, Teck Hin; Nordback, Isto H

    2007-06-01

    Creating a well-functioning hepaticojejunostomy (HJ) anastomosis with nondilated bile ducts remains a challenge. Our aim was to study the use in a large animal model of a novel, braided polylactide barium sulfate biodegradable biliary stent (BDBS) without external connection and with no need for later removal. Fifty swine were randomly operated on for Roux-Y HJ with or without BDBS in the anastomosis, and followed up (dynamic biligraphy, x-ray, serum determinations, anastomosis inner diameter, and histology) for 1.5, 3, 6, 12, and 18 months. During the follow-up, one nonstented animal died because of anastomotic leakage. In x-ray BDBS was seen in place until 1.5 months in all of the stented animals. In the nonstented animals HJ anastomosis inner diameter was decreased at 18 months [6.3 (5.0-7.0) mm vs 7.4 (7.0-9.0) mm, p = 0.05] and liver clearance reduced at 12 and 18 months compared to stented animals. Serum liver values and liver and bile duct histology did not differ between the groups. We conclude that this novel BDBS is easy to insert into the HJ anastomosis with nondilated ducts. It is nontoxic, dissolves safely, and may be associated with a larger and better draining anastomosis at 18-month follow-up. These results encourage us to proceed to clinical studies. PMID:17436052

  18. Hypoglossal-facial nerve anastomosis and rehabilitation in patients with complete facial palsy: cohort study of 30 patients followed up for three years.

    Science.gov (United States)

    Dalla Toffola, Elena; Pavese, Chiara; Cecini, Miriam; Petrucci, Lucia; Ricotti, Susanna; Bejor, Maurizio; Salimbeni, Grazia; Biglioli, Federico; Klersy, Catherine

    2014-01-01

    Our study evaluates the grade and timing of recovery in 30 patients with complete facial paralysis (House-Brackmann grade VI) treated with hypoglossal-facial nerve (XII-VII) anastomosis and a long-term rehabilitation program, consisting of exercises in facial muscle activation mediated by tongue movement and synkinesis control with mirror feedback. Reinnervation after XII-VII anastomosis occurred in 29 patients, on average 5.4 months after surgery. Three years after the anastomosis, 23.3% of patients had grade II, 53.3% grade III, 20% grade IV and 3.3% grade VI ratings on the House-Brackmann scale. Time to reinnervation was associated with the final House-Brackmann grade. Our study demonstrates that patients undergoing XIIVII anastomosis and a long-term rehabilitation program display a significant recovery of facial symmetry and movement. The recovery continues for at Hypoglossal-facial nerve anastomosis and rehabilitation in patients with complete facial palsy: cohort study of 30 patients followed up for three years least three years after the anastomosis, meaning that prolonged follow-up of these patients is advisable.

  19. Surgical management of presbyopia

    Directory of Open Access Journals (Sweden)

    Torricelli AA

    2012-09-01

    Full Text Available André AM Torricelli, Jackson B Junior, Marcony R Santhiago, Samir J BecharaDivision of Ophthalmology, University of São Paulo Medical School, São Paulo, BrazilAbstract: Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages.Keywords: presbyopia, surgical correction, treatment

  20. Regional diagnosis of lymphoedema and selection of sites for lymphaticovenular anastomosis using elastography

    International Nuclear Information System (INIS)

    Aim: To evaluate the use of ultrasound elastography as a basis for determining the most appropriate sites for lymphaticovenular anastomosis (LVA) for treatment of lymphoedema. Materials and methods: Preoperative elastography and LVA were performed in 11 patients (11 legs) with leg lymphoedema, including two cases of primary oedema and nine of secondary oedema. Results: The mean number of LVAs applied per leg was 4.4 (range 3-7). The mean reduction in the leg circumference was 91.7%, and 10 of the 11 cases (90.0%) were improved. Hardness was reduced from a mean of 1.6 before surgery to 0.9 after surgery, and improvement was also noted in 10 cases (90.9%). The severity of oedema was determined in five regions in each leg, and was classified as elastography stage (ES) 0 in 11 regions, ES1 in 23, ES2 in 15, and ES3 in six. Conclusions: These results demonstrate the value of ultrasound elastography for the diagnosis of early-stage lymphoedema and determination of LVA sites. This is the first report of diagnosis of lymphoedema using elastography and the findings suggest that this procedure followed by LVA could be used as a new therapeutic method for early-stage lymphoedema.

  1. Resection and primary anastomosis with or without modified blow-hole colostomy for sigmoid vovulus

    Institute of Scientific and Technical Information of China (English)

    Sacid Coban; Mehmet Yilmaz; Alpaslan Terzi; Fahrettin Yildiz; Dincer Ozgor; Cengiz Ara; Saim Yologlu; Vedat Kirimlioglu

    2008-01-01

    AIM: To evaluate the efficacy of resection and primary anastomosis (RPA) and RPA with modified blow-hole colostomy for sigmoid volvulus.METHODS: From March 2000 to September 2007,77 patients with acute sigmoid volvulus were treated.A total of 47 patients underwent RPA or RPA with modified blow-hole colostomy.Twenty-five patients received RPA (Group A),and the remaining 22 patients had RPA with modified blow-hole colostomy (Group B).The clinical course and postoperative complications of the two groups were compared.RESULTS: The mean hospital stay,wound infection and mortality did not differ significantly between the groups.Superficial wound infection rate was higher in group A (32% vs 9.1%).Anastomotic leakage was observed only in group A,with a rate of 6.3%.The difference was numerically impressive but was statistically not significant.CONCLUSION: RPA with modified blow-hole colostomy provides satisfactory results.It is easy to perform and may become a method of choice in patients with sigmoid volvulus.Further studies are required to further establish its role in the treatment of sigmoid volvulus.

  2. Effects of hyperbaric oxygen and Pgg-glucan on ischemic colon anastomosis

    Institute of Scientific and Technical Information of China (English)

    Suna Guzel; Oguzhan Sunamak; Abdullah AS; Varol Celik; Mehmet Ferahman; Muhammed MK Nuri; Ertugrul Gazioglu; Pinar Atukeren; Ozgur Mutlu

    2006-01-01

    AIM: In colorectal surgery, anastomotic failure is still a problem in ischemia. Here, we analyzed the effects of hyperbaric oxygen and beta-glucan on colon anastomoses in ischemic condition.METHODS: Colonic resection and anastomosis in rectosigmoid region were done in forty Wistar-Albino rats of four groups of equal number. Colon mesentery was ligated to induce ischemia. The first group was the control group. The subjects of second group were treated with hyperbaric oxygen; the third group with glucan and the forth group were treated with both. At the forth day, rats were sacrificed, anastomotic segment was resected and burst pressures and hydroxyproline levels of anastomotic line were measured.RESULTS: The burst pressure difference of second and third groups from the control group were meaningful (P< 0.01); the forth group differed significantly from the control (P<0.001). There was no difference between the treated groups on burst pressure level (P> 0.05).The hydroxyproline levels in all treated groups were different from the control group significantly (P< 0.001).Hydroxyproline levels in the forth group were higher than those of the second and the third groups (P< 0.001).There were no significant differences between the second and the fourth groups in burst pressure and hydroxyproline levels (P> 0.05).CONCLUSION: Hyperbaric oxygen and glucan improve healing in ischemic colon anastomoses by anti-microbic,immune stimulating properties and seem to act synergistically when combined together.

  3. [Laparoscopic resection-anastomosis in diverticular sigmoiditis and its complications apropos of 65 cases].

    Science.gov (United States)

    Cady, J; Godfroy, J; Sibaud, O

    1996-01-01

    From 1992 to 1995, 77 cases of diverticular sigmoiditis were treated laparoscopically. Conversion to open surgery was required in only 6 cases. There were 27 cases with perforated sigmoid including 5 with peritonitis. Leakages from the anastomosis occurred intraoperatively in 3 cases and were repaired laparoscopically. Early complications were fistulae (n = 2.3%), occlusion by loop agglutination (n = 1) and Richter's hernia (n = 1). A cerebral vascular event lead to death in one patient over 80. Late complications were limited to extensible anastomotic diaphragms (27%) as no true stenoses were observed. There was 1 occlusion on bride and 1 eventration through the extraction orifice. Both were treated laparoscopically. Our overall results after laparoscopic treatment of diverticular sigmoiditis show a 3-fold increase in operative time over classical surgery without any modification in operative risks, a 2-fold reduction in intensive care after surgery and preserved parietal wall (10-fold reduction in the number of eventrations and to a lesser extent fewer occlusions). Laparoscopic surgery does however have its limitations in major peritoneo-occlusive syndromes and in patients with a high risk for anesthesia. PMID:8945840

  4. Stented ureterovesical anastomosis in renal transplantation: does it influence the rate of urinary tract infections?

    Directory of Open Access Journals (Sweden)

    Mathe Z

    2010-07-01

    Full Text Available Abstract Objective Our objective was to evaluate the impact of routine use of double-J stents on the incidence of urinary tract infection after renal transplantation. Methods We conducted a retrospective-comparative single-centre study in 310 consecutive adult deceased donor kidney recipients transplanted from 2002 to 2006. Patients were divided in two groups, with or without urinary stent implantation. To evaluate the predictive factors for UTI, donor and recipients pre- and post-transplantation data were analysed. Early urological complications and renal function within 12 months of transplantation were included as well. Results A total of 157 patients were enrolled to a stent (ST and 153 patients to a no-stent (NST group. The rate of urinary tract infection at three months was similar between the two groups (43.3% ST vs. 40.1% NST, p = 0.65. Of the identified pathogens Enterococcus and Escherichia coli were the most common species. In multivariate analysis neither age nor immunosuppressive agents, BMI or diabetes seemed to have influence on the rate of UTI. When compared to males, females had a significantly higher risk for UTI (54.0% vs. 33.5%. Conclusion Prophylactic stenting of the ureterovesical anastomosis does not increase the risk of urinary tract infection in the early postoperative period.

  5. Hyperspectral imaging of vascular anastomosis associated with blood flow and hemoglobin concentration.

    Science.gov (United States)

    Sakota, Daisuke; Nagaoka, Eiki; Maruyama, Osamu

    2015-08-01

    The feasibility of optical non-invasive evaluation of the graft function of vascular anastomosis was investigated in vitro using hyperspectral imaging (HSI) in the wavelength range from 500 to 600 nm. A Y-shaped vessel was made using porcine carotid arteries having an inner diameter of 3.5 to 4 mm. The graft vessel was anastomosed at a 45° angle with 8-0 polypropylene suture. Fresh porcine blood at an oxygen saturation of 100% was circulated in the specially designed circuit loop and through the graft or main vessel. The vessels were then irradiated with light, and the reflected light was captured with an HSI camera. The attenuation (A) image at each wavelength (λ) was obtained and the spectral A(λ) image was created. The spectral A(λ) image showed graft patency and changes in the hemoglobin concentration. The A(λ) decreased as the flow rate increased due to the orientation of the red blood cells. The experimental results indicated that imaging of the hemoglobin concentration without distortion from blood flow is possible using two wavelengths: 625 and 770 nm. This method is able to distinguish between the blood flow and changes in hemoglobin concentration. The multispectral and hyperspectral imaging method is useful for the non-invasive evaluation of graft function. PMID:26737232

  6. Advantageous swirling flow in 45° end-to-side anastomosis

    Science.gov (United States)

    Ha, Hojin; Choi, Woorak; Park, Hanwook; Lee, Sang Joon

    2014-12-01

    The effects of swirling flow on the flow field in 45° end-to-side anastomosis are experimentally investigated using a particle image velocimetry technique to reveal fluid dynamic advantages of swirling flow in the vascular graft. Non-swirling Poiseuille inlet flow unnecessarily induces pathological hemodynamic features, such as high wall shear stress (WSS) at the `bed' side and large flow separation at the `toe' side. The introduction of swirling flow is found to equalize the asymmetric WSS distribution and reduces the peak magnitude of WSS. In particular, the intermediate swirling intensity of S = 0.45 induces the most uniform axial velocity and WSS distributions compared with weaker or stronger swirling flows, which addresses the importance of proper selection of swirling intensity in the vascular graft to obtain optimum flow fields at the host vessel. In addition, swirling flow reduces the size of flow separation because it disturbs the formation of Dean-type vortices in secondary flow and inhibits secondary flow collision. The beneficial fluid dynamic features of swirling flow obtained in this study are helpful for designing better vascular graft suppressing pathological hemodynamic features in the recipient host vessel.

  7. Esophageal Anastomosis Medial to Preserved Azygos Vein in Esophageal Atresia with Tracheoesophageal Fistula: Restoration of Normal Mediastinal Anatomy

    Directory of Open Access Journals (Sweden)

    Kumar Abdul Rashid

    2012-09-01

    Full Text Available Objective: We intended to prospectively study the technical feasibility and advantages of esophageal anastomosis medial to the preserved azygos vein in neonates diagnosed with esophageal atresia with tracheoesophageal fistula (EA/TEF. The results were compared to the cases where azygos vein was either not preserved, or the anastomosis was done lateral to the arch of preserved azygos vein. Material and methods: A total of 134 patients with EA/TEF were admitted between January 2007 and July 2008 of which 116 underwent primary repair. Eleven patients with long gap esophageal atresia with or without tracheoesophageal fistula and 7 patients who expired before surgery were excluded. Patients were randomly divided in three groups comparable with respect to the gestational age, age at presentation, sex, birth weight, associated anomalies and the gap between the pouches after mobilization: Group A (azygos vein ligated and divided, Group B (azygos vein preserved with esophageal anastomosis lateral to the vein, and Group C azygos vein preserved with esophageal anastomosis medial to the vein. All the patients were operated by extra-pleural approach. The three groups were compared with respect to operative time and early postoperative complications like pneumonitis, anastomotic leaks and mortality. Odds ratio and Chi square test were used for the statistical analysis. Results: Group A, B and C had 35, 43 and 38 patients respectively. No significant difference was observed in average operative time in the 3 groups. Though incidence of postoperative pneumonitis was higher in group A (28% as compared to group B (13.95% and group C (11.62%, it was not statistically significant (p > 0.005. Anastomotic leak occurred in 7 patients in group A (20%, 6 patients in group B (13.95% and 4 patients (10.52% in group C (p > 0.005. Group A had 3 major and 4 minor anastomotic leaks; group B had 2 major and 4 minor leaks and group C had 1 major and 3 minor leaks. There were10

  8. Flow and wall shear stress in end-to-side and side-to-side anastomosis of venous coronary artery bypass grafts

    Directory of Open Access Journals (Sweden)

    Poulikakos Dimos

    2007-09-01

    Full Text Available Abstract Purpose Coronary artery bypass graft (CABG surgery represents the standard treatment of advanced coronary artery disease. Two major types of anastomosis exist to connect the graft to the coronary artery, i.e., by using an end-to-side or a side-to-side anastomosis. There is still controversy because of the differences in the patency rates of the two types of anastomosis. The purpose of this paper is to non-invasively quantify hemodynamic parameters, such as mass flow and wall shear stress (WSS, in end-to-side and side-to-side anastomoses of patients with CABG using computational fluid dynamics (CFD. Methods One patient with saphenous CABG and end-to-side anastomosis and one patient with saphenous CABG and side-to-side anastomosis underwent 16-detector row computed tomography (CT. Geometric models of coronary arteries and bypasses were reconstructed for CFD analysis. Blood flow was considered pulsatile, laminar, incompressible and Newtonian. Peri-anastomotic mass flow and WSS were quantified and flow patterns visualized. Results CFD analysis based on in-vivo CT coronary angiography data was feasible in both patients. For both types of CABG, flow patterns were characterized by a retrograde flow into the native coronary artery. WSS variations were found in both anastomoses types, with highest WSS values at the heel and lowest WSS values at the floor of the end-to-side anastomosis. In contrast, the highest WSS values of the side-to-side anastomosis configuration were found in stenotic vessel segments and not in the close vicinity of the anastomosis. Flow stagnation zones were found in end-to-side but not in side-to-side anastomosis, the latter also demonstrating a smoother stream division throughout the cardiac cycle. Conclusion CFD analysis of venous CABG based on in-vivo CT datasets in patients was feasible producing qualitative and quantitative information on mass flow and WSS. Differences were found between the two types of anastomosis

  9. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Jensen, Asger Lundorff;

    2012-01-01

    The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training...... in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination...... Skills); both courses were offered in multiple classes (with a total of 171 students in 2009 and 156 students in 2010). All classes in 2009 participated in the SSL stage of the Basic Surgical Skills course before performing live-animal surgery, and one class (28 students) in 2010 did not. Two validated...

  10. Surgical infections with Mycoplasma

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Prag, Jørgen Brorson; Jensen, J S;

    1997-01-01

    Mycoplasma hominis and Ureaplasma urealyticum are common inhabitants of the human genital tract. Evidence for an aetiological role in pyelonephritis, pelvic inflammatory disease, post-abortion and post-partum fever has been presented. There are sporadic reports of Mycoplasma causing serious extra...... extragenital infection such as septicemia, septic arthritis, neonatal meningitis and encephalitis. We review 38 cases of surgical infections with Mycoplasma....

  11. Surgical wound care

    Science.gov (United States)

    ... F for more than 4 hours Alternate Names Surgical incision care; Open wound care Images Proper hand washing References Lynn PB. Cleaning a wound and applying a dry, sterile dressing. In: Lynn PB. Taylor’s Handbook of Nursing Skills . Philadelphia, PA: Lippincott Williams and Wilkins, Wolters ...

  12. Ancient Egyptian surgical heritage.

    Science.gov (United States)

    Saber, Aly

    2010-12-01

    Egyptian medicine influenced the medicine of neighboring cultures, including the culture of ancient Greece. From Greece, its influence spread onward, thereby affecting Western civilization significantly. The oldest extant Egyptian medical texts are six papyri: The Edwin Smith Surgical Papyrus and the Ebers Medical Papyrus are famous. PMID:21208098

  13. Gastrojejunal anastomosis stricture after laparoscopic gastric bypass: Our experience with 62 patients Estenosis de la anastomosis gastroyeyunal en el bypass gástrico laparoscópico: Nuestra experiencia con 62 pacientes

    Directory of Open Access Journals (Sweden)

    A. Campillo-Soto

    2010-03-01

    Full Text Available Objective: gastrojejunal stricture (GYS, not only is a common complication after laparoscopic gastric bypass (LGBP, but its frequency is about 15% according to bibliography. Our aim is to present our experience after 62 LGBP. Patients and method: from January 2004 to September-2006, we performed 62 consecutive laparoscopic gastric bypass (Wittgrove's technique. The gastrojejunal anastomosis is performed with auto suture material type CEAA No 21 termino-lateral (ILS, Ethicon. In 4 cases (6.45% was converted to laparotomy, perform the anastomosis in the same way. Monitoring has a range of 3-35 months, conducted in 61 patients because one patient died of pulmonary thromboembolism in the immediate postoperative period after reoperation, after two weeks of gastric bypass, by necrosis of a small fragment of the remnant gastric. In all patients with persistent feeding intolerance were performed barium transit and/or gastroscopy. When gastrojejunal stricture showed proceeded to endoscopic pneumatic dilation (recommending dilate the anastomosis to a maximum 1.5 cm. Results: five cases (8.1% developed a gastrojejunal stricture, in 4 of these cases the initial diagnosis was made by barium transit and in 1 case by endoscopy. Two patients had a history of digestive bleeding that required endoscopic sclerosis of the bleeding lesion (circumferentially sclerosis within 48 hours of surgery and sclerosis of bleeding points. All cases were resolved by endoscopic dilatation. At follow-up has not been detected re-stricture. Conclusion: Clinically, gastrojejunal stricture results in a progressive oral intolerance, revealing stenosis between 1 and 3 months postoperatively. The situations of sclerosis of the bleeding lesions favor, especially in cases of extensive sclerosis. In cases of suspected barium transit offers us a high diagnostic yield. Endoscopic dilatation resolved, so far, all cases.Objetivo: la estenosis de la anastomosis gastroyeyunal representa una

  14. 磁压榨吻合技术快速无缝线吻合犬股动脉%Rapid and effective sutureless anastomosis of femoral artery by magnetic compression anastomosis technique

    Institute of Scientific and Technical Information of China (English)

    刘仕琪; 雷鹏; 吕毅; 高睿; 关正; 王善佩; 史建华; 刘艳奎

    2015-01-01

    Objective To investigate the magnetic pinned-ring device for non-suture vascular anastomosis.Methods Twelve adult mongrel dogs of either gender were randomly divided for femoral artery in situ end-to-end anastomosis,one side of the femoral artery was anastomosised with MCA,and the other side of the femoral artery was anastomosised by hand suturing in each dog.Operation time and stoma errhysis were recorded during operation.Patency and stoma stenosis was confirmed via color Doppler ultrasound scans and X-ray cholangiography at different time points as late as 6 weeks after surgery.Results The time required to perform the vascular anastomosis was significantly shorter for the magnetic device than hand sewing[(3.89 ± 1.16) min vs.(14.16 ± 3.72) min,P =0.000].There were 6 patients who happened stoma errhysis during femoral artery hand-sewing anastomosis,and needed to be repaired.Vascular X-ray angiography and color Doppler ultrasound found blood flow magnetic anastomosis group normal with 100% patency rate and there wasn't stoma stenosis,but one stoma occlusive and four stoma stenosis in the manual suture groups.Conclusion The magnetic pinned-ring device offers a simple,fast,reliable,and efficacious technique for non-suture artery anastomosis.Application of the MCA technique can effectively reduce the complication caused by operation technique,resulting in smooth operation and improved prognosis.%目的 利用磁性压榨式吻合(MCA)技术自制新型磁性吻合环,探讨其快速无缝线吻合血管的可行性.方法 西安近郊杂种犬12只,雌雄不限,6~8月龄,体质量(16.5±3.6) kg.每只的犬左、右侧股动脉分别行MCA与手工缝合,观察并比较两种缝合技术吻合股动脉耗时、术中渗漏血情况,术后6周行超声心动图与血管X线造影检查吻合口血流及并发症情况.结果 MCA血管吻合耗时(3.89±1.16) min,手工缝合(14.16±3.72) min,两者差异有统计学意义(P =0.000).MCA术中吻合口无

  15. Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis: Relationship with colonic metaplasia

    Institute of Scientific and Technical Information of China (English)

    Livia Biancone; Francesco Pallone; Emma Calabrese; Giampiero Palmieri; Carmelina Petruzziello; Sara Onali; Giuseppe Sigismondo Sica; Marta Cossignani; Giovanna Condino; Kiron Moy Das

    2008-01-01

    AIM:To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA),ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium.METHODS:A total of 19 patients with IRA under regular follow up were enrolled,including 11.UC and 8 controls (6 Crohn's disease,CD;1 familial adenomatous polyposis,FAP;1 colon cancer,colon K).Ileal lesions were identified by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump.Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5,hTMS (CG3).Possible relation between development of colonic metaplasia and ileal lesions was investigated.RESULTS:Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient.The neo-terminal ileum was therefore investigated in 10/11 UC patients.Ileal ulcers were detected in 7/10 UC,associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC.In controls,recurrence occurred in 4/6 CD,associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3.CONCLUSION:Present findings suggest that in UC,ileal lesions associated with changes towards colonic epithelium may develop also after IRA.Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia,leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.

  16. Hepatic surgical anatomy.

    Science.gov (United States)

    Skandalakis, John E; Skandalakis, Lee J; Skandalakis, Panajiotis N; Mirilas, Petros

    2004-04-01

    The liver, the largest organ in the body, has been misunderstood at nearly all levels of organization, and there is a tendency to ignore details that do not fit the preconception. A complete presentation of the surgical anatomy of the liver includes the study of hepatic surfaces, margins, and fissures; the various classifications of lobes and segments; and the vasculature and lymphatics. A brief overview of the intrahepatic biliary tract is also presented.

  17. Louis Pasteur surgical revolution.

    Science.gov (United States)

    Toledo-Pereyra, Luis H

    2009-01-01

    Louis Pasteur (1822-1895) is considered the most notable medical scientist of his time and perhaps one of the most distinguished of all times in the history of medicine. From Dole in France to Paris, from a student of crystals to "living ferments," and from chemistry to biology and medicine, Pasteur changed the world for the benefit of humanity. The genius of Pasteur dealt with the most pressing issues of his time, basing the germ theory on the effects that microorganisms had on fermentation and putrefaction of organic matter, which gave birth to the science of bacteriology. Many other difficult problems in medicine and biology were tackled by Pasteur, culminating in the spectacular results seen with the treatment of rabies. Surgery was no exception to the scientific conquests of Pasteur. The transformation of the surgical world arose from the antiseptic concepts of Lister that were based on the germ theory of the disease, which had been derived from the germ theory of fermentation and putrefaction discovered by Pasteur. The acceptance of these principles represented the surgical revolution brought on by the science of Pasteur, a revolution that is now accepted in our daily care of surgical patients.

  18. Crohn's disease recurrence in patients with ileocolic anastomosis: Value of computed tomography enterography with water enema

    International Nuclear Information System (INIS)

    Objectives: the main objective of the present work was to determine the diagnostic value of CT-enterography with water enema (CTe-WE) in the assessment of the ileocolic anastomosis in patients with Crohn's disease (CD). The prevalence of synchronous inflammatory lesions (SILs) involving gastrointestinal segments distinct from the anastomosis was also determined. Further, the association between the type of ileocolic anastomosis and the behavior (i.e. inflammatory, stricturing, penetrating) of CD recurrence was evaluated. Methods: 51 patients were retrospectively included (26 [51%] male and 25 [49%] female; mean age: 52.88 years ± 13.35). Ileocolic anastomoses were: 18 (35.3%) stapled side-to-side, 17 (33.3%) end-to-side, and 16 (31.4%) end-to-end. CTe-WEs were reviewed in consensus by two gastrointestinal radiologists. Endoscopy and medical records were used as reference standards. Results: CTe-WE yielded 95.35% sensitivity (CI 95%: 84.19–99.43%), 75.00% specificity (CI 95%: 34.91–96.81%), and 92.15% diagnostic accuracy (CI 95%: 81.31–98.02%). Anastomotic recurrence was found in 41/51 (80.4%) patients, including 30/41 (73.2%) cases of isolated anastomotic recurrence, and 11/41 (26.8%) cases of anastomotic recurrence with a SIL. A significant lower prevalence of stricturing recurrence was observed in patients with stapled side-to-side anastomoses (p = 0.033). Conclusions: CTe-WE provides a good distension of both sides of ileocolic anastomoses allowing the detection of SILs

  19. Anomalous external carotid artery-internal carotid artery anastomosis in two patients with proximal internal carotid arterial remnants

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chang Hun [Dept. of Neurology, Stroke Center, Myongji Hospital, Goyang (Korea, Republic of); Cho, Young Dae; Kang, Hyun Seung; Kim, Jeong Eun; Han, Moon Hee [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Seung Chai [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Ahn, Jun Hyong [Dept. of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of)

    2015-08-15

    Two angiographic instances of anomalous external carotid artery (ECA) and internal carotid artery (ICA) anastomosis are described, each occurring at the C2-3 level and bearing remnants of proximal ICA. The ICA remnant of one patient (identifiable immediately upon bifurcation of the common carotid artery) was hypoplastic, and that of the other patient was an occluded arterial stump. These features are not typical of non-bifurcating ICA. The occipital artery originated from an anomalous connection in one instance and from the main trunk of the ECA (just past the ECA-ICA connection) in the other.

  20. Anastomose duodenoduodenal na pancreatoduodenectomia por pancreatite crônica Duodenumduodenal anastomosis in pancreatoduodenectomy for chronic pancreatitis

    Directory of Open Access Journals (Sweden)

    Olívio Louro Costa

    2001-04-01

    Full Text Available Literature has been showing a tendency of reducing the limits of Whipple's resection. The main technical advance was the pylorus preserving resection, technique proposed by Traverso and Longmire in 1978. The pancreticoduodenectomy for chronic pancreatitis, is probably the best opportunity to apply this type of procedure. In these specific patients, the author preserved the pylorus and the third portion of the duodenum. The gastrointestinal transit was reconstructed by the duodenumduodenal anastomosis and the bile duct and the pancreas were drained in a Roux-en-way loop . Follow-up showed no important complication, with no problems related to gastric emptying and without pain.

  1. Interventional and surgical therapeutic strategies for pulmonary arterial hypertension: Beyond palliative treatments.

    Science.gov (United States)

    Sandoval, Julio; Gomez-Arroyo, Jose; Gaspar, Jorge; Pulido-Zamudio, Tomas

    2015-10-01

    Despite significant advances in pharmacological treatments, pulmonary arterial hypertension remains an incurable disease with an unreasonably high morbidity and mortality. Although specific pharmacotherapies have shifted the survival curves of patients and improved exercise endurance as well as quality of life, it is also true that these pharmacological interventions are not always accessible (particularly in developing countries) and, perhaps most importantly, not all patients respond similarly to these drugs. Furthermore, many patients will continue to deteriorate and will eventually require an additional, non-pharmacological, intervention. In this review we analyze the role of atrial septostomy and Potts anastomosis in the management of patients with pulmonary arterial hypertension, we summarize the current worldwide clinical experience (case reports and case series), and discuss why these interventional/surgical strategies might have a therapeutic role beyond that of a "bridge" to transplantation.

  2. Combined surgical and endovascular approach to treat a complex aortic coarctation without extracorporeal circulation.

    Science.gov (United States)

    Carrel, Thierry P; Berdat, Pascal A; Baumgartner, Iris; Dinkel, Hans-Peter; Schmidli, Jürg

    2004-10-01

    Various therapeutic approaches have been proposed to treat complex coarctation of the aorta (eg, recoarctation, which requires repetitive interventions, or coarctation with a hypoplastic aortic arch). Resection followed by end-to-end anastomosis or by graft interposition is technically demanding and exposes the patient to considerable perioperative risks. Cardiopulmonary bypass and deep hypothermic circulatory arrest may be necessary to control the distal aortic arch. The role of stent technology in treating this type of lesion has not yet been defined. We present a 21-year-old woman with a recurrent coarctation of the aorta associated with a hypoplastic aortic arch and a pseudoaneurysm of the proximal descending aorta. She had undergone 4 previous interventions. Treatment consisted of a combined surgical and endovascular approach without cardiopulmonary bypass and included extraanatomic aortic bypass, partial debranching of the supraaortic vessels, and stent-graft insertion to exclude the aneurysm.

  3. Autologous nerve graft repair of different degrees of sciatic nerve defect: stress and displacement at the anastomosis in a three-dimensional fnite element simulation model

    Directory of Open Access Journals (Sweden)

    Cheng-dong Piao

    2015-01-01

    Full Text Available In the repair of peripheral nerve injury using autologous or synthetic nerve grafting, the magnitude of tensile forces at the anastomosis affects its response to physiological stress and the ultimate success of the treatment. One-dimensional stretching is commonly used to measure changes in tensile stress and strain however, the accuracy of this simple method is limited. Therefore, in the present study, we established three-dimensional finite element models of sciatic nerve defects repaired by autologous nerve grafts. Using PRO E 5.0 finite element simulation software, we calculated the maximum stress and displacement of an anastomosis under a 5 N load in 10-, 20-, 30-, 40-mm long autologous nerve grafts. We found that maximum displacement increased with graft length, consistent with specimen force. These findings indicate that three-dimensional finite element simulation is a feasible method for analyzing stress and displacement at the anastomosis after autologous nerve grafting.

  4. The interventional treatment for recurrent jaundice after palliative bilio-intestinal anastomosis in patients with malignant obstructive jaundice due to cholangiocarcinoma

    International Nuclear Information System (INIS)

    Objective: To explore the interventional methods to treat recurrent jaundice after palliative bilio-intestinal anastomosis in patients with malignant obstructive jaundice due to cholangiocarcinoma. Methods: Ten patients with recurrent jaundice after bilio-intestinal anastomosis were retrospectively evaluated. Nine of ten underwent PTCD with metallic stent placement, one underwent the inner-outer draining catheter procedure. The patients were evaluated with comparison in regard to preoperative conditions, TBIL, ALT, GTP and AKP values. Results: Stent placement was successful only once in all 10 cases with successful rate of 100%. TBIL, ALT, GTP and AKP values were significantly lower 7 days postoperative than that preoperation. Subsidence of jaundice was satisfactory for 100% in all patients after the treatment. Conclusions: Percutaneous placement of biliary metallic stents is a safety, simple, low complication method for managing recurrent jaundice after palliative bilio-intestinal anastomosis for the terminal stage of malignant obstructive jaundice

  5. The Impact of Obesity on Surgical Outcome after Pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Roger Noun

    2008-07-01

    Full Text Available Context The effect of obesity on surgical outcome is becoming an increasingly relevant issue given the growing rate of obesity worldwide. Objective To investigate the specific impact of obesity on pancreaticoduodenectomy. Design A retrospective comparative study of a prospectively maintained database was carried out to investigate the specific impact of obesity on the technical aspects and postoperative outcome of pancreaticoduodenectomy. Patients Between 1999 and 2006, 92 consecutive patients underwent pancreaticoduodenectomy using a standardized technique. The study population was subdivided according to the presence or absence of obesity. Results Nineteen (20.7% patients were obese and 73 (79.3% patients were non-obese. The two groups were comparable in terms of demographics, American Society of Anesthesiology (ASA score as well as nature and type of pancreatico-digestive anastomosis. The rate of clinically relevant pancreatic fistula (36.8% vs. 15.1%; P=0.050 and hospital stay (23.1±13.9 vs. 17.0±8.0 days; P=0.015 were significantly increased in obese vs. non-obese patients, respectively. Pancreatic fistula was responsible for one-half of the deaths (2/4 and two ruptured pseudoaneurysms. The incidence of the other procedure-related and general postoperative complications were not significantly different between the two groups. Intrapancreatic fat was increased in 10 obese patients (52.6% and correlated positively both with BMI (P=0.001 and with the occurrence of pancreatic fistula (P=0.003. Conclusion Obese patients are at increased risk for developing pancreatic fistula after pancreaticoduodenectomy. Special surgical caution as well as vigilant postoperative monitoring are therefore recommended in obese patients.

  6. Detection of biliary stenoses in patients after liver transplantation: Is there a different diagnostic accuracy of MRCP depending on the type of biliary anastomosis?

    International Nuclear Information System (INIS)

    Purpose: Two different forms of biliary anastomosis can be created in patients undergoing liver transplantation: (a) bilio-digestive anastomoses or (b) choledocho-choledochostomy. Aim of this study was to assess the accuracy of MR cholangiopancreatography (MRCP) for the depiction of biliary stenoses in liver transplant patients depending on the type of biliary anastomosis. Method and materials: 24 liver transplant patients with clinical suspicion of biliary stenosis were studied (each 12 with bilio-digestive anastomosis/choledocho-choledochostomy). MRCP was performed on a 1.5T scanner (Magnetom Avanto, Siemens) including 2D single shot RARE, 2D T2w HASTE, TrueFISP and 3D high-resolution navigator corrected sequences. Presence of (a) anastomotic stenoses (AST) and (b) NAS (non-anastomotic strictures) were assessed. Percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP) were performed within 48 h after MRCP and served as the standard of reference. Results: In patients with bilio-digestive anastomoses sensitivities of MRCP for the detection of AST and NAS amounted to 50% and 67%, respectively with specificity values of 83% and 50%. In patients with choledocho-chledochostomy sensitivities (AST: 100%, NAS: 100%) and specificities (AST: 100%, NAS: 88%) were significantly higher. Conclusion: Biliary strictures after liver transplantation can be accurately detected by MRCP in patients after choledocho-chledochostomy. However, the diagnostic value of MRCP is lower if liver transplantation was performed in combination with a bilio-digestive anastomosis. This may be due to the less exact depiction of the anastomosis in the bowel wall. Thus, it is crucial to know the type of biliary anastomosis before choosing a diagnostic procedure.

  7. Detection of biliary stenoses in patients after liver transplantation: Is there a different diagnostic accuracy of MRCP depending on the type of biliary anastomosis?

