scholarly journals Pancreatico-Gastric Anastomosis with and without Sutures – Experimental Swine Model

2015 ◽  
Vol 61 (2) ◽  
pp. 105-109
Author(s):  
A Tudor ◽  
C Molnar ◽  
C Copotoiu ◽  
VO Butiurca ◽  
C Nicolescu ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Coagulation Necrosis ◽  
Swine Model ◽  
Purse String Suture ◽  
Purse String ◽  
Pancreatic Stump ◽  
Surgical Technical ◽  
Pancreatic Fistulas ◽  
Gastric Anastomosis ◽  
Seromuscular Layer

Abstract Objectives. The aim of our study is to identify a surgical technical that has the lowest rate of pancreatic fistulas in pancreatico-gastric anastomosis following duodenopancreatectomies. We studied pancreatico-gastric anastomosis performed with stitches compared to the ones performed without stitches. Methods. Our experimental model is based on ten piglets, which were divided into 2 groups. In the first group (n=5) the pancreatico-gastric anastomosis was done using double purse-string threads one passed through the gastric seromuscular layer and one through the gastric mucosa. In the second group (n=5) the pancreatico-gastric anastomosis was performed using sutures through the stomach and pancreas. Results. Postoperative amylasemia was higher in the second group. In the first group no pancreatico-gastric fistulas were observed, whereas pancreatic necrosis was observed only at a superficial level of the pancreatic stump. In the second group, two cases had developed fistulas, both bordered by large areas of coagulation necrosis accompanied by pancreatic duct hyperplasia. Duration of the anastomosis was shorter for the first group. Conclusions. In conclusion, the pancreatico-gastric anastomosis performed using two purse-string suture is a feasible, safe and fast process.

scholarly journals Pancreatico-gastric Anastomosis Following Cephalic Duodenopancreatectomy: New Perspectives

2015 ◽  
Vol 61 (3) ◽  
pp. 172-175
Author(s):  
A Tudor ◽  
VO Butiurca ◽  
C Nicolescu ◽  
Bianca Tudor ◽  
Simona Gurzu ◽  
...  
Keyword(s):  
Biliary Fistula ◽  
Type B ◽  
Fast Process ◽  
Purse String Suture ◽  
Purse String ◽  
Pancreatic Anastomosis ◽  
Group 3 ◽  
Group 2 ◽  
Gastric Anastomosis ◽  
Group 1

Abstract Introduction. Although in recent years there have been various versions of pancreatic - digestive reconstruction after cephalic duodenopancreatectomy, this issue is still highly debated. Purpose. This paper aims at comparing postoperative outcomes after gastric pancreatic anastomosis using transfixing threads as opposed to the purse-string suture method. Material and methods. Our study consisted of a lot of 15 patients that underwent cephalic duodenopancreatectomy from the 1th of May 2014 to the 30th of April 2015. The pancreatico - digestive reconstruction was done by pancreatico-gastric anastomosis using three different techniques: double purse-string suture used for the patients in the first group (group 1, n = 5 patients); one purse-string suture and 2 transfixing “U-sutures” passed through the stomach and the pancreas for the patients in the second group (group 2, n = 5 patients) and ductomucosa anastomosis with pancreatico-gastric transfixing threads in the third group (group 3, n = 5 patients). Results. Morbidity was 40% for the entire lot. Pancreatic fistula, occurred in two patients, one type A fistula in a patient in group 2 and one type B fistula in a patient in group 3. Biliary fistula occurred in one patient in group 2. Mortality was at 13.3%. The median time to carry out the anastomosis in group 1 was 14 minutes, for patients in group 2, 20 minutes, and for patients in group 3, 25 minutes. Conclusions. Gastric pancreatic anastomosis using purse-string sutures is a feasible, safe and fast process which reduces complications due to transfixing pancreatic threads.

