scholarly journals Comparison of two end-to-end continuous sutures for intestinal anastomoses in dogs.

2021 ◽  
Author(s):  
CORNEL IGNA ◽  
ROXANA DASCALU ◽  
BOGDAN SICOE ◽  
CRISTIAN ZAHA ◽  
ILEANA BRUDIU ◽  
...  
Keyword(s):  
Intestinal Anastomosis ◽  
Intestinal Resection ◽  
Intestinal Lumen ◽  
Complication Rates ◽  
Continuous Suture ◽  
Intestinal Anastomoses ◽  
Equilibrium Angle ◽  
Anastomosis Site ◽  
End To End ◽  
Clinical Cases

Abstract Background: Single-layer appositional closures are preferred to inverting or everting patterns, as submucosal apposition has been shown to promote primary healing of the intestinal wall, whereas inverted or everted closures require second-intention healing and can increase the risk of luminal stenosis or anastomosis site leakage. There are different suture patterns available, but relatively few studies comparing these aspects have been published.The aim of this study was to compare two suture techniques for end-to-end anastomosis of the canine intestine (jejunum and colon): handsewn intestinal anastomosis by appositional simple continuous suture and inverting Cushing suture. The objectives of this study were to investigate 1.) whether the type of suture influences the specific effort to which the anastomosis site is submitted to, 2.) whether the anastomosis technique influences the diameter of the intestinal lumen and 3.) survival and complication rates in canine clinical cases undergoing end-to-end anastomoses. Results: The equilibrium angle for implanting the sutures in an anastomosis is 35°, aspect completely fulfilled by the simple continuous suture. The efforts to which sutures are submitted to in anastomoses are minimal for the Cushing suture. The difference in size of the anastomoses’ lumen between simple continuous suture and the Cushing suture are minimal, without being statistically relevant. The differences between the lumen of the anastomoses performed using PDS and those performed using PGA are not statistically relevant. The retrospective analysis of the outcome for 676 dogs (clinical cases) that underwent intestinal resection and anastomosis reveals that the dehiscence rate was 1.48%, out of which 1.18% following simple continuous anastomoses, and 0.3% following Cushing anastomoses. Narrowing of the intestinal lumen due to anastomotic healing was not registered.Conclusions: Use of the Cushing suture should be considered for performing an end-to-end intestinal anastomosis, although more studies are required to determine if there are any clinically significant differences between the sutures investigated in this study.

Intestinal Anastomosis

2015 ◽  
Author(s):  
Neil J. Mortensen ◽  
Shazad Ashraf
Keyword(s):  
Double Layer ◽  
Bowel Obstruction ◽  
Intestinal Anastomosis ◽  
Anastomotic Healing ◽  
Cancer Trial ◽  
Defunctioning Stoma ◽  
Intestinal Anastomoses ◽  
Increased Risk ◽  
Mechanical Bowel Obstruction ◽  
End To End

The creation of a join between two bowel ends is an operative procedure that is of central importance in the practice of a general surgeon. Leakage from an intestinal anastomosis can be disastrous, resulting in prolonged hospital stays and increased risk of mortality. To minimize the risk of potential complications, it is important to create a tension-free join with good apposition of the bowel edges in the presence of an excellent blood supply. This review discusses the factors that influence intestinal anastomotic healing, the various technical operations for creating anastomoses, and operative techniques currently used in constructing anastomoses. Tables review the principles of successful intestinal anastomosis, consequences of postoperative dehiscence, factors linked with dehiscence, anastomotic techniques ranked by best blood flow to the healing site, comparison of hand and stapled techniques, leak rates from the Rectal Cancer Trial on Defunctioning Stoma and the Contant and colleagues mechanical bowel obstruction trial, leak and wound infection rates from mechanical bowel obstruction meta-analyses, diseases and systemic factors associated with poor anastomotic healing, lifestyle-associated leakage rates, salvage after anastomotic leakage, standard checks for creation of anastomoses, and steps for left-sided stapled colorectal anastomoses for cancer. Figures show the phases of wound healing, the tissue layers of the jejunum, interrupted and continuous suture techniques, stitches commonly used in fashioning intestinal anastomoses, double-layer end-to-end anastomosis, traction sutures, anatomic relations between the colon and the retroperitoneal organs, single-layer sutured side-to-side enteroenterostomy, Finney strictureplasty, double-layer sutured end-to-side enterocolostomy, double-stapled end-to-end coloanal anastomosis, use of a “glove” port in laparoscopic surgery, and perfusion assessment at the time of anastomotic creation. This review contains 14 figures, 13 tables, and 85 references.