    Energy Technology Data Exchange (ETDEWEB)

    Kinner, Sonja, E-mail: Sonja.Kinner@uni-due.de [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen (Germany); Dechene, Alexander [Department of Hepatology and Gastroenterology, University Hospital Essen (Germany); Paul, Andreas [Department of General-, Visceral- and Transplant Surgery, University Hospital Essen (Germany); Umutlu, Lale; Ladd, Susanne C. [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen (Germany); Dechene, Evelin Maldonado de; Zoepf, Thomas; Gerken, Guido [Department of Hepatology and Gastroenterology, University Hospital Essen (Germany); Lauenstein, Thomas C. [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen (Germany)

    2011-11-15

    Purpose: Two different forms of biliary anastomosis can be created in patients undergoing liver transplantation: (a) bilio-digestive anastomoses or (b) choledocho-choledochostomy. Aim of this study was to assess the accuracy of MR cholangiopancreatography (MRCP) for the depiction of biliary stenoses in liver transplant patients depending on the type of biliary anastomosis. Method and materials: 24 liver transplant patients with clinical suspicion of biliary stenosis were studied (each 12 with bilio-digestive anastomosis/choledocho-choledochostomy). MRCP was performed on a 1.5T scanner (Magnetom Avanto, Siemens) including 2D single shot RARE, 2D T2w HASTE, TrueFISP and 3D high-resolution navigator corrected sequences. Presence of (a) anastomotic stenoses (AST) and (b) NAS (non-anastomotic strictures) were assessed. Percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP) were performed within 48 h after MRCP and served as the standard of reference. Results: In patients with bilio-digestive anastomoses sensitivities of MRCP for the detection of AST and NAS amounted to 50% and 67%, respectively with specificity values of 83% and 50%. In patients with choledocho-chledochostomy sensitivities (AST: 100%, NAS: 100%) and specificities (AST: 100%, NAS: 88%) were significantly higher. Conclusion: Biliary strictures after liver transplantation can be accurately detected by MRCP in patients after choledocho-chledochostomy. However, the diagnostic value of MRCP is lower if liver transplantation was performed in combination with a bilio-digestive anastomosis. This may be due to the less exact depiction of the anastomosis in the bowel wall. Thus, it is crucial to know the type of biliary anastomosis before choosing a diagnostic procedure.

  8. The retained surgical sponge.

    Science.gov (United States)

    Kaiser, C W; Friedman, S; Spurling, K P; Slowick, T; Kaiser, H A

    1996-01-01

    OBJECTIVE. A review was performed to investigate the frequency of occurrence and outcome of patients who have retained surgical sponges. METHODS. Closed case records from the files of the Medical Professional Mutual Insurance Company (ProMutual, Boston, MA) involving a claim of retained surgical sponges were reviewed for a 7-year period. RESULTS. Retained sponges occurred in 40 patients, comprising 48% of all closed claims for retained foreign bodies. A falsely correct sponge count after an abdominal procedure was documented in 76% of these claims. Ten percent of claims involved vaginal deliveries and minor non-body cavity procedures, for which no sponge count was performed. Total indemnity payments were $2,072,319, and defense costs were $572,079. In three cases, the surgeon was deemed responsible by the court despite the nursing staff's admitting liability and evidence presented that the surgeon complied completely with the standard of care. A wide range of indemnity payments was made despite a remarkable similarity of outcome in the patients studied. CONCLUSIONS. Despite the rarity of the reporting of a retained surgical sponge, this occurrence appears to be encountered more commonly than generally is appreciated. Operating teams should ensure that sponges be counted for all vaginal and any incisional procedures at risk for retaining a sponge. In addition, the surgeon should not unquestioningly accept correct count reports, but should develop the habit of performing a brief but thorough routine postprocedure wound/body cavity exploration before wound closure. The strikingly similar outcome for most patients would argue for a standardized indemnity payment being made without the need for adversarial legal procedures. PMID:8678622

  9. Surgical Simulation and Competency.

    Science.gov (United States)

    Kim-Fine, Shunaha; Brennand, Erin A

    2016-09-01

    Simulation in surgical training is playing an increasingly important role as postgraduate medical education programs navigate an environment of increasing costs of education, increased attention on patient safety, and new duty hour restrictions. In obstetrics and gynecology, simulation has been used to teach many procedures; however, it lacks a standardized curriculum. Several different simulators exist for teaching various routes and aspects of hysterectomy. This article describes how a formal framework of increasing levels of competencies can be applied to simulation in teaching the procedure of hysterectomy. PMID:27521885

  10. Partial restoration of blink reflex function after spinal accessory-facial nerve anastomosis.

    OpenAIRE

    Danziger, N; Chassande, B; Lamas, G.; Fligny, I; Soudant, J; Willer, J C

    1995-01-01

    Functional motor control requires perfect matching of the central connections of motoneurons with their peripheral inputs. It is not known, however, to what extent these central circuits are influenced by target muscles, either during development or after a lesion. Surgical interventions aimed at restoring function after peripheral nerve lesions provide an opportunity for studying this interaction in the mature human nervous system. A patient was studied in whom the spinal accessory nerve was...

  11. Salvage with a Secondary Infrahepatic Cavocavostomy of the Occluded Modified Piggyback Anastomosis during Split Liver Transplantation: A Case Report

    Directory of Open Access Journals (Sweden)

    Erdem Kinaci

    2014-01-01

    Full Text Available Hepatic venous outflow obstruction following liver transplantation is rare but disastrous. Here we described a 14-year-old boy who underwent a split right lobe liver transplantation with modified (side-to-side piggyback technique which resulted in hepatic venous outflow obstruction. When the liver graft was lifted up, the outflow drainage returned to normal but when it was placed back into the abdomen, the outflow obstruction recurred. Because reanastomosis would have resulted in hepatic reischemia, alternatively, a second infrahepatic cavocavostomy was planned without requiring hepatic reischemia. During this procedure, the first assistant hung the liver up to provide sufficient outflow and the portal inflow of the graft continued as well. We only clamped the recipient’s infrahepatic vena cava and the caudal cuff of the graft cava. After the second end-to-side cavocaval anastomosis, the graft was placed in its orthotopic position and there was no outflow problem anymore. The patient tolerated the procedure well and there were no problems after three months of follow-up. A second cavocavostomy can provide an extra bypass for some hepatic venous outflow problems after piggyback anastomosis by avoiding hepatic reischemia.

  12. Salvage with a Secondary Infrahepatic Cavocavostomy of the Occluded Modified Piggyback Anastomosis during Split Liver Transplantation: A Case Report.

    Science.gov (United States)

    Kinaci, Erdem; Kayaalp, Cuneyt; Yilmaz, Sezai; Otan, Emrah

    2014-01-01

    Hepatic venous outflow obstruction following liver transplantation is rare but disastrous. Here we described a 14-year-old boy who underwent a split right lobe liver transplantation with modified (side-to-side) piggyback technique which resulted in hepatic venous outflow obstruction. When the liver graft was lifted up, the outflow drainage returned to normal but when it was placed back into the abdomen, the outflow obstruction recurred. Because reanastomosis would have resulted in hepatic reischemia, alternatively, a second infrahepatic cavocavostomy was planned without requiring hepatic reischemia. During this procedure, the first assistant hung the liver up to provide sufficient outflow and the portal inflow of the graft continued as well. We only clamped the recipient's infrahepatic vena cava and the caudal cuff of the graft cava. After the second end-to-side cavocaval anastomosis, the graft was placed in its orthotopic position and there was no outflow problem anymore. The patient tolerated the procedure well and there were no problems after three months of follow-up. A second cavocavostomy can provide an extra bypass for some hepatic venous outflow problems after piggyback anastomosis by avoiding hepatic reischemia. PMID:24959369

  13. Early Introduction of Everolimus Immunosuppressive Regimen in Liver Transplantation with Extra-Anatomic Aortoiliac-Hepatic Arterial Graft Anastomosis

    Directory of Open Access Journals (Sweden)

    Emanuele Felli

    2014-01-01

    Full Text Available Liver transplantation is the treatment of choice for patients with acute and chronic end-stage liver disease, when no other medical treatment is possible. Despite high rates of 1- to 5-year survival, long-term adverse effects of immunosuppressant agents remain of major concern. Current research and clinical efforts are made to develop immunosuppressant agents that minimize adverse effects along with a low rate of graft rejection. Tailoring immunosuppressive therapy to individual patients by the use of proliferation signal inhibitors seems to be the best way to minimize toxicity and increase efficacy. Recently everolimus has been introduced in clinical practice; among its adverse effects an increased incidence of arterial graft thrombosis in renal transplants, vascular anastomosis leakage, impaired wound healing, and thrombotic microangiopathy have been reported. We present the case of a 54-year-old patient submitted to liver transplantation for end-stage liver disease treated by an extra-anatomic aortoiliac-hepatic arterial graft anastomosis and early postoperative introduction of everolimus for acute renal failure. Postoperative period was characterized by two abdominal collections and reactivation of cytomegalovirus infection that were treated by percutaneous drainage and antiviral therapy, respectively; the patient is well after 8-month followup with patency of the arterial conduit and no leakage.

  14. Ivy signs on FLAIR images before and after STA-MCA anastomosis in patients with Moyamoya disease

    Energy Technology Data Exchange (ETDEWEB)

    Ideguchi, Reiko; Enokizono, Mikako; Uetani, Masataka (Dept. of Radiological Sciences, Nagasaki Univ. Graduate School of Biomedical Sciences, Nagasaki (Japan)), e-mail: qqtt37gd9@forest.ocn.ne.jp; Morikawa, Minoru (Dept. of Radiology, Nagasaki Univ. School of Medicine, Nagasaki (Japan)); Ogawa, Yoji (Dept. of Radiology, Hanwa Daini Senboku Hospital, Osaka (Japan)); Nagata, Izumi (Dept. of Neurosurgery, Nagasaki Univ. School of Medicine, Nagasaki (Japan))

    2011-04-15

    Background: Leptomeningeal high signal intensity (ivy sign) on fluid-attenuated inversion-recovery (FLAIR) MR imaging is one of the features of Moyamoya disease. However, the correlation between ivy sign and cerebral perfusion status has not been fully evaluated. Purpose: To characterize ivy sign on FLAIR images in Moyamoya disease and compare this finding with hemodynamic alterations on perfusion single-photon emission CT (SPECT) obtained before and after bypass surgery. Material and Methods: Sixteen patients with angiographically confirmed Moyamoya disease who underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis were included in the study. The presence of ivy sign on FLAIR images was classified as 'negative', 'minimal' and 'positive'. We evaluated the relationship between ivy sign and findings of SPECT, including cerebral vascular reserve (CVR) before and after surgery. Results: Minimal or positive ivy sign was seen in 13 (81%) of 16 patients, and 21 (66%) of 32 hemispheres. CVR in the areas with positive or minimal ivy sign was lower than that in the areas with negative ivy sign. After STA-MCA anastomosis, ivy sign disappeared or decreased in all 21 hemispheres demonstrating ivy sign. SPECT demonstrated apparent hemodynamic improvement in areas demonstrating disappearance or decrease of ivy sign. Conclusion: Ivy sign on FLAIR image is seen in areas with decreased cerebral perfusion. The sign is useful for non-invasive assessment of cerebral hemodynamic status before and after surgery

  15. Fibrin glue protection of primary anastomosis in the obstructed left colon. An experimental study on the rat.

    Science.gov (United States)

    Hulkko, O A; Haukipuro, K A; Laitinen, S T

    1988-01-01

    A left-sided colon obstruction was produced with a polypropylene sling in 65 rats. Colon resection and primary anastomosis were performed three days later. The animals were then randomly allocated to the FG (fibrin glue) group receiving sealing of the anastomosis with 0.4 ml of fibrin glue (Beriplast R), or to the NG (non-glue) group. The anastomoses were assessed 30 min, two days and four days later. Adhesion formation was similar in both groups. The number of macroscopic or radiological leakages did not differ either. At 30 min the mean bursting pressure was 74.6 +/- 8.6 (SD) mmHg in the FG group and 58.3 +/- 21.6 mmHg in NG (non-glue) group (p less than 0.05, Mann-Whitney test). Later on the strength of the anastomoses was equal in both groups. We conclude that the initial sealing of weak points in the anastomoses was beneficial but the inherent strength per se could not be enhanced. PMID:2451367

  16. Bacterial migration through punctured surgical gloves under real surgical conditions

    OpenAIRE

    Heidecke Claus-Dieter; Assadian Ojan; Stanislawski Natalie; Goerdt Anna-Maria; Hübner Nils-Olaf; Kramer Axel; Partecke Lars

    2010-01-01

    Abstract Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag met...

  17. Surgical treatments for osteoarthritis.

    Science.gov (United States)

    de l'Escalopier, Nicolas; Anract, Philippe; Biau, David

    2016-06-01

    There are two main surgical treatments for osteoarthritis: conservative treatments, where the damaged cartilage is left in place, and radical treatments, where the cartilage is replaced by an artificial endoprosthesis; this latter procedure is termed joint arthroplasty. These treatments are only offered to symptomatic patients. Arthrodesis is yet another surgical intervention in cases of osteoarthritis. It will sacrifice the joint's articular function and is performed on small osteoarthritic joints, such as wrists and ankles, for instance. Osteoarthritis symptoms are usually the consequence of an imbalance between the load applied to a joint and the surface available to support that load. Therefore, conservative treatments will either tend to decrease the load exerted on the joint, such as in a tibial valgus osteotomy for instance, or to improve the articular surface supporting that load. Sometimes, both can be provided at the same time; the peri-acetabular osteotomy for hip dysplasia is an example of such a procedure. Conservative treatments are usually offered to young patients in order to delay, if not avoid, the need for a joint prosthesis. They are usually performed before osteoarthritis appears or at an early stage. Joint arthroplasties have overwhelmingly excellent functional results and today's research is directed towards providing rapid recovery, very long-term stability, and the assurance of a good functionality in extreme conditions. However, complications with joint arthroplasties can be serious with little, if any, reasonable salvage solution. Therefore, these procedures are offered to patients who have failed adequate medical treatment measures. PMID:27185463

  18. Barcelona Lymphedema Algorithm for Surgical Treatment in Breast Cancer-Related Lymphedema.

    Science.gov (United States)

    Masià, Jaume; Pons, Gemma; Rodríguez-Bauzà, Elena

    2016-06-01

    Background Breast cancer-related lymphedema is a prevalent condition that has a major impact on quality of life. Surgical treatment has become an alternative to help affected patients with good results. However, there is no consensus on surgical procedure and protocol. Methods We analyzed our data in two periods: from June 2007 to December 2011 and from January 2012 to June 2014. Data included the analysis of the limb circumferences and the subjective symptoms felt by patients. Results Of the 200 patients treated in the study, 81 had lymphaticovenous anastomosis, 7 had autologous lymph node transfer, 16 had total breast anatomy restoration, 52 had vibroliposuction, and 44 had combined reconstructive procedures. In the first period, the circumference of the superior limb showed a decrease of 0.9 to 6.1 cm (average 2.75 cm). In the second period, the circumference of the superior limb showed a decrease of 2.9 to 6.1 cm (average 3.85 cm). Clinical results and data from the questionnaires confirmed the improvement and subjective benefits. Conclusion We have obtained considerable improvements in results of limb circumferences and subjective symptoms after incorporating several modifications into our surgical strategy for lymphedema treatment. A detailed preoperative assessment should be performed to determine whether reconstructive surgery or palliative surgery is indicated. PMID:26975564

  19. Surgical Considerations and Challenges for Bilateral Continuous-Flow Durable Device Implantation.

    Science.gov (United States)

    Maltais, Simon; Womack, Sara; Davis, Mary E; Danter, Matthew R; Kushwaha, Sudhir S; Stulak, John M; Haglund, Nicholas

    2016-01-01

    The concept of biventricular support with durable centrifugal pumps is evolving, and the surgical strategy and best practice guidelines for implantation of right-sided devices are still unknown. We present optimal strategy for bilateral HeartWare continuous-flow ventricular assist device (HVAD) implantation in a series of four patients. Patients were implanted with the HVAD pumps simultaneously or sequentially. This report offers a perspective on surgical considerations such as right ventricular positioning, implications related to potential risks of obstruction from the tricuspid apparatus, the role if any of downsizing the outflow anastomosis, and considerations for speed adjustments. In this series, one patient died on support and three patients experienced pump thrombosis requiring device revision. All other patients survived until orthotopic heart transplantation, although one of these patients died from perioperative complications, 2 days posttransplantation. Surgical management of patients with medically refractory biventricular heart failure remains challenging and associated with a high incidence of pump thrombosis. Best practice guidelines from experts' consensus are still needed to address this challenging population. PMID:26479465

  20. Surgical Management of Internal Pancreatic Fistula in Chronic Pancreatitis: A Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Siarhei M Rashchynski

    2016-09-01

    Full Text Available Management of internal pancreatic fistula is challenging because it is a rare and uncommon complication of chronic pancreatitis. The aim of this study was to evaluate the efficiency of the different ways of diagnostics and treatment for internal pancreatic fistula. Material and methods The prospective analysis of surgical treatment of the internal pancreatic fistula among 39 patients was carried out. Patients’ data, diagnostic findings and surgical procedure were analyzed. The comparative estimation of surgical interventions was executed using questionnaire SF-36 v2тм. Results The results of the current study demonstrate good facilities of computed tomography, magnetic resonance cholangiopancreatography (92.3% for determination of internal pancreatic fistula. 28 patients underwent Frey’s procedure, 8 - cystopancreatojejunal anastomosis using Roux-en-Y loop, 3 - combination of Frey’s procedure and cystopancreatojejunal. Total morbidity and mortality was 12.8% and 2.6% respectively. We admitted significant improvement in comparison of life quality before and after operation (p<0.01. Conclusion Surgery remains an excellent and safe option for patients suffering from internal pancreatic fistula in chronic pancreatitis with significant improvement in their quality of life.

  1. Surgical Technique in Distal Pancreatectomy: A Systematic Review of Randomized Trials

    Directory of Open Access Journals (Sweden)

    Filip Čečka

    2014-01-01

    Full Text Available Despite recent improvements in surgical technique, the morbidity of distal pancreatectomy remains high, with pancreatic fistula being the most significant postoperative complication. A systematic review of randomized controlled trials (RCTs dealing with surgical techniques in distal pancreatectomy was carried out to summarize up-to-date knowledge on this topic. The Cochrane Central Registry of Controlled Trials, Embase, Web of Science, and Pubmed were searched for relevant articles published from 1990 to December 2013. Ten RCTs were identified and included in the systematic review, with a total of 1286 patients being randomized (samples ranging from 41 to 450. The reviewers were in agreement for application of the eligibility criteria for study selection. It was not possible to carry out meta-analysis of these studies because of the heterogeneity of surgical techniques and approaches, such as varying methods of pancreas transection, reinforcement of the stump with seromuscular patch or pancreaticoenteric anastomosis, sealing with fibrin sealants and pancreatic stent placement. Management of the pancreatic remnant after distal pancreatectomy is still a matter of debate. The results of this systematic review are possibly biased by methodological problems in some of the included studies. New well designed and carefully conducted RCTs must be performed to establish the optimal strategy for pancreatic remnant management after distal pancreatectomy.

  2. Surgical scar revision: An overview

    Directory of Open Access Journals (Sweden)

    Shilpa Garg

    2014-01-01

    Full Text Available Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.

  3. Surgical Safety Checklists : an Update

    OpenAIRE

    BERGS, J.; Hellings, Johan; CLEEMPUT, Irina; SIMONS, Pascale; ZUREL, Ozhan; Vertriest, Sonja; Vandijck, Dominique

    2014-01-01

    Surgical safety checklists aim to improve patient safety by prompting the attention of the surgical team towards critical steps during the operation. The checklist's items are aimed to improve compliance with proven interventions, and to facilitate multidisciplinary communication and teamwork. Based on the current literature, corroborated by systematic reviews and meta-analysis, surgical safety checklists have a positive impact on communication and reduce postoperative complications including...

  4. Neuronavigation. Principles. Surgical technique.

    Science.gov (United States)

    Ivanov, Marcel; Ciurea, Alexandru Vlad

    2009-01-01

    Neuronavigation and stereotaxy are techniques designed to help neurosurgeons precisely localize different intracerebral pathological processes by using a set of preoperative images (CT, MRI, fMRI, PET, SPECT etc.). The development of computer assisted surgery was possible only after a significant technological progress, especially in the area of informatics and imagistics. The main indications of neuronavigation are represented by the targeting of small and deep intracerebral lesions and choosing the best way to treat them, in order to preserve the neurological function. Stereotaxis also allows lesioning or stimulation of basal ganglia for the treatment of movement disorders. These techniques can bring an important amount of confort both to the patient and to the neurosurgeon. Neuronavigation was introduced in Romania around 2003, in four neurosurgical centers. We present our five-years experience in neuronavigation and describe the main principles and surgical techniques. PMID:20108488

  5. Neuronavigation. Principles. Surgical technique.

    Science.gov (United States)

    Ivanov, Marcel; Ciurea, Alexandru Vlad

    2009-01-01

    Neuronavigation and stereotaxy are techniques designed to help neurosurgeons precisely localize different intracerebral pathological processes by using a set of preoperative images (CT, MRI, fMRI, PET, SPECT etc.). The development of computer assisted surgery was possible only after a significant technological progress, especially in the area of informatics and imagistics. The main indications of neuronavigation are represented by the targeting of small and deep intracerebral lesions and choosing the best way to treat them, in order to preserve the neurological function. Stereotaxis also allows lesioning or stimulation of basal ganglia for the treatment of movement disorders. These techniques can bring an important amount of confort both to the patient and to the neurosurgeon. Neuronavigation was introduced in Romania around 2003, in four neurosurgical centers. We present our five-years experience in neuronavigation and describe the main principles and surgical techniques.

  6. Identification of anastomosis group of Rhizoctonia solani, the causal agent of seed rot and damping-off of bean in Iran.

    Science.gov (United States)

    Bohlooli, A; Okhowat, S M; Javan-Nikkhah, M

    2005-01-01

    Bean is one of the major crops in Iran. Seed rot and damping-off caused by Rhizoctonia solani is the most important disease of bean. In this research, infected roots and seedlings of beans were collected from different fields of Tehran Province. The samples were sterilized with 10% sodium hypochloride (5% stock) and incubated on PDA surface in petri-dishes. The purified fungi kept on filter paper and identified, pathogenicity test of R. solani was carried out on 2 cultivars of bean (red bean cv. Naz and white bean cv. Dehghan) and it determined. For identification of the anastomosis groups, the discs of cultured media with 5 mm. diameter of standard AG placed on one side of microscopic slides covered with water agar (2%) of 1 mm. thick and the isolates of the fungus on another side of slide about 2 cm away from each other. Experiment carried out in 4 replications. The cultures were incubated in 25 +/- 1 degrees C incubator for 24 hours, then the mycelial contact stained with lactophenol, cotton blue and hyphal anastomosis looked for under the light microscope with 10 x 40 and 10 x 100 magnifications. As a result, anastomosis groups: AG4, AG4HGII, AG2-2-2B and AG6 determined, frequency of these groups were 64, 18, 2, 16%, respectively. The group AG6 and subgroups AG4HGII and AG2-2-2B are introduced as new anastomosis groups on bean in Iran. PMID:16637168

  7. A rare variant of persistent trigeminal artery: cavernous carotid-cerebellar artery anastomosis--a case report and a systematic review.

    Science.gov (United States)

    Raphaeli, Guy; Bandeira, Alexandra; Mine, Benjamin; Brisbois, Denis; Lubicz, Boris

    2009-12-01

    We report a very rare anomalous anatomic variant of the cavernous internal carotid artery supplying directly the posterior inferior cerebellar artery, with no basilar artery opacification. A systematic review as well as a description of other variants of trigeminal-cerebellar anastomosis is given. PMID:19517204

  8. 胆肠吻合术后再发梗阻性黄疸的介入治疗%Interventional Treatment for Recurrent Obstructive Jaundice After Biliary-intestinal Anastomosis

    Institute of Scientific and Technical Information of China (English)

    温锋; 卢再鸣; 张军; 孙巍; 郭启勇

    2012-01-01

    Purpose To explore the effect of various interventional methods for recurrent obstructive jaundice after biliary-intestinal anastomosis. Materials and Methods Forty-three patients underwent interventional treatment because of recurrent obstructive jaundice after biliary-intestinal anastomosis were followed up and retrospectively analyzed. Percutaneous transhepatic cholangial drainage (PTCD) were performed in all cases, and percutaneous biliary metal stents implantation were performed through biliary-intestinal anastomotic stoma or primary obstruction locations. Results According to percutaneous transhepatic cholangiography (PTC), biliary-intestinal anastomotic stoma stricture was found in 32 patients, anastomotic stoma stricture with ansa interstinalis angulation and hypertonia were found in 7 patients, and no stenosis of anastomotic stoma was found in 4 cases. PTCD were performed in 16 cases (external drainage in 9 cases, exterior and interior drainage in 7 cases). Metal biliary stents implantation were performed in 27 cases (through biliaryintestinal anastomotic stoma in 22 cases, through primary obstruction locations in 5 cases). The jaundice symptoms were satisfactorily relieved in 37 patients one week after operation. The jaundice was not relieved in 6 patients because of ansa interstinalis hypertonia and bile reflux. Among them, 4 patients underwent second surgical procedures. No severe complications occurred in all patients. Conclusion PTCD or biliary stent implantation is a safe, reliable, microinvasive and effective procedure for patients with recurrent obstructive jaundice after biliary-intestinal anastomosis.%目的 探讨胆肠吻合术后再发梗阻性黄疸的介入治疗方法及疗效.资料与方法 回顾性分析胆肠吻合术后再发梗阻性黄疸而行介入治疗的43例患者,行经皮经肝胆管穿刺置管引流术,并选择胆肠吻合口或原发梗阻部位进一步行经皮胆道金属支架植入术.结果 本组经皮经肝胆

  9. Morbimortalidade relacionada à técnica de anastomose pancreática (ducto-mucosa x telescopagem após cirurgia de Whipple Morbimortality related to pancreatic anastomosis technique (duct-to-mucosa vs. telescopic after Whipple's surgery

    Directory of Open Access Journals (Sweden)

    Jorge Mali Junior

    2005-04-01

    Full Text Available OBJETIVOS: A gastroduodenopancreatectomia (GDP é atualmente a única forma de tratamento segura e eficaz para pacientes selecionados com doenças benignas e malignas do pâncreas e da região periampular. Entre as complicações pós-operatórias, a fístula pancreática continua sendo a mais importante, com uma incidência que varia de 5 a 25% nas grandes séries. Os objetivos deste trabalho são os de avaliar a morbimortalidade relacionada a duas técnicas de anastomoses pancreatojejunais (ducto-mucosa X telescopagem, e comparar seus resultados. MÉTODO: Foram analisados retrospectivamente 64 pacientes submetidos à GDP, no Serviço de Cirurgia Abdômino-Pélvica, do INCA, no período de 1987 a 2002. Destes doentes, 42 foram submetidos à anastomose tipo ducto-mucosa e 22 à telescopagem. A análise estatística foi realizada através do teste de Fischer. RESULTADOS: A taxa de fístula pancreática no grupo ducto-mucosa foi de 12% e no telescopagem foi 36%. Esta diferença percentual se mostrou estatisticamente significativa (p = 0,02. A mortalidade operatória relacionada à fístula pancreática foi de 2,4% para o grupo ducto-mucosa e 4,5% para o telescopagem, com nível de significância estatística > 5%. CONCLUSÕES: A técnica de anastomose pancreatojejunal tipo ducto-mucosa é associada a menores índices de fístula pancreática em relação a técnica de telescopagem, enquanto que a mortalidade operatória relacionada a fístula não mostrou diferença estatística entre os dois grupos estudados.BACKGROUND: Pancreaticoduodenectomy has been used as a safe and appropriate surgical option in selected patients with malignant and benign disorders of the pancreas and periampullary region. Among the complications of the pancreatoduodenectomy, pancreatic anastomosis failure is the most important and sometimes fatal complication. According to recent reports, the incidence of leakage of pancreatic anastomosis after PD is high (between 5% and

  10. Evolution of surgical skills training

    OpenAIRE

    Roberts, Kurt E.; Bell, Robert L.; Duffy, Andrew J

    2006-01-01

    Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients.

  11. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart

    2016-01-01

    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated n

  12. The normal post-surgical anatomy of the male pelvis following radical prostatectomy as assessed by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Allen, Steven D.; Sohaib, S.A. [Royal Marsden Hospital, Department of Imaging, Sutton, Surrey (United Kingdom); Thompson, Alan [Royal Marsden Hospital, Department of Surgery, Sutton, Surrey (United Kingdom)

    2008-06-15

    The magnetic resonance imaging (MRI) appearances of recurrent prostate cancer following radical prostatectomy have been documented in the radiology literature; however little has been written on the range of normal post-operative appearances. Common routes of surgical access for radical prostatectomy include retropubic and transperineal, although newer minimally invasive methods are gaining increasing acceptance. Specifically the range of appearances of the anastomotic site, the prostatic bed, the position of the bladder base, periurethral tissue, levator sling, rectum and residual seminal vesicles (if present) are demonstrated. A non-enhancing low signal nodule is frequently seen at the vesicourethral anastomosis or within the seminal vesicle remnant and usually represents fibrosis. Appearances following different surgical accesses do not differ tremendously, although the retropubic fat pad is reduced or absent following a retropubic approach. Anterior rectal-wall scarring may be present following a transperineal approach. Other post-surgical findings that may mimic disease include a lymphocoele and injected bladder-neck bulking agent. Many patients referred for MRI following radical prostatectomy will have a pathological study showing disease recurrence, although in non-pathological studies the radiological features can differ significantly. It is important for the radiologist to be aware of the spectrum of normal post-surgical appearances so not to confuse these with locally recurrent disease. (orig.)

  13. Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique

    Directory of Open Access Journals (Sweden)

    Ana K. Islam

    2016-01-01

    Full Text Available Background. Acceptance of dual kidney transplantation (DKT has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT recipients. Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013. Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p<0.001. For DKT versus SKT, the rates of delayed graft function (10.3 versus 9.2% and acute rejection (20.7 versus 22.4% were equivalent (p = ns. A higher than expected urologic complication rate in the DKT cohort (14 versus 2%, p<0.01 was reduced through modification of the ureteral anastomosis. Graft survival was equivalent between DKT and SKT groups (p = ns with actuarial 3-year DKT patient and graft survivals of 100% and 93%. At 3 years, the groups had similar renal function (p = ns. Conclusions. By utilizing extended criteria donor organs as DKT, the donor pool was enlarged while providing excellent patient and graft survival. The DKT urologic complication rate was reduced by modification of the ureteral anastomosis.

  14. 先天性食管闭锁的外科治疗体会%Surgical Treatment for Esophageal Atresia

    Institute of Scientific and Technical Information of China (English)

    谷兴琳

    1990-01-01

    During the period from 1961 to 1981,11 of the 15 cases with esophageal atresia(EA)died postoperatively. Since the establishment of thoracic surgical department in our hospital in 1982,10cases of EA(Type Ⅲ)aged from 1 to 21 days(mean 7.5 days)and weighed 1.8to 3.0 kg have been admitted.Of them,9 cases were operated on with primary end to side anastomosis and fistula-ligation,one with Livaditis procedure.Aftar operation,I had anastomosis leakage and was healed up by thoracic drainage,2had esophageal stricture(cured by dilation)and only one died.The authors stress that early diagnosis and adequate pre-and postoperative management are important to successful treatment.%我院近5年来共收治先天性食管闭锁10例.由于加强了术前术后管理,9例成活,仅1例死亡,疗效较好.本文着重介绍作者的治疗经验.

  15. Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique.

    Science.gov (United States)

    Islam, Ana K; Knight, Richard J; Mayer, Wesley A; Hollander, Adam B; Patel, Samir; Teeter, Larry D; Graviss, Edward A; Saharia, Ashish; Podder, Hemangshu; Asham, Emad H; Gaber, A Osama

    2016-01-01

    Background. Acceptance of dual kidney transplantation (DKT) has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT) recipients. Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013. Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p < 0.001). For DKT versus SKT, the rates of delayed graft function (10.3 versus 9.2%) and acute rejection (20.7 versus 22.4%) were equivalent (p = ns). A higher than expected urologic complication rate in the DKT cohort (14 versus 2%, p < 0.01) was reduced through modification of the ureteral anastomosis. Graft survival was equivalent between DKT and SKT groups (p = ns) with actuarial 3-year DKT patient and graft survivals of 100% and 93%. At 3 years, the groups had similar renal function (p = ns). Conclusions. By utilizing extended criteria donor organs as DKT, the donor pool was enlarged while providing excellent patient and graft survival. The DKT urologic complication rate was reduced by modification of the ureteral anastomosis.

  16. Partially hydrolyzed guar gum attenuates the severity of pouchitis in a rat model of ileal J pouch-anal anastomosis.

    Science.gov (United States)

    Atila, Koray; Terzi, Cem; Canda, Aras Emre; Akhisaroglu, Serpil Tanriverdi; Avci, Hatice Sanli; Sarioglu, Sulen; Oktay, Gulgun; Gulay, Zeynep

    2009-03-01

    We aimed to evaluate the efficacy of treatment with partially hydrolyzed guar gum (PHGG) using a rat model of ileal pouch-anal anastomosis and pouchitis. In the J pouch groups, tissue myeloperoxidase activities were significantly higher than native myeloperoxidase activities (P = 0.020; P = 0.015; P = 0.004, respectively). A statistically significant difference in total histological score was detected in the J pouch + 5% dextran sulfate sodium (DSS) group, compared to the J pouch control and the J pouch + 5% DSS + PHGG groups (P < 0.01 and P < 0.01, respectively). There was a significant overgrowth of aerobes and anaerobes in the J pouch + 5% DSS group. This study demonstrated that rectal administration of PHGG attenuates the severity of pouchitis in a rat model. In conclusion, PHGG may be an additional therapeutic strategy for the treatment of pouchitis. PMID:18594969

  17. Efficacy of Endoscopically Created Bypass Anastomosis in Treatment of Afferent Limb Syndrome: A Single-Center Study.

    Science.gov (United States)

    Rodrigues-Pinto, Eduardo; Grimm, Ian S; Baron, Todd H

    2016-04-01

    Afferent limb syndrome is a postoperative complication of gastrointestinal surgery, resulting from obstruction of a biliary-enteric limb. Surgery has been the cornerstone of treatment for this condition, but advances in endoscopic and percutaneous techniques could offer less-invasive options. Creation of an internal endoscopic anastomosis between the obstructed afferent limb and an adjacent gastrointestinal lumen can relieve symptoms and might provide a long-term solution. We report the efficacy of endoscopic treatment of afferent limb syndrome using lumen-apposing self-expandable metal stents to create 3 types of enteric anastomoses: a jejunojejunostomy, 2 gastrojejunostomies, and a duodenuojejunostomy in patients who developed afferent limb obstruction following a resection for pancreaticobiliary cancer. PMID:26674590

  18. The diagnosis and treatment of postoperative leakage of esophageal anastomosis in patients with esophageal atresia of type Ⅲ%Ⅲ型食管闭锁术后吻合口漏的临床分析

    Institute of Scientific and Technical Information of China (English)

    赵瑞; 郑珊; 沈淳; 肖现民

    2008-01-01

    were males(71.7%)and 15 were females (28.3%),with the mean birth weight of 2.53±0.63 kg.Among them,21(39.62%)suffered leak-age.According to Gross classification,14 cases were type Ⅲ a and 7 were type Ⅲ b,which had significant difference(P<0.05).In 15 patients suffering severe leakage,10 cases were type Ⅲa and 5 were Ⅲb;while in 6 patients suffering minor leakage,4 cases were typeⅢa and 2 wereⅢb.Among 21 patients with leakage,the birth weight of 9 cases(9/32)were beyond 2500 g,10 cases(10/17)were between 2 000 g and 2 500 g,and 5 cases(5/32)were less than 2 000 g.In the 21 patients with leak-age,15 cases were without any associated abnormities,5 cases were with moderate associated abnormities,and only 1 case was with severe associated abnormities.Five patients died during hospitalization,but only one died of leakage.All the other patients with leakage accepted non-operative therapy and recovered well.The anastomosis stricture index of the patients with leakage was 0.604±0.023,which was significantly higher than that in patients without leakage(0.519±0.028).Eleven patients (11/53)accepted esophageal dilatation for anastomosis stricture,in whom 6 cases had leakage while the other 5 without,which showed no statistical difference.Conclusions The incidence of esophageal anastomosis leakage is related to the distance between two ends of the esophagus.All leakage except for complete anastomotic disruption could be managed by non-surgical therapy,such as thorax drainage and parenteral nutrition,until spontaneous closures formed in the next 1 to 3 weeks.