scholarly journals Distal purse-string suture technique for TaTME

2018 ◽  
Vol 23 (1) ◽  
pp. 67-68 ◽  
Author(s):  
R. Wu ◽  
R. Benedict ◽  
A. Caycedo-Marulanda
Keyword(s):  
Suture Technique ◽  
Purse String Suture ◽  
Purse String

The usefulness and feasibility of placing a clinch knot with a guidewire to achieve temporary hemostasis in arteriovenous dialysis access interventions

2020 ◽  
pp. 112972982095474
Author(s):  
Sung-Joon Park ◽  
Hwan Hoon Chung ◽  
Seung Hwa Lee ◽  
Sung Beom Cho ◽  
Tae-Seok Seo ◽  
...  
Keyword(s):  
Clinical Success ◽  
Primary Patency ◽  
Interventional Treatment ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
Purse String Suture ◽  
Purse String ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

Pancreaticogastrostomy after Pancreaticoduodenectomy Using Twin Square Wrapping with Duct-to-Mucosa Anastomosis

2015 ◽  
Vol 55 (1-2) ◽  
pp. 109-118 ◽  
Author(s):  
Kosei Maemura ◽  
Yuko Mataki ◽  
Hiroshi Kurahara ◽  
Shinichiro Mori ◽  
Naotomo Higo ◽  
...  
Keyword(s):  
Operating Time ◽  
Conventional Group ◽  
C Reactive Protein ◽  
Pancreatic Anastomosis ◽  
Pancreatic Stump ◽  
Reactive Protein ◽  
Significant Difference ◽  
Pancreatic Fistulas ◽  
Hospital Stays ◽  
Blood Loss Volume

Background/Purpose: This study aimed to evaluate the feasibility and safety of a novel pancreaticogastrostomy technique for diminishing pancreatic fistulas after pancreaticoduodenectomy using gastric wrapping of the pancreatic stump with a twin square-shaped horizontal mattress and a suture fixing the main pancreatic duct to the gastric mucosa anastomosis [twin square wrapping (TSW) method]. Methods: Fifty-three patients undergoing pancreaticogastrostomy after pancreaticoduodenectomy were included in the study and chronologically divided into a conventional group (n = 32) and a TSW group (n = 21). The perioperative factors and the postoperative outcomes were retrospectively analyzed. Results: The operating time for the pancreatic anastomosis, the total operating time, and the blood loss volume in the TSW group were lower than in the conventional group, but without a statistically significant difference. The TSW group had a significantly lower postoperative white blood cell count and C-reactive protein level, with a reduced intra-abdominal fluid accumulation as assessed by computed tomography on postoperative day 7, had a lower incidence of postoperative complications and pancreatic fistulas, and achieved a shorter duration of drain placement and shorter postoperative hospital stays as compared to the conventional group. Conclusions: The TSW technique should be considered for reducing pancreatic fistulas by diminishing the postoperative inflammatory response and improving patient outcomes without increasing the operating time.

scholarly journals Reconstruction of Areolar Projection Using a Purse-String Suture Technique

2015 ◽  
Vol 3 (7) ◽  
pp. e453 ◽  
Author(s):  
Stephanie A. Caterson ◽  
Mansher Singh ◽  
Simon G. Talbot ◽  
Elof Eriksson
Keyword(s):  
Suture Technique ◽  
Purse String Suture ◽  
Purse String

scholarly journals Intraoperative Visualization of Pancreatic Juice Leaking From the Pancreatic Stump in a Swine Model

2015 ◽  
Vol 149 (6) ◽  
pp. 1334-1336 ◽  
Author(s):  
Kazuhiro Mori ◽  
Takeaki Ishizawa ◽  
Suguru Yamashita ◽  
Mako Kamiya ◽  
Yasuteru Urano ◽  
...  
Keyword(s):  
Pancreatic Juice ◽  
Swine Model ◽  
Pancreatic Stump ◽  
Intraoperative Visualization

Comparison of three purse-string suture techniques for prevention of anal leakage during surgery