scholarly journals Single layer versus double layer intestinal anastomoses: a comparative study

2020 ◽  
Vol 7 (9) ◽  
pp. 2991
Author(s):  
Ajit Kumar ◽  
Vinod Kumar
Keyword(s):  
Comparative Study ◽  
Anastomotic Leak ◽  
Double Layer ◽  
Intestinal Anastomosis ◽  
Single Layer ◽  
Anastomosis Group ◽  
Layer Versus ◽  
Intestinal Anastomoses ◽  
Significant Difference ◽  
End To End

Background: There are still conflicting views regarding suitability of single layer and double layer anastomotic technique. This prospective single blinded randomized comparative study conducted at Rajendra Institute of Medical Sciences to assess various aspects viz. safety, efficacy, duration of hospital stays and chances of perforation in single- and double-layer anastomotic surgery.Methods: 26 patients each in single layer and double layer anastomosis group were included in the study.  Single layer intestinal anastomosis was carried using extramucosal technique with 2-0 vicryl suture (round body). Double layer anastomosis was carried out using interrupted 3-0 silk lembert sutures for the outer layer and a continuous 2-0 vicryl for the inner layer. End to end colocolic, end to end ileocolic, end to side ileocolic, end to end ileoileal, side to side ileoileal, end to end jejunoileal and end to end jejunojejunal anastomosis were performed. Each group was compared for anastomotic leak, time required to construct the anastomosis, cost incurred, and length of hospital stay.Results: Findings of the study indicated that single layer is economical in comparison to double layer anastomosis and took significant less time to operate. There was no significant difference in hospital stay of the patients in two groups. There was no anastomotic leak in group-S (single layer) while one (3.8%) patient in group-D (double layer) suffered from anastomotic leak.Conclusions: It was concluded that single layer anastomosis method is beneficial and safe as it required less operative time, suturing material and no leak took place after surgery.

Use of indocianine green fluorescence in acute mesenteric ischemia

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Jaime Bonnín-Pascual
Keyword(s):  
Indocyanine Green ◽  
Terminal Ileum ◽  
Mesenteric Ischemia ◽  
Intestinal Anastomosis ◽  
Acute Mesenteric Ischemia ◽  
Left Colon ◽  
Infrared Light ◽  
High Morbidity ◽  
Green Fluorescence ◽  
Clinical Cases

Introduction: Acute mesenteric ischemia has a high morbidity and mortality and constitutes an intraoperative challenge in the management of ischemic areas. In this context, we analyze the use of indocyanine green fluorescence to assess intestinal vascularization through 3 clinical cases. Case presentation: we present 3 clinical cases operated for acute mesenteric ischemia. Evaluation of intestinal viability is performed under infrared light after intravenous infusion of 25 mg of indocyanine green. Case 1 is a 42-year-old male with multiple antecedents of severe vascular disease, presenting with a massive acute mesenteric ischemia involving multiple intestinal segments. Fluorescence allows two adjusted bowel resections with double intestinal anastomosis. Case 2 is a 74-year-old woman with a history of non-anticoagulated atrial fibrillation who is decided to perform an urgent surgery when an esophageal, gastric and portal system pneumatosis is observed, as indirect signs of ischemia, in urgent CT. During the surgical act there is an ischemia of the terminal ileum and right colon without clear signs of involvement at the esophageal-gastric level. The assessment after administration of ICG discriminates the clear ischemic involvement from terminal ileum to ascending colon and patched in the transverse and left colon, without esophageal or gastric involvement. Case 3 is a 49-year-old woman with aortoiliac and visceral Takayasu disease and revascularization surgery of the celiac trunk. Given the increase in abdominal pain, a new CT scan demonstrates colonic pneumatosis. Urgent laparotomy shows necrosis at the level of the left colon and hypoperfusion of the cecum. The administration of ICG finds a lack of uptake of the entire colon. A subtotal colectomy with ileostomy and mucous fistula is performed. Introduction: Acute mesenteric ischemia has a high morbidity and mortality and constitutes an intraoperative challenge in the management of ischemic areas. In this context, we analyze the use of indocyanine green fluorescence to assess intestinal vascularization through 3 clinical cases. Case presentation: we present 3 clinical cases operated for acute mesenteric ischemia. Evaluation of intestinal viability is performed under infrared light after intravenous infusion of 25 mg of indocyanine green. Case 1 is a 42-year-old male with multiple antecedents of severe vascular disease, presenting with a massive acute mesenteric ischemia involving multiple intestinal segments. Fluorescence allows two adjusted bowel resections with double intestinal anastomosis. Case 2 is a 74-year-old woman with a history of non-anticoagulated atrial fibrillation who is decided to perform an urgent surgery when an esophageal, gastric and portal system pneumatosis is observed, as indirect signs of ischemia, in urgent CT. During the surgical act there is an ischemia of the terminal ileum and right colon without clear signs of involvement at the esophageal-gastric level. The assessment after administration of ICG discriminates the clear ischemic involvement from terminal ileum to ascending colon and patched in the transverse and left colon, without esophageal or gastric involvement. Case 3 is a 49-year-old woman with aortoiliac and visceral Takayasu disease and revascularization surgery of the celiac trunk. Given the increase in abdominal pain, a new CT scan demonstrates colonic pneumatosis. Urgent laparotomy shows necrosis at the level of the left colon and hypoperfusion of the cecum. The administration of ICG finds a lack of uptake of the entire colon. A subtotal colectomy with ileostomy and mucous fistula is performed. Conclusions: The fluorescence with ICG provides a better visualization of the intestinal vascularization in the AMI, and allows to determine the limits of the affected tissue to perform adjusted resections.