  19. SURGICAL METHODS OF TREATMENT OF PATIENTS WITH FORMED PANCREATIC CYSTS

    Directory of Open Access Journals (Sweden)

    N. V. Merzlikin

    2015-01-01

    Full Text Available Objective: a comparative analysis of the results of the use of different surgical methods of treatment of patients with formed pancreatic cysts.Material and methods. 108 patients with formed pancreatic cysts were treated and analysis of shortand long-term results of their surgical treatment was performed. Patients were divided into three groups depending on the type of surgical intervention: I – external drainage – 44 (40.7%, II – internal drainage –33 (30.6%, III – resection operations – 31 (28.7%.Results and discussions. Marsupialization of cyst by laparotomy incision was performed in patients of I group (n = 44. 18 (40.9% complications, 9 (20.5% lethal cases were after operation. Anastomoses of cysts with the small intestine were mostly performed in II group (n = 33 – 21 (63.6%. 7 (21.2% complications, 1 (3.0% lethal case were after operation. Distal resections were performed in patients of III group (n = 31 in 16 (51.6% cases. Duodenum-preserving resections were introduced for treatment of cyst of pancreas head – 12 (38.7%. When performing this type of operations we proposed nikelid titanium stents for the prevention of anastomosis stenosis and preoperative retrograde stenting of the common bile duct for the prevention of damage. 10 (32.3% complications and no lethal cases were after operation. Immediate results were worse in patients of I group. 47 (43.5% patients were analyzed in long-term period. The number of recurrences of the disease (13.3% and long-term mortality (33.3% prevailed in the group of patients undergoing internal drainage of cysts. Quality of life, level of mental and physical health, that was assessed using SF-36, were higher in group of patients with reactionary treatment.Conclusion. The best immediate and long-term results were noted after resection operations, that enables to recommend their as the most optimal and radical method for treatment of patients with pancreatic cysts. Introducing of duodenum

  20. Surgical management of large and giant intracavernous and paraclinoid aneurysms

    Institute of Scientific and Technical Information of China (English)

    Xu Bai-nan; SUN Zheng-hui; JIANG Jin-li; WU Chen; ZHOU Ding-biao; YU Xin-guang; LI Bao-min

    2008-01-01

    Background Due to their location,large and giant intracavernous and paraclinoid aneurysms remain a challenge for vascular neurosurgeons.We identified characteristics.surgical indications and treatment strategies of large and giant intracavernous and paraclinoid aneurysms in 36 patients.Methods The pterional approach was routinely used.The cervical internal carotid artery was exposed for proximal control of parent vessel and retrograde suction decompression.Paraclinoid aneurysms were directly clipped,intracavernous pseudoaneurysm was repaired and the intracavernous aneurysms were trapped with extracranial-intracranial bypass of saphenous vein graft.Intraoperative electroencephaIogram (EEG) and somatosensory evoked potential (SSEP) monitoring were used to detect cerebral ischemia during the temporary occlusion of parent arteries.Microvascular Doppler ultrasonography was used to assess blood flow of the parent and branch vessels.Endoscopy was helpful particularly in dealing with internal carotid artery posterior wall aneurysms.Postoperative digital subtraction angiography (DSA) was performed in 33 of the 36 patients.Results Thirty-two paraclinoid aneurysms were directly clipped,1 intracavernous pseudoaneurysm was repaired and the other 3 intracavernous aneurysms were trapped with revascula rization.Except for two patients who died in the early postoperative stage,34 patients' follow-up was 6-65 months (mean 10 months)and a Glasgow Outcome Scale score of 4 to 5 at discharge.At the 6-month follow-up examination,Rankin Outcome Scale scores were 0 to 2 in 32 patients.EEG and SSEP monitoring changed in six patients.Twelve clips were readjusted when insufficient blood flow in parent and branch vessels was detected.Three posterior wall aneurysms were clipped.Conclusions Intracavernous aneurysms not amenable to endovascular treatment should be treated surgically and surgical treatment is the first option for paraclinoid aneurysms.The temporary parent vessel occlusion

  1. Complete lymph flow reconstruction: A free vascularized lymph node true perforator flap transfer with efferent lymphaticolymphatic anastomosis.

    Science.gov (United States)

    Yamamoto, Takumi; Yoshimatsu, Hidehiko; Yamamoto, Nana

    2016-09-01

    Treatment of primary lower extremity lymphedema (LEL) is challenging, and lymph node transfer (LNT) can be a choice of treatment for progressive LEL. However, LNT has a risk of donor site lymphedema and possible lymph node (LN) sclerosis due to efferent lymphatic vessel (ELV) obstruction. Here, we report the first case of complete lymph flow reconstruction with true perforator LNT with efferent lymphaticolymphatic anastomosis (ELLA) for a patient with primary LEL and severe lymphosclerosis. A 49-year-old female suffered from primary progressive unilateral left LEL refractory to conservative treatments with frequent episodes of cellulitis. A true perforator LN flap was selectively harvested from the left lateral thoracic region under indocyanine green (ICG) lymphography navigation and transferred to the left groin with perforator-to-perforator anastomosis. The ELV of the transplanted LN was supermicrosurgically anastomosed to the contralateral iliac lymphatic vessel that was subcutaneously transferred to the left groin. Postoperatively, the patient experienced no episode of cellulitis with reduced degree of compression treatment, and lymphedematous volume decreased from 306 to 264 in terms of LEL index. Postoperative ICG lymphography showed evidence of reconstructed lymph flow from the left foot to the left groin and to the right inguinal LN through the transplanted LN flap and the ELLA. There were no subjective or objective findings of donor site lymphedema of the left arm or the right back and the lower extremity. True perforator LN flap with ELLA is a safe and effective treatment and has the potential to be a useful therapeutic option for primary unilateral LEL. PMID:27449876

  2. Improvement of C peptide zero BMI 24-34 diabetic patients after tailored one anastomosis gastric bypass (BAGUA

    Directory of Open Access Journals (Sweden)

    M. Garcia-Caballero

    2013-01-01

    Full Text Available Background: Although bariatric surgery proved to be a very effective method in the treatment of patients in whose pancreas still produce insulin (type 2 diabetes, the accompanied metabolic syndrome and their diabetes complications, there is no information on the effect of this type of surgery in BMI24-34 patients when pancreas do not produce insulin at all (type 1, LADA and long term evolution type 2 diabetes among others. Patients and methods: We report preliminary data of a serie of 11 patients all with a C-peptide values below 0.0 ng/ml. They were followed for 6 to 60 months (mean 19 months after surgery. We studied the changes in glycemic control, evolution of the metabolic syndrome and diabetes complications after one anastomosis gastric bypass (BAGUA. Results: All values relative to glycemic control were improved HbA1c (from 8.9 ± 0.6 to 6.7 ± 0.2%, FPG (Fasting Plasma Glucose [from 222.36 ± 16.87 to 94 ± 5 (mg/dl] as well as the daily insulin requirement of rapid (from 40.6 ± 12.8 to 0 (U/d and long-lasting insulin (from 41.27 ± 7.3 U/day to 15.2 ± 3.3 U/day. It resolved 100% of the metabolic syndrome diseases as well as severe hypoglycaemia episodes present before surgery and improved some serious complications from diabetes like retinopathy, nephropathy, neuropathy, peripheral vasculopathy and cardiopathy. Conclusions: Tailored one anastomosis gastric bypass in BMI 24-34 C peptide zero diabetic patients eliminated the use of rapid insulin, reduced to only one injection per day long-lasting insulin and improved the glycemic control. After surgery disappear metabolic syndrome and severe hypoglycaemia episodes and improves significantly retinopathy, neuropathy, nephropathy, peripheral vasculopathy and cardiopathy.

  3. Towards Safe Robotic Surgical Systems

    DEFF Research Database (Denmark)

    Sloth, Christoffer; Wisniewski, Rafael

    2015-01-01

    A proof of safety is paramount for an autonomous robotic surgical system to ensure that it does not cause trauma to patients. However, a proof of safety is rarely constructed, as surgical systems are too complex to be dealt with by most formal verification methods. In this paper, we design...... a controller for motion compensation in beating-heart surgery, and prove that it is safe, i.e., the surgical tool is kept within an allowable distance and orientation of the heart. We solve the problem by simultaneously finding a control law and a barrier function. The motion compensation system is simulated...

  4. Surgical Skills Beyond Scientific Management

    Science.gov (United States)

    Whitfield, Nicholas

    2015-01-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel’s attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel–Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  5. Evidence-based surgical wound care on surgical wound infection.

    Science.gov (United States)

    Reilly, Jaqueline

    2002-09-01

    Surgical wound infection is an important outcome indicator in the postoperative period. A 3-year prospective cohort epidemiological study of 2202 surgical patients from seven surgical wards across two hospitals was carried out using gold standard surveillance methodology. This involved following patients up as inpatients and postdischarge surveillance to 30 days by an independent observer. The results led to the development of a mathematical model for risk of clean, elective surgical wound infection. Risk of surgical wound infection was increased by smoking, higher body mass index, presence of malignancy, haematoma formation, increasing numbers of people in theatre, adherent dressing usage, and higher times to suture removal (P<0.05). The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It was noted that patient care practices affected the surgical wound infection rate and the surveillance was used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the risk from extrinsic risk factors for wound infection. As a result of the implementation of this evidence-based practice there was a significant reduction (P<0.05) in the clean wound infection rate.

  6. Spectrum of clinical presentation and surgical management of intestinal tuberculosis at tertiary care hospital

    International Nuclear Information System (INIS)

    anastomosis was performed on 24 (40%) cases, right hemicolectomy on 22 (36.7%), stricturoplasty on 8 (13.3%), adhesionolysis on 4 (6.7%), and Ileostomy on 2 (3.3%) patients. Conclusion: Abdominal pain, vomiting, fever and weight loss are the commonest symptoms in abdominal tuberculosis. Single and multiple strictures in the ileum, and mass in the ileocaecal region were the commonest lesions. Definitive surgical procedure like resection and anastomosis, stricturoplasty and right hemicolectomy are the main surgical options. (author)

  7. Surgical Procedures for Vestibular Dysfunction

    Science.gov (United States)

    ... Rated Nonprofit! Volunteer. Donate. Review. Surgical Procedures for Vestibular Dysfunction When is surgery necessary? When medical treatment ... organ (cochlea) is also sacrificed with this procedure. Vestibular nerve section A vestibular nerve section is a ...

  8. Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique

    Science.gov (United States)

    Islam, Ana K.; Mayer, Wesley A.; Hollander, Adam B.; Patel, Samir; Teeter, Larry D.; Graviss, Edward A.; Saharia, Ashish; Podder, Hemangshu; Asham, Emad H.; Gaber, A. Osama

    2016-01-01

    Background. Acceptance of dual kidney transplantation (DKT) has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT) recipients. Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013. Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p urologic complication rate in the DKT cohort (14 versus 2%, p urologic complication rate was reduced by modification of the ureteral anastomosis.

  9. Achados fonoaudiológicos em pacientes submetidos a anastomose hipoglosso facial Phonoaudiological findings in patients submitted to hypoglossal-facial anastomosis

    Directory of Open Access Journals (Sweden)

    Elisabete C. C. F. Silva

    2003-06-01

    Full Text Available A anastomose hipoglosso-facial (AHF tem sido realizada em pacientes com lesão dos segmentos mais proximais do nervo facial em que outros procedimentos cirúrgicos não foram possíveis ou não obtiveram êxito. OBJETIVO: O objetivo atual da pesquisa é verificar as alterações na mobilidade dos órgãos fonoarticulatórios, quanto à função da fala, mastigação e da deglutição, em pacientes submetidos a AHF. FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO: Foram avaliados 8 pacientes, com paralisia facial periférica (PFP, submetidos a AHF, na UNIFESP/EPM, no período de 1998 a 2000, sendo 6 do sexo feminino e 2 do sexo masculino, idades entre 21 e 71 anos e mediana de 50 anos. Desses, 5 pós-exerése do Schwannoma do Nervo Vestibular, 1 pós-exerése de Fibrossarcoma, 1 pós-ferimento por arma de fogo e 1 pós-paralisia facial idiopática de má evolução. Na avaliação fonoaudiológica, o protocolo consta de: dados de identificação; classificação da recuperação do nervo facial; tratamentos realizados; simetria facial no repouso e no movimento voluntário; sincinesias para olho, boca, nariz e bochechas; distúrbios fonoarticulatórios e da motricidade da língua; alteração na mastigação e do paladar, e questionário referente ao parecer dos respectivos distúrbios para serem respondidos pelo paciente. RESULTADO: O grau de paralisia pós-anastomose e reabilitação variou para os olhos entre II e V e para a boca entre III e V (House & Brackemann, 1985. Concluímos que recuperação foi satisfatória e importante, mas a expectativa de melhora foi inferior ao esperado pelos pacientes. Foram observados: imprecisão articulatória, disfunção mastigatória, escape bucal de alimentos e disfagia.The hypoglossal-facial anastomosis (HFA have been related in patients with facial nerve lesion where proximal segment more other surgical produceres had been faited or had not been possible success. AIM: The objective of the

  10. Aesthetic Surgical Crown Lengthening Procedure

    Directory of Open Access Journals (Sweden)

    Pablo Santos de Oliveira

    2015-01-01

    Full Text Available The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey, crown lengthening is the most habitual surgical periodontal treatment.

  11. Aesthetic Surgical Crown Lengthening Procedure.

    Science.gov (United States)

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A; Shibli, Jamil A; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment.

  12. Undernutriton and surgical site infection

    OpenAIRE

    Weimann, Arved

    2007-01-01

    There is strong evidence for the impact of nutritional status and nutritional intervention on surgical morbidity with special regard to surgical site infectious complications. Aiming on the decrease of length of hospital stay in surgery, the identification of nutritional risk patients and candidates for preoperative nutritional support has to be realized in an outpatient setting. This has to be established by improvement of health care networking. Whenever possible, nutritional support should...

  13. Surgical checklists: the human factor

    OpenAIRE

    O’Connor, Paul; Reddin, Catriona; O’Sullivan, Michael; O’Duffy, Fergal; Keogh, Ivan

    2013-01-01

    Background Surgical checklists has been shown to improve patient safety and teamwork in the operating theatre. However, despite the known benefits of the use of checklists in surgery, in some cases the practical implementation has been found to be less than universal. A questionnaire methodology was used to quantitatively evaluate the attitudes of theatre staff towards a modified version of the World Health Organisation (WHO) surgical checklist with relation to: beliefs about levels of compli...

  14. Surgical treatment for liver cancer

    Institute of Scientific and Technical Information of China (English)

    Nicole; C; Tsim; Adam; E; Frampton; Nagy; A; Habib; Long; R; Jiao

    2010-01-01

    Primary liver cancer is amongst the commonest tumors worldwide,particularly in parts of the developing world,and is increasing in incidence. Over the past three decades,surgical hepatic resection has evolved from a high risk,resource intensive procedure with limited application,to a safe and commonly performed operation with a range of indications. This article reviews the approach to surgical resection for malignancies such as hepatocellular cancer,metastatic liver de-posits and neuroendocrine tumors. Surv...

  15. Innovation in pediatric surgical education.

    Science.gov (United States)

    Clifton, Matthew S; Wulkan, Mark L

    2015-06-01

    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees.

  16. Blepharoplasty and periorbital surgical rejuvenation

    OpenAIRE

    Milind Naik

    2013-01-01

    The periorbital region forms the epicenter of facial aging changes and receives highest attention from physicians and patients. The concern about visual function, clubbed with the need for hidden incisions, makes the periocular region a highly specialized surgical area, most appropriately handled by an ophthalmic plastic surgeon. The article provides an overview of cosmetic eyelid and facial surgery in the periocular region. Common aesthetic surgical procedures as well as ocular side-effects ...

  17. Surgical treatment of primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Brasso, K; Karstrup, S; Lundby, C M;

    1994-01-01

    One hundred and two patients with primary hyperparathyroidism underwent a total of 108 bilateral neck explorations with attempted identification and biopsy of all four glands. Hypercalcaemia was surgically eliminated in 97 of 102 patients (95%). Of the remaining hypercalcaemic patients one.......9%). Permanent paralysis of the recurrent nerve occurred in three patients (2.9%). Twenty-one patients developed other postoperative complications from which they all recovered without sequelae. No postoperative deaths occurred. Our results show that surgical treatment of primary hyperparathyroidism...

  18. Surgical innovations in canine gonadectomy

    OpenAIRE

    Van Goethem, Bart

    2016-01-01

    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated negative consequences (lengthy placement, impaired wound healing around bulky knots, and the effect of unsightly knots on cosmetics). A study in 9 dogs found that celiotomy closure was easily achiev...

  19. Middle cerebral artery revascularization: anatomical studies and considerations on the anastomosis site Revascularização da artéria cerebral média: estudo anatômico e considerações sobre o local de sutura

    Directory of Open Access Journals (Sweden)

    Murilo S. Meneses

    1997-01-01

    Full Text Available In the surgical management of skull base lesions and vascular diseases such as giant aneurysms, involvement of the internal carotid artery may require the resection or the occlusion of the vessel. The anastomosis of the external carotid artery and the middle cerebral artery with venous graft may be indicated to re-establish the blood flow. To determine the best suture site in the middle cerebral artery, an anatomical study was carried out. Fourteen cerebral hemispheres were analysed after the injection of red latex into the internal carotid artery. The superior and inferior trunk of the main division of the middle cerebral artery have more than 2 mm of diameter. They are superficial allowing an anastomosis using a venous graft. The superior trunk has a disadvantage, it gives rise to branches for the precentral and post-central giri. The anastomosis with the inferior trunk presents lower risk of neurological deficit even though the angular artery originates from it.No tratamento cirúrgico das lesões da base do crânio e patologias vasculares como aneurismas gigantes, a ressecção ou oclusão da artéria carótida interna pode ser necessária. A anastomose das artérias carótida externa e cerebral média com interposição de enxerto venoso pode ser utilizada para restabelecer o fluxo sangüíneo. Para determinar o melhor local de sutura na artéria cerebral média, realizou-se um estudo anatômico. Quatorze hemisférios cerebrais foram analisados depois da injeção de látex vermelho na artéria carótida interna. Os ramos superior e inferior da divisão principal da artéria cerebral média têm mais de 2 mm de diâmetro. Eles são superficiais e permitem uma anastomose utilizando um enxerto venoso. O tronco superior tem a desvantagem de dar origem aos ramos para os giros pré e pós-centrais. A anastomose com o tronca inferior apresenta menor risco de déficit neurológico, apesar da artéria angular ter origem desse vaso.

  20. Evolution of surgical skills training

    Institute of Scientific and Technical Information of China (English)

    Kurt E Roberts; Robert L Bell; Andrew J Duffy

    2006-01-01

    Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients.Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced,virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations.The Accreditation Council of Graduate Medical Education's (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent.Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery.An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training,ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients.

  1. Bacterial migration through punctured surgical gloves under real surgical conditions

    Directory of Open Access Journals (Sweden)

    Heidecke Claus-Dieter

    2010-07-01

    Full Text Available Abstract Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab. Results In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes. Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25% punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98 of outer gloves and in 1% (1/96 of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers, the calculated migration was 50% (n = 5. The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes. Conclusions This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods.

  2. Surgical versus non-surgical treatment of congenital hyperinsulinism.

    Science.gov (United States)

    Mazor-Aronovitch, Kineret; Landau, Heddy; Gillis, David

    2009-03-01

    Congenital hyperinsulinism is a functional disorder of insulin secretion. In its diffuse severe form, it is traditionally treated with over 95% pancreatectomy. However, even after this procedure normoglycemia is not always achieved. Non-surgical therapy with frequent or continuous feeding, medication and close monitoring is another alternative. In this review we compare the two approaches to this condition focusing on early complications, diabetes, neurological outcome and home management issues. Early complications of pancreatectomy include mechanical, metabolic and infectious complications. Non-surgical interventions can be complicated by unwarranted effects of medications and of invasive procedures. Diabetes occurs with both approaches but much less frequently and years later with non-surgical treatment. Regarding neurodevelopmental outcome, most data come from heterogeneous groups. Nevertheless, it appears that outcome is not adversely affected by avoiding surgery. Home management is far more difficult for the non-surgical form. When the non-surgical approach is successful in achieving normoglycemia and parents are highly motivated, this mode of therapy should be considered.

  3. Modelling and simulation of the mechanical response of a Dacron graft in the pressurization test and an end-to-end anastomosis.

    Science.gov (United States)

    Bustos, Claudio A; García-Herrera, Claudio M; Celentano, Diego J

    2016-08-01

    This work presents the modeling and simulation of the mechanical response of a Dacron graft in the pressurization test and its clinical application in the analysis of an end-to-end anastomosis. Both problems are studied via an anisotropic constitutive model that was calibrated by means of previously reported uniaxial tensile tests. First, the simulation of the pressurization test allows the validation of the experimental material characterization that included tests carried out for different levels of axial stretching. Then, the analysis of an end-to-end anastomosis under an idealized geometry is proposed. This case consists in evaluating the mechanical performance of the graft together with the stresses and deformations in the neighborhood of the Dacron with the artery. This research contributes important data to understand the functioning of the graft and the possibility of extending the analysis to complex numerical cases like its insertion in the aortic arch. PMID:26826765

  4. Post re-anastomosis demonstration of regain in function in non-visualized upper half of kidney in a dual arterial allogenic renal graft on renal scintigraphy

    International Nuclear Information System (INIS)

    A young male patient with end stage renal disease underwent renal allograft having dual arterial supply. Immediate post-operative urine output dropped, an urgent Technetium-99m-mercaptoacetyltriglycine (99mTc-MAG3) renogram revealed non-visualized upper-half and the preserved perfusion and parenchymal function of the small transplant kidney. Patient was re-explored and re-anastomosis was performed. A renogram at 24h post re-anastomosis revealed increase in the size of renal allograft, with preserved perfusion to the upper-half of transplant. Transplant kidney biopsy of the Upper-half showed acute tubular necrosis. 99mTc-MAG3renogram at 10 days post re-vascularization remains unchanged with persistent improvement at 2 months follow-up. We conclude that early recognition of renal functional loss allows early management and the high probability of salvaging the renal function

  5. Agenesis of the internal carotid artery with a trans-sellar anastomosis: CT and MRI findings in late-onset congenital hypopituitarism

    Energy Technology Data Exchange (ETDEWEB)

    Mellado, J.M.; Merino, X.; Ramos, A.; Salvado, E.; Sauri, A. [Inst. de Diagnostic per la Imatge, Centre de Ressonancia Magnetica de Tarragona (Spain)

    2001-03-01

    A 29-year-old woman with a history of hypothyroidism since early childhood developed hypopituitarism. CT and MRI revealed anterior pituitary hypoplasia, an ectopic posterior lobe, a Chiari I malformation and agenesis of the right internal carotid artery with a trans-sellar anastomosis. This constellation of findings constitutes a previously unreported association in congenital hypopituitarism of late onset. The usefulness of imaging modalities and the pathogenic implications are also discussed. (orig.)

  6. Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy – Case report

    Directory of Open Access Journals (Sweden)

    Jianlin Tang

    2014-12-01

    Conclusion: The lessons we learned are (1 Before SMPV confluence resection, internal jugular vein graft should be ready for reconstruction. (2 Synthetic graft is an alternative for internal jugular vein graft. (3 Direct portal vein to SMV anastomosis can be achieved by mobilizing liver. (4 It is possible that venous collaterals secondary to SMV tumor obstruction may have allowed this patient's post-operative survival.

  7. Fontan procedure: imaging of normal post-surgical anatomy and the spectrum of cardiac and extracardiac complications

    International Nuclear Information System (INIS)

    Univentricular congenital heart diseases include a range of entities that result in a functionally single ventricular chamber. Although the only curative therapy is cardiac transplantation, there are several palliative surgical techniques that prevent ventricular volume overload, diverting part or all the systemic venous circulation into the pulmonary arteries. The modern Fontan procedure, which consists of anastomosing both the superior (SVC) and inferior vena cava (IVC) to the right pulmonary artery (RPA), is nowadays the last step before transplantation. The importance of imaging in these entities lies not only in the understanding of the new circuit established after surgical correction, but also in the early detection of the wide spectrum of cardiac and extracardiac complications that can occur due to the new physiological condition. Due to the increased survival of these patients, long-term complications are becoming more common. The main cardiac complications are atrial enlargement, ventricular dysfunction, and stenosis or thrombosis of the conduit. Pulmonary artery stenosis, pulmonary arteriovenous fistulae (PAVF), systemic-pulmonary veno venous shunts (VVS), hepatic congestion, cardiac cirrhosis, and protein-losing enteropathy are potential extracardiac complications. - Highlights: • Fontan procedure is the main palliative surgical procedure for univentricular heart correction. • Fontan procedure entails the anastomosis of SVC and IVC to the RPA. • Complications are becoming more common due to the increased survival of patients with Fontan

  8. Stress and strain analysis on the anastomosis site sutured with either epineurial or perineurial sutures after simulation of sciatic nerve injury

    Institute of Scientific and Technical Information of China (English)

    Guangyao Liu; Qiao Zhang; Yan Jin; Zhongli Gao

    2012-01-01

    The magnitude of tensile stress and tensile strain at an anastomosis site under physiological stress is an important factor for the success of anastomosis following suturing in peripheral nerve injury treatment.Sciatic nerves from fresh adult cadavers were used to create models of sciatic nerve injury.The denervated specimens underwent epineurial and perineurial suturing.The elastic modulus (40.96 ± 2.59 MPa) and Poisson ratio (0.37 ± 0.02) of the normal sciatic nerve were measured by strain electrical measurement.A resistance strain gauge was pasted on the front,back,left,and right of the edge of the anastomosis site after suturing.Strain electrical measurement results showed that the stress and strain values of the sciatic nerve following perineurial suturing were lower than those following epineurial suturing.Scanning electron microscopy revealed that the sciatic nerve fibers were disordered following epineurial compared with perineurial suturing.These results indicate that the effect of perineurial suturing in sciatic nerve injury repair is better than that of epineurial suturing.

  9. Small gap anastomosis to repair peripheral nerve rupture using a nerve regeneration chamber constructed by scissoring and sleeve jointing autologous epineurium

    Institute of Scientific and Technical Information of China (English)

    Peiji Wang; Zhongliang Zhou; Qirong Dong

    2011-01-01

    A number of studies have shown how to eliminate the misorientated docking of the peripheral nerve bundle in the traditional epineurium or perineudum anastomosis, thus avoiding neuroma formation and axonal outgrowth from the coaptation sites, and seriously hindering neural function recovery. Based on the "peripheral nerve selective regeneration theory", this experiment was designed to investigate the feasibility and benefits of a new small gap anastomosis repairing peripheral nerve rupture, by scissoring and sleeve jointing an autologous epineurium. In the proximal stump of the nerve, a 1 mm-long epineurium was annularly separated and removed, while a 3 mm-long epineurium was longitudinally incised in the distal stump after the epineurium was dissociated from proximal to distal. The epineuria of the two stumps and the longitudinal incision were sutured, leaving a 2 mm gap between the two nerve stumps. Results show that the experimental rats quickly recovered autonomic activities, and there were minimal adhesions at the outer surface of the epineurial tube to the surrounding tissue. The morphologic changes to the sciatic nerve showed that connective tissue hyperplasia of the small gaps was significantly reduced, and nerve fibers were arranged orderly. No such changes were observed in the neurorrhaphy in situ group. Thus, the experiment confirmed that the new small gap anastomosis to repair peripheral nerve rupture by scissoring and sleeve jointing autologous epineurium is feasible, and that it is superior to epineurium neurorrhaphy in situ.

  10. Stationary surgical smoke evacuation systems.

    Science.gov (United States)

    2001-03-01

    Two types of systems are available for evacuating the surgical smoke created by electrosurgery and laser surgery: portable and stationary surgical smoke evacuation systems. While portable systems dominate the market today, stationary systems are an alternative worth considering--even though they are still in their infancy, with fewer than 90 systems installed to date. Stationary systems represent a major commitment on the part of the healthcare facility. Several system components must be installed as part of the physical plant (for instance, within the walls), making the system a permanent fixture in the surgical suite. Installation of these systems is often carried out during building construction or major renovation--although the systems can be cost-effective even if no renovations are planned. For this Evaluation, we tested three stationary systems. All three are adequate to capture surgical smoke and evacuate it from the operating room. These systems are easy to use, are quietter than their portable counterparts, and require minimal user maintenance. They represent an excellent option for most hospitals actively evacuating surgical smoke. In this article, we discuss the factors to consider when selecting from among these systems. We also offer guidance on choosing between stationary systems and portable ones. PMID:11321758

  11. Os ácidos graxos de cadeia curta na cicatrização de anastomoses colônicas: estudo experimental em ratos The short chain fatty acids on colonic anastomosis healing: experimental study on rats

    Directory of Open Access Journals (Sweden)

    Fernando Hintz Greca

    2003-08-01

    effects of short chain fatty acids (SCFA on the healing of defunctioned colon and in the presence of faecal loading in rats. METHODS: Fifty adult Wistar rats were divided in four groups. Two of them, twenty six rats, were submitted to Hartmann's procedure (HC - Hartmann Control - and HSCFA - Hartmann SCFA and colonic anastomosis were performed in the other two groups (AC - Anastomosis Control - and ASCFA - Anastomosis SCFA. The control groups (HC and AC received rectal infusions of saline, while the experimental groups (HSCFA and ASCFA received the same kind of infusion but with an isosmolar solution of sodium butyrate at 80mmol/l (SCFA. The animals were sacrificed at the 7th and 14th postoperative day. Histologic preparations with sirius red staining were performed to analyse the collagen densitometry by optic microscopy with a polarized light. Collagen I, collagen III and total collagen were quantified by a computer software. RESULTS: In the groups submitted to Hartman's operation - with bowel rest - the animals submitted to rectal infusions of SCFA showed an increase in the quantity of total and collagen I. Evaluating the groups submitted to colonic anastomosis - with interference of intraluminal bulk - there was an increase in collagen I in the experimental group. The interference of the diet bowel content in the healing process, with or without SCFA rectal infusions, was analyzed crossing the groups of different surgical procedures. CONCLUSION: The main effect of rectal infusions of SCFA was related to the collagen I, either with or without interference of the intestinal bulk. The presence of diet bowel content also increased the collagen production.

  12. Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis Resultado precoce e tardio da anastomose íleoanal com reservatório ileal na retocolite ulcerativa

    Directory of Open Access Journals (Sweden)

    Magaly Gemio Teixeira

    2003-01-01

    Full Text Available Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results. PATIENTS AND METHODS: Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up. RESULTS: The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41 occurred in 34 patients (42.5%. Late complications (29 occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8% 1 year after ileal pouch-anal anastomosis, 9 (14.8% after 3 years, 13 (21.3% after 5 years, and 16 (26.2% after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later. CONCLUSIONS: Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up.A anastomose íleo-anal com reservatório ileal foi um importante avanço no tratamento da retocolite ulcerativa. O objetivo deste trabalho foi determinar se os maus

  13. Mechanical performance of disposable surgical needle holders.

    Science.gov (United States)

    Francis, E H; Towler, M A; Moody, F P; McGregor, W; Himel, H N; Rodeheaver, G T; Edlich, R F

    1992-01-01

    The mechanical performance of disposable Webster surgical needle holders supplied by three different surgical instrument companies was determined by recording the forces (clamping moment) applied by the different needle holder jaws to curved surgical needles. This investigation demonstrated that there was a large variability in the mechanical performance of the disposable needle holders supplied by each surgical instrument company. In addition, the mechanical performance of the disposable needle holder of each surgical instrument company was distinctly different.

  14. Satiety signalling histaminergic system and brain-gut peptides in regulation of food intake in rats with portocaval anastomosis.

    Science.gov (United States)

    Fogel, W A; Stasiak, A; Lewinski, A; Maksymowicz, M; Jochem, J

    2008-08-01

    Brain histamine plays a regulatory role in feeding behaviour, acting as an inhibitory modulator. Portocaval anastomosis (PCA) is associated with cerebral aminergic systems alterations, including high histamine accumulation and release from neurons. Despite that, the rats with PCA eat significantly more, their body mass being lower than sham-operated animals. To disclose underlying regulatory mechanisms, food intake was measured before and after treatment with antagonists of histamine H(1) and H(2), orexin type 1 (OX(1)) and cannabinoid type 1 (CB(1)) receptors in adult male Lewis rats 6 months following the end-to-side PCA or sham operation. Hypothalamic concentrations of orexin A and histamine as well as serum concentrations of leptin, insulin and cholecystokinin (CCK) were analysed. PCA rats with body mass lower by 30%, have consumed more feed and water 150% and 200%, respectively. The modifying effects of pyrilamine, ranitidine, SB 334867 and rimonabant were less pronounced in PCA compared with sham-operated rats. Hypothalamic orexin A and histamine concentrations were higher in PCA rats than in the control group with intact portocaval system. In PCA rats, serum concentrations of CCK were higher, leptin concentrations lower, while there were no differences between the groups in insulin levels. In conclusion, the adaptive mechanisms efficiently render PCA rats less sensitive to peripheral and central anorexigenic signals. Orexin A appears to be involved in the counteracting mechanisms preventing further body mass loss in PCA rats.

  15. Acute traumatic subclavian artery thrombosis and its successful repair via resection and end-to-end anastomosis

    Institute of Scientific and Technical Information of China (English)

    Saulat H Fatimi; Amna Anees; Marium Muzaffar; Hashim M Hanif

    2010-01-01

    Subclavian artery thrombosis is a rare complication of clavicle fractures. We reported a 20-year-old man who was admitted to the emergency room after a road traffic accident. He was a pedestrian who was initially hit by a bus and after he fell down on the road, he was run over by a car. On evaluation, he was found to have multiple facial and rib fractures, distal right humerus and right clavicle fracture. Significantly, right radial pulse was absent. After further evaluation including Doppler studies and an angiography which revealed complete obstruction of right subclavian artery just distal to its 1st portion, the patient was urgently taken to the operation room. A midclavicular fracture was adjacent to the injured vessel. We established proximal and distal control, removed damaged part. After mobilizing the subclavian artery, an end-to-end anastomosis was made. Then open reduction and internal fixation of right distal humerus was performed. The rest of the postoperative course was unremarkable. To prevent complications of subclavian artery thrombosis, different treatment modalities can be used, including anticoagulation therapy,angioplasty, stenting and bypass procedures.

  16. Is Roux-Y Binding Pancreaticojejunal Anastomosis Feasible for Patients Undergoing Left Pancreatectomy? Results from a Prospective Randomized Trial

    Directory of Open Access Journals (Sweden)

    Anne Antila

    2014-01-01

    Full Text Available Background. After pancreaticoduodenectomy, the Finnish binding pancreaticojejunal anastomosis (FBPJ seems to reduce the risk for pancreatic fistula (POPF. Our aim was to investigate whether FBPJ is feasible and prevents the risk for POPF even after left pancreatectomy (LP. Patients and Methods. 47 consecutive patients underwent LP. 27 patients were recruited on the basis of CT and, of these, 16 patients were randomized on the basis of findings during surgery (transection line must be left of portal vein, as 2-3 cm pancreatic mobilization is required for FBPJ to receive either Roux-Y FBPJ or hand-sewn closure of the pancreatic remnant. Results. Only 34% (16/47 of the patients met the randomization criteria. Clinically significant POPF rate was higher in FBPJ group (60% compared to thand-sewn closure group (13%; P<0.05. POPF rate in FBPJ group was higher even when compared to all patients with hand-sewn closure (60% versus 37%; P<0.05. Overall, FBPJ was technically feasible for only 28% of patients. Conclusion. FBPJ cannot be recommended for the routine closure of the pancreatic remnant after LP, as it was not technically achievable in 72% of the cases. Moreover, the technique does not seem to reduce the risk for POPF compared to the hand-sewn closure.