2021 ◽  
pp. 1-5
Author(s):  
Jo Anne Au Yong ◽  
Daniel D. Smeak
Keyword(s):  
Clinical Relevance ◽  
Suture Technique ◽  
Suture Techniques ◽  
Leak Pressure ◽  
Purse String Suture ◽  
Purse String ◽  
Pressure Testing ◽  
Nylon Suture ◽  
Cutaneous Tissue ◽  
Suture Placement

Abstract OBJECTIVE To compare 3 anal purse-string suture techniques for resistance to leakage and to identify the suture technique requiring the fewest tissue bites to create a consistent leak-proof orifice closure. ANIMALS 18 large-breed canine cadavers. PROCEDURES 3 purse-string suture techniques (3 bites with 0.5 cm between bites [technique A], 5 bites with 0.5 cm between bites [technique B], and 3 bites with 1.0 cm between bites [technique C]) were evaluated. Each technique involved 2-0 monofilament nylon suture that was placed in the cutaneous tissue around the anus and knotted with 6 square throws. Standardized 2.0-cm-diameter circular templates with the designated bite number and spacing indicated were used for suture placement. Leak-pressure testing was performed, and the pressure at which saline was first observed leaking from the anus was recorded. The median and interquartile (25th to 75th percentile) range (IQR) were compared among 3 techniques. RESULTS Median leak pressure for technique A (101 mm Hg; IQR, 35 to 131.3 mm Hg) was significantly greater than that for technique C (19 mm Hg; IQR, 14.3 to 25.3 mm Hg). Median pressure did not differ between techniques A and B (50 mm Hg; IQR, 32.5 to 65 mm Hg) or between techniques B and C. CLINICAL RELEVANCE Placement of an anal purse-string suture prevented leakage at physiologic colonic and rectal pressures, regardless of technique. Placement of 3 bites 0.5 cm apart (technique A) is recommended because it used the fewest number of bites and had the highest resistance to leakage.

Modified Intrathoracic Esophagogastrostomy with Minimally Invasive Robot-Assisted Ivor-Lewis Esophagectomy for Cancer

2018 ◽  
Vol 36 (3) ◽  
pp. 218-225 ◽  
Author(s):  
Wen-Ping Wang ◽  
Long-Qi Chen ◽  
Han-Lu Zhang ◽  
Yu-Shang Yang ◽  
Song-Lin He ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Circular Stapler ◽  
Purse String Suture ◽  
Robot Assisted ◽  
Purse String ◽  
Ivor Lewis ◽  
Intrathoracic Anastomosis ◽  
Ivor Lewis Esophagectomy ◽  
Estimated Blood Loss ◽  
Esophagectomy For Cancer

Background: Intrathoracic esophagogastrostomy plays an important role in minimally invasive Ivor-Lewis esophagectomy for cancer. Intrathoracic anastomosis with robot-assisted Ivor-Lewis esophagectomy (RAILE) includes hand-sewn and circular stapler methods, which remain technically challenging. In this study, we modified the techniques for intrathoracic anastomosis at RAILE, in order to simplify the complex procedures. Methods: “Side-insertion” technique was used for anvil placement and purse string suture for intrathoracic anastomosis at RAILE. Medical records for consecutive patients who had undergone robot-assisted minimally invasive Ivor-Lewis esophagectomy for cancer between January 2015 and June 2018 were analyzed. Results: A total of consecutive 31 patients were enrolled. There was no conversion to open thoracotomy in this cohort. Mean operation duration in the robotic group was 387.4 ± 68.2 min. Median estimated blood loss was 110 mL (range 50–400 mL). Two patients (6.5%) had postoperative anastomotic leak. No postoperative reoperation was needed and there were no mortality. Six patients (19.4%) had anastomotic stricture and 2 patients of them needed endoscopic dilation. Conclusion: RAILE is safe and feasible. Our modified procedure highlighting the “side-insertion” method may simplify the process of intrathoracic anvil placement and purse string suture for anastomosis at RAILE.

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