scholarly journals An Integrated Framework Based on Full Monte Carlo Simulations for Double-Scattering Proton Therapy

2019 ◽  
Vol 6 (2) ◽  
pp. 31-41
Author(s):  
Jiankui Yuan ◽  
David Mansur ◽  
Min Yao ◽  
Tithi Biswas ◽  
Yiran Zheng ◽  
...  
Keyword(s):  
Monte Carlo ◽  
Proton Therapy ◽  
Treatment Plan ◽  
Planning System ◽  
Treatment Planning System ◽  
Patient Specific ◽  
Double Scattering ◽  
Integrated Framework ◽  
End To End ◽  
Clinical Cases

ABSTRACT Purpose: We developed an integrated framework that employs a full Monte Carlo (MC) model for treatment-plan simulations of a passive double-scattering proton system. Materials and Methods: We have previously validated a virtual machine source model for full MC proton-dose calculations by comparing the percentage of depth-dose curves, spread-out Bragg peaks, and lateral profiles against measured commissioning data. This study further expanded our previous work by developing an integrate framework that facilitates its clinical use. Specifically, we have (1) constructed patient-specific applicator and compensator numerically from the plan data and incorporated them into the beamline, (2) created the patient anatomy from the computed tomography image and established the transformation between patient and machine coordinate systems, and (3) developed a graphical user interface to ease the whole process from importing the treatment plan in the Digital Imaging and Communications in Medicine format to parallelization of the MC calculations. End-to-end tests were performed to validate the functionality, and 3 clinical cases were used to demonstrate clinical utility of the framework. Results: The end-to-end tests demonstrated that the framework functioned correctly for all tested functionality. Comparisons between the treatment planning system calculations and MC results in 3 clinical cases revealed large dose difference up to 17%, especially in the beam penumbra and near the end of beam range. The discrepancy likely originates from a variety of sources, such as the dose algorithms, modeling of the beamline, and the dose metric. The agreement for other regions was acceptable. Conclusion: An integrated framework was developed for full MC simulations of double-scattering proton therapy. It can be a valuable tool for dose verification and plan evaluation.

THE USE OF BIOTECHNOLOGY IN THE PREVENTION OF FAILURE IN THE IMPOSITION OF SMALL INTESTINAL ANASTOMOSES IN THE EXPERIMENT

2020 ◽  
pp. 87-91
Author(s):  
M. Tymchenko ◽  
Yu. Ivanova ◽  
V. Padalko ◽  
H. Sheremet ◽  
O. Kozlova ◽  
...  
Keyword(s):  
Mucous Membrane ◽  
Intestinal Mucosa ◽  
Intestinal Anastomosis ◽  
Experimental Studies ◽  
Operating Conditions ◽  
Laboratory Animals ◽  
Control Group ◽  
Intestinal Anastomoses ◽  
Series Of Experiments ◽  
Immunohistochemical Studies