  17. The effect of portacaval anastomosis on the expression of glutamine synthetase and ornithine aminotransferase in perivenous hepatocytes.

    Science.gov (United States)

    da Silva, Robin; Levillain, Oliver; Brosnan, John T; Araneda, Silvia; Brosnan, Margaret E

    2013-05-01

    There is functional zonation of metabolism across the liver acinus, with glutamine synthetase restricted to a narrow band of cells around the terminal hepatic venules. Portacaval anastomosis, where there is a major rerouting of portal blood flow from the portal vein directly to the vena cava bypassing the liver, has been reported to result in a marked decrease in the activity of glutamine synthetase. It is not known whether this represents a loss of perivenous hepatocytes or whether there is a specific loss of glutamine synthetase. To answer this question, we have determined the activity of glutamine synthetase and another enzyme from the perivenous compartment, ornithine aminotransferase, as well as the immunochemical localization of both glutamine synthetase and ornithine aminotransferase in rats with a portacaval shunt. The portacaval shunt caused a marked decrease in glutamine synthetase activity and an increase in ornithine aminotransferase activity. Immunohistochemical analysis showed that the glutamine synthetase and ornithine aminotransferase proteins maintained their location in the perivenous cells. These results indicate that there is no generalized loss of perivenous hepatocytes, but rather, there is a significant alteration in the expression of these proteins and hence metabolism in this cell population.

  18. Reno-portal anastomosis as an approach to pediatric kidney transplantation in the setting of inferior vena cava thrombosis.

    Science.gov (United States)

    Cauley, R P; Potanos, K; Fullington, N; Lillehei, C; Vakili, K; Kim, H B

    2013-05-01

    In pediatric renal transplantation in the setting of IVC thrombosis, the retrohepatic IVC or gonadal veins are often used for outflow. However, if use of systemic venous outflow is unsuccessful, options become limited. We report the use of the portal vein for venous outflow in kidney retransplantation in the setting of IVC thrombosis. The patient is a 19-month-old male who developed end-stage renal failure at seven months of age secondary to hypotension after spontaneous rupture of an accessory renal vein. The IVC was occluded during emergent laparotomy, and the patient developed extensive IVC thrombosis. The first two transplant attempts used the retrohepatic IVC for venous outflow. Despite good initial flow, in both instances the renal vein thrombosed on post-operative day 1. In an unsuccessful salvage attempt of the second transplant, a reno-portal anastomosis was performed. With few options for vascular access, a third transplant was attempted. The reno-portal stump from the second transplant was used for outflow. The patient recovered well from his third transplant (creatinine 0.6 mg/dL 35 months post-surgery), demonstrating that the portal vein can be used for outflow in cases of extensive IVC thrombosis.

  19. Possible role of human cytomegalovirus in pouchitis after proctocolectomy with ileal pouch-anal anastomosis in patients with ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Damian Casadesus; Tatsuo Tani; Toshifumi Wakai; Satoshi Maruyama; Tsuneo Iiai; Haruhiko Okamoto; Katsuyoshi Hatakeyama

    2007-01-01

    AIM:To detect the presence of human cytomegalovirus(HCMV)proteins and genes on the ileal pouch of patients with ulcerative colitis who have undergone proctocolectomy with ileal pouch-anal anastomosis(IPAA).METHODS:Immunohistochemistry,polymerase chain reaction(PCR)and PCR sequencing methods were utilized to test the presence of HCMV in pouch specimens taken from 34 patients in 86 endoscopies.RESULTS:HCMV genes and proteins were detected in samples from 12(35.2%)patients.The rate of detection was significant in the endoscopies from patients diagnosed with pouchitis(5 of 12,41.6%),according to the Japanese classification of pouchitis,in comparison to patients with normal pouch(7 of 62,11.2%;P = 0.021).In all patients with pouchitis in which the HCMV was detected,it was the first episode of pouchitis.The virus was not detected in previous biopsies taken in normal endoscopies of these patients.During the followup,HCMV was detected in one patient with recurrent pouchitis and in 3 patients whose pouchitis episodes improved but whose positive endoscopic findings persisted.CONCLUSION:HCMV can take part in the inflammatory process of the pouch in some patients with ulcerative colitis who have undergone proctocolectomy with IPAA.

  20. Malabsorption and intestinal adaptation after one anastomosis gastric bypass compared with Roux-en-Y gastric bypass in rats.

    Science.gov (United States)

    Cavin, Jean-Baptiste; Voitellier, Eglantine; Cluzeaud, Françoise; Kapel, Nathalie; Marmuse, Jean-Pierre; Chevallier, Jean-Marc; Msika, Simon; Bado, André; Le Gall, Maude

    2016-09-01

    The technically easier one-anastomosis (mini) gastric bypass (MGB) is associated with similar metabolic improvements and weight loss as the Roux-en-Y gastric bypass (RYGB). However, MGB is controversial and suspected to result in greater malabsorption than RYGB. In this study, we compared macronutrient absorption and intestinal adaptation after MGB or RYGB in rats. Body weight and food intake were monitored and glucose tolerance tests were performed in rats subjected to MGB, RYGB, or sham surgery. Carbohydrate, protein, and lipid absorption was determined by fecal analyses. Intestinal remodeling was evaluated by histology and immunohistochemistry. Peptide and amino acid transporter mRNA levels were measured in the remodeled intestinal mucosa and those of anorexigenic and orexigenic peptides in the hypothalamus. The MGB and RYGB surgeries both resulted in a reduction of body weight and an improvement of glucose tolerance relative to sham rats. Hypothalamic orexigenic neuropeptide gene expression was higher in MGB rats than in RYGB or sham rats. Fecal losses of calories and proteins were greater after MGB than RYGB or sham surgery. Intestinal hyperplasia occurred after MGB and RYGB with increased jejunum diameter, higher villi, and deeper crypts than in sham rats. Peptidase and peptide or amino acid transporter genes were overexpressed in jejunal mucosa from MGB rats but not RYGB rats. In rats, MGB led to greater protein malabsorption and energy loss than RYGB. This malabsorption was not compensated by intestinal overgrowth and increased expression of peptide transporters in the jejunum.

  1. Emotions in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Pedersen, Lene Tanggaard;

    2012-01-01

    A surgical educational environment is potentially stressful and can negatively affect students' learning. The aim of the present study was to investigate the emotions experienced by veterinary students in relation to their first encounter with live-animal surgery and to identify possible sources ...... and enhance positive emotions and engagement, thereby improving students' learning.......A surgical educational environment is potentially stressful and can negatively affect students' learning. The aim of the present study was to investigate the emotions experienced by veterinary students in relation to their first encounter with live-animal surgery and to identify possible sources...... of positive and negative emotions, respectively. During a Basic Surgical Skills course, 155 veterinary fourth-year students completed a survey. Of these, 26 students additionally participated in individual semi-structured interviews. The results of the study show that students often experienced a combination...

  2. Surgical Complications of Cochlear Implantation

    Directory of Open Access Journals (Sweden)

    Basir Hashemi

    2010-03-01

    Full Text Available Cochlear implantation is a method used for the treatment ofpatients with profound hearing loss. This procedure may theaccompanied by some major or minor complications. Weevaluated the surgical complications of cochlear implantationin Fars province (south of Iran. A total of 150 patients withcochlear implantation were enrolled in the present study. Mostof the patients were pre-lingual children and most of our deviceswere nucleus prosthesis. We had three device failuresand four major complications, including one misplaced electrode,one case of meningitis, one case of foreign body reactionto suture and one case with extensive hematoma. Thesecomplications were managed successfully by surgical interventionor re-implantation. Facial nerve damage or woundbreakdown was not seen. Minor complications including smallhematoma, edema, stitch infection and dizziness were found in15 cases, which were managed medically. In our center, therate of minor complications was comparable to other centersin the world. But the rate of major surgical complications waslower than other centers.

  3. Surgical treatment of facial paralysis.

    Science.gov (United States)

    Mehta, Ritvik P

    2009-03-01

    The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (facial paralysis (3 weeks to 2 yr) and chronic facial paralysis (>2 yr). For acute facial paralysis, the main surgical therapies are facial nerve decompression and facial nerve repair. For facial paralysis of intermediate duration, nerve transfer procedures are appropriate. For chronic facial paralysis, treatment typically requires regional or free muscle transfer. Static techniques of facial reanimation can be used for acute, intermediate, or chronic facial paralysis as these techniques are often important adjuncts to the overall management strategy.

  4. Surgical management of ectopic pregnancy.

    Science.gov (United States)

    Stock, Laura; Milad, Magdy

    2012-06-01

    Surgery remains an acceptable, and sometimes necessary, modality for the treatment of ectopic pregnancy. Laparoscopy is the preferred method of access, yet controversy remains regarding the optimal procedure and postoperative management. Generally, salpingostomy is employed with the goal of maintaining fertility, although data to support this tenet are lacking. In most cases, the decision to perform conservative versus radical surgery is on the basis of the patient's history, her desire for future fertility, and surgical findings. The procedures of salpingostomy and salpingectomy, techniques to prevent and control blood loss at the time of surgery, and surgical options for nontubal ectopic pregnancies are reviewed. PMID:22510627

  5. Blepharoplasty and periorbital surgical rejuvenation

    Directory of Open Access Journals (Sweden)

    Milind Naik

    2013-01-01

    Full Text Available The periorbital region forms the epicenter of facial aging changes and receives highest attention from physicians and patients. The concern about visual function, clubbed with the need for hidden incisions, makes the periocular region a highly specialized surgical area, most appropriately handled by an ophthalmic plastic surgeon. The article provides an overview of cosmetic eyelid and facial surgery in the periocular region. Common aesthetic surgical procedures as well as ocular side-effects of commonly performed periocular injections are discussed from the dermatologist′s point of view.

  6. Update on medical and surgical options for patients with acute severe ulcerative colitis: What is new?

    Science.gov (United States)

    Andrew, Rachel E; Messaris, Evangelos

    2016-01-01

    Acute severe ulcerative colitis (UC) is a highly morbid condition that requires both medical and surgical management through the collaboration of gastroenterologists and colorectal surgeons. First line treatment for patients presenting with acute severe UC consists of intravenous steroids, but those who do not respond require escalation of therapy or emergent colectomy. The mortality of emergent colectomy has declined significantly in recent decades, but due to the morbidity of this procedure, second line agents such as cyclosporine and infliximab have been used as salvage therapy in an attempt to avoid emergent surgery. Unfortunately, protracted medical therapy has led to patients presenting for surgery in a poorer state of health leading to poorer post-operative outcomes. In this era of multiple medical modalities available in the treatment of acute severe UC, physicians must consider the advantages and disadvantages of prolonged medical therapy in an attempt to avoid surgery. Colectomy remains a mainstay in the treatment of severe ulcerative colitis not responsive to corticosteroids and rescue therapy, and timely referral for surgery allows for improved post-operative outcomes with lower risk of sepsis and improved patient survival. Options for reconstructive surgery include three-stage ileal pouch-anal anastomosis or a modified two-stage procedure that can be performed either open or laparoscopically. The numerous avenues of medical and surgical therapy have allowed for great advances in the treatment of patients with UC. In this era of options, it is important to maintain a global view, utilize biologic therapy when indicated, and then maintain an appropriate threshold for surgery. The purpose of this review is to summarize the growing number of medical and surgical options available in the treatment of acute, severe UC.

  7. Surgical strategies of re-operation for non-anastomotic biliary duct stricture after liver transplantation

    Directory of Open Access Journals (Sweden)

    Shao-ping WANG

    2015-10-01

    Full Text Available Objective To investigate the re-operation timing and surgical modality for non-anastomotic biliary stricture (NABS after orthotopic liver transplantation (OLT. Methods The clinical data of 14 NABS patients hospitalized in our center from August 2003 to April 2014 were analyzed retrospectively. The patients were treated with different modalities of re-operation according to cholangiographic results, and the outcomes of re-operation were noted by postoperative follow-up. Results Among 421 OLT patients, NABS was seen in 14 (3.3%, 14/421, and it was accompanied by stenosis of hepatic artery in 4. Their total bilirubin, ALP and r-GGT levels were significantly higher in NABS patients than in non-NABS patients (P<0.01. According to cholangiographic findings, NABS was divided into 3 types: hepatic bile duct strictures (4 patients, type Ⅰ, multiple extrahepatic and intrahepatic biliary strictures (8 patients, type Ⅱ, intrahepatic biliary stricture (2 patients, type Ⅲ. The cure rate of interventional treatment in this study was 57.1% (8/14, and 6 patients eventually required surgical treatment again. The type Ⅰ patient was treated with Roux-en-Y anastomosis, and re-transplantation for other 5 patients (type Ⅱ in 4 and type Ⅲ in 1. Among these 5 patients receiving liver re-transplantation, 1 patient died of perioperative fungal infection. The blood loss (2570±851ml and operation time (492±173min in those re-transplantation patients were almost the same as their previous-transplantation (P> 0.05. More than half of type Ⅱ and Ⅲ patients needed re-transplantation, but the probability of re-transplantation was especially higher for those with hepatic artery stenosis (75%, 3/4. Cholangitis disappeared and the total bilirubin significantly reduced from 123.4µmol/L to 31.6µmol/L after resurgery. Conclusions For those NABS patients who may fail to be improved after a minimally invasive treatment, especially when it was combined with

  8. 动静脉内瘘吻合术式的临床观察%Clinical Observation on Anastomosis of Arteriovenous Fistula

    Institute of Scientific and Technical Information of China (English)

    吴云; 叶中景; 魏伟强; 曾纳新

    2011-01-01

    [Objective] To compare the different methods of arteriovenous fistula(AVF) surgery and concerned operative skills, and to evaluate the postoperative patency rate of AVF. [Methods] The clinical data of 296 cases undergoing forearm AVF surgery were analyzed retrospectively. Among them, 279 cases underwent autogenous AVF surgery, and 11 cases underwent autogenous vein graft, and 6 cases underwent vascular prosthesis implantation. End-to-side (ETS) or side-to-side (STS) anastomosis was performed for 216 cases,while end-to-end(ETE) anastomosis was performed for 74 cases. [Results] The postoperative patency rate of ETS or STS and ETE anastomosis was 97.6% and 97.2%, respectively, and there was no significant difference( P >0.05). The patency rate of ETS or STS anastomosis 3 months after operation was 94.4% which was obviously higher than that of ETE anastomosis(87.8 %), and there was significant difference(p<0. 05).The patency rate of AVF with vascular prosthesis implantation after operation and 3 months after operation was 100%. [Conclusion] ETS or STS anastomosis is the preferred method for forearm AVF operation. AVF with autogenous vein graft or vascular prosthesis implantation can be as the preferred operative methods for patients without appropriate autogenous vessel for anastomosis.%[目的]比较不同动静脉内瘘成形手术(AVF术)方法及手术相关技巧,评估术后瘘管通畅率.[方法]回顾性分析290例前臂AVF术患者的临床资料,其中自体AVF术279例,自体静脉移植AVF术及人工血管植入AVF术11例.采取端-侧或侧-侧吻合术216例;端-端吻合术74例.[结果]采取端-侧或侧-侧吻合术术后通畅率(97.6%)与端-端吻合术术后通畅率(97.2%),相比差异无显著性(P>0.05),术后3个月通畅率(94.4%)明显高于端-端吻合术(87.8%),且差异有显著性(P<0.05);人工血管植入AVF术后及术后3月通畅率达100%.[结论]前臂AVF术采取端-侧或侧-侧吻合术是首选方法,对无

  9. Should surgical outcomes be published?

    Science.gov (United States)

    Chou, Evelyn; Abboudi, Hamid; Shamim Khan, Mohammed; Dasgupta, Prokar; Ahmed, Kamran

    2015-04-01

    Despite publishing surgical outcomes being a positive step forwards in the progression of England's healthcare system, it has no doubt been faced with criticism and reservations. This review article aims to discuss the pros and cons of publishing individual surgical outcomes, as well as the challenges faced. Publishing outcomes requires data from a number of sources such as national clinical audits, hospital episode statistics, patient-reported outcomes, registers and information from revalidation. As yet, eight surgical specialties have begun publishing their data, including cardiac (coronary artery bypass graft, valve and aortic surgery), endocrine (thyroidectomy, lobectomy, isthmusectomy), orthopaedic (hip and knee replacement), urological (full and partial nephrectomies, nephroureterectomy), colorectal (bowel tumour removal), upper gastrointestinal (stomach cancer and oesophageal cancer removal, bariatric surgery), ear, nose and throat surgery (larynx, oral cavity, oropharynx, hypopharynx and salivary gland cancer removal), as well as vascular surgery (abdominal aortic aneurysm, carotid endarterectomy). However, not all procedures have been addressed. Despite the controversy surrounding the topic of publishing surgical outcomes, the advantages of reporting outcomes outweigh the disadvantages, and these challenges can be overcome, to create a more reliable, trustworthy and transparent NHS. Perhaps one of the main challenges has been the difficulty in collecting large amounts of clinically significant data able to quantify the performance of surgeons.

  10. Surgical Treatment of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Naghmeh Moshtaghi

    2008-12-01

    Full Text Available Atrial fibrillation is the most prevalent permanent arrhythmia. It may be associated with other cardiac pathologies which need surgical treatment. Various types of surgery including the traditional cut-sew operations and operations using different energy sources are currently in use. In comparison with medical treatment, surgery is safe, effective, and has reliable results.

  11. [Surgical education has its price].

    Science.gov (United States)

    Schröder, W; Krones, C J

    2012-04-01

    The radical economisation of the German health-care system has caused an increasing cost awareness. Following this trend, medical education has been identified as a possible expense factor. The theoretical and practical training of young doctors needs time and costs money. However, a detailed cost analysis is still not available, since the complex daily work schedule of young professionals only allows the calculation of single cost factors. Investigations in the USA estimate the costs of surgical training at US$ 80 000 per year and per resident. At present in Germany, surgical training is indirectly financed by the DRG flat rates of the health insurance companies. Possible alternatives include the implementation of a "training fond" which is financed by a percentage fee of the DRG's as well as an on-top funding by the federal government. This "training fond" would support only those surgical units that offer a structured and certified training to surgical residents. However, a systematic cost analysis of such a structured curriculum is necessary for any further discussion.

  12. Surgical Lasers In Veterinary Medicine

    Science.gov (United States)

    Newman, H. C.

    1987-03-01

    Veterinary medicine is a latecomer in benefiting from the advent of surgical lasers. It is ironic that although most of the basic work in lasers is carried out in animal species with which we are most conversant, veterinary medicine as a profession has not been very extensively involved.

  13. Surgical Training in the Netherlands

    NARCIS (Netherlands)

    Borel Rinkes, I.H.M.; Gouma, D.J.; Hamming, J.F.

    2008-01-01

    Surgical training in the Netherlands has traditionally been characterized by learning on the job under the classic master-trainee doctrine. Over the past decades, it has become regionally organized with intensive structural training courses, and a peer-based quality control system. Recently, the nat

  14. Thoracoscopy: a collaborative surgical approach.

    Science.gov (United States)

    Brand, A F

    1995-07-01

    Perioperative nurses, surgeons, anesthesiologists, certified registered nurse anesthetists, and pharmacists are meeting the challenge of decreasing thoracic surgical patients' length of hospital stay with thoracoscopy. This innovative alternative to traditional thoracotomy procedures has been achieved through an attentive team approach using the fundamental perioperative skills of assessment, positioning, safety, and sharing of knowledge. PMID:7647761

  15. The experience of exploration of vascular crisis after 55 cases of vascular anastomosis%吻合血管术后55例血管危象探查体会

    Institute of Scientific and Technical Information of China (English)

    熊胜; 巨积辉; 金光哲; 赵强; 刘跃飞; 李雷; 李建宁; 侯瑞兴

    2011-01-01

    目的 对吻合血管术后55例(63次)血管危象进行临床分析.方法 对2004年4月至2007年12月在我院手外科有完整资料的55例(63次)发生血管危象的病例资料进行回顾性分析,其中断指再植29例、足趾移植手指再造17例、游离皮瓣8例、手指不全离断1例.所有病例均经保守治疗1h后血管危象无缓解而进行手术探查,根据术中所见血管情况进行相应处理,其中26例30次动脉栓塞、17例20次动脉痉挛、10例11次静脉栓塞、2例2次血管受压;其中包括动脉张力过低1例、静脉张力过高1例、动脉分支未结扎1例.根据术中所见,20例23次行前臂浅静脉血管移植,33例38次行栓塞段血管切除重新吻合,1例修剪压迫组织,1例清除局部血肿.结果 本组55例,存活51例,成活率92.73%.其中坏死的有断指再植2例,足趾移植手指再造1例,游离皮瓣1例.结论 血管吻合术后一旦发生血管危象,经保守治疗无效后,早期、积极地手术探查是挽救的关键措施.%Objective To comduct clinical analysis of 55 cases (63 incidents) of vascular crisis after vascular anastomosis.Methods Fifty-five cases (63 incidents) of vascular crisis treated in the Department of Hand Surgery in our hospital from April 2004 to December 2007 with complete data were retrospectively reviewed.There were 29 cases of finger replantation,17 cases of toe-to-finger transfer,8 cases of free flaps,and 1 case of incomplete finger amputation.All the cases of vascular crisis underwent surgical exploration after one hour conservative treatment failed to relieve the crisis.Intraoperative findings revealed the following vascular conditions:26 cases (30 incidents) of arterial embolization,17 cases (20 incidents) of artery spasm,10 cases (11 incidents) of vein thrombosis,2 cases (2 incidents) of vascular compression,1 case of too low arterial tension,1 cases of too high venous tension,and 1 case of arterial branches not being ligated

  16. Surgical management of chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Stavros Gourgiotis; Stylianos Germanos; Marco Pericoli Ridolifni

    2007-01-01

    BACKGROUND:Treatment of chronic pancreatitis (CP) is a challenging condition for surgeons. During the last decades, increasing knowledge about pathophysiology of CP, improved results of major pancreatic resections, and integration of sophisticated diagnostic methods in clinical practice have resulted in signiifcant changes in surgery for CP. DATA SOURCES:To detail the indications for CP surgery, the surgical procedures, and outcome, a Pubmed database search was performed. The abstracts of searched articles about surgical management of CP were reviewed. The articles could be identiifed and further scrutinized. Further references were extracted by cross-referencing. RESULTS: Main indications of CP for surgery are intractable pain, suspicion of malignancy, and involvement of adjacent organs. The goal of surgical treatment is to improve the quality of life of patients. The surgical approach to CP should be individualized according to pancreatic anatomy, pain characteristics, baseline exocrine and endocrine function, and medical co-morbidity. The approach usually involves pancreatic duct drainage and resection including longitudinal pancreatojejunostomy, pancreatoduodenectomy (Whipple's procedure), pylorus-preserving pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy, duodenum-preserving pancreatic head resection (Beger's procedure), and local resection of the pancreatic head with longitudinal pancreatojejunostomy (Frey's procedure). Non-pancreatic and endoscopic management of pain has also been advocated. CONCLUSIONS:Surgical procedures provide long-term pain relief, a good postoperative quality of life with preservation of endocrine and exocrine pancreatic function, and are associated with low early and late mortality and morbidity. In addition to available results from randomized controlled trials, new studies are needed to determine which procedure is the most effective for the management of patients with CP.

  17. Effect of right thoracotomy, ventrotomy and right upper mediastinum anastomosis on patients with thoracic segment esoplageal carcinoma: a report of 34 cases%经右胸、上腹正中二切口行食管癌切除右胸内吻合术34例

    Institute of Scientific and Technical Information of China (English)

    朱学应; 王保明; 徐先全; 高理锦

    2011-01-01

    Objective To evaluate the clinical effects of surgical treatment by right posterior thoracotomy, ventrotomy and right upper mediastinum anastomosis for patients with thoracic esophageal carcinoma. Methods 34 patients with esophageal carcinoma of the thoracic segment underwent a radical esophagectomy and a two - incision lymphadenectomy by right posterior thoracotomy and upper middle laparotomy were selected. Stapler was used to perform the anastomoses inside the thoracic cavity, including 8 cases of super - cupula pleurae anastomosis. Results The rate of surgical resection was 100%, including radical resection 30 cases, palliative resection 4 cases. There was no postoperative death, nor stomas fistula occurred, and no serious complications occurred in this group. Stomas stricture 1 man - time, and through persistent repeating pneumatic dilation in the period of 40d post operation, clinical symptom improved. Conclusion Esophagectomy by right thoracotomy and laparotomy is a safe and effective procedure, which enhances the resection rate of tumours, thoroughly scavenging thoracic cavity and abdominal cavity lymphaden, little affecting respiratory function, little pulmonary complications, lower rate of stomas fistula and quickly postoperative recovery.%目的 探讨经右胸、腹二切口行食管癌切除术式的应用.方法 经右胸、上腹正中二切口行食管癌切除胸顶食管胃底端侧吻合手术34例,其中胸上段8例,胸中段癌22例,胸下段癌4例;均用吻合器在胸腔内吻合,其中8例在超胸顶吻合.结果 手术切除率为100%,其中根治性切除30例,姑息性切除4例,无手术死亡病例、无吻合口瘘及其他严重并发症发生,吻合口狭窄1例,术后40 d分次行食管扩张后临床症状好转.结论 经右胸、上腹正中二切口行食管癌切除胸顶食管胃底端侧吻合手术,提高肿瘤切除率,充分清扫胸、腹腔淋巴结,对呼吸功能影响小,肺部并发症少,吻合口瘘发生率低,术后恢复快.

  18. 舌下-面神经吻合术治疗前庭神经鞘瘤术后面瘫%Hypoglossal-facial nerve anastomosis for facial paralysis resulting from vestibular schwannoma surgery

    Institute of Scientific and Technical Information of China (English)

    苏少波; 岳树源; 张建宁

    2013-01-01

    Objective To evaluate the results of hypoglossal-facial nerve anastomosis (HFA) for facial paralysis following vestibular schwannoma surgery,and to discuss the surgical techniques.Methods A retrospective study of 16 consecutive cases who underwent HFA operation between January 2000 and January 2010 was done.All the patients had undergone surgery for excision of vestibular schwannomas and had suffered facial paralysis as a consequence of this procedure.Classical end-to-end HFA was performed in all cases,and in 9 cases the classical HFA is combined with an anastomosis of the descending branch of the hypoglossal nerve to the distal stump of the same hypoglossal nerve.The pre-and postoperative facial nerve function of all patients was evaluated with the House-Brackmann (HB) grading.Results There were 9 female and 7 male patients with a mean age of 42.5 years (Range 31 ~ 61 years).The mean time interval between tumoral and reparative surgery was 7.6 months (Range 1-13 months).The preoperative HB grades were Ⅵ in 13 patients,Ⅴ in 3 patients.In the majority of the cases the first sign of reinnervation were detected between 3 and 6 months after surgery.All but one patient recovered facial muscle tone and some voluntary movement and exhibited complete restoration of facial symmetry at rest and regained complete voluntary eye closing ability.The final HB grades were Ⅱ in 2 patients,Ⅲ in 10 patients and Ⅳ in 4 patients.Conclusions HFA is a useful procedure for facial reanimation and can produce good clinical results as well as leading to an improvement in the quality of life in patients with facial paralysis.%目的 探讨舌下-面神经吻合术治疗前庭神经鞘瘤术后面瘫的效果、策略和显微外科技巧.方法 回顾性分析16例行舌下-面神经吻合术患者的临床和随访资料.结果 舌下-面神经吻合术与肿瘤切除的时间间隔为1-13个月(平均7.6个月).术前面神经功能House-Brackmann分级Ⅵ级13例,Ⅴ级3

  19. Surgical Treatment of Neonatal Necrotic Enterocolitis: An Analysis of 17 Cases%新生儿坏死性小肠结肠炎的外科处理(附17例报告)

    Institute of Scientific and Technical Information of China (English)

    陈永田; 谷兴琳

    1983-01-01

    @@ 新生儿坏死性小肠结肠炎(简写NNE)是新生儿严重的消化道疾病.虽然近年来外科处理有很大进展,但手术死亡率仍高达39~68(1~5)%.%Neonatal necrotic enterocolitis, a lethal disease in premature infancy, is common in newborns. This report details surgical treatment of 17 infants (13 males and 4 females) in the past 10 years.Asphyxia -was noted only in 2 cases. All the patients had abdominal distension. Other physical findings include: vomiting (6 cases), diarrhea (2), lower abdomen mass (1), blood in stool (6)and fiery swelling in the abdominal wall (8).In 16 cases, the X-rays demonstrated intestinal distension with fluid levels resulting from:pneumoperitoneum (12 cases), pneu-motosis (4), portal vein gas (2) and ascites (2).Surgical interventions were indicated to 11 patients with pneumoperitoneum, 2 with clinical deterioration and 1 with positive paracentesis findings.Procedures applied in this series consist of: simple repairing of restricted perforation (4), simple explorative laparotomy or colonic resection followed by primary anastomosis or enterostomy. But in one case, the necrosis was not clearly bordered, so only the completely necrotic segment of the intestine was resected while the less affected part left untouched. Then, an anastomosis. Yet, short-bowel syndrome developed afterwards.Mortality was recorded as 30%.

  20. Improvement of C peptide zero BMI 24-34 diabetic patients after tailored one anastomosis gastric bypass (BAGUA).

    Science.gov (United States)

    Garciacaballero, M; Martínez-Moreno, J M; Toval, J A; Miralles, F; Mínguez, A; Osorio, D; Mata, J M; Reyes-Ortiz, A

    2013-03-01

    Introducción: Aunque la cirugía bariátrica ha demostrado ser un método muy eficaz en el tratamiento de pacientes diabéticos cuyo páncreas aún es capaz de producir insulina (diabetes tipo 2), así como del síndrome metabólico y las complicaciones relacionadas con la diabetes, no hay información sobre el efecto de este tipo de cirugía en pacientes IMC 24-34 cuando el páncreas no produce insulina en absoluto (tipo 1, tipo LADA y diabetes tipo 2 de larga evolución, entre otros). Métodos: Presentamos datos preliminares de una serie de 11 pacientes todos con valores de Péptido C insulina, tanto de insulina rápida (de 40,6 ± 12,8 a 0 U/día) como de insulina retardada (41,27 ± 7,3 U/día a 15,2 ± 3,3 U/día). Se resolvieron el 100% de las comorbilidades estudiadas y se mejoraron algunas complicaciones graves derivadas de la diabetes como retinopatía o nefropatía. Conclusiones: El bypass gástrico de una anastomosis adaptado a pacientes diabéticos IMC24-34 con péptido C cero elimina el uso de insulina de acción rápida, reduce a una sola inyección diaria la insulina retardada y mejora el control glucémico. Tras la cirugía desaparecen el síndrome metabólico y los episodios severos de hipoglucemia, y mejora significativamente la retinopatía, neuropatía, nefropatía, vasculopatía periférica y cardiopatía.

  1. Rotator Cuff Tears: Surgical Treatment Options

    Science.gov (United States)

    .org Rotator Cuff Tears: Surgical Treatment Options Page ( 1 ) The following article provides in-depth information about surgical treatment for rotator cuff injuries, and is a continuation of the article “ ...

  2. Anastomoses colônicas após mucosectomia química, em ratos Colonic anastomosis after chemical mucosectomy in rats

    Directory of Open Access Journals (Sweden)

    Ivana Duval-Araujo

    2009-03-01

    Full Text Available OBJETIVO: Avaliar, experimentalmente, os efeitos da mucosectomia química sobre a cicatrização de anastomoses colônicas. METODOLOGIA: Estudou-se 17 ratos Wistar machos divididos nos seguintes grupos: A (n=12, anastomose colônica; B (n=13, anastomose colônica após mucosectomia. A mucosectomia foi realizada através da introdução de um bastão de nitrato de prata a 10%, durante um minuto, através das duas bocas a serem anastomosadas, e as anastomoses realizadas em plano único total, evertente, com fio polivicril 6-0 em pontos separados. Os animais foram estudados após 7 dias (6 do grupo A1 e 6 do grupo B1 e 14 dias (7 do grupo A2 e 6 do grupo B2 da cirurgia, e realizadas observações macroscópicas da presença de aderências, fístulas (saída de secreção através da anastomose ou teste da pressão de ruptura igual a zero, estenose (dilatação intestinal proximal à anastomose, abscessos peri-anastomóticos e peritonite. Foi também avaliada a pressão de ruptura das anastomoses e histologia das anastomoses. Os resultados qualitativos foram avaliados pelo teste do Qui-quadrado (com correção de Yates e os quantitativos através do teste de Kruskall-Wallis, sendo considerados significativos valores de pOBJECTIVE: To evaluate, experimentally, the effects of chemical mucosectomy on colon healing in rats. METHODS: We studied 17 male Wistar rats divided into following groups: A (n=12, colonic anastomosis; B (n=13, colonic anastomosis after use of 10% silver nitrate. The mucosectomy in group B was made by means introduction of 10% silver nitrate pencil into anastomotic surfaces during 1 minute in an extension of 0.5 cm. The anastomosis was made in single plane with evertent sutures of polyvicryl 6-0 in separated sutures. The animals were evaluated in the seventh postoperative day (A1, 6 of the group A and B1, 6 of the group B and fourth postoperative day (A2, 7 of the group A and B2, 6 of the group B. The anastomosis was evaluated in

  3. The Surgically Induced Stress Response

    Science.gov (United States)

    Finnerty, Celeste C.; Mabvuure, Nigel Tapiwa; Ali, Arham; Kozar, Rosemary A.; Herndon, David N.

    2013-01-01

    The stress response to surgery, critical illness, trauma, and burns encompasses derangements of metabolic and physiological processes which induce perturbations in the inflammatory, acute phase, hormonal, and genomic responses. Hypermetabolism and hypercatabolism result, leading to muscle wasting, impaired immune function and wound healing, organ failure, and death. The surgery-induced stress response is largely similar to that triggered by traumatic injuries; the duration of the stress response, however, varies according to the severity of injury (surgical or traumatic). This spectrum of injuries and insults ranges from small lacerations to severe insults such as large poly-traumatic and burn injuries. Although the stress response to acute trauma evolved to improve chances of survival following injury, in modern surgical practice the stress response can be detrimental. PMID:24009246

  4. Surgical skin-marking techniques.

    Science.gov (United States)

    Granick, M S; Heckler, F R; Jones, E W

    1987-04-01

    Surgical skin-marking inks and dyes are in everyday use for designing and planning incisions in plastic and reconstructive surgery. We have traced the historical development of surgical skin-marking techniques from ancient times to the present. The biochemical characteristics of the commonly used marking agents are discussed. A three-part experiment utilizing a pig model was carried out to test the tissue inflammatory response to the various dyes and inks when used intradermally as tattoos, the persistence of such tattoos, and the ease of skin erasure for each of eight stains. Methylene blue and gentian violet are recommended as the best all-purpose marking agents. The use of proprietary inks is discouraged.

  5. Surgical treatment of pathological obesity

    International Nuclear Information System (INIS)

    The obesity is the chronic non-communicable disease with a higher rate of growth in past 20 years. It is a risk factor for type 2 diabetes mellitus, high blood pressure, cardiovascular and respiratory affections, infertility, sexual and functional impotence, metabolic syndrome, load joint disorders and some types of cancer (breast, colon, prostate). The metabolic bariatric surgery is the surgical treatment more effective for the morbid obesity at long -and medium- term and not the pharmacologic treatment and the isolated diets. The aim of present historical review of the international literature on the evolution of surgical techniques of the bariatric surgery (malabsorption techniques, gastric restrictive techniques and mixed techniques), is to make available to those interested in this subject, a valuable therapeutic tool to be rationally used. (author)

  6. The surgically induced stress response.

    Science.gov (United States)

    Finnerty, Celeste C; Mabvuure, Nigel Tapiwa; Ali, Arham; Kozar, Rosemary A; Herndon, David N

    2013-09-01

    The stress response to surgery, critical illness, trauma, and burns encompasses derangements of metabolic and physiological processes that induce perturbations in the inflammatory, acute phase, hormonal, and genomic responses. Hypermetabolism and hypercatabolism result, leading to muscle wasting, impaired immune function and wound healing, organ failure, and death. The surgery-induced stress response is largely similar to that triggered by traumatic injuries; the duration of the stress response, however, varies according to the severity of injury (surgical or traumatic). This spectrum of injuries and insults ranges from small lacerations to severe insults such as large poly-traumatic and burn injuries. Burn injuries provide an extreme model of trauma induced stress responses that can be used to study the long-term effects of a prolonged stress response. Although the stress response to acute trauma evolved to confer improved chances of survival following injury, in modern surgical practice the stress response can be detrimental. PMID:24009246

  7. Surgical tools and medical devices

    CERN Document Server

    Jackson, Mark

    2016-01-01

    This new edition presents information and knowledge on the field of biomedical devices and surgical tools. The authors look at the interactions between nanotechnology, nanomaterials, design, modeling, and tools for surgical and dental applications, as well as how nanostructured surfaces can be created for the purposes of improving cell adhesion between medical devices and the human body. Each original chapter is revised in this second edition and describes developments in coatings for heart valves, stents, hip and knee joints, cardiovascular devices, orthodontic applications, and regenerative materials such as bone substitutes. There are also 8 new chapters that address: Microvascular anastomoses Inhaler devices used for pulmonary delivery of medical aerosols Surface modification of interference screws Biomechanics of the mandible (a detailed case study) Safety and medical devices The synthesis of nanostructured material Delivery of anticancer molecules using carbon nanotubes Nano and micro coatings for medic...

  8. Surgical skin-marking techniques.

    Science.gov (United States)

    Granick, M S; Heckler, F R; Jones, E W

    1987-04-01

    Surgical skin-marking inks and dyes are in everyday use for designing and planning incisions in plastic and reconstructive surgery. We have traced the historical development of surgical skin-marking techniques from ancient times to the present. The biochemical characteristics of the commonly used marking agents are discussed. A three-part experiment utilizing a pig model was carried out to test the tissue inflammatory response to the various dyes and inks when used intradermally as tattoos, the persistence of such tattoos, and the ease of skin erasure for each of eight stains. Methylene blue and gentian violet are recommended as the best all-purpose marking agents. The use of proprietary inks is discouraged. PMID:2434965

  9. Surgical treatment of cleft lip

    OpenAIRE

    Mateus Domingues Miachon; Pedro Luiz Squilacci Leme

    2014-01-01

    We performed a systematic review of the literature on the surgical treatment of cleft lip, emphasizing the prevalence, complications associated with the treatment and the points of disagreement between authors. We conducted a literature cross-sectional search that analyzed publications in books, articles and on the databases SciELO - Scientific Electronic Library Online, PubMed, of the National Center for Biotechnology Information. We conclude that: 1) the severity of the cleft will indicate ...

  10. Tattoo preservation during surgical procedures

    OpenAIRE

    Tenna, Stefania; DelleFemmine,Pietro Francesco; Pendolino, Alfonso Luca; Brunetti, Beniamino; Persichetti,Paolo

    2014-01-01

    Stefania Tenna, Pietro Francesco Delle Femmine, Alfonso Luca Pendolino, Beniamino Brunetti, Paolo Persichetti Plastic Surgery Unit, University Campus Bio-Medico of Rome, University of Rome, Rome, Italy Abstract: In recent years, the number of people getting tattoos has continued to increase. Tattoos are much more than cultural fads and cosmetic complements, and nowadays often represent events that express the patient's personality without words. The presence of a tattoo in the surgic...

  11. Tattoo preservation during surgical procedures

    OpenAIRE

    Tenna S; Delle Femmine PF; Pendolino AL; Brunetti B; Persichetti P

    2014-01-01

    Stefania Tenna, Pietro Francesco Delle Femmine, Alfonso Luca Pendolino, Beniamino Brunetti, Paolo Persichetti Plastic Surgery Unit, University Campus Bio-Medico of Rome, University of Rome, Rome, Italy Abstract: In recent years, the number of people getting tattoos has continued to increase. Tattoos are much more than cultural fads and cosmetic complements, and nowadays often represent events that express the patient's personality without words. The presence of a tattoo in the surgical f...

  12. Surgical Treatment of Winged Scapula

    OpenAIRE

    Galano, Gregory J.; Bigliani, Louis U.; Ahmad, Christopher S.; Levine, William N.

    2008-01-01

    Injuries to the long thoracic and spinal accessory nerves present challenges in diagnosis and treatment. Palsies of the serratus anterior and trapezius muscles lead to destabilization of the scapula with medial and lateral scapular winging, respectively. Although nonoperative treatment is successful in some patients, failures have led to the evolution of surgical techniques involving various combinations of fascial graft and/or transfer of adjacent muscles. Our preferred method of reconstruct...

  13. Stereolithographic Surgical Template: A Review

    OpenAIRE

    Dandekeri, Shilpa Sudesh; M K Sowmya; Bhandary, Shruthi

    2013-01-01

    Implant placement has become a routine modality of dental care.Improvements in surgical reconstructive methods as well as increased prosthetic demands,require a highly accurate diagnosis, planning and placement. Recently,computer-aided design and manufacturing have made it possible to use data from computerised tomography to not only plan implant rehabilitation,but also transfer this information to the surgery.A review on one of this technique called Stereolithography is presented in this art...

  14. Surgical checklists: the human factor.

    LENUS (Irish Health Repository)

    O Connor, Paul

    2013-05-14

    BACKGROUND: Surgical checklists has been shown to improve patient safety and teamwork in the operating theatre. However, despite the known benefits of the use of checklists in surgery, in some cases the practical implementation has been found to be less than universal. A questionnaire methodology was used to quantitatively evaluate the attitudes of theatre staff towards a modified version of the World Health Organisation (WHO) surgical checklist with relation to: beliefs about levels of compliance and support, impact on patient safety and teamwork, and barriers to the use of the checklist. METHODS: Using the theory of planned behaviour as a framework, 14 semi-structured interviews were conducted with theatre personnel regarding their attitudes towards, and levels of compliance with, a checklist. Based upon the interviews, a 27-item questionnaire was developed and distribute to all theatre personnel in an Irish hospital. RESULTS: Responses were obtained from 107 theatre staff (42.6% response rate). Particularly for nurses, the overall attitudes towards the effect of the checklist on safety and teamworking were positive. However, there was a lack of rigour with which the checklist was being applied. Nurses were significantly more sensitive to the barriers to the use of the checklist than anaesthetists or surgeons. Moreover, anaesthetists were not as positively disposed to the surgical checklist as surgeons and nurse. This finding was attributed to the tendency for the checklist to be completed during a period of high workload for the anaesthetists, resulting in a lack of engagement with the process. CONCLUSION: In order to improve the rigour with which the surgical checklist is applied, there is a need for: the involvement of all members of the theatre team in the checklist process, demonstrated support for the checklist from senior personnel, on-going education and training, and barriers to the implementation of the checklist to be addressed.

  15. Surgical management of tubal pregnancy

    OpenAIRE

    Mol, F

    2013-01-01

    The work presented in this thesis first addresses the magnitude of the clinical problem of surgically treated tubal pregnancy in The Netherlands. Next, we studied the adherence to recommendations from the Dutch guideline on diagnosis and management of ectopic pregnancy. A systematic review and meta-analysis was performed to evaluate the effectiveness of surgery, medical treatment and expectant management in terms of treatment success (i.e. complete elimination of trophoblastic tissue), financ...

  16. Fighting surgical site infections in small animals

    DEFF Research Database (Denmark)

    Verwilghen, Denis; Singh, Ameet

    2015-01-01

    A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. ...

  17. Crown lengthening: a surgical flap approach.

    Science.gov (United States)

    Lundergan, W; Hughes, W R

    1996-09-01

    In many instances it is not possible to place a restoration margin without encroaching on the periodontal attachment apparatus. A surgical crown-lengthening procedure can provide a good solution to this common clinical problem. This article discusses indication and contraindication for surgical crown-lengthening procedures and presents an appropriate surgical technique.

  18. Surgical smoke and ultrafine particles

    Directory of Open Access Journals (Sweden)

    Nowak Dennis

    2008-12-01

    Full Text Available Abstract Background Electrocautery, laser tissue ablation, and ultrasonic scalpel tissue dissection all generate a 'surgical smoke' containing ultrafine ( Methods To measure the amount of generated particulates in 'surgical smoke' during different surgical procedures and to quantify the particle number concentration for operation room personnel a condensation particle counter (CPC, model 3007, TSI Inc. was applied. Results Electro-cauterization and argon plasma tissue coagulation induced the production of very high number concentration (> 100000 cm-3 of particles in the diameter range of 10 nm to 1 μm. The peak concentration was confined to the immediate local surrounding of the production side. In the presence of a very efficient air conditioning system the increment and decrement of ultrafine particle occurrence was a matter of seconds, with accumulation of lower particle number concentrations in the operation room for only a few minutes. Conclusion Our investigation showed a short term very high exposure to ultrafine particles for surgeons and close assisting operating personnel – alternating with longer periods of low exposure.

  19. Decision making in surgical oncology.

    Science.gov (United States)

    Lamb, B; Green, J S A; Vincent, C; Sevdalis, N

    2011-09-01

    Decisions in surgical oncology are increasingly being made by multi-disciplinary teams (MDTs). Although MDTs have been widely accepted as the preferred model for cancer service delivery, the process of decision making has not been well described and there is little evidence pointing to the ideal structure of an MDT. Performance in surgery has been shown to depend on non-technical skills, such as decision making, as well as patient factors and the technical skills of the healthcare team. Application of this systems approach to MDT working allows the identification of factors that affect the quality of decision making for cancer patients. In this article we review the literature on decision making in surgical oncology and by drawing from the systems approach to surgical performance we provide a framework for understanding the process of decision making in MDTs. Technical factors that affect decision making include the information about patients, robust ICT and video-conferencing equipment, a minimum dataset with expert review of radiological and pathological information, implementation and recording of the MDTs decision. Non-technical factors with an impact on decision making include attendance of team members at meetings, leadership, teamwork, open discussion, consensus on decisions and communication with patients and primary care. Optimising these factors will strengthen the decision making process and raise the quality of care for cancer patients.

  20. Surgical treatment for pulmonary emphysema.

    Science.gov (United States)

    Delarue, N C; Woolf, C R; Sanders, D E; Pearson, F G; Henderson, R D; Cooper, J D; Nelems, J M

    1977-05-01

    Three in-vivo observations stimulated interest in surgical treatment for emphysema: (a) the destructive changes are rarely generalized, (b) the central portions of the lungs are frequently less seriously affected, and (c) marginal folding produces obstructive change in the more normal lung tissue. If destroyed avascular space-occupying areas can be removed, the compressed lung tissue may be stretched to fill pleural space in a functionally effective fashion. Residual elastic tissue will them maintain patency of terminal bronchioles. Preoperatively the extent of the destructive change can be defined most accurately by pulmonary angiography, and zones of functioning capilary circulation can be identified. Forty-seven patients with multifocal space-occupying emphysematous change have been treated surgically. The postoperative mortality was 21% but worthwhile long-term improvement has been obtained in 45% of patients presenting with disabling dyspnea. In these patients, surgical treatment warrants consideration if significant space occupation accompanies the bullous disease, provided alveolar vascularization can be demonstrated in the compressed adjacent normal lung tissue. Limited resections that preserve all vascularized and potentially functioning lung tissue are preferable. It is essential that obliteration of the hemithorax be obtained promptly in view of the high incidence of postoperative complications requiring secondary operative procedures, if 'leaks' and residual spaces are allowed to persist. Postoperative care in a respiratory intensive care unit is mandatory. PMID:870155

  1. Ethical issues in surgical innovation.

    Science.gov (United States)

    Miller, Megan E; Siegler, Mark; Angelos, Peter

    2014-07-01

    Innovation is responsible for most advances in the field of surgery. Innovative approaches to solving clinical problems have significantly decreased morbidity and mortality for many surgical procedures, and have led to improved patient outcomes. While innovation is motivated by the surgeon's expectation that the new approach will be beneficial to patients, not all innovations are successful or result in improved patient care. The ethical dilemma of surgical innovation lies in the uncertainty of whether a particular innovation will prove to be a "good thing." This uncertainty creates challenges for surgeons, patients, and the healthcare system. By its very nature, innovation introduces a potential risk to patient safety, a risk that may not be fully known, and it simultaneously fosters an optimism bias. These factors increase the complexity of informed consent and shared decision making for the surgeon and the patient. Innovative procedures and their associated technology raise issues of cost and resource distribution in the contemporary, financially conscious, healthcare environment. Surgeons and institutions must identify and address conflicts of interest created by the development and application of an innovation, always preserving the best interest of the patient above the academic or financial rewards of success. Potential strategies to address the challenges inherent in surgical innovation include collecting and reporting objective outcomes data, enhancing the informed consent process, and adhering to the principles of disclosure and professionalism. As surgeons, we must encourage creativity and innovation while maintaining our ethical awareness and responsibility to patients.

  2. Simulation-based surgical education.

    Science.gov (United States)

    Evgeniou, Evgenios; Loizou, Peter

    2013-09-01

    The reduction in time for training at the workplace has created a challenge for the traditional apprenticeship model of training. Simulation offers the opportunity for repeated practice in a safe and controlled environment, focusing on trainees and tailored to their needs. Recent technological advances have led to the development of various simulators, which have already been introduced in surgical training. The complexity and fidelity of the available simulators vary, therefore depending on our recourses we should select the appropriate simulator for the task or skill we want to teach. Educational theory informs us about the importance of context in professional learning. Simulation should therefore recreate the clinical environment and its complexity. Contemporary approaches to simulation have introduced novel ideas for teaching teamwork, communication skills and professionalism. In order for simulation-based training to be successful, simulators have to be validated appropriately and integrated in a training curriculum. Within a surgical curriculum, trainees should have protected time for simulation-based training, under appropriate supervision. Simulation-based surgical education should allow the appropriate practice of technical skills without ignoring the clinical context and must strike an adequate balance between the simulation environment and simulators. PMID:23088646

  3. Quantitative cerebral perfusion assessment using microscope-integrated analysis of intraoperative indocyanine green fluorescence angiography versus positron emission tomography in superficial temporal artery to middle cerebral artery anastomosis

    Directory of Open Access Journals (Sweden)

    Shinya Kobayashi

    2014-01-01

    Full Text Available Background: Intraoperative qualitative indocyanine green (ICG angiography has been used in cerebrovascular surgery. Hyperperfusion may lead to neurological complications after superficial temporal artery to middle cerebral artery (STA-MCA anastomosis. The purpose of this study is to quantitatively evaluate intraoperative cerebral perfusion using microscope-integrated dynamic ICG fluorescence analysis, and to assess whether this value predicts hyperperfusion syndrome (HPS after STA-MCA anastomosis. Methods: Ten patients undergoing STA-MCA anastomosis due to unilateral major cerebral artery occlusive disease were included. Ten patients with normal cerebral perfusion served as controls. The ICG transit curve from six regions of interest (ROIs on the cortex, corresponding to ROIs on positron emission tomography (PET study, was recorded. Maximum intensity (I MAX , cerebral blood flow index (CBFi, rise time (RT, and time to peak (TTP were evaluated. Results: RT/TTP, but not I MAX or CBFi, could differentiate between control and study subjects. RT/TTP correlated (|r| = 0.534-0.807; P < 0.01 with mean transit time (MTT/MTT ratio in the ipsilateral to contralateral hemisphere by PET study. Bland-Altman analysis showed a wide limit of agreement between RT and MTT and between TTP and MTT. The ratio of RT before and after bypass procedures was significantly lower in patients with postoperative HPS than in patients without postoperative HPS (0.60 ± 0.032 and 0.80 ± 0.056, respectively; P = 0.017. The ratio of TTP was also significantly lower in patients with postoperative HPS than in patients without postoperative HPS (0.64 ± 0.081 and 0.85 ± 0.095, respectively; P = 0.017. Conclusions: Time-dependent intraoperative parameters from the ICG transit curve provide quantitative information regarding cerebral circulation time with quality and utility comparable to information obtained by PET. These parameters may help predict the occurrence of postoperative

  4. 良性声门下狭窄的外科治疗%Surgical treatment for benign subglottic stenosis

    Institute of Scientific and Technical Information of China (English)

    王学军; 张绍明; 张珩; 才志刚; 徐小平; 汪雷

    2012-01-01

    目的 探讨良性声门下狭窄手术治疗方式和围手术期处理要点.方法 回顾分析良性声门下狭窄7例的临床资料,均行声门下狭窄切除(部分环状软骨切除)、甲状软骨-气管一期吻合术.结果 围手术期无死亡病例.除2例术后早期出现一过性误吸外,无其他并发症发生.患者随访期间无再狭窄发生,生活质量满意.结论 部分环状软骨切除、甲状软骨-气管一期吻合术是治疗良性声门下狭窄的安全、有效术式.细致的术前评估和准备及预防控制感染是围手术期处理的关键.%Objective To explore the surgical treatment and perioperative management of benign sub-glottic stenosis. Methods The clinical data of 7 cases of benign subgiottic stenosis were retrospectively studied. All patients underwent partial cricoidectomy with primary thyrotracheal anastomosis. Results There was no death during the perioperative period except that transient aspiration happened in 2 patients.no other minor or major complications were observed. All patients led a life of high quality,none of them suffered from subglottic restenosis. Conclusion The partial cricoidectomy with primary thyrotracheal anastomosis technique was a safe and effective method for the treatment of benign subglottic stenosis. Meticulous preoperative assessment and preparation,preventing infection,and controlling infection were crucial in the perioperative period.

  5. Pathophysiology and surgical treatment for radiation enteritis

    International Nuclear Information System (INIS)

    We analyzed 23 patients (5 males and 18 females, mean age 60) who had been operated on in our department for radiation enteritis. 1) These patients were divided into two types according to the time of surgery. Sixteen of 23 (79%) patients were operated on a median of 12 months after radiotherapy, while 7 (30%) underwent surgery more than 10 years later. 2) They were also divided according to the dominant symptoms. Fourteen of 23 (60%) complained of nausea and abdominal distension suggestive of small bowel injury, whereas 7 (30%) had tenesmus and anal bleeding indicating proctitis. Two patients developed perforative peritonitis. 3) The operations performed were as follows: extensive intestinal resection and anastomosis (13), pull-through procedure (3), rectal excision (2), ileostomy (3), by-pass operation (2). Two patients with peritonitis died despite open drainage. Nineteen intestinal anastomoses were all successfully performed. Patients who underwent extensive small bowel resection could resume ordinary daily life without symptoms. Our analysis showed that small bowel injury should be treated by generous resection of the affected bowels followed by anastomosis of the disease-free ends, while rectal lesions are best dealt with by restorative proctectomy. This may provide a good quality of life and minimize major postoperative complications such as leakage. (author)

  6. Factors affecting surgical mortality and morbidity in patients with obstructive jaundice.

    Science.gov (United States)

    Gönüllü, N N; Cantürk, N Z; Utkan, N Z; Yidirir, C; Dülger, M

    1998-01-01

    The importance of clinical and laboratory parameters which have an effect on postoperative mortality and morbidity was evaluated in 124 patients operated on because of obstructive jaundice. The causes of obstructive jaundice were a malign disease in 38 patients (30.6%) and a benign disease in 86 patients (69.4%). Biliary enteric anastomosis in 66 patients (53%), external drainage in 46 patients (37%), and cholecystectomy in 12 patients (10%) were the surgical techniques of choice for correction of obstructive jaundice. There were significantly high mortality rates in patients with weight loss, more than 10 kg during preoperative the month (p bilirubine above 10 mg/dl (p < 0.01) were determined as risk factors in mortality. Direct relationships between the number of risk factors, complications, and mortality ratios were determined. One or more complications were determined in patients with more than six risk factors. High mortality rate was also determined in patients who had five and more risk factors. The following factors were evaluated: respiratory, circulatory, renal functions, and infection, and metabolic concomitant diseases, and comorbid scores for each patient were calculated. High rate complications in patients with eight and more comorbid scores and high mortality rates in patients with six and more were also determined. Finally, all these parameters were important in demonstrating postoperative mortality in obstructive jaundice patients. We suggest that surgery after treatment of correctable risk factors decreases postoperative morbidity and mortality.

  7. 气管浆细胞瘤的手术治疗及文献复习%Surgical treatment of tracheal extramedullary plasmocytoma and pertinent literature review

    Institute of Scientific and Technical Information of China (English)

    Shanqing Li; Naixin Liang; Hongsheng Liu; Cheng Huang; Yingzhi Qin

    2007-01-01

    Objective:To study the diagnostic method, surgical management and complications of the tracheal malignant tumor, as well as the characteristics of plasmocytoma. Methods:One patient with tracheal plasmocytoma and pertinent literature were analyzed retrospectively. Results:Resection of the tracheal tumor and reconstruction of the trachea were performed successfully in this case, and the pathological diagnosis is plasmocytoma. Conclusion:The nature, location and extent of tracheal tumor are precisely determined from radiologic studies before resection, as well as tracheal intubation and tracheal anastomosis without tension in operative procedures, are very important for triumphal operation. Even extramedullary plasmocytoma may occur in a lot of organs, but the incidence of it is rare. Both surgery and radiotherapy are cardinal methods for extramedullary plasmocytoma.

  8. Spleen and pancreatic tail thorax translocation facilitating residual stomach esophagus anastomosis%胰脾胸腔易位在残胃食管吻合术中的应用

    Institute of Scientific and Technical Information of China (English)

    Haizhou Guo; Fuyou Zhou; Weijie Wang; Jianyun Guan; Weimin Zhang

    2007-01-01

    Objective: To investigate the value of spleen and pancreatic tail thorax translocation on the residual stomach esophagus anastomosis. Methods: 10 patients with esophageal carcinoma after gastrectomy were enrolled in this study.Lesions were removed through left thoracotomy and residual stomach was fully mobilized, with short gastric artery being reserved. Spleen and pancreatic tail were dissected from the back of peritoneum and transposed into thorax. Residual stomach esophagus anastomosis was performed. Results: All the operation went favorably. Patients were recovered rapidly and a relatively good prognosis was acquired. Late leakage and pleural effusion happened in one case respectively, but these complications were cured through conservative management without operation death. Conclusion: Residual stomach is an ideal candidate for the replacement of esophagus and residual stomach esophagus anastomosis is a simple operative alternative with few trauma and good results for the treatment of esophageal carcinoma after gastrectomy.

  9. Using dummies for surgical skills training

    DEFF Research Database (Denmark)

    Langebæk, Rikke

    2011-01-01

    Effective acquisition of a skill requires practise. Therefore it is of great importance to provide veterinary students with opportunities to practice their surgical skills before carrying out surgical procedures on live patients. Some veterinary schools let students perform entire surgical...... procedures on research animals, in order to learn the basic skills along the way. From an ethical point of view it is questionable however to use live research animals for the sole purpose of practising surgery, and also, research animals are very costly. It is therefore necessary to identify alternative...... teaching methods for veterinary surgical training. At the Department of Small Animal Clinical Sciences, Faculty of Life Sciences, a number of low fidelity, stuffed toy animal dummies was developed for the Surgical Skills Lab in order to teach 4th year students the basic surgical skills. In the Surgical...

  10. Transanal drainage tube reduces rate and severity of anastomotic leakage in patients with colorectal anastomosis: A case controlled study

    Science.gov (United States)

    Brandl, A.; Czipin, S.; Mittermair, R.; Weiss, S.; Pratschke, J.; Kafka-Ritsch, R.

    2016-01-01

    Background and aims The aim of this study was to investigate the clinical usefulness of the placement of a transanal drainage tube to prevent anastomotic leakage in colorectal anastomoses. Material and methods This single-center retrospective trial included all patients treated with surgery for benign or malign colorectal disease between January 2009 and December 2012. The transanal drainage tube was immediately placed after colorectal anastomosis until day five and was routinely used since 2010. Patients treated with a transanal drainage tube were compared with the control group. Statistical analysis was performed using Fisher's exact or Chi-square tests for group comparison and a linear regression model for multivariate analysis. Results This study included 242 patients (46% female; median age 63 years; range 18–93); 34% of the patients underwent a laparoscopic procedure, and 57% of the patients received a placement of a transanal drainage tube. Anastomotic leakage occurred in 19 patients (7.9%). Univariate analysis showed a higher rate of anastomotic leakage in patients with an ASA score 4 (p = 0.02) and a lower rate in patients with transanal drainage placement (3.6% vs. 13.6%; p = 0.007). The grading of the complication of anastomotic leakage was reduced with transanal drainage (e.g., Dindo ≧ 3b: 20.0% vs. 92.9%; p = 0.006), and the hospital stay was shortened (17.6 ± 12.5 vs. 22.1 ± 17.6 days; p = 0.02). Multivariate analysis revealed that transanal drainage was the only significant factor (HR = −2.90; −0.168 to −0.032; p = 0.007) affecting anastomotic leakage. Conclusions Placement of a transanal drainage tube in patients with colorectal anastomoses is a safe and simple technique to perform and reduces anastomotic leakage, the severity of the complication and hospital stay. PMID:27158483

  11. Wall shear stress and near-wall convective transport: Comparisons with vascular remodelling in a peripheral graft anastomosis

    Science.gov (United States)

    Gambaruto, A. M.; Doorly, D. J.; Yamaguchi, T.

    2010-08-01

    Fluid dynamic properties of blood flow are implicated in cardiovascular diseases. The interaction between the blood flow and the wall occurs through the direct transmission of forces, and through the dominating influence of the flow on convective transport processes. Controlled, in vitro testing in simple geometric configurations has provided much data on the cellular-level responses of the vascular walls to flow, but a complete, mechanistic explanation of the pathogenic process is lacking. In the interim, mapping the association between local haemodynamics and the vascular response is important to improve understanding of the disease process and may be of use for prognosis. Moreover, establishing the haemodynamic environment in the regions of disease provides data on flow conditions to guide investigations of cellular-level responses. This work describes techniques to facilitate comparison between the temporal alteration in the geometry of the vascular conduit, as determined by in vivo imaging, with local flow parameters. Procedures to reconstruct virtual models from images by means of a partition-of-unity implicit function formulation, and to align virtual models of follow-up scans to a common coordinate system, are outlined. A simple Taylor series expansion of the Lagrangian dynamics of the near-wall flow is shown to provide both a physical meaning to the directional components of the flow, as well as demonstrating the relation between near-wall convection in the wall normal direction and spatial gradients of the wall shear stress. A series of post-operative follow-up MRI scans of two patient cases with bypass grafts in the peripheral vasculature are presented. These are used to assess how local haemodynamic parameters relate to vascular remodelling at the location of the distal end-to-side anastomosis, i.e. where the graft rejoins the host artery. Results indicate that regions of both low wall shear stress and convective transport towards the wall tend to be

  12. Evaluation of carotid artery stenosis with three-dimensional CT angiography and surgical revascularization

    International Nuclear Information System (INIS)

    The accuracy of three-dimensional CT angiography (3D-CTA) for delineating atherosclerotic carotid stenosis was examined in comparison with digital subtraction angiography (DSA) in symptomatic patients. In cases undergoing carotid endarterectomy (CEA), the clinical usefulness of 3D-CTA for surgical planning was also evaluated in the light of intraoperative findings. From July 1992 to Jun 1995, 52 patients suffering from internal carotid ischemia and/or presenting carotid bruit were evaluated to detect carotid bifurcation stenosis by 3D-CTA. Shaded surface reconstruction (SSR) for three-dimensional display and maximum intensity projection (MIP) were employed in multiple projection to evaluate sites of stenosis. DSA was performed in 18 out of 31 patients having atherosclerotic carotid stenosis shown by 3D-CTA. MIP reconstructions accurately delineated sites of stenosis close to DSA and allowed precise depiction of ulcerated plaque and intramural calcification. The percentage of carotid stenosis was determined by comparing the narrowest point to the internal carotid artery (ICA) beyond the bulb on both 3D-CTA and DSA. Assessment of carotid stenosis was highly correlated between 3D-CTA and DSA (r=0.987, p< 0.0001). In this series, 9 carotid arteries in 8 patients underwent CEA for severe stenosis. 3 patients with ICA occlusion and 1 patient with elongated severe stenosis underwent STA-MCA anastomosis. Using MIP reconstructions and two-dimensional original images it was found that ICA occlusion was apparently distinguished from high grade ICA stenosis. SSR provided valuable informations during CEA for atherosclerotic plaque regarding anatomical relationship with the internal jugular vein and bony structures. This advanced means of 3D-CTA can be adequate as a screening method to detect carotid stenosis in symptomatic patients and useful for surgical planning of CEA and post-operative follow-up examination. (author)

  13. Disc degeneration: current surgical options

    Directory of Open Access Journals (Sweden)

    C Schizas

    2010-10-01

    Full Text Available Chronic low back pain attributed to lumbar disc degeneration poses a serious challenge to physicians. Surgery may be indicated in selected cases following failure of appropriate conservative treatment. For decades, the only surgical option has been spinal fusion, but its results have been inconsistent. Some prospective trials show superiority over usual conservative measures while others fail to demonstrate its advantages. In an effort to improve results of fusion and to decrease the incidence of adjacent segment degeneration, total disc replacement techniques have been introduced and studied extensively. Short-term results have shown superiority over some fusion techniques. Mid-term results however tend to show that this approach yields results equivalent to those of spinal fusion. Nucleus replacement has gained some popularity initially, but evidence on its efficacy is scarce. Dynamic stabilisation, a technique involving less rigid implants than in spinal fusion and performed without the need for bone grafting, represents another surgical option. Evidence again is lacking on its superiority over other surgical strategies and conservative measures. Insertion of interspinous devices posteriorly, aiming at redistributing loads and relieving pain, has been used as an adjunct to disc removal surgery for disc herniation. To date however, there is no clear evidence on their efficacy. Minimally invasive intradiscal thermocoagulation techniques have also been tried, but evidence of their effectiveness is questioned. Surgery using novel biological solutions may be the future of discogenic pain treatment. Collaboration between clinicians and basic scientists in this multidisciplinary field will undoubtedly shape the future of treating symptomatic disc degeneration.

  14. Giant choledochal calculosis: Surgical treatment

    Directory of Open Access Journals (Sweden)

    Hasan Bektas

    2014-01-01

    Full Text Available Context: Gallstone disease is one of the most common surgical pathologies. Choledocholithiasis may occur in some of these cases and require surgical intervention. Although there are relatively non-invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP, this technique is usually unsuccessful in patients with stones larger than 10 mm. In our case, we aimed to report a giant choledochal stone (15 cm × 4.5 cm, which is rare in surgical practice and our treatment with open surgery. Case Report: The patient was a 59-year-old woman. Magnetic resonance cholangiopancreatography (MRCP had showed a hydropic gallbladder with an excessively dilated CBD and a 110 mm × 41 mm stone. In the operation, an excessively dilated CBD was seen and after choledochotomy and a very large calculus that filled CBD completely. Choledochotomy incision was carried forward and a T-tube choledochostomy with choledochoduodenostomy (CD was performed. The patient was discharged without any complications on postoperative 8 th day. Conclusion: Benign gallstone disease is a multifactorial process, with risk factors such as obesity, hemolytic diseases, diabetes mellitus, and pregnancy. Risk factors for choledocholithiasis are similar to those for gallstone disease. MRCP is a non-invasive technique in detecting choledocholithiasis. The gold standard intervention for CBD stones is ERCP. Stones in CBD may reach very considerable dimensions without causing serious symptoms. The most common symptom is jaundice. During preoperative radiological examination, giant stones may be interfered with malignancies. Surgeons should obey conventional algorithms in diagnosis and open surgery must be kept in mind in earlier stages without being too insistent on endoscopic interventions.

  15. Tattoo preservation during surgical procedures

    Directory of Open Access Journals (Sweden)

    Tenna S

    2014-02-01

    Full Text Available Stefania Tenna, Pietro Francesco Delle Femmine, Alfonso Luca Pendolino, Beniamino Brunetti, Paolo Persichetti Plastic Surgery Unit, University Campus Bio-Medico of Rome, University of Rome, Rome, Italy Abstract: In recent years, the number of people getting tattoos has continued to increase. Tattoos are much more than cultural fads and cosmetic complements, and nowadays often represent events that express the patient's personality without words. The presence of a tattoo in the surgical field may be a problem for both the patient and the surgeon. However, the relevant literature is mostly based on complications related to application of tattoos or methods used to remove them. To date, few reports have focused on the importance of preserving a tattoo during a surgical procedure, and no organized studies could be found. The aim of this paper is to provide an overview of the range of solutions that surgeons can use to preserve tattoos during surgery. A PubMed database search was done to assess other surgeons' experience. The terms "tattoo" in combination with "incision", "surgery", "surgical", or "operative" were used as key words. Following a review of the literature, photographs of patients presenting with a tattoo in the last 5 years at University Campus Bio-Medico of Rome were identified in order to determine the frequency of patients presenting with tattoos in our department. The patients were classified according to sex, age, type of surgery, number of tattoos, and tattoo location. Specific requests to preserve tattoos were recorded. Finally, an algorithm of treatment according to tattoo dimension and location is proposed. Knowledge of all the strategies available for saving tattoos is important for plastic and cosmetic surgeons. If a tattooed area needs to be operated on, surgeons should attempt, when possible, to avoid altering the tattoo in order to maximize the final cosmetic result. Keywords: tattoo incision, body contouring, surgery

  16. Surgical Ablation of Atrial Fibrillation.

    Science.gov (United States)

    Ramlawi, Basel; Abu Saleh, Walid K

    2015-01-01

    The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept consists of creating a series of transmural lesions in the right and left atria that disrupt re-entrant circuits responsible for propagating the abnormal atrial fibrillation rhythm. The left atrial appendage is excluded as a component of the Maze procedure. For the first three iterations of the Cox- maze procedure, these lesions were performed using a surgical cut-and-sew approach that ensured transmurality. The Cox-Maze IV is the most currently accepted iteration. It achieves the same lesion set of the Cox- maze III but uses alternative energy sources to create the transmural lesions, potentially in a minimally invasive approach on the beating heart. High-frequency ultrasound, microwave, and laser energy have all been used with varying success in the past. Today, bipolar radiofrequency heat or cryotherapy cooling are the most accepted sources for creating linear lesions with consistent safety and transmurality. The robust and reliable nature of these energy delivery methods has yielded a success rate reaching 90% freedom from atrial fibrillation at 12 months. Such approaches offer a significant long-term advantage over catheter-based ablation, especially in patients having longstanding, persistent atrial fibrillation with characteristics such as dilated left atrial dimensions, poor ejection fraction, and failed catheter ablation. Based on these improved results, there currently is significant interest in developing a hybrid ablation strategy that incorporates the superior transmural robust lesions of surgical ablation, the reliable stroke prevention potential of epicardial left atrial appendage exclusion, and sophisticated mapping and confirmatory catheter-based ablation technology. Such a minimally invasive hybrid strategy for ablation may lead to the development of multidisciplinary "Afib teams" to

  17. Surgical treatment of cleft lip

    Directory of Open Access Journals (Sweden)

    Mateus Domingues Miachon

    2014-06-01

    Full Text Available We performed a systematic review of the literature on the surgical treatment of cleft lip, emphasizing the prevalence, complications associated with the treatment and the points of disagreement between authors. We conducted a literature cross-sectional search that analyzed publications in books, articles and on the databases SciELO - Scientific Electronic Library Online, PubMed, of the National Center for Biotechnology Information. We conclude that: 1 the severity of the cleft will indicate the technique presenting more advantages; 2 the different approaches indicate that there is no consensus on the optimal technique; and 3 the surgeon experience contributes to choosing the best option.

  18. Lesson plans in surgical training.

    Science.gov (United States)

    Lester, S E; Robson, A K R

    2007-06-01

    Lesson plans in surgery enable trainers and trainees to agree on goals that balance training needs with service commitments. Lesson plans are individualised to the trainee and encourage ownership of learning. They are based on SMART criteria and therefore have a sound educational footing. Most of the work in creating a lesson plan falls to the trainee. The total time for creation of each plan is approximately 20 min. Our use of lesson plans for surgical training has been met with favourable response from both trainer and trainees.

  19. Surgical Challenges of Familial Hypercholesterolemia.

    Science.gov (United States)

    Bhoje, Amolkumar; Talwar, Sachin; Saxena, Rachit; Gharde, Parag; Choudhary, Shiv Kumar

    2016-06-01

    A 21-year-old patient with familial hypercholesterolemia presented with angina caused by ostial stenosis of the left internal mammary artery and severe calcific aortic stenosis with small aortic root 9 years after coronary revascularization. The ostium of the left internal mammary artery was enlarged using a saphenous vein patch through a left supraclavicular incision, which improved left ventricular function. Successful aortic valve replacement with posterior aortic root enlargement was subsequently performed. The surgical management of this condition is discussed briefly. PMID:27211947

  20. Surgical navigation in oral implantology.

    Science.gov (United States)

    Miller, Robert J; Bier, Jurgen

    2006-03-01

    The ability to generate 3-dimensional volumetric images of the maxillofacial area has allowed surgeons to evaluate anatomy before surgery and plan for the placement of implants in ideal positions. However, the ability to transfer that information to surgical reality has been the most challenging part of implant dentistry. With the advent of computer-assisted surgery, the surgeon may now navigate through the entire implant procedure with extremely high accuracy. A new portable laptop navigated system for oral implantology is discussed as an adjunct for complex implant cases. PMID:16569960

  1. Surgical castration, coercion and ethics

    DEFF Research Database (Denmark)

    Ryberg, Jesper; Petersen, Thomas Søbirk

    2014-01-01

    John McMillan's detailed ethical analysis concerning the use of surgical castration of sex offenders in the Czech Republic and Germany is mainly devoted to considerations of coercion.1 This is not surprising. When castration is offered as an option to offenders and, at the same time, constitutes...... the only means by which these offenders are likely to be released from prison, it is reasonable—and close to the heart of modern medical ethics—to consider whether the offer involves some kind of coercion. However, despite McMillan's seemingly careful consideration of this question, it appears to us...

  2. Novel Visceral-Anastomosis-First Approach in Open Repair of a Ruptured Type 2 Thoracoabdominal Aortic Aneurysm: Causes behind a Mortal Outcome

    Directory of Open Access Journals (Sweden)

    Einar Dregelid

    2013-01-01

    Full Text Available Case reports to analyze causes and possible prevention of complications in a new setting are important. We present an open repair of a ruptured type 2 thoracoabdominal aortic aneurysm in a 78-year-old man. Lower-body perfusion through a temporary extracorporeal axillobifemoral arterial prosthesis shunt was combined with the use of a branch to the permanent aortic prosthesis to enable rapid visceral revascularization using a visceral-anastomosis-first approach. The patient died due to transfusion-induced capillary leak syndrome and left colon necrosis; the latter was probably caused by a combination of back-bleeding from lumbar arteries causing a steal effect, an accidental shunt obstruction, and hemodynamic instability towards the end of the operation. The visceral-anastomosis-first approach did not contribute to the complications. This approach reduces the time when visceral organs are perfused only via collateral arteries to the time needed for suturing the visceral anastomoses. This may be important when collateral perfusion is marginal.

  3. 磁吻合技术实现门静脉快速无缝线吻合动物实验研究%Experimental animal study of rapid and sutureless anastomosis of portal vein by the magnetic compression anastomosis technique

    Institute of Scientific and Technical Information of China (English)

    刘仕琪; 雷鹏; 高睿; 吕毅; 李建辉; 崔晓海; 王善佩; 向俊西; 张前进

    2013-01-01

    目的 研究一种能快速完成门静脉(PV)端-端吻合的磁性血管吻合器,利用磁吻合技术(MCA)达到肝移植术中PV快速吻合目的.方法 西安近郊杂种犬16只按照PV吻合方式不同随机分为MCA组与手工缝合组.比较磁吻合与手工缝合技术吻合PV的效果,观察两组吻合时间、术中吻合口渗漏血情况.术后彩色多普勒超声与血管造影检查观察吻合口血流及并发症情况.结果 MCA组较手工缝合组血管吻合耗时明显缩短[(3.55±2.11) min比(13.25±2.74) min;P<0.01].MCA组术中吻合口无渗漏血发生,手工缝合组有5例出现吻合口渗漏血并发症.血管X线造影与彩色多普勒超声检查显示MCA组吻合口血流通畅,无狭窄及血栓形成;手工缝合组术后1~4周时2例发生吻合口轻度狭窄并发症.结论 MCA是一种简单、快速、效果可靠的血管吻合技术,可减少由于传统手工缝合方法导致的吻合口并发症,改善吻合口质量,有利于手术后恢复.%Objective To evaluate the magnetic pinned-ring device for non-suture vascular anastomosis.Methods Sixteen adult mongrel dogs of either gender were randomly divided into two groups for portal vein (PV) in situ end-to-end anastomosis.The magnetic compressive anastomosis (MCA) group (n=8) used magnetic rings for PV reconstruction,and the hand-sewn group (n=8) used hand suturing for PV reconstruction.Operation time and stoma errhysis were recorded.Patency and stoma stenosis was confirmed via color Doppler ultrasound scans and X-ray cholangiography at different time points as late as 4 weeks after surgery.Results The time required to perform the vascular anastomosis was significantly shorter for the magnetic device than for hand sewing [(3.55± 2.11) min vs (13.25±2.74) min; P<0.01].5 cases had stoma errhysis during PV hand-sewing anastomosis that had to be repaired,but no stoma errhysis occurred in the MCA group.Vascular X-ray angiography and color Doppler

  4. Application of Transanal Anastomosis with Stapler in Laparoscopic Radical Resection for Rectal Cancer%经肛门拖出吻合器吻合法在腹腔镜直肠癌根治术中的应用

    Institute of Scientific and Technical Information of China (English)

    陈金水; 张少炎; 张罕松; 湛继久; 王铁虎; 胡旭辉; 蔡晓棠

    2014-01-01

    hospital were retrospectively analyzed.cTNM stage of the cases included 22 cases of T1 or T2 and 8 cases of T3;all the 30 cases were N0 and M0.Electronic colonoscopy showed the distance from anal edge to the tumor was 4.0-10.0 cm (mean, 7.6 ±1.5 cm).The diameter of tumor was 2-6 cm (mean, 3.8 ±1.3 cm).The surgery was performed under laparoscopy with the standard total mesorectal excision (TME) technique first and a lower abdominal midline incision was made afterwards .The proximal colon was cut off under direct gaze , and the rectal stump was pulled out through the anus .The anastomosis was performed using a double ring suture and single stapling technique , with a 31.5 mm or 28.5 mm circular stapler in diameter made in China . Results All the 30 surgeries were successfully completed . The operative time was 170-280 (216.3 ±25.9) min and the intraoperative blood loss was 50-700 (273.3 ±160.1) ml.Intestinal function recovery time was 1-4 (2.5 ±0.8) d, and postoperative hospital stay was 8-30 (12.2 ±4.2) d.The lengths of distal resection margin was 2.0-6.0 (3.9 ±0.9) cm, and no residual tumor was found in the margin .Anastomotic leakage occurred in 1 case (3.3%), and peritoneal effusion and infection in 1 case (3.3%).The 2 cases were treated by non-surgical treatment.No intra-abdominal bleeding, intestinal obstruction,or anastomotic bleeding occurred.During the follow-up of 6-24 months (mean, 11.8 ± 3.9 months), the defecation frequency was 1 to 5 times per day, 1 case had anastomotic stenosis with difficult defecation due to scar contraction , which improved after anal dilatation , and one case had local recurrence of tumor 16 months after the surgery and treated by Miles operation . Conclusion Transanal anastomosis with stapler in laparoscopic radical resection for middle -low rectal cancer is safe and feasible .

  5. Surgical considerations in FAP-related pouch surgery: Could we do better?

    Science.gov (United States)

    Möslein, Gabriela

    2016-07-01

    The ileoanal pouch has become the standard restorative procedure of choice for patients with the classical phenotype in FAP (familial adenomatous polyposis) and also for ulcerative colitis (UC). Whilst we tend to encounter descriptive analyses comparing functional outcome, fertility and quality of life (QOL) between series in literature, there may be an urgent need to discuss the subtle technical modifications that may be pivotal for improving long-term QOL in FAP patients. Our aim is to review the current literature and discuss the aspects of ileal pouch-anal anastomosis that may require specific reevaluation for FAP. Surgical strategies aimed at minimizing post-interventional desmoid growth is one of the most important aspects. For this study, the following topics of interest were selected: Timing of surgery, IRA or ileoanal pouch for classical FAP, laparoscopic or conventional surgery, TME or mesenteric dissection, preservation of the ileocolic vessels, handsewn or double-staple anastomosis, shape and size of pouch, protective ileostomy, Last and definitely not least: how to manage desmoid plaques or desmoids at the time of prophylactic surgery. For the depicted technicalities of the procedure, a review of recent literature was performed and evaluated. For the topics selected, only sparse reference in literature was identified that was focused on the specific condition situation of FAP. Almost all pouch literature focusses on the procedural aspects, and FAP patients are always a very minor number. Therefore it becomes obvious that the specific entity is not adequately taken into account. This is a serious bias for identification of important steps in the procedure that may be beneficial for patients with either of the diseases. The results of this study demonstrate that several technical differences for construction of ileoanal pouches in FAP patients deserve more attention and prospective evaluation-perhaps even randomized trials. The role, importance and

  6. Photocurable surgical tissue adhesive glues composed of photoreactive gelatin and poly(ethylene glycol) diacrylate.

    Science.gov (United States)

    Nakayama, Y; Matsuda, T

    1999-01-01

    This article presents a novel photochemically driven surgical tissue adhesive technology using photoreactive gelatins and a water-soluble difunctional macromer (poly(ethylene glycol) diacrylate: PEGDA).The gelatins were partially derivatized with photoreactive groups, such as ultraviolet light (UV)-reactive benzophenone and visible light-reactive xanthene dye (e.g., fluorescein sodium salt, eosin Y, and rose bengal). A series of the prepared photocurable tissue adhesive glues, consisting of the photoreactive gelatin, PEGDA, and a saline solution with or without ascorbic acid as a reducing agent, were viscous solutions under warming, and their effectiveness was evaluated as hemostasis- and anastomosis-aid in cardiovascular surgery. Regardless of the type of photoreactive groups, the irradiation of the photocurable tissue adhesive glues by UV or visible light within 1 min produced water-swollen gels, which had a high adhesive strength to wet collagen film. These were due to the synergistic action of photoreactive group-initiated photo-cross-linking and photograft polymerization. An increase in the irradiation time resulted in increased gel yield and reduced water swellability. A decrease in the molecular weight of PEGDA and an increase in concentration of both gelatin and PEGDA resulted in reduced water swellability and increased tensile and burst strengths of the resultant gels. In rats whose livers were injured with a trephine in laparotomy, the bleeding spots were coated with the photocurable adhesive glue and irradiated through an optical fiber. The coated solution was immediately converted to a swollen gel. The gel was tightly adhered to the liver tissue presumably by interpenetration, and concomitantly hemostasis was completed. The anastomosis treatment with the photocurable glue in the canine abdominal or thoracic aortas incised with a knife resulted in little bleeding under pulsatile flow after declamping. Histological examination showed that the glues

  7. Surgical management of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Tony CY Pang; Vincent WT Lam

    2015-01-01

    Hepatocellular carcinoma (HCC) is the second mostcommon cause of death from cancer worldwide.Standard potentially curative treatments are eitherresection or transplantation. The aim of this paper isto provide an overview of the surgical managementof HCC, as well as highlight current issues in hepaticresection and transplantation. In summary, due to therelationship between HCC and chronic liver disease,the management of HCC depends both on tumourrelatedand hepatic function-related considerations. Assuch, HCC is currently managed largely through nonsurgicalmeans as the criteria, in relation to the aboveconsiderations, for surgical management is still largelyrestrictive. For early stage tumours, both resectionand transplantation offer fairly good survival outcomes(5 years overall survival of around 50%). Selectiontherefore would depend on the level of hepatic functionderangement, organ availability and local expertise.Patients with intermediate stage cancers have limitedoptions, with resection being the only potential forcure. Otherwise, locoregional therapy with transarterialchemoembolization or radiofrequency ablation are viableoptions. Current issues in resection and transplantationare also briefly discussed such as laparoscopic resection,ablation vs resection, anatomical vs non-anatomicalresection, transplantation vs resection, living donor livertransplantation and salvage liver transplantation.

  8. [Amebiasis. Surgical treatment in 1989].

    Science.gov (United States)

    Sigler Morales, L; Mier y Díaz, J; Melgoza Ortiz, C; Blanco Benavides, R; Medina González, E

    1989-01-01

    Even when the number of patients with invasive amebiasis has decreased, the internist and surgeon must be alert in case that the patient requires an operation. Amebic liver abscess is treated medically; percutaneous evacuation is rarely used and surgical drainage is made when there is not response to medical treatment or there is high risk of abscess rupture. Operation is mandatory when the abscess has ruptured to the abdominal cavity or through the pericardial sac. In fulminant colitis it is necessary to resect the diseased portion of the colon without primary anastomoses. Amebic apendicitis is difficult to diagnosis before an operation. It may be suspected in cases of apendicitis if the cecal wall is inflammed. Colon ameboma requires medical treatment except if it is associated with necrosis or perforation. In a four year period (1985-1988) 294 patients with diagnosis of invasive amebiasis were admitted to three hospitals of the Instituto Mexicano del Seguro Social in Mexico City. 218 had hepatic abscess, 45 required surgical drainage with four deaths (9%) and four not operated patients died. In this series only four patients had their abscess drained percutaneously. 31 patients with amebic colitis were treated; three required colonic resection with one death. Ameboma was seen in five patients and there were 11 cases of amebic apendicitis. No deaths occurred in these last two groups.

  9. Surgical Treatment of Calcaneal Spur.

    Directory of Open Access Journals (Sweden)

    Eduardo Sarmiento Sánchez

    2007-12-01

    Full Text Available Background: Pain in the plantar region of the heel is technically known as talalgia, and it is a very frequent complaint in the orthopaedic service in Guyana. Due to its frequent mortality, the current investigation was carried out. Objectives: To characterize the application of the surgical treatment to a group of patients in Guyana. Method: 70 patients surgically treated were studied presenting rebel talalgia with no responses to the conservative treatment. Age, sex, race, educational level, antibiotic prophylaxis, final outcomes, and patient's satisfaction with the treatment were the set of variables selected. Results: High morbidity of the heel pain syndrome was evidenced in this studied. The most frequent cause was the calcaneal spur. There is predominance in female Indian race. The high influenced of the socio-cultural factor in the genesis of this disease is proved as well as the impossibility of carrying out the conservative treatment due to high cost of medications. Conclusions: The efficacy achieved with combined treatment technique allowed the results obtained. All this contributed to achieve high satisfaction levels.

  10. SURGICAL PROCEDURES IN SUSHRUTA SAMHITA

    Directory of Open Access Journals (Sweden)

    Singh R.K

    2011-05-01

    Full Text Available The Sushruta Samhita is an Ayurvedic text, by the legendary Sushruta, foundational to Ayurvedic medicine (Indian traditional medicine, with innovative chapters mainly on surgery. There is a general impression that Sushruta Samhita is only an ancient Indian Ayurvedic text book of surgery. Sushruta Samhita contains 184 chapters and description of 1120 illnesses, 700 medicinal plants, a detailed study on anatomy, 64 preparations from mineral sources and 57 preparations based on animal sources. It still retains the land mark position in the field of surgical texts. In addition to his worldwide known work of historical significance on plastic surgery, he also made similar unique contributions on numerous aspects of medicine, such as fracture and dislocations, urinary stones, skin diseases including leprosy, Pancha Karma (Purification procedures, toxicology, pediatrics, eye diseases, psychiatry, obstetrics and gynaecology, etc. A very limited conceptual work has been performed on the selected chapters of Sushruta Samhita. Therefore a review conceptual study has been carried out on the various surgical concepts of Sushruta Samhita. Outcome of this study shows, Sushruta Samhita is written in the aphorism form and the techniques described in it are eminently in line with technical abilities of the times. It is need of the hour to explore the hidden truth by decoding the versions of the texts.

  11. Surgical infections: a microbiological study

    Directory of Open Access Journals (Sweden)

    Santosh Saini

    2004-04-01

    Full Text Available Surgical infections are mostly polymicrobial, involving both aerobes and anaerobes. One hundred seventeen cases comprised of abscesses (n=51, secondary peritonitis (n=25, necrotizing fascitis (n=22 and wounds with devitalized tissues (n=19 were studied. The number of microorganisms isolated per lesion was highest in secondary peritonitis (2.32. The aerobe/ anaerobe ratio was 0.81 in secondary peritonitis and 1.8 in necrotizing fascitis. Most secondary peritonitis (80%, necrotizing fascitis (75% and wounds with devitalized tissues (66.7% were polymicrobial. Common microorganisms isolated in our study were E. coli, Staphylococcus aureus, Klebsiella spp., Pseudomonas aeruginosa, Bacteroides fragilis and Peptostreptococcus spp. The most effective antibiotics for S. aureus were clindamycin (79.1% and cefuroxime (70.8%. For Gram-negatives (Klebsiella spp., E. coli and Proteus spp., the most effective antibiotics were cefotaxime, ceftizoxime, amikacin and ciprofloxacin. Pseudomonas aeruginosa was maximally sensitive to amikacin (35.2% and ciprofloxacin (35.2%. The greatest degree of multidrug resistance to all the drugs was found in P. aeruginosa (52.9%, followed by Klebsiella spp. (33.3%, Proteus spp. (33.3%, E. coli (22.2%, and S. aureus (12.5%. All the anaerobes that we isolated were 100% sensitive to metronidazole and chloramphenicol, followed by clindamycin (95% to 100%. Apart from antibiotic therapy, non-antimicrobial methods, such as hyperbaric oxygen therapy and debridement also play an important role in the treatment of surgical infections.

  12. PREPARATIVE SKIN PREPARATION AND SURGICAL WOUND INFECTION

    OpenAIRE

    Anjanappa; Arjun

    2015-01-01

    BACKGROUND AND OBJECTIVE: It is an established fact now that the normal skin of healthy human beings harbours a rich bacterial fl ora. Normally considered non - pathogenic , these organisms way be a potential source of infection of the surgical wound. Approximately 20% of the resident flora is beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganism...

  13. Three-Dimensional Printing Surgical Applications

    OpenAIRE

    AlAli, Ahmad B.; Griffin, Michelle F; Butler, Peter E

    2015-01-01

    Introduction: Three-dimensional printing, a technology used for decades in the industrial field, gains a lot of attention in the medical field for its potential benefits. With advancement of desktop printers, this technology is accessible and a lot of research is going on in the medical field. Objective: To evaluate its application in surgical field, which may include but not limited to surgical planning, surgical education, implants, and prosthesis, which are the focus of this review. Method...

  14. [SURGICAL HAND WASHING: HANDSCRUBBING OR HANDRUBBING].

    Science.gov (United States)

    Santacatalina Mas, Roser; Peix Sagues, Ma Teresa; Miranda Salmerón, Josep; Claramunt Jofre, Marta; López López, Alba; Salas Marco, Elena

    2016-02-01

    The importance of protocols for preoperative antisepsis of the hands is given by the risk of transferring bacteria from the hands of the surgical team to the patient during surgery and it is relationship with infection of surgical wound site (SSI). Careful surgical scrub reduces the number of bacteria on the skin, but does not eliminate them completely, remaining transient microorganisms on hands after the surgical scrub. There fore if micropuncture in surgical gloves occurs, the correct preoperative preparation of hands and double gloving will be essential to reduce the risk of bacterial transmission to patients. The protocols for surgical hand antisepsis are two: Surgical scrub with antiseptic soap (hand scrubbing). Surgical scrub by rubbing alcohol (handrubbing). The hand antisepsis by rubbing with an alcohol solution has proved to be significantly more effective compared to soap solutions. We must also see that in surgical hand antisepsis with soap, you must rinse them with water. And often hospitals' taps and keys are contaminated by Pseudomonas spp., including P. aeuinosa. PMID:27101645

  15. Phosphate-activated glutaminase activity is enhanced in brain, intestine and kidneys of rats following portacaval anastomosis

    Institute of Scientific and Technical Information of China (English)

    Manuel Romero-Gómez; María Jover; Daníel Diaz-Gómez; Laura Collantes de Terán; Regina Rodrigo; Inés Camacho; Miriam Echevarría; Vicente Felipo; Juan D Bautista

    2006-01-01

    AIM: To assess whether portacaval anastomosis (PCA)in rats affects the protein expression and/or activity of glutaminase in kidneys, intestines and in three brain areas of cortex, basal ganglia and cerebellum and to explain the neurological alterations found in hepatic encephalopathy (HE).METHODS: Sixteen male Wistar rats weighing 250-350g were grouped into sham-operation control (n=8) or portacaval shunt (n = 8). Twenty-eight days after the procedure, the animals were sacrificed. The duodenum,kidney and brain were removed, homogenised and mitochondria were isolated. Ammonia was measured in brain and blood. Phosphate-activated glutaminase (PAG)activity was determined by measuring ammonia production following incubation for one hour at 37℃ with O-phthalaldehyde (OPA) and specific activity expressed in units per gram of protein (μkat/g of protein). Protein expression was measured by immunoblotting.RESULTS: Duodenal and kidney PAG activities together with protein content were significantly higher in PCA group than in control or sham-operated rats (duodenum PAG activity was 976.95±268.87 μkat/g of protein in PCA rats vs 429.19±126.92. μkat/g of protein in shamoperated rats; kidneys PAG activity was 1259.18±228.79μkat/g protein in PCA rats vs 669.67±400.8 μkat/g of protein in controls, P<0.05; duodenal protein content:173% in PCA vs sham-operated rats; in kidneys the content of protein was 152% in PCA vs sham-operated rats).PAG activity and protein expression in PCA rats were higher in cortex and basal ganglia than those in shamoperated rats (cortex: 6646.6 ± 1870.4 μkat/g of protein vs 3573.8±2037.4 μkat/g of protein in control rats,P<0.01; basal ganglia, PAG activity was 3657.3±1469.6μkat/g of protein in PCA rats vs 2271.2 ± 384 μkat/g of protein in sham operated rats, P<0.05; In the cerebellum, the PAG activity was 2471.6±701.4 μkat/g of protein vs 1452.9± 567.8 μkat/g of protein in the PCA and sham rats, respectively, P< 0.05; content

  16. [Living donor transplantation. Surgical complications].

    Science.gov (United States)

    Karam, Georges

    2008-02-01

    Although nephrectomy by open surgery is the most used technique for the extraction of kidney transplants in the living donor, nephrectomy under laparaoscopy is increasingly practiced. Laparoscopic nephrectomy is less invasive and performed under videoscopy control, after insufflation of the peritoneal cavity. Three to four incisions are done in order to enter the surgical instruments. The kidney is extracted through a horizontal sus-pubic incision. The exposition is either exclusively transperitoneal, retroperitoneal or hand assisted. The advantages of laparoscopy are esthetical, financial due to a shorter hospitalisation and a quicker recovery, as well a confort for the donor. The disadvantages are a longer warm ischemia time and possibly a higher risk of delayed graft function. Randomised studies having compared laparoscopy and open surgery in the living donor have not find any significant difference regarding the per- and perioperative in the complications. PMID:18160357

  17. Intraoperative OCT in Surgical Oncology

    Science.gov (United States)

    South, Fredrick A.; Marjanovic, Marina; Boppart, Stephen A.

    The global incidence of cancer is rising, putting an increasingly heavy burden upon health care. The need to effectively detect and treat cancer is one of the most significant problems faced in health care today. Effective cancer treatment typically depends upon early detection and, for most solid tumors, successful removal of the cancerous tumor tissue via surgical procedures. Difficulties arise when attempting to differentiate between normal and tumor tissue during surgery. Unaided visual examination of the tissue provides only superficial, low-resolution information and often with little visual contrast. Many imaging modalities widely used for cancer screening and diagnostics are of limited use in the operating room due to low spatial resolution. OCT provides cellular resolution allowing for more precise localization of the tumor tissue. It is also relatively inexpensive and highly portable, making it well suited for intraoperative applications.

  18. Surgical treatment of acute pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Klose, K.J.; Neher, M.; Kuhn, F.P.; Kuemmerle, F.; Thelen, M.

    1983-03-31

    The diagnosis of acute pancreatitis is based on anamnestic, clinical and chemical data. Ultrasound and computed tomography permit direct visualisation of the pancreas and establish the diagnosis. In cases of haemorrhagic-necrotising pancreatitis they demonstrate the extent of morphological changes and permit exclusion of other causes of an acute abdomen. The imaging methods support indications for operation in cases of subtotal or total parenchymatous necrosis and in pancreatic abscesses. Conservative expectant approaches in patients with severe clinical course and slight morphological changes as well as in agreement of clinical and morphological findings are facilitated. Complete demonstration of parenchymatous and peripancreatic necroses furnishes useful additional information for total extirpation. Gallstone disease can be demonstrated or excluded preoperatively. Since introduction of ultrasound and computed tomography for the diagnosis of acute pancreatitis a marked diminution of early surgical intervention and delayed operation has been achieved.

  19. Surgical Management of Enterocutaneous Fistula

    International Nuclear Information System (INIS)

    Enterocutaneous (EC) fistula is an abnormal connection between the gastrointestinal (GI) tract and skin. The majority of EC fistulas result from surgery. About one third of fistulas close spontaneously with medical treatment and radiologic interventions. Surgical treatment should be reserved for use after sufficient time has passed from the previous laparotomy to allow lysis of the fibrous adhesion using full nutritional and medical treatment and until a complete understanding of the anatomy of the fistula has been achieved. The successful management of GI fistula requires a multi-disciplinary team approach including a gastroenterologist, interventional radiologist, enterostomal therapist, dietician, social worker and surgeons. With this coordinated approach, EC fistula can be controlled with acceptable morbidity and mortality.

  20. [Living donor transplantation. Surgical complications].

    Science.gov (United States)

    Karam, Georges

    2008-02-01

    Although nephrectomy by open surgery is the most used technique for the extraction of kidney transplants in the living donor, nephrectomy under laparaoscopy is increasingly practiced. Laparoscopic nephrectomy is less invasive and performed under videoscopy control, after insufflation of the peritoneal cavity. Three to four incisions are done in order to enter the surgical instruments. The kidney is extracted through a horizontal sus-pubic incision. The exposition is either exclusively transperitoneal, retroperitoneal or hand assisted. The advantages of laparoscopy are esthetical, financial due to a shorter hospitalisation and a quicker recovery, as well a confort for the donor. The disadvantages are a longer warm ischemia time and possibly a higher risk of delayed graft function. Randomised studies having compared laparoscopy and open surgery in the living donor have not find any significant difference regarding the per- and perioperative in the complications.

  1. Efectos de la desnutrición sobre la colagenización de anastomosis intestinales: análisis de procolágeno y telopéptido carboxiterminal mediante radioinmunoanálisis Role of malnutrition in intestinal anastomosis collagenization: an analysis of procollagen (PINP and carboxyterminal telopeptide (ICTP by radioimmunoassay

    Directory of Open Access Journals (Sweden)

    J. M. Álamo

    2007-02-01

    Full Text Available Introducción: diversos factores influyen en la cicatrización correcta de las suturas intestinales tras la práctica de una resección intestinal. Uno de los factores más implicados es el estado nutricional del paciente. Objetivos: evaluar la influencia de la desnutrición inducida sobre la viabilidad de una anastomosis intestinal primaria mediante el análisis del procolágeno (PINP como marcador de la síntesis de colágeno I, y del telopéptido carboxiterminal del colágeno I (ICTP como marcador de la destrucción del mismo. Métodos: 40 ratas Wistar y material de radioinmunoensayo. Métodos: diseñamos 2 grupos de ratas, 20 animales por cada grupo: grupo control (A y grupo "desnutrición" (B. Se analiza PINP e ICTP mediante RIA sobre tejido colónico homogeneizado, preanastomótico y anastomótico. Resultados: existen unos niveles menores de PINP en el colon de las ratas del grupo B comparado con el colon del grupo A (0,3620 y 0,4340 µg/g respectivamente (p = 0,032. Hay un mayor nivel de ICTP analizado en el colon del grupo B (0,9545 en contraposición a 0,8460 µg/g en el grupo A (p = 0,875. En las anastomosis del grupo B existe una menor síntesis de PINP en comparación con el grupo A (0,376 y 0,468 µg/g respectivamente, p = 0,002. Conclusiones: la anastomosis colónica incrementa los niveles de PINP e ICTP en el tejido cicatricial (p = 0,000; la malnutrición reduce la colagenización de las anastomosis (p = 0,000.Introduction: some clinical, anatomo-pathological, and technical factors influence the correct healing of intestinal suture following an intestinal resection. One of the most influential factors is patient nutritional status. Objectives: to evaluate the influence of malnutrition on the viability of primary intestinal anastomosis by the analysis of collagen I deposition. Methods: 40 Wistar rats, radioimmunoassay material. We used 2 groups of rats, 20 animals in each group: a control group (A and a "malnutrition" group (B

  2. 食管癌切除行弓上食管胃机械吻合术150例%Use of disposable pipe type stapling aortic arch anastomosis of esophagusand stomach on 150 cases of middle and lower esophageal cancer

    Institute of Scientific and Technical Information of China (English)

    贾伟; 于文江; 岳志; 常王玉

    2012-01-01

    Objective To summarize the clinical experience of using of disposable pipe type stapling aortic arch anastomosis of esophagus and stomach. Methods Retrospective analysis was made of 150 cases of middle and lower esophageal cancer resection, with disposable pipe type of stapling bow mechanical esophagogastric anastomosis. Results A hundred and forty-nine cases achieved successful, however,1 patient failed. There was one case of anastomotic bleeding. Postoperative follow-up was performed on 144 cases,3 deaths,the causes of which were anastomotic fistula,a serious infection in 1 ,and aortic esophageal fistula in 2 cases. There was chylothorax in 1 case,cured by symptomatic treatment. The other patients recovered well. Long-term anastomotic stricture appeared in 5 cases, all expanded by balloon dilator to ease or cure after 7 times. 6 cases lost. Conclusion The use of lower esophageal intercostal posterolateral left chest incision and pipe-type esophagus and stomach stapling arch anastomosis performs with surgical difficulty, but there are fewer complications and improved quality of life of patients after the stomach intestine reconstruction.%目的 探讨一次性弯管型吻合器行主动脉弓上食管胃吻合术的临床经验.方法 回顾性分析150例采用一次性弯管型吻合器行弓上食管胃机械吻合根治性切除术中、下段食管癌.结果 一次吻合成功149例,1例失败改为弓旁手工吻合.全组患者1例吻合口出血.术后随访144例,死亡3例,死亡原因:吻合口瘘、严重感染1例,食管主动脉瘘2例.,乳糜胸1例,经对症处理治愈;其余患者术后恢复良好.远期出现吻合口狭窄5例,均经球囊扩张器扩张7次后缓解或治愈.6例失访.结论 中、下段食管癌采用左胸后外侧肋间切口,使用弯管型吻合器行食管胃弓上吻合,手术难度虽较大,但术后胃肠道重建并发症较少,患者的生活质量得到提高.

  3. Surgical management of pancreatic neuroendocrine tumors

    NARCIS (Netherlands)

    A.P.J. Jilesen

    2015-01-01

    This thesis gives an overview of the surgical management and prognosis of patients with pancreatic neuroendocrine tumors (pNET). A systematic review including 2600 studies, was performed on complications and survival after different surgical procedures for pNETs. The overall pancreatic fistula rate

  4. Non-surgical embryo transfer in pigs

    NARCIS (Netherlands)

    Hazeleger, W.

    1999-01-01

    Embryo transfer in pigs has been performed surgically for a long time. However, a less invasive, non-surgical, procedure of embryo transfer could be a valuable tool for research (to study embryo survival and embryo-uterus interactions) and practical applications (export, prevention of disease transm

  5. Radiodiagnosis of lung syndrome in surgical sepsis

    International Nuclear Information System (INIS)

    The results of treatment of 23 patients with acute surgical sepsis were analysed. It was shown that the X-ray examination must be obligatory in surveillance of patients with purulent foci. Two roentgenological variants are possible in surgical sepsis: central and perepheric. X-ray examinations of chest organs should be conducted every 2-3 day

  6. Learning Basic Surgical Skills through Simulator Training

    Science.gov (United States)

    Silvennoinen, Minna; Helfenstein, Sacha; Ruoranen, Minna; Saariluoma, Pertti

    2012-01-01

    Computer-based surgical training simulators are instrumental in skill-based training and performance measurement. However, to date, the educational employment of these tools lacks empirically founded insights and effective practical guidelines. This study examined surgical residents during computer-based simulator training of basic laparoscopic…

  7. Surgical management of primary and recurrent melanoma.

    Science.gov (United States)

    Farma, Jeffrey M; Kulkarni, Nandini; Hsu, Cary

    2015-04-01

    Melanoma accounts for less than 2% of skin cancer cases but causes most skin cancer-related deaths. Surgery continues to be the cornerstone of treatment of melanoma and surgical principles are guided by data derived from clinical research. This article examines the evolution of surgical techniques for the diagnosis and treatment of primary and locally recurrent melanoma.

  8. Efficacy and safety of a NiTi CAR 27 compression ring for end-to-end anastomosis compared with conventional staplers: A real-world analysis in Chinese colorectal cancer patients

    Science.gov (United States)

    Lu, Zhenhai; Peng, Jianhong; Li, Cong; Wang, Fulong; Jiang, Wu; Fan, Wenhua; Lin, Junzhong; Wu, Xiaojun; Wan, Desen; Pan, Zhizhong

    2016-01-01

    OBJECTIVES: This study aimed to evaluate the safety and efficacy of a new nickel-titanium shape memory alloy compression anastomosis ring, NiTi CAR 27, in constructing an anastomosis for colorectal cancer resection compared with conventional staples. METHODS: In total, 234 consecutive patients diagnosed with colorectal cancer receiving sigmoidectomy and anterior resection for end-to-end anastomosis from May 2010 to June 2012 were retrospectively analyzed. The postoperative clinical parameters, postoperative complications and 3-year overall survival in 77 patients using a NiTi CAR 27 compression ring (CAR group) and 157 patients with conventional circular staplers (STA group) were compared. RESULTS: There were no statistically significant differences between the patients in the two groups in terms of general demographics and tumor features. A clinically apparent anastomotic leak occurred in 2 patients (2.6%) in the CAR group and in 5 patients (3.2%) in the STA group (p=0.804). These eight patients received a temporary diverting ileostomy. One patient (1.3%) in the CAR group was diagnosed with anastomotic stricture through an electronic colonoscopy after 3 months postoperatively. The incidence of postoperative intestinal obstruction was comparable between the two groups (p=0.192). With a median follow-up duration of 39.6 months, the 3-year overall survival rate was 83.1% in the CAR group and 89.0% in the STA group (p=0.152). CONCLUSIONS: NiTi CAR 27 is safe and effective for colorectal end-to-end anastomosis. Its use is equivalent to that of the conventional circular staplers. This study suggests that NiTi CAR 27 may be a beneficial alternative in colorectal anastomosis in Chinese colorectal cancer patients. PMID:27276395

  9. Preoperative color duplex echographical venous mapping before autologous fat graft for calf augmentation: a case report of superficial vein thrombosis and prevalence of intersaphenic anastomosis.

    Science.gov (United States)

    Fraccalvieri, Marco; Contessa, Luigi; Salomone, Marco; Zingarelli, Enrico Maria; Bruschi, Stefano

    2014-08-01

    Autologous fat grafting for calf augmentation is considered an easy and safe technique. Only few cases of potential complications have been described in literature; among them, vein thrombosis was never reported. We report a case of superficial vein thrombosis of the intersaphenic anastomosis after fat graft for calf symmetrization in club-foot syndrome. A color duplex echographical study showed that such intersaphenic anastomoses are present in all patients, but they have an ectatic diameter in 70% of patients with great saphenous vein insufficiency and in 50% of patients without insufficiency. The plastic surgeon should be aware of the presence and topography of such anatomical variations before performing the procedure. Moreover, a preoperative color duplex echographical venous mapping may help the surgeon in avoiding the trauma on vein variants and subsequent complications. PMID:23528632

  10. Ulceração de anastomose esôfago-entérica causada por alendronato Esophagus-enteric anastomosis ulceration caused by alendronate

    Directory of Open Access Journals (Sweden)

    Pedro DUQUES

    2001-04-01

    could be present. Objective — Report a case of a patient who underwent total gastrectomy with Y-en-Roux anastomosis for a gastric carcinoid tumor and developed an esophagus-enteric anastomosis ulceration after the use of alendronate. Patient and Method — A 63-year-old woman started medical therapy with alendronate in a dose of 10 mg daily. After a period of one month of medical treatment with this drug she began to complain of dysphagic symptoms and abdominal pain. She was submitted to endoscopic examination that showed an esophageal ulceration, an enteric ulceration of the anastomosis and an esophageal stenosis. Results - Medical treatment with alendronate was discontinued and the symptom of abdominal pain desapeared. The intensity of dysphagia has decreased. The ulcerated lesion remitted although esophageal stenosis did not. The patient was subsequently treated with esophagus-enteric anastomosis dilation. She improved in her general state and nowadays she is free of symptoms. Conclusion — Alendronate sodium could cause lesions of the inferior esophageal portion or in distal segments of the gastrointestinal tube, in patients with a fast gastrointestinal transit. Special attention must be given to gastrectomized patients that use this drug because of the possibility to develop mucosal lesions in the enteric anastomosed part and its fearfull complications as stenosis.

  11. Factores de riesgo de fuga en anastomosis colo-rectales mecánicas tras cirugía oncológica. Importancia del Factor Cirujano.

    OpenAIRE

    Navarro Vicente, Francisco

    2014-01-01

    Introducción: El cáncer colo-rectal es la tercera neoplasia más común y la segunda causa de mortalidad por cáncer en los países desarrollados. La anastomosis primaria es la norma tras la cirugía exerética, y la fuga anastomótica (FA) es la complicación postoperatoria más importante en este tipo de intervención porque se ha demostrado que aumenta la morbimortalidad y los costes y parece aumentar la tasa de recidiva tumoral a nivel local y disminuir la supervivencia global. En la literatura se ...

  12. [Intraoperative anaphylaxis caused by latex surgical gloves].

    Science.gov (United States)

    Tomita, S; Sugawara, K; Tamakawa, S; Saitoh, Y

    1998-02-01

    A 17-year-old male encountered anaphylaxis caused by latex surgical gloves during emergency surgery under general anesthesia. He had undergone multiple surgical procedures, bladder catheterization and was suffering from atopic dermatitis. The patient developed bronchospasm and circulatory collapse 20 minutes after the start of surgery. Administration of dopamine, aminophylline and methylprednisolone helped to normalize airway pressure and blood pressure. Latex allergy occurs in persons considered at high risk including patient with spina bifida, urogenital abnormalities, atopic dermatitis, health care workers and rubber industry workers. These persons may develop hypersensitivity to latex products. If patients who are suspected to be latex allergy undergo surgical procedures, anesthesiologist should check past history and sensitivity to rubber in detail. In patients known to be allergic to latex, we must avoid latex products, such as surgical gloves, or anesthetic and surgical equipments. PMID:9513338

  13. Advances in the surgical management of prolapse.

    Science.gov (United States)

    Slack, Alex; Jackson, Simon

    2007-03-01

    Prolapse is an extremely common condition, for which 11% of women will have a surgical procedure at some point in their lives. The recurrence rate after most of the traditional surgical procedures is high and upto 29% of women who have had surgery for prolapse will require a further operation. In order to improve the surgical outcome, there is currently much interest in the use of grafts to augment traditional repairs and new procedures have been developed using specifically developed grafts. These have been combined with minimally invasive surgical techniques in an attempt to reduce surgical morbidity. These procedures may improve the outcome of surgery for prolapse. However, there is currently a lack of long-term data from randomized trials to demonstrate their effectiveness and safety. PMID:17448267

  14. Direct anastomosis of contralateral C7 nerve root transfer with affected-side inferior trunk for repair of brachial plexus avulsion injury

    Institute of Scientific and Technical Information of China (English)

    Houjun Yan; Changqing Hu; Yingli Jia; Chunjie Cui; Xuefeng Li; Jingyang Zhang

    2006-01-01

    AIM:To observe the effect of direct anastomosis of contralateral C7 nerve root transferred through prespinal route with affected-side inferior trunk for repair of brachial plexus avulsion injury,and investigate its feasibility. METHODS:Two male patients.with the age of 24 and 41 years respectively,were retrieved.When admitted to the hospital,they were diagnosed as brachial plexus avulsion injury.They subjected the operation in the 252 Hospital of Chinese PLA in March 2006 and May 2006 respectively.The proximal end of contralateral C7 nerve root was dissociated to nerve root pore and the distal end was dissociated to anterior and posterior divisions of middle trunk.The injured C7 nerve root was widely dissociated to inferior trunk,medial cord,ulnar nerve and medial head of median nerve.When elbow and shoulder joints were in flexion,the injured C7 nerve root was directly anastomosed with contralateral C7 nerve root in the gap between affected-side cervical vagina vasorum and esophagus with no tensions. RESULTS:Durling 3 to 5 hours of operation,little hemorrhage was found,nerves were not used for connection.Dyspnea,hoarse voice and other complications did not appear,either.In the postoperative 7th to 8th months.electremyogram examination showed that the growth velocity of anastomosed nerve was normal.CONCLUSION:Direct anastomosis of contralateral C7 nerve root transferred through prespinal route with affected-side inferior trunk can be used for repair of brachial plexus avulsion injury with satisfying therapeutic effects.

  15. An experimental study on minimally occlusive laser-assisted vascular anastomosis in bypass surgery: the importance of temperature monitoring during laser welding procedures.

    Science.gov (United States)

    Esposito, G; Rossi, F; Puca, A; Albanese, A; Sabatino, G; Matteini, P; Lofrese, G; Maira, G; Pini, R

    2010-01-01

    Laser welding has been proposed as an alternative technique to conventional stitching in microvascular anastomosis, with the advantages of improving the vascular healing process and reducing the risk of malfunction of a bypass. Our group recently proposed a laser-assisted end-to-side anastomotic technique, providing the advantages of laser welding and reducing the occlusion time of the recipient vessel, that is important in neurosurgical bypass procedures, in order to reduce the risk of cerebral ischemia. This in vivo study focuses on the control of the temperature dynamics developing in the welded tissue. A jugular vein graft was harvested and implanted on the rabbit carotid artery by means of two end-to-side anastomosis. Laser welding procedure was then carried out to implant the bypass. A real-time monitoring of the temperature during welding was performed with an infrared thermocamera, in order to control the laser-induced heating effect on the external surface of the vessel walls. The temperature analysis highlighted the dynamic of the heating effect in space and time and enabled us to define an optimal temperature range in operative conditions. The temperature control provided safe tissue heating confined within the directly irradiated area, with negligible damage to surrounding tissues, as well as effective sealing and welding of the vessel edges at the anastomotic sites. The average occlusion time of the carotid artery was about 11 minutes. After a follow-up of 30 days, all the bypasses were patent and no signs of thrombosis or leak point pressure were present, thus confirming the safety of this laser-assisted anastomotic procedure. PMID:20846478

  16. Temporary Tube Stoma versus Conventional Loop Stoma for the Protection of a Low Anastomosis in Colorectal Surgery: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Zong, Zhen; Zhou, Taicheng; Jiang, Zhipeng; Li, Yingru; Yang, Bin; Hou, Zehui; Han, Fanghai; Chen, Shuang

    2016-03-01

    The aim of this systematic review is to evaluate and compare the efficacy and safety of temporary tube stoma and conventional loop stoma for the protection of a low anastomosis in colorectal cancer. A systematic literature search was performed using PubMed, EMBASE, Science Citation Index, and Cochrane Central Register of Controlled Trails. Primary outcome measures were anastomotic leakage rate, the reoperation rate for anastomotic leakage, and stoma-related complications. Secondary outcome measures were operation time, length of hospital stay, time to stoma closure, and permanent stoma rate. Four studies were carried out and 642 patients (332 with temporary tube stoma and 310 with conventional loop stoma) met the inclusion criteria. The incidences of anastomotic leakage and reoperation rate were statistically similar in tube stoma and loop stoma groups. In comparison with conventional loop stoma, temporary tube stoma was associated with a significantly less stoma-related complications (odds ratio = 0.20; 95% confidence interval [CI]: 0.08-0.50), and shorter operation and hospital stay time (weighted mean difference = -47.28 minutes, 95% CI: -74.68 to -19.88; and weighted mean difference = -5.22 days, 95% CI: -10.32 to -0.13, respectively). Time to stoma closure was significantly shorter in the temporary tube stoma groups (weighted mean difference = -114.58 days, 95% CI: -148.38 to -80.77). Patients receiving temporary tube stoma had lower rates of stoma-related complications, shorter operation and hospital stay time, and stoma closure time. Tube can be easily removed without second surgery in most cases. Therefore, temporary tube stoma is a feasible and effective alternative to conventional loop stoma for the protection of a low colorectal anastomosis. PMID:27099062

  17. Stable gastric pentadecapeptide BPC 157 heals cysteamine-colitis and colon-colon-anastomosis and counteracts cuprizone brain injuries and motor disability.

    Science.gov (United States)

    Klicek, R; Kolenc, D; Suran, J; Drmic, D; Brcic, L; Aralica, G; Sever, M; Holjevac, J; Radic, B; Turudic, T; Kokot, A; Patrlj, L; Rucman, R; Seiwerth, S; Sikiric, P

    2013-10-01

    Stable gastric pentadecapeptide BPC 157 was suggested to link inflammatory bowel disease and multiple sclerosis, and thereby, shown to equally counteract the models of both of those diseases. For colitis, cysteamine (400 mg/kg intrarectally (1 ml/rat)) and colon-colon anastomosis (sacrifice at day 3, 5, 7, and 14) were used. BPC 157 (10 μg/kg, 10 ng/kg) was applied either intraperitoneally once time daily (first application immediately after surgery, last at 24 hours before sacrifice) or per-orally in drinking water (0.16 μg/ml/12 ml/day till the sacrifice) while controls simultaneously received an equivolume of saline (5 ml/kg) intraperitoneally or drinking water only (12 ml/day). A multiple sclerosis suited toxic rat model, cuprizone (compared with standard, a several times higher regimen, 2.5% of diet regimen + 1 g/kg intragastrically/day) was combined with BPC 157 (in drinking water 0.16 μg or 0.16 ng/ml/12 ml/day/rat + 10 μg or 10 ng/kg intragastrically/day) till the sacrifice at day 4. In general, the controls could not heal cysteamine colitis and colon-colon anastomosis. BPC 157 induced an efficient healing of both at the same time. Likewise, cuprizone-controls clearly exhibited an exaggerated and accelerated damaging process; nerve damage appeared in various brain areas, with most prominent damage in corpus callosum, laterodorsal thalamus, nucleus reunions, anterior horn motor neurons. BPC 157-cuprizone rats had consistently less nerve damage in all damaged areas, especially in those areas that otherwise were most affected. Consistently, BPC 157 counteracted cerebellar ataxia and impaired forelimb function. Thereby, this experimental evidence advocates BPC 157 in both inflammatory bowel disease and multiple sclerosis therapy.

  18. [Surgical treatment of chiasmal gliomas in children].

    Science.gov (United States)

    Helcl, F

    1997-03-01

    Chiasmal gliomas are rare brain tumors occurring especially in children. Their proper treatment is still controversial and consists of surgery, radiotherapy and chemotherapy. Surgical removal of these tumors can usually be only partial or subtotal and radiotherapy frequently follows. There are supporters of surgical approach, as well as its enemies. The author has been engaged in problems of optimal treatment of this entity for more than 10 years. He is offering a review of knowledge from the literature concerning surgical treatment of this disease in children. The great majority of articles in the literature are dealing with retrospective analysis of relatively small series of patients usually treated in single neurosurgical department and the surgical treatment is enclosed like a part of combined therapy. Articles dealing only with surgical treatment of chiasmal gliomas are few and reviews determining the contemporary role of surgery of this entity are also lacking. This was the main impulse for writing this compilation. The short history of surgical therapy is reviewed. Some new trends of this therapy are also mentioned (microsurgery, Cavitron Ultrasonic Surgical Aspirator and peroperative use of visual evoked potentials). Up to date criteria for surgical treatment of chiasmal gliomas in children are given-exploration of chiasmal region and performing a biopsy in all cases, radical surgery only in extrinsic gliomas of the chiasmal region and conservative surgical approach to intrinsic chiasmal gliomas. It is emphasized that the significance of obstructive hydrocephalus in this entity has not been fully estimated till now, as well as the role of shunting procedures. Surgical treatment remains, nevertheless, an important armamentarium in the management of chiasmal gliomas in children. (Ref. 20.)

  19. Guideline implementation: surgical instrument cleaning.

    Science.gov (United States)

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-05-01

    Cleaning, decontaminating, and handling instructions for instruments vary widely based on the type of instrument and the manufacturer. Processing instruments in accordance with the manufacturer's instructions can help prevent damage and keep devices in good working order. Most importantly, proper cleaning and disinfection may prevent transmission of pathogenic organisms from a contaminated device to a patient or health care worker. The updated AORN "Guideline for cleaning and care of surgical instruments" provides guidance on cleaning, decontaminating, transporting, inspecting, and storing instruments. This article focuses on key points of the guideline to help perioperative personnel implement appropriate instrument care protocols in their practice settings. The key points address timely cleaning and decontamination of instruments after use; appropriate heating, ventilation, and air conditioning parameters for the decontamination area; processing of ophthalmic instruments and laryngoscopes; and precautions to take with instruments used in cases of suspected prion disease. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. PMID:25946180

  20. Surgical Treatment for Pulmonary Hamartomas

    Directory of Open Access Journals (Sweden)

    Funda Ižncekara

    2015-11-01

    Full Text Available Aim: In this study, we evaluated the patients operated for hamartoma and treated endobronchially and the diagnostic value of this approach has been examined. Material and Method: 59 patients (24 females, 35 males; mean age 53 years, range 28-78 years which were operated and endobronchial treated for hamartoma in our clinic between January 2003 - January 2013 were analyzed retrospectively. Patient age, sex, symptoms, histopathological, surgical procedures and treatment outcomes were evaluated. Results: The most common complaint was shortness of breath, while 25 patients were asymptomatic. Thoracotomy and mass enucleation in 29 patients (%49,15, thoracotomy and wedge resection in 18 patients (%30.5, VATS and wedge resection in 4 patients (%6.77, thoracotomy and upper lobectomy in 4 patients (%6.77, thoracotomy and lower lobectomy in 2 patients (%3.38 and left upper lobe segmentectomy in 1 patient (%1.69 and right upper bronchial sleeve resection in 1 patient were performed. The postoperative pathology of lesions examined and diagnosis were chondroid hamartoma in 28 , pulmonary hamartoma in 20 , hamartoma chondrolypomatous in 11 and the bronchial hamartoma in 2 . No mortality was observed intraoperatively. Discussion: Although hamartomas are benign , diagnosis should be made because it can be confused with lung cancer. Definitive diagnosis and treatment can be performed successfully through VATS in primarily appropriate cases with minimal morbidity or thoracotomy or endobronchial treatment.

  1. Audit of Orthopaedic Surgical Documentation

    Directory of Open Access Journals (Sweden)

    Fionn Coughlan

    2015-01-01

    Full Text Available Introduction. The Royal College of Surgeons in England published guidelines in 2008 outlining the information that should be documented at each surgery. St. James’s Hospital uses a standard operation sheet for all surgical procedures and these were examined to assess documentation standards. Objectives. To retrospectively audit the hand written orthopaedic operative notes according to established guidelines. Methods. A total of 63 operation notes over seven months were audited in terms of date and time of surgery, surgeon, procedure, elective or emergency indication, operative diagnosis, incision details, signature, closure details, tourniquet time, postop instructions, complications, prosthesis, and serial numbers. Results. A consultant performed 71.4% of procedures; however, 85.7% of the operative notes were written by the registrar. The date and time of surgery, name of surgeon, procedure name, and signature were documented in all cases. The operative diagnosis and postoperative instructions were frequently not documented in the designated location. Incision details were included in 81.7% and prosthesis details in only 30% while the tourniquet time was not documented in any. Conclusion. Completion and documentation of operative procedures were excellent in some areas; improvement is needed in documenting tourniquet time, prosthesis and incision details, and the location of operative diagnosis and postoperative instructions.

  2. Do psychological variables affect early surgical recovery?

    Directory of Open Access Journals (Sweden)

    Michael N Mavros

    Full Text Available BACKGROUND: Numerous studies have examined the effect of psychological variables on surgical recovery, but no definite conclusion has been reached yet. We sought to examine whether psychological factors influence early surgical recovery. METHODS: We performed a systematic search in PubMed, Scopus and PsycINFO databases to identify studies examining the association of preoperative psychological variables or interventions with objectively measured, early surgical outcomes. RESULTS: We identified 16 eligible studies, 15 of which reported a significant association between at least one psychological variable or intervention and an early postoperative outcome. However, most studies also reported psychological factors not influencing surgical recovery and there was significant heterogeneity across the studies. Overall, trait and state anxiety, state anger, active coping, subclinical depression, and intramarital hostility appeared to complicate recovery, while dispositional optimism, religiousness, anger control, low pain expectations, and external locus of control seemed to promote healing. Psychological interventions (guided relaxation, couple support visit, and psychiatric interview also appeared to favor recovery. Psychological factors unrelated to surgical outcomes included loneliness, perceived social support, anger expression, and trait anger. CONCLUSION: Although the heterogeneity of the available evidence precludes any safe conclusions, psychological variables appear to be associated with early surgical recovery; this association could bear important implications for clinical practice. Large clinical trials and further analyses are needed to precisely evaluate the contribution of psychology in surgical recovery.

  3. Surgical treatment of traumatic lower limb pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    Pan Zhongjie; Zhang Hua; Li Li; Jia Yutao; Tian Rong

    2014-01-01

    Objective:To summarize our experience in surgical treatment of traumatic lower limb pseudoaneurysm.Methods:Twenty patients with traumatic lower limb pseudoaneurysm were surgically treated in our department from January 2007 to January 2012.The treatment protocols included interventional covered-stent placement (10 cases),spring coil embolization (2 cases),and surgical operation (8 cases).Surgical operations included pseudoaneurysm repair (2 cases),autologousvein transplantation (1 case),and artificial-vessel bypass graft (5 cases).Results:All the patients were successfully treated without aggravating lower limb ischemia.Pseudoaneurysm disappeared after treatment.A surgical operation is suitable to most pseudoaneurysms,but its damage is relatively obvious and usually leads to more bleeding.It also requires a longer operating time.Compared to a surgical operation,interventional therapy is less traumatic and patients usually have a quicker recovery (P<0.05).All patients were followed up once per month for 12-36 months by color Doppler ultrasound examination.There were no cases of pseudoaneurysm recurrence.Conclusion:Both surgical operation and interventional therapy are safe and effective in the treatment of pseudoaneurysm.

  4. Surgical treatment of perforated gastric ulcer

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    Korica Milan

    2002-01-01

    Full Text Available Introduction Peptic ulcer perforation is a complication of ulcer disease which requires urgent surgical treatment. The aim of this paper was to point out our experience in surgical treatment of perforated peptic ulcer. Material and methods This retrospective study analyzes results of surgical treatment in 365 patients with perforated peptic ulcer during the period January 1996 to December 2000. Results During the last 5-year period 365 patients were treated following peptic ulcer perforation. The average age was 43.53±8.26, with the span from 18 to 86. The most frequent surgical procedures in treatment of peptic ulcer perforation were: simple closure with biopsy (55.88%, excision of the ulcer with a pyloroplasty and vagotomy (35.29% as nonresection surgical procedures and stomach resection after Billroth II (8.83%. The postoperative mortality was 4.41%. Conclusions The methods of choice in surgical treatment of gastric ulcer perforation are nonresection surgical procedures with drug therapy and eradication of Helicobacter pylori, if present.

  5. Arthroscopic Posterior Subtalar Arthrodesis: Surgical Technique

    Science.gov (United States)

    Vilá y Rico, Jesús; Ojeda Thies, Cristina; Parra Sanchez, Guillermo

    2016-01-01

    Surgical fusion of the subtalar joint is a procedure indicated to alleviate pain of subtalar origin, such as in post-traumatic osteoarthritis, adult-acquired flatfoot deformity, and other disorders. Open subtalar arthrodesis has been performed with predictable results, but concerns exist regarding injury to proprioception and local vascularity due to wide surgical dissection. Minimally invasive techniques try to improve results by avoiding these issues but have a reputation for being technically demanding. We describe the surgical technique for arthroscopic subtalar arthrodesis, which has proved to be a safe and reliable technique in our experience, with consistent improvements in American Orthopaedic Foot & Ankle Society scores. PMID:27073783

  6. Misuse of statistics in surgical literature.

    Science.gov (United States)

    Thiese, Matthew S; Ronna, Brenden; Robbins, Riann B

    2016-08-01

    Statistical analyses are a key part of biomedical research. Traditionally surgical research has relied upon a few statistical methods for evaluation and interpretation of data to improve clinical practice. As research methods have increased in both rigor and complexity, statistical analyses and interpretation have fallen behind. Some evidence suggests that surgical research studies are being designed and analyzed improperly given the specific study question. The goal of this article is to discuss the complexities of surgical research analyses and interpretation, and provide some resources to aid in these processes.

  7. Surgical treatments for vaginal apical prolapse.

    Science.gov (United States)

    Kong, Mi Kyung; Bai, Sang Wook

    2016-07-01

    Pelvic organ prolapse is a common condition, occurring in up to 11% of women in the United States. Often, pelvic organ prolapse recurs after surgery; when it recurs after hysterectomy, it frequently presents as vaginal apical prolapse. There are many different surgical treatments for vaginal apical prolapse; among them, abdominal sacral colpopexy is considered the gold standard. However, recent data reveal that other surgical procedures also result in good outcome. This review discusses the various surgical treatments for vaginal apical prolapse including their risks and benefits. PMID:27462591

  8. [Orthognathic surgery: surgical failures and complications].

    Science.gov (United States)

    Guyot, Laurent

    2016-03-01

    Orthognathic surgery procedures mark the endpoint of lengthy orthodontic-surgical preparations and herald the completion of treatment for patients and their families. The main types of procedure are full maxillary Le Fort I osteotomies, mandibular osteotomies and chin surgery. To ensure a successful outcome, all require a favorable environment and extreme technical skill. But, like all surgical operations, they are also subject to peri- and post-operative complications resulting from treatment hazards or errors. Whatever the cause, surgical complications can entail failures in the management of the malformation. By seeking to understand and analyzing these complications, we can already help to prevent and reduce the contingent risks of failure.

  9. Surgical Procedures of Morbid Obesity

    Directory of Open Access Journals (Sweden)

    Zinat Salem

    2013-02-01

    Full Text Available Background: Surgical intervention has been recently advocated in the treatment of morbid obesity. The objective of this study was to review surgery as an alternative in the treatment of morbidly obese adolescents. Materials and Methods: This research was conducted by searching English websites such as PubMed, Up to Date, and Google Scholar, as well as some Persian websites including SID, Iranmedex, and Magiran. Articles published from 2000 to 2010 on interventional and clinical trials were reviewed for treatment of morbid obesity in adolescents. Keywords used in internet searches include obesity; adolescence; and surgery.Results: The results obtained from the studies indicated that 4% of American adolescents suffer from morbid obesity. So far, pharmacological treatment and other approaches toward this type of obesity have been inefficient. Hence, surgery was employed as one of the new approaches to the treatment of this disorder. According to the National Health Institute criteria, in the treatment of adolescent candidates for surgery, anthropometric measurements are performed together with the measurement of other co-morbidities of obesity. Adolescents whose percentiles are ≥99 are considered as morbidly obese patients. Conclusion: The results of the studies suggested that for the extremely obese adolescents, who do not respond to other types of medical interventions within 6 months, surgery can be performed. Adolescents with BMI of ≥40 kg/m2 and skeletal maturity, or those with co morbidities of obesity, or 13-year-old girls and boys ≥15 years of age can be candidates for surgery. However, the side effects of obesity should not be neglected. Therefore, before the adolescent obesity become morbid obesity, preventive measures should be taken through changes in lifestyle.

  10. Keratometry device for surgical support

    Directory of Open Access Journals (Sweden)

    Saia Paula

    2009-12-01

    Full Text Available Abstract Background High astigmatisms are usually induced during corneal suturing subsequent to tissue transplantation or any other surgery which involves corneal suturing. One of the reasons is that the procedure is intimately dependent on the surgeon's skill for suturing identical stitches. In order to evaluate the influence of the irregularity on suturing for the residual astigmatism, a prototype for ophthalmic surgical support has been developed. The final intention of this prototype is to be an evaluation tool for guided suture and as an outcome diminish the postoperative astigmatism. Methods The system consists of hand held ring with 36 infrared LEDs, that is to be projected onto the lachrymal film of the cornea. The image is reflected back through the optics of the ocular microscope and its distortion from the original circular shape is evaluated by developed software. It provides keratometric and circularity measurements during surgery in order to guide the surgeon for uniformity in suturing. Results The system is able to provide up to 23D of astigmatism (32D - 55D range and is ± 0.25D accurate. It has been tested in 14 volunteer patients intraoperative and has been compared to a commercial keratometer Nidek Oculus Hand-held corneal topographer. The correlation factors are 0.92 for the astigmatism and 0.97 for the associated axis. Conclusion The system is potentially efficient for guiding the surgeon on uniformity of suturing, presenting preliminary data indicating an important decrease on the residual astigmatism, from an average of 8D - for patients not submitted to the prototype guidance - to 1.4D - for patients who have actually been submitted to the prototype guidance - after the first 24 hours post-surgery and in the subsequent weeks. It also indicates that the surgeon should achieve circularity greater or equal to 98% in order to avoid postoperative astigmatisms over 1D. Trial Registration Trial registration number: CAAE - 0212.0.004.000-09.

  11. Clinical experiences of delayed primary anastomosis for type I congenital esophageal atresia%Ⅰ型食管闭锁延期根治手术临床经验总结

    Institute of Scientific and Technical Information of China (English)

    沈淳; 郑珊; 李凯; 刘小舟; 朱海涛; 孙松; 肖现民

    2014-01-01

    Objective To summarize our experiences of delayed primary anastomosis for type Ⅰcongenital esophageal atresia.Methods A retrospective review was performed for 7 patients with typeⅠ congenital esophageal atresia.There were 5 females and 2 males with a birth weight of 2.170 to 2. 615 kilograms.All had a prenatal diagnosis of hydramnios.And esophageal atresia was suspected in 5 cases by ultrasonic examinations.There were congenital heart disease (n=4)and congenital anal-recta malformation (n=2).Gastrostomy was performed after birth and the gap between proximal and distal esophagus measured radiologically. Second surgery was performed by end-to-end esophageal anastomosis at weeks 8-16.The correlation was analyzed between the growth body weight and the growth of blind esophagus during delayed operation period.The intra-operative blind end distance was observed and different operative approaches were selected. Then follow-ups were conducted for postoperative complications,long-term growth and development,including feedings.Results During 8-16 weeks,7 cases grew well with an average growth weight of 2.98 kg.The esophageal growth of two blind sides was 1-2.5 cm.Esophageal growth length and weight gain had no significant correlation (R=0.171,P=0.713).And there was no obvious correlation with two surgical intervals (R=0. 084,P=0.084).During second surgery,after a full separation of two blind esophageal sides,the gap was 3个椎体;生后8~16周行经胸食管-食管端端吻合术。分析延期手术食管断端生长与体质量的相关性;观察术中断端距离与采用不同手术方式的判断;随访术后并发症和生长发育、喂养情况。结果7例8~16周体质量平均增长2.98 kg,造影示两断端生长1.0~2.5 cm,生长长度与体质量增长无明显相关性(R=0.171,P=0.713);与两次手术间隔无明显相关性(R=0.084,P=0.858)。根治手术充分游离两断端,3例距离<1.0 cm者完成食管-食管端端吻合;3例距离1

  12. A porcine model for teaching surgical cricothyridootomy

    Directory of Open Access Journals (Sweden)

    Fernando Antonio Campelo Spencer Netto

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the acceptability of an educational project using A porcine model of airway for teaching surgical cricothyroidotomy to medical students and medical residents at a university hospital in southern Brazil.METHODS: we developed a teaching project using a porcine model for training in surgical cricothyroidotomy. Medical students and residents received lectures about this surgical technique and then held practical training with the model. After the procedure, all participants filled out a form about the importance of training in airway handling and the model used.RESULTS: There were 63 participants. The overall quality of the porcine model was estimated at 8.8, while the anatomical correlation between the model and the human anatomy received a mean score of 8.5. The model was unanimously approved and considered useful in teaching the procedure.CONCLUSION: the training of surgical cricothyroidotomy with a porcine model showed good acceptance among medical students and residents of this institution.

  13. Surgical Webcast for Treatment of Acid Reflux

    Medline Plus

    Full Text Available ... surgical audience, pledgets can be made of a number of different types of material. Basically it’s a ... do. We try to decrease their air intake, number one, so that they don’t have bloating. ...

  14. SURGICAL TREATMENT OF METASTATIC SPINAL TUMOR

    Institute of Scientific and Technical Information of China (English)

    徐宏光; 王以朋; 邱贵兴; 叶启彬; 张嘉

    2002-01-01

    Objectives. To evaluate the effect of surgical treatment on metastatic spinal tumor. Methods. The results of surgical intervention for metastatic spinal tumor of 31 consecutive patients since October 1985 were reviewed. Results. The average survival time was 17.6 months (range from 3 months to 9 years), and 4 patients are still alive with an average survival time of 24.6 months (range, 14~ 84 months). No postoperative complication was noted. The preoperative symptoms were partially relieved and neurological functions were improved after surgery. Conclusions. Surgical treatment for metastatic spinal tumor could improve the life quality, but should be adopted cautiously. The surgical procedures such as decompression and internal fixation should be involved only when neurological deficits occurred. The surgery with postoperative complementary therapy may not only improve the life quality , but also extend the patients' life span.

  15. Surgical Webcast for Treatment of Acid Reflux

    Medline Plus

    Full Text Available ... after being fully trained in our surgical residency spends a year in a program like this. And ... a hundred of these programs around the country. Spends a year learning these more advanced techniques and ...

  16. Non-surgical therapy of Peyronie's disease

    Institute of Scientific and Technical Information of China (English)

    Frederick L. Taylor; Laurence A. Levine

    2008-01-01

    The present paper provides a review of the available non-surgical treatments for Peyronie's disease (PD). A review of published literature on oral, intralesional, external energy and iontophoresis therapies for PD was performed,and the published results of available treatment options reviewed. The authors' recommendations for appropriate non-surgical management of PD are provided. Although there are many published reports that show the efficacy of non-surgical therapies for PD, there is a lack of large scale, multicenter controlled clinical trials, which makes treatment recommendations difficult. Careful review of the literature does suggest that there are treatment options that make scientific sense and appear to stabilize the disease process, reduce deformity, and improve function. Offering no treatment at all will encourage our patients to pursue alternative treatments, which might do harm, and misses the opportunity to do some good. Clearly further work is necessary to develop safe and effective non-surgical treatments for PD.

  17. Surgical Webcast for Treatment of Acid Reflux

    Medline Plus

    Full Text Available ... tremendous strides as a surgical community throughout the world in converting this operation that we’re doing ... doesn’t have the largest fundus in the world. What I’m going to do is just ...

  18. Guideline Implementation: Prevention of Retained Surgical Items.

    Science.gov (United States)

    Fencl, Jennifer L

    2016-07-01

    A surgical item unintentionally retained in a patient after an operative or other invasive procedure is a serious, preventable medical error with the potential to cause the patient great harm. Perioperative RNs play a key role in preventing retained surgical items (RSIs). The updated AORN "Guideline for prevention of retained surgical items" provides guidance for implementing a consistent, multidisciplinary approach to RSI prevention; accounting for surgical items; preventing retention of device fragments; reconciling count discrepancies; and using adjunct technologies to supplement manual count procedures. This article focuses on key points of the guideline to help perioperative personnel provide optimal care during a procedure. Key points addressed include taking responsibility for RSI prevention as a team; minimizing distractions, noise, and interruptions during counts; using consistent counting methods; reconciling discrepancies; and participating in performance-improvement activities. Perioperative RNs should review the complete guideline for additional information and for guidance in writing and updating policies and procedures. PMID:27350354

  19. [Our surgical heritage. Surgery in ancient Egypt].

    Science.gov (United States)

    Oelschlegel, F F; Luther, B; Arnst, C B

    1986-01-01

    In its 3,000 years History the surgery of the Old Egypt came on to an important development. Some of the antique instruments used in traumatology, the general surgery and in cosmetic-plastic operations, are in a scarcely modified manner employed for the same purposes in modern surgical interventions nowadays. The surgical diagnostics and therapy of that time is demonstrated by the surgical instruments stock being in the possession of the "Agyptisches Museum" of the "Staatlichen Museen zu Berlin". The surgery of Egypt transferred its leading part to the prosperous medical schools of Greece at the late period of the Old Egyptian empire (1085-332 B.C.). Its surgical diagnostics and therapy depending on an empirical rationalism, the applied instruments but also its ethical attitude towards the patients have been one of the dedisive bases influencing the development of the surgery in the antiquity. PMID:3532623

  20. Right Diaphragm Spontaneous Rupture: A Surgical Approach

    Directory of Open Access Journals (Sweden)

    Duilio Divisi

    2011-01-01

    Full Text Available We present a case of spontaneous rupture of the diaphragm, characterized by nonspecific symptoms. The rapid diagnosis and appropriate surgical approach led to a positive resolution of the pathology.

  1. Unique surgical tool as an iatromagic charm.

    Science.gov (United States)

    Somma, Alfredo Musajo; Somma, Laura Musajo

    2010-12-01

    Papyri are writings made on special sheets made out of reeds grown on the banks of the river Nile. The Authors comment on the relationship between a ritual text and surgical therapy with an exploration of an ancient charm as recorded in a Greek written papyrus stored in the Medicea Laurenziana Library papyri collection. This charm was presumably intended to act apotropaically, rendering harmless the aggressive surgical tool by means of still keeping its therapeutic value and thereby affording healing protection. This ritual charm acts as a "therapeutic medium" to help the surgical procedure useful to cut or to excise the uvula. The surgical power of stafillotomos is linked to the protective power of the iatromagic charm, giving the chance to analyze ancient data and to suggest a possible shape of the original scalpel. PMID:21657101

  2. Percentage of Surgical Patients Receiving Recommended Care

    Science.gov (United States)

    ... view charts and maps. State Percentage of Surgical Patients Receiving Recommended Care by ... U.S. Department of Health & Human Services — 200 Independence Avenue, S.W. — Washington, D.C. 20201

  3. Surgical Management of Obstructive Sleep Apnea.

    Science.gov (United States)

    Tanna, Neil; Smith, Benjamin D; Zapanta, Philip E; Karanetz, Irena; Andrews, Brian T; Urata, Mark M; Bradley, James P

    2016-04-01

    Surgical management of snoring and obstructive sleep apnea is indicated when a surgically correctable abnormality is believed to be the source of the problem. Many patients opt for surgical treatment after noninvasive forms of treatment have been proven ineffective or difficult to tolerate. With increasing frequency, functional rhinoplasty, septoplasty, turbinoplasty, palatal surgery, and orthognathic surgery are being used in the management of snoring and obstructive sleep apnea. Plastic surgeons' experience with aesthetic nasal surgery, nasal reconstruction, palatal surgery, and craniofacial surgery puts them at the forefront of performing surgery for snoring and sleep apnea. The role of functional septorhinoplasty, turbinoplasty, palatal surgery, genioglossal advancement, and orthognathic surgery is indispensable in the surgical management of obstructive sleep apnea. Multidisciplinary management of these patients is critical, and plastic surgeons are encouraged to work collaboratively with sleep medicine clinicians and centers. PMID:27018680

  4. 'Medical Tattoos' Help Hide Surgical Scars

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_161132.html 'Medical Tattoos' Help Hide Surgical Scars Pigments can restore more ... scars from cancer surgeries may benefit from "medical tattoos" that can help restore some of the skin's ...

  5. Encapsulation process sterilizes and preserves surgical instruments

    Science.gov (United States)

    Montgomery, L. C.; Morelli, F. A.

    1964-01-01

    Ethylene oxide is blended with an organic polymer to form a sterile material for encapsulating surgical instruments. The material does not bond to metal and can be easily removed when the instruments are needed.

  6. SURGICAL TREATMENT OF METASTATIC SPINAL TUMOR

    Institute of Scientific and Technical Information of China (English)

    徐宏光; 王以朋; 等

    2002-01-01

    Objective:To evaluate the effect of surgical treatment on metastatic spinal tumor.Methods:The results of surgical intervention for metastatic spinal tumor of 31 consecutive patients since October 1985 were reviewed.Results:The average survival time was 17.6 months (range from 3 months to 9 years),and 4 patients are still alive with an average survival time of 24.6 months(range,14-84 months).No postoperative complication was noted.The preoperative symptoms were partially relieved and neurological functions were improved after surgery.Conclusions:Surgical treatment for metastatic spinal tumor could improve the life quality,but should be adopted cautiously.The surgical procedures such as decompression and internal fixation should be involved only when neurological deficits occurred.The surgery with postoperative complementary therapy may not only improve the life quality,but also extend the patients' life span.

  7. Liability exposure for surgical robotics instructors.

    Science.gov (United States)

    Lee, Yu L; Kilic, Gokhan; Phelps, John Y

    2012-01-01

    Surgical robotics instructors provide an essential service in improving the competency of novice gynecologic surgeons learning robotic surgery and advancing surgical skills on behalf of patients. However, despite best intentions, robotics instructors and the gynecologists who use their services expose themselves to liability. The fear of litigation in the event of a surgical complication may reduce the availability and utility of robotics instructors. A better understanding of the principles of duty of care and the physician-patient relationship, and their potential applicability in a court of law likely will help to dismantle some concerns and uncertainties about liability. This commentary is not meant to discourage current and future surgical instructors but to raise awareness of liability issues among robotics instructors and their students and to recommend certain preventive measures to curb potential liability risks.

  8. [Surgical criteria for reoperation in abdominal surgery].

    Science.gov (United States)

    Bricot, R

    1975-07-01

    Analysis of the surgical criteria for reintervention in Abdominal Surgery led to the accentuation of a certain number of pictures of occlusion, general infectious syndromes, postoperative peritonitis, gastro-intestinal fistula and hemorrhagic syndrome. In all cases, the clinical examination can be misleading in particular in the case of peritonitis, and the history and non-surgical criteria must be strongly borne in mind. PMID:2036

  9. Tracheal necrosis with surgical emphysema following thyroidectomy

    OpenAIRE

    Chauhan A; Ganguly M; Saidha N; Gulia P

    2009-01-01

    Tracheal necrosis after thyroidectomy is an extremely rare event with only a few published reports. We present a case of a 65-year-old male who developed rapidly progressive surgical emphysema of face and upper thorax on the seventh day following total thyroidectomy. Prompt surgical exploration of neck revealed a tracheal rent at the level of the second tracheal ring. This hole was then refashioned into a formal tracheostomy. Patient had an eventful recovery. Tracheostomy was closed by the 14...

  10. Evolution of hemostatic agents in surgical practice

    OpenAIRE

    Sundaram, Chandru P.; Keenan, Alison C.

    2010-01-01

    Objective: Topical hemostatic agents are used in a wide variety of surgical settings, and the evolution of this class of surgical tools is an interesting topic. We reviewed and outlined the historical progress of topical hemostats into present day surgery and urology, and highlight opportunities for future research. Materials and Methods: A MEDLINE search of all available literature concerning several classes of topical hemostatic agents was performed. Fibrins sealants, Gelatin sponge hemosta...

  11. Surgical Treatment of dialysis-associated spondylosis

    OpenAIRE

    Baba, Hideo; Tagami, Atsushi; Adachi, Shinji; Hiura, Takeshi; Shindou, Hiroyuki

    2011-01-01

    【Objective】The purposes of this study were to classify the lesions of dialysis-associated spondylosis and evaluate the results of surgical treatment. 【Subjects and methods】The subjects were 87 patients (43 men and 44 women) who underwent surgery. These patients were studied in terms of lesion classification, surgical method, duration of dialysis, duration of surgery, intraoperative blood loss, and postoperative complications. 【Results】Among patients with cervical spine involvement, 13 had des...

  12. Modifiable risk factors for surgical site infection.

    Science.gov (United States)

    Moucha, Calin S; Clyburn, Terry A; Evans, Richard P; Prokuski, Laura

    2011-01-01

    Multiple risk factors for orthopaedic surgical site infection have been identified. Some of these factors directly affect the wound-healing process, whereas others can lead to blood-borne sepsis or relative immunosuppression. Modifying a patient's medications; screening for comorbidities, such as HIV or diabetes mellitus; and advising the patient on options to diminish or eliminate adverse behaviors, such as smoking, should lower the risk for surgical site infections.

  13. A new concept for surgical hand disinfection

    OpenAIRE

    Hübner, NO; Below, H.; Kramer, A.

    2006-01-01

    This paper presents the development of and justification for a different procedure in surgical hand disinfection based on results of our own studies and data from the literature. An overview of the importance of hand disinfection, outstanding persons who substantially contributed to its development, and fundamentals of its implementation are also presented. Focussing on the resident flora as the target of surgical hand disinfection, the microflora of the hand is addressed. Consequences for di...

  14. A new concept for surgical hand disinfection

    OpenAIRE

    Kramer, Axel; Below, Harald; Hübner, Nils-Olaf

    2006-01-01

    This paper presents the development of and justification for a different procedure in surgical hand disinfection based on results of our own studies and data from the literature. An overview of the importance of hand disinfection, outstanding persons who substantially contributed to its development, and fundamentals of its implementation are also presented.Focussing on the resident flora as the target of surgical hand disinfection, the microflora of the hand is addressed. Consequences for dis...

  15. Nursing diagnosis of delayed surgical recovery

    OpenAIRE

    Rosimere Ferreira Santana; Tallita Mello Delphino; Nathalia Martins Henriques; Priscilla Alfradique de Souza; Thais da Silva Soares; Shimmenes Kamacael Pereira

    2014-01-01

    The purpose of this study was to identify and analyze the nursing diagnosis of delayed surgical recovery, its defining characteristics and related factors according to NANDA-I taxonomy, through an integrative review. 34 articles were selected from MEDLINE, CINAHL, LILACS, and BDENF databases. In these, the delayed surgical recovery diagnosis was identified in a study. However, it was possible to identify the defining characteristics: difficulty to move about (36.4%) which requires help to com...

  16. Non-surgical treatment of esophageal achalasia

    Institute of Scientific and Technical Information of China (English)

    Vito Annese; Gabrio Bassotti

    2006-01-01

    Esophageal achalasia is an infrequent motility disorder characterized by a progressive stasis and dilation of the oesophagus; with subsequent risk of aspiration,weight loss, and malnutrition. Although the treatment of achalasia has been traditionally based on a surgical approach, especially with the introduction of laparoscopic techniques, there is still some space for a medical approach. The present article reviews the non-surgical therapeutic options for achalasia.

  17. Surgical management of laryngomalacia: update 2000

    Science.gov (United States)

    Shah, Udayan K.

    2000-05-01

    Laryngomalacia is the most common cause of inspiratory stridor in children. This disease of excess tissue collapse most often does not require surgical correction. Surgery when necessary is best performed with the aid of the carbon dioxide (CO2) laser, delivered through a mirrored-arm micromanipulator- controlled system, while the supraglottis is exposed using a bivalved laryngoscope. This paper reviews the details of surgical technique used for the safe alleviation of airway distress due to larnyngomalacia.

  18. Synthesis and Simulation of Surgical Process Models.

    Science.gov (United States)

    Claude, Guillaume; Gouranton, Valérie; Caillaud, Benoit; Gibaud, Bernard; Arnaldi, Bruno; Jannin, Pierre

    2016-01-01

    Virtual Reality for surgical training is mainly focused on technical surgical skills. We work on providing a novel approach to the use of Virtual Reality focusing on the procedural aspects. Our system relies on a specific work-flow generating a model of the procedure from real case surgery observation in the operating room. This article presents the different technologies created in the context of our project and their relations as other components of our workflow. PMID:27046555

  19. Surgical techniques: past, present and future

    Directory of Open Access Journals (Sweden)

    Karim Qayumi

    2012-04-01

    Full Text Available The aim of this paper is to provide an analytical survey of the information available on the development of past and present surgical techniques, and to make projections for the future. For the purposes of this paper, the Past starts in the Neolithic period and ends in the 1800s. In this context, I have divided the Past into Prehistoric, Ancient and Middle Ages, and this period ends in the second half of the 19th century when the major obstacles to the further development of surgery, such as overcoming pain and infection, were removed. We will discuss the development of surgical techniques, and the obstacles and opportunities prevalent in these periods. In the context of this paper, the Present begins in 1867, when Louis Pasteur discovered microorganisms, and ends in the present day. There have been many important changes in the development of surgical techniques during this period, such as the transfer of surgery from the unsterile operating room to the modern hospital operating theater, the development of advanced and specialized surgical practices, such as transplants and laparoscopy, and minimally invasive surgical methods, robotic and Natural Orifice Transluminal Endoscopic Surgery. It is very difficult to foresee how surgical techniques will develop in the Future because of the unpredictable nature of technological progress. Therefore, in this paper, the forecast for the Future is limited to the next 50- 100 years and is a realistic calculation based on already existing technologies. In this context, the Future is divided into the development of surgical techniques that will develop in the near and distant future. It is anticipated that this overview will shed light on the historical perspective of surgical techniques and stimulate interest in their further development.

  20. Surgical simulation in orthopaedic skills training.

    Science.gov (United States)

    Atesok, Kivanc; Mabrey, Jay D; Jazrawi, Laith M; Egol, Kenneth A

    2012-07-01

    Mastering rapidly evolving orthopaedic surgical techniques requires a lengthy period of training. Current work-hour restrictions and cost pressures force trainees to face the challenge of acquiring more complex surgical skills in a shorter amount of time. As a result, alternative methods to improve the surgical skills of orthopaedic trainees outside the operating room have been developed. These methods include hands-on training in a laboratory setting using synthetic bones or cadaver models as well as software tools and computerized simulators that enable trainees to plan and simulate orthopaedic operations in a three-dimensional virtual environment. Laboratory-based training offers potential benefits in the development of basic surgical skills, such as using surgical tools and implants appropriately, achieving competency in procedures that have a steep learning curve, and assessing already acquired skills while minimizing concerns for patient safety, operating room time, and financial constraints. Current evidence supporting the educational advantages of surgical simulation in orthopaedic skills training is limited. Despite this, positive effects on the overall education of orthopaedic residents, and on maintaining the proficiency of practicing orthopaedic surgeons, are anticipated. PMID:22751160

  1. Hybrid surgical management of a patient with an aneurysm of the arch and descending portion of the right-sided aorta combined with type B dissection and decompensated tracheal stenosis.

    Science.gov (United States)

    Belov, Yu V; Abugov, S A; Komarov, R N; Puretskiĭ, M V; Stepanenko, A B; Stogniĭ, N Yu; Magamadov, Ya U

    2011-01-01

    The right-sided aorta is a rare congenital abnormality of the cardiovascular system encountered in 0.05-0.1% of cases during roentgenological examinations and in 0.04-0.1% of cases of autopsy series. Given utterly low prevalence of this pathology, we considered it wise to present herein our own case report dealing with hybrid surgical management of a patient suffering from an aneurysm of both the arch and descending portion of the right-sided aorta combined with type B dissection thereof and decompensated tracheal stenosis. The first stage of the operation consisted in prosthetic repair of the distal third of the arch and the descending portion of the aorta with the "Vascutek" stent graft 20 mm with type 1 haemodynamical correction (i. e., re-establishing the blood flow into the true channel in the zone of the distal anastomosis) in the conditions of extracorporeal circulation (EC) and bihemispheric antegrade cerebral perfusion ACP, followed by replantation of the left subclavian artery ostium into the left common carotid artery. An aneurysmal growth rate of more than 1 cm a year was considered an absolute indication for the second stage of correction of the aortic pathology concerned. The second stage included stenting of the thoracic portion of the aorta. The TF262C150X Valiant thoracic stent graft was implanted into the area of the distal anastomosis with a conduit, followed by positioning the TF 323C150X Valiant thoracic system inserted into the distal end of the first stent. The use of hybrid techniques (a combination of open and endovascular interventions) predetermined the success of surgical management of the patient presenting with dissection of the right-sided aorta. PMID:22616242

  2. Improving Surgical Access in Rural Africa through a Surgical Camp Model.

    Science.gov (United States)

    Galukande, M; Kituuka, O; Elobu, E; Jombwe, J; Sekabira, J; Butler, Elissa; Faulal, J

    2016-01-01

    Introduction. Surgical camps are preplanned activities where volunteer surgical teams congregate at specified place(s) and perform a wide range of mostly elective procedures for a limited period of time. This is usually at no cost to the patients, who belong to vulnerable (poor and hard to reach) communities. We describe a surgical camp model and its challenges as a means of improving access to surgical services. Methods. A cross-sectional descriptive study. Data from a recent Association of Surgeons of Uganda surgical camp were collected and analyzed for demographics, costs, procedure types, and rates and, in addition, challenges encountered and solutions. Personnel that participated in this exercise included specialist surgeons, surgical residents, medical officers, clinical officers, anesthetists, and theater nurses (a total of 121 staff). Results. In total, 551 procedures were performed during a four-day-long camp. Mean age was 35 years (SD 23), M : F ratio was 2 : 1. Herniorrhaphy, skin lump excision, hydrocelectomy, and thyroidectomy formed 81% of all the procedures. Average cost per procedure was $73 USD. Conclusion. Surgical camps offer increased access to surgical services to vulnerable populations. Hernias and goiters were most common. Surgical camps should become an integral part of the Health Service delivery in low-resourced environments. PMID:27413775

  3. 慢性放射性肠损伤的外科治疗%Outcomes of chronic radiation intestinal injury treated with surgical interventions

    Institute of Scientific and Technical Information of China (English)

    李幼生; 李宁; 李元新; 任建安; 朱维铭; 赵允召; 王剑; 郑磊; 黎介寿

    2012-01-01

    Objective To explore the surgical approaches and clinical outcomes of chronic radiation intestinal injury ( CRII ).Methods From January 1,2001 to December 31,2010,at Department of Surgery,Nanjing General Hospital of Nanjing Command a consecutive series of 206 CRII patients undergoing surgical interventions was reviewed retrospectively.There were 64 males and 142 females with an age range of (50 ± 11 ) years old.The indications,surgical approaches,surgical complications and mortality were analyzed.Results 206 CRII patients received 229 surgical treatment,31 patients underwent two or more operations.The course of surgical interventions included intestinal obstruction ( n =142 ),intestinal fistula (n=56),proctitis (n =12),bleeding (n =6) and others (n =13).They underwent 229 laparotomies including intestinal resection and primary anastomosis (n =142),intestinal resection and enterostomy (n =57),exclusion of radiation-related gastrointestinal diseases ( n =14 ) and other procedures ( n =16).The occurrence rate of postoperative intestinal complications was 25.7% ( 53/206 ).Five patients ( 2.4% ) died within the postoperative 28 days.Conclusion Surgery is often required for patients with chronic radiationinduced intestinal obstruction,fistula,hemorrhage and perforation,etc.Resection and primary anastomosis with undamaged segments may be performed safely in selected patients.And a judicious use of stoma can reduce the rates of major surgical mortality and morbidity.%目的 探讨慢性放射性肠损伤( CRII)外科治疗的方法及临床效果.方法 回顾性总结2001年1月至2010年12月南京军区南京总医院外科连续治疗的206例CRII患者资料.其中男64例,女142例,年龄(50±11)岁.总结手术原因、手术方式、手术并发症及病死率.结果 206例CRII患者手术治疗229次,其中手术≥2次者31例.手术原因为肠梗阻142例次、肠瘘56例次、直肠炎12例次、出血6例次及其他手术13例次.229例次手术包括:

  4. Self-expanding plastic stents for the treatment of post-operative esophago-jejuno anastomosis leak: A case series study Prótesis plástica autoexpandibles para el tratamiento de las fístulas anastomóticas esófago-yeyunales postoperatorias

    Directory of Open Access Journals (Sweden)

    A. Fernández

    2010-12-01

    Full Text Available Objetive: Self-expandable plastic stents (SEPS are increasingly being used for treatment of postoperative esophageal leak. This complication occurs in 4-27% of patients after radical gastrectomy, and has a high mortality rate up to 60%. The aim of this study is to evaluate the efficacy of SEPS (Polyflex® for treatment of post-operative eshopago-jejuno anastomosis leak after radical gastrectomy for gastric cancer. Material and methods: During one year period patients who underwent a radical gastrectomy in our hospital for gastric cancer and developed a postoperative anastomotic leak were prospectively included in the study after signing a consent form, and treated with SEPS placement under endoscopic and fluoroscopic control for leak occlusion. Results: Four patients were included (3 men/1 woman. The mean interval between operation and SEPS placement was 16 days (range: 4-34. SEPS deployment was easily performed in all patients with complete occlusion of esophageal lumen in three patients. In the fourth patient we needed to deploy a second coaxial stent to achieve a complete occlusion of the fistula. SEPS migration did not happen in our series. One patient had already developed a mediastinitis by the time we placed the SEPS and he died 3 days later. Extraction of the SEPS was easily performed 4-8 weeks after deployment. Conclusion: We achieved a complete healing of the anastomotic fistula after radical gastrectomy in 3 out of 4 patients, without major complications related to SEPS. Placement of SEPS is an appealing minimally invasive alternative to surgical repair for patients with postoperative anastomotic leak.

  5. Assessment of Hyperperfusion by Brain Perfusion SPECT in Transient Neurological Deterioration after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis Surgery

    International Nuclear Information System (INIS)

    Transient neurological deterioration (TND) is one of the complications after extracranial-intracranial bypass surgery, and it has been assumed to be caused by postoperative transient hyperperfusion. This study was performed to evaluate the relationship between TND and preoperative and postoperative cerebral perfusion status on brain perfusion SPECT following superficial temporal artery.middle cerebral artery (STA-MCA) anastomosis surgery. A total of 60 STA-MCA anastomosis surgeries of 56 patients (mean age: 50±16 yrs; M:F=29:27; atherosclerotic disease: 33, moyamoya disease: 27) which were done between September 2003 and July 2006 were enrolled. The resting cerebral perfusion and cerebral vascular reserve (CVR) after acetazolamide challenge were measured before and 10 days after surgery using 99mTc-ethylcysteinate dimer (ECD) SPECT. Moreover, the cerebral perfusion was measured on the third postoperative day. With the use of the statistical parametric mapping and probabilistic brain atlas, the counts for the middle cerebral artery (MCA) territory were calculated for each image, and statistical analyses were performed. In 6 of 60 cases (10%), TND occurred after surgery. In all patients, the preoperative cerebral perfusion of affected MCA territory was significantly lower than that of contralateral side (p=0.002). The cerebral perfusion on the third and tenth day after surgery was significantly higher than preoperative cerebral perfusion (p=0.001, p=0.02). In TND patients, basal cerebral perfusion and CVR on preoperative SPECT were significantly lower than those of non-TND patients (p=0.01, p=0.05). Further, the increases in cerebral perfusion on the third day after surgery were significant higher than those in other patients (p=0.008). In patients with TND, the cerebral perfusion ratio of affected side to contralateral side on third postoperative day was significantly higher than that of other patients (p=0.002). However, there was no significant difference of the

  6. Assessment of Hyperperfusion by Brain Perfusion SPECT in Transient Neurological Deterioration after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Won; Kim, Yu Kyeong; Lee, Sang Mi; Eo, Jae Sun; Oh, Chang Wan; Lee, Won Woo; Paeng, Jin Chul; Kim, Sang Eun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2008-08-15

    Transient neurological deterioration (TND) is one of the complications after extracranial-intracranial bypass surgery, and it has been assumed to be caused by postoperative transient hyperperfusion. This study was performed to evaluate the relationship between TND and preoperative and postoperative cerebral perfusion status on brain perfusion SPECT following superficial temporal artery.middle cerebral artery (STA-MCA) anastomosis surgery. A total of 60 STA-MCA anastomosis surgeries of 56 patients (mean age: 50{+-}16 yrs; M:F=29:27; atherosclerotic disease: 33, moyamoya disease: 27) which were done between September 2003 and July 2006 were enrolled. The resting cerebral perfusion and cerebral vascular reserve (CVR) after acetazolamide challenge were measured before and 10 days after surgery using 99mTc-ethylcysteinate dimer (ECD) SPECT. Moreover, the cerebral perfusion was measured on the third postoperative day. With the use of the statistical parametric mapping and probabilistic brain atlas, the counts for the middle cerebral artery (MCA) territory were calculated for each image, and statistical analyses were performed. In 6 of 60 cases (10%), TND occurred after surgery. In all patients, the preoperative cerebral perfusion of affected MCA territory was significantly lower than that of contralateral side (p=0.002). The cerebral perfusion on the third and tenth day after surgery was significantly higher than preoperative cerebral perfusion (p=0.001, p=0.02). In TND patients, basal cerebral perfusion and CVR on preoperative SPECT were significantly lower than those of non-TND patients (p=0.01, p=0.05). Further, the increases in cerebral perfusion on the third day after surgery were significant higher than those in other patients (p=0.008). In patients with TND, the cerebral perfusion ratio of affected side to contralateral side on third postoperative day was significantly higher than that of other patients (p=0.002). However, there was no significant difference of

  7. Hepatobiliary scintigraphy in the assessment of long-term complication after biliary-enteric anastomosis: role in the diagnosis of post-operative segmental or total biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Seung; Moon, Dae Hyuk; Lee, Sung Gyu; Lee, Yung Joo; Park, Kwang Min; Shin, Jung Woo; Ryu, Jin Sook; Lee, Hee Kyung [Asan Medicial Center, Seoul (Korea, Republic of)

    1998-07-01

    The purpose of this study was to investigate the accuracy of hepatobiliary scintigraphy (HBS) in the diagnosis of segmental or total biliary obstruction during long-term follow-up period after curative radical surgery with biliary-enteric anastomosis. The study population included 80 patients who underwent biliary-enteric anastomoses for benign (n=33) or malignant (n=47) biliary disease. Fifty-six of these 80 patients also underwent curative hepatic resection. Ninety eight hepatobiliary scintigrams using {sup 99m}Tc-DISIDA were performed at least 1 month after surgery (median 9 month). The scintigraphic criteria of total biliary obstruction we used were intestinal excretion beyond one hour or delayed hepatobiliary washout despite the presence of intestinal excretion. Segmental biliary obstruction was defined as delayed segmental excretion. The accuracy for biliary obstruction was evaluated according to different clinical situations. There were 9 instances with total biliary obstruction and 23 with segmental bile duct obstruction. Diagnosis of biliary obstruction was confirmed by percutaneous transhepatic cholangiography or surgery in 13, and follow-up clinical data for at least 6 months in 19 instances. Among the 32 instances with biliary symptoms and abnormal liver function, HBS allowed correct diagnosis in all 32(9 total, 14 segmental obstruction and 9 non-obstruction). Of the 40 with nonspecific symptom or isolated elevation of serum alkaline phosphatase, HBS diagnosed 8 of the 9 segmental biliary obstruction and 30 of the 31 non-obstruction. There were no biliary obstruction and no false positive result of scintigraphy in 26 instances which had no clinical symptom or signs of biliary obstruction. Diagnostic sensitivity of HBS was 100% (9/9) for total biliary obstruction, and 96%(22/23) for segmental bile obstruction. Specificity was 98%(39/40) in patients who had abnormal symptom or sign. Hepatobiliary scintigraphy is a highly accurate modality in the

  8. The effect of anastomosis of pancreas and jejunum in the anastomosis of pancreatic duct and jejunum mucosa on postoperative complications after PD%胰腺-空肠套入式吻合与胰管-空肠黏膜吻合对胰十二指肠切除术术后并发症发生情况的影响

    Institute of Scientific and Technical Information of China (English)

    华小斌; 付强; 佘明杰; 徐永建; 房克敬

    2016-01-01

    Objective To investigate the effect of the anastomosis between the pancreatic and jejunum anastomosis and the anasto-mosis of the pancreatic duct jejunum mucosa to the postoperative complications after PD. Methods 60 patients with PD were randomly divid-ed into pancreatic duct and pancreatic duct mucosa group, 30 cases in each group,two groups of patients with PD were operated by the same doctor. To investigate the postoperative complications of the two groups of patients. Results Mortality rate was 2,mortality rate was 6. 67%, mortality rate was 1,mortality rate was 40% in pancreatic duct and mucosa group,mortality was 3. 33%,the incidence rate was 43. 33%. The complication rate was significantly higher than that of pancreatic duct mucosa group (P>0. 05). The incidence rate was 30%. POPF level was significantly higher than that of pancreatic duct and mucosa. The incidence rate was 26. 67%. Logistics regression analysis showed that POPF was significantly associated with sex,pancreatic duct diameter and pathological type. Correlation (P0.05);除胰瘘(POPF)外,胰腺-空肠组的的术后并发症发生率为43.33%,胰管-黏膜组为40.00%,组间比较差异无统计学意义(P>0.05);但胰腺-空肠组的并发症严重程度高于胰管-黏膜组,Ⅲ级以上并发症发生率组间比较差异有统计学意义(P0.05),但胰管-黏膜组POPF的严重程度低于胰腺-空肠组(P<0.05);logistics回归分析发现,POPF与性别、胰管直径以及病理类型具相关性(P<0.05).结论 除胰管较细患者建议行胰腺-空肠套入式吻合外,胰管-空肠黏膜吻合在PD手术中可最大程度降低PD术后并发症.

  9. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

    OpenAIRE

    Damstra, R. J.; Voesten, H. G. J.; Schelven, W. D.; Lei, B.

    2008-01-01

    Abstract Objective The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic, this study was undertaken to prospectively determine the effect of Lympho Venous Anastomosis (LVA) on BCRL and to review the current lit...

  10. The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitisA and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitisB in perforated diverticulitis (NTR2037

    Directory of Open Access Journals (Sweden)

    Bruin Sjoerd C

    2010-10-01

    Full Text Available Abstract Background Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy. The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective treatment for patients with purulent peritonitis (LOLA-arm and to determine the optimal resectional strategy in patients with a purulent or faecal peritonitis (DIVA-arm: perforated DIVerticulitis: sigmoidresection with or without Anastomosis. Methods/Design In this multicentre randomised trial all patients with perforated diverticulitis are included. Upon laparoscopy, patients with purulent peritonitis are treated with laparoscopic lavage and drainage, Hartmann's procedure or sigmoidectomy with primary anastomosis in a ratio of 2:1:1 (LOLA-arm. Patients with faecal peritonitis will be randomised 1:1 between Hartmann's procedure and resection with primary anastomosis (DIVA-arm. The primary combined endpoint of the LOLA-arm is major morbidity and mortality. A sample size of 132:66:66 patients will be able to detect a difference in the primary endpoint from 25% in resectional groups compared to 10% in the laparoscopic lavage group (two sided alpha = 5%, power = 90%. Endpoint of the DIVA-arm is stoma free survival one year after initial surgery. In this arm 212 patients are needed to significantly demonstrate a difference of 30% (log rank test two sided alpha = 5% and power = 90% in favour of the patients with resection with primary anastomosis. Secondary endpoints for both arms are the number of days alive and outside the hospital, health related quality of life, health care utilisation and associated costs. Discussion The Ladies trial is a nationwide multicentre randomised trial on perforated diverticulitis that will provide evidence on the merits of laparoscopic lavage and drainage for purulent generalised peritonitis and on the optimal resectional strategy

  11. Characterization of aerosols produced by surgical procedures

    Energy Technology Data Exchange (ETDEWEB)

    Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K. [Inhalation Toxicology Research Institute, Albuquerque, NM (United States); Turner, R.S. [Lovelace Health Systems, Albuquerque, NM (United States)

    1994-07-01

    In many surgeries, especially orthopedic procedures, power tools such as saws and drills are used. These tools may produce aerosolized blood and other biological material from bone and soft tissues. Surgical lasers and electrocautery tools can also produce aerosols when tissues are vaporized and condensed. Studies have been reported in the literature concerning production of aerosols during surgery, and some of these aerosols may contain infectious material. Garden et al. (1988) reported the presence of papilloma virus DNA in the fumes produced from laser surgery, but the infectivity of the aerosol was not assessed. Moon and Nininger (1989) measured the size distribution and production rate of emissions from laser surgery and found that particles were generally less than 0.5 {mu}m diameter. More recently there has been concern expressed over the production of aerosolized blood during surgical procedures that require power tools. In an in vitro study, the production of an aerosol containing the human immunodeficiency virus (HIV) was reported when power tools were used to cut tissues with blood infected with HIV. Another study measured the size distribution of blood aerosols produced by surgical power tools and found blood-containing particles in a number of size ranges. Health care workers are anxious and concerned about whether surgically produced aerosols are inspirable and can contain viable pathogens such as HIV. Other pathogens such as hepatitis B virus (HBV) are also of concern. The Occupational Safety and Health funded a project at the National Institute for Inhalation Toxicology Research Institute to assess the extent of aerosolization of blood and other tissues during surgical procedures. This document reports details of the experimental and sampling approach, methods, analyses, and results on potential production of blood-associated aerosols from surgical procedures in the laboratory and in the hospital surgical suite.

  12. 21 CFR 880.2740 - Surgical sponge scale.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgical sponge scale. 880.2740 Section 880.2740... Devices § 880.2740 Surgical sponge scale. (a) Identification. A surgical sponge scale is a nonelectrically powered device used to weigh surgical sponges that have been used to absorb blood during surgery so...

  13. 21 CFR 878.4160 - Surgical camera and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgical camera and accessories. 878.4160 Section... (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4160 Surgical camera and accessories. (a) Identification. A surgical camera and accessories is a device intended to be...

  14. 21 CFR 886.4570 - Ophthalmic surgical marker.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ophthalmic surgical marker. 886.4570 Section 886...) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4570 Ophthalmic surgical marker. (a) Identification. An ophthalmic surgical marker is a device intended to mark by use of ink, dye, or indentation...

  15. Usefulness of color and pulsed Doppler's in the evaluation of surgical portosystemic shunts in pediatric patients; Utilidad del Doppler color y pulsado en la valoracion de los shunts portosistemicos quirurgicos en la edad pediatrica

    Energy Technology Data Exchange (ETDEWEB)

    Berrocal, T.; Prieto, C.; Cortes, P.; Rodriguez, R.; Pastor, I. [Hospital Universitario La Paz. Madrid (Spain)

    2003-07-01

    Portosystemic shunts are performed to relieve symptomatic portal hypertension symptomatic or removal pressure in hepatic vascularisation in patients with Budd-Chiari's syndrome. Most surgical portosystemic shunts can be suitably studied by means of ultrasound scan complemented by color and pulsed Dopplers, proved one understands the hemodynamics of the surgical procedures involved. This article demonstrates the usefulness and limitations of the ultrasound scan Duplex Doppler in the evaluation of portosystemic shunts performed on pediatric patients. Pulsed Doppler provides information regarding the nature and direction of blood flow. Color doppler is capable of directly revealing the shunt and, in most cases, permits the anastomosis to be located. The types of shunts that appear include proximal and distal spleno-renal, portocaval and mesocaval. Types of vascular connections are illustrated,s well as expected post-surgical blood flow direction in affected vessels. The ultrasound scanning technique is discussed, as well as the criteria for determining vascular permeability. Also highlighted are the advantages, limitations and diagnostic difficulties associated with the different forms of Doppler. (Author) 17 refs.

  16. Comparison of surgical hand scrub and alcohol surgical hand rub on reducing hand microbial burden.

    Science.gov (United States)

    Ghorbani, Azam; Shahrokhi, Akram; Soltani, Zahra; Molapour, Azam; Shafikhani, Mahin

    2012-02-01

    This study was performed to compare the effects of two hand decontamination methods on the microbial burden of operating room staff hands. The surgical hand washing methods compared were a traditional surgical hand scrub using a povidone iodine solution, and a social wash using a liquid non-antibacterial soap followed by the application of an alcoholic hand rub. PMID:22724306

  17. Occurrence and prevention of surgical adverse events for quality improvement of surgical care.

    NARCIS (Netherlands)

    Zegers, M.; Bruijne, M.C. de; Wagner, C.; Groenewegen, P.P.; Wal, G. van der

    2008-01-01

    Objective: To assess the occurrence, impact, type of adverse outcomes, causes and preventability of surgical adverse events (AEs) among hospitalised patients for quality improvement of surgical care. Methods: A retrospective patient records review study was performed in a random sample of 7926 patie

  18. Surgical site markers: potential source of infection.

    Science.gov (United States)

    Driessche, Ann Marie

    2012-01-01

    Observing licensed independent practitioners mark surgical sites with all types of marking pens is a concern related to the potential spread of infections from patient to patient. The practice of using the same marking pen to mark a surgical site has been questioned as a source of cross contamination. A literature review was done on recent studies and best practice recommendations to determine whether marking pens can act as fomites for nosocomial infections. The review indicated that surgical site markers, ink pens, and aging permanent marking pens can be a source for cross-infection with methicillin-resistant Staphylococcus aureus, other bacteria, fungus, or virus. The type of marking pens used and the act of using the same marking pen from patient to patient could contribute to nosocomial infections. The literature reviewed recommends a single time use of a surgical marking pen. Interventions to prevent cross contamination and postoperative surgical site infections are a major concern in the care of the orthopaedic patient.

  19. Surgical treatment for complex acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    LIU Qiang; WU Dou; LI Ping; HAN Shu-feng

    2006-01-01

    Objective: To explore the effect of surgical treatment on complex acetabular fractures.Methods: The data of 46 patients (38 males and 8 females, aged 16-75 years, mean = 38. 5 years ) with complex acetabular fractures, who were admitted to our hospital from January 1998 to December 2005, were analyzed retrospectively in this study. According to Letournel rules, posterior wall and posterior column fractures were found in 11 patients, transverse and posterior wall fractures in 13, T-type fracture in 4, both columns fracture in 10, and anterior column and posterior transverse fracture in 8. The choice of surgical approach was based on the individual fractures, which included ilioinguinal approach in 5 patients, Kocher-Langenbech approach in 7, combined approach in 26, and extended iliofemoral approach in 8.Results: All the patients were followed up for 3.5 years averagely. The clinical outcomes were analyzed with Harris hip score and radiography. In 36 patients (78.3%), the surgical procedure was successful (Harris hip score > 80 points). The rate of excellent and good was about 86 %.Conclusions: The keys to increase the effectiveness of surgical treatment on acetabular fractures are correct preoperative classification of factures and choices of appropriate surgical approach and time.

  20. Surgical acute abdomen in elderly patients.

    Directory of Open Access Journals (Sweden)

    Itengré Ouédraogo

    2004-08-01

    Full Text Available Fundaments : The surgical acute abdomen usually is the most frequent cause of abdominal surgery of urgency in t he old one, with the high mortality in spite of the modern surgical technologies. Objective: To evaluate the surgery of the surgical acute abdomen in the old one. Method: Appears a prospectivo descriptive study that includes 102 patients of 60 years or more who underwent surgery at the ¨Dr Gustavo Aldereguía Lima¨ University Hospital of Cienfuegos with this diagnostic. The primary data were obtained from clinical cards of the patients and the daily clinical observation until the debit. Results: The patients presented an average age of 74 years, being the most frequent causes of the syndrome intestinal obstruction (32,4%, the biliary tract affections (22,5%, and acute appendicitis (21,6%. The most frequent symptom was abdominal pain (96,08%, and we noticed tachycardia in 80,4%. Postoperating complications in 47,06% of the patients appeared and was observed a mortality of 26,5% with statistically significant relation with the age, ASA classification, surgical risk, time of evolution and the surgical time. The peritonitis heads the direct causes of death.