Summary. The aimof the study is to develop a method of sealing the sutured of the small intestine anastomosis in conditions of high risk anastomosis leakege by stopping the inflammation’ cascade in experiment. Materials and methods.The work was experimental in nature, was performed in the SI «ZIGUS NAMSU» in collaboration with the Scientific Research Institute of Biology V. N. Karazin KhNU in the period from 2018 to 2019. To increase the tightness of the intestinal anastomoses applied under conditions of laparatomy, experimental studies were conducted on laboratory animals. The studies were carried out after the permission of the ethics committee SI «ZIGUS NAMSU» in compliance with all ethical requirements for the humane treatment of animals.Surgical operations in two series of experiments were performed under operating conditions under general anesthesia on 10 white sexually mature linear rats – Wistar males, 12-18 months old, weighing about 250 grams. All morphological material (the first and second series of experiments) was marked and fixed in a 10% solution of neutral formalin. Subsequently, paraffin sections were prepared according to the generally accepted histotechnical method and stained with hematoxylin - eosin; according to Van Gieson and Mallory, an immunohistochemical study was used to study microenvironment factors. Results and Discussion. Immunohistochemical examination of the intestine was carried out in several stages, at the first stage we took intestinal tissue during the surgery to form the intestinal anastomosis, before the introduction of allogeneic cell transplants. Also carried out immunohistochemical studies of the emerging mucous membrane at various times after the formation of insolvency of intestinal anastomoses in both studied groups. When using a cell allograft, the mechanisms of repair of the intestinal mucosa include the appearance of cells that carry the expression of markers of mesenchymal and epithelial differentiation (Vim, CD34, CKW, Ecad), and are usually localized in the walls of blood vessels of granulation tissue, as well as in areas of the repairing epithelium. In addition, in the main group, only 7 days after the reaction to cytokeratins (CKW) and Ecad, areas of the repairing epithelium were detected, while the visualization of the epithelium in the control group did not begin even after 10 days. The analysis of immunophenotypes of repairing cells allows us to suggest the participation of mesenchymal-epithelial transformation mechanisms in this process. Conclusions.Thus, studies have shown that the use of cell transplantation of culture of allogeneic cells of the intestine leads to the reconstruction of the intestinal mucosa in a fairly short time. Conducted histological and immunohistochemical studies showed that in the vast majority of animals (77.2%) 10-14 days after the operation, an almost unchanged mucous membrane forms with the preservation of its elasticity.

Stapled Intestinal Anastomosis in Neonates: Validation of Safety and Efficacy

2010 ◽  
Vol 76 (6) ◽  
pp. 644-646 ◽  
Author(s):  
Jon D. Simmons ◽  
Joseph W. Gunter ◽  
Justin D. Manley ◽  
David E. Sawaya ◽  
Christopher J. Blewett
Keyword(s):  
Small Bowel ◽  
Gestational Age ◽  
Medical Center ◽  
Intestinal Anastomosis ◽  
Outcome Data ◽  
High Rate ◽  
Average Weight ◽  
Colon Anastomosis ◽  
Long Term Effects ◽  
Intestinal Anastomoses

The safety and effectiveness of a stapled intestinal anastomosis in adults and children is well documented. However, the role of this technique in neonates is not well validated. We report our experience with stapled intestinal anastomoses in the neonate at the University of Mississippi Medical Center. All patients from the neonatal intensive care unit who had a stapled intestinal anastomosis between February 2007 and May 2008 were identified. A stapled side-to-side functional end-to-end intestinal anastomosis was performed in all patients using a gastrointestinal anastomosis stapler. Demographic, management, and outcome data were collected via chart review. Variables collected included: birth weight, estimated gestational age at birth and surgery, weight at surgery, the use of vasopressors, associated diagnoses, location of the anastomosis, and postoperative clinic visits. A total of 18 patients were identified during the study period. Nine had small bowel to small bowel, eight had ileum to colon, and one had a colon to colon anastomosis. The average weight at time of operation was 2.8 kilograms (Kg) and the average estimated gestational age at surgery was 38.7 weeks. The only complication reported was a partial small bowel obstruction on postoperative day 12, which was successfully treated nonoperatively. Two patients died from problems not associated with the anastomosis. There were no anastomotic leaks or strictures. The literature regarding the use of stapled bowel anastomoses in neonates is scant. Stapled intestinal anastomoses can be performed safely in neonates without a high rate of complication. The long term effects of stapled intestinal anastomoses in the neonate are unknown. Future areas of interest would include effects on postoperative feeding and operative time.

Continuous suturing as a wound closure technique for circumcisions

2019 ◽  
Vol 12 (6) ◽  
pp. 470-473
Author(s):  
Manoj Ravindraanandan ◽  
Herman Fernando ◽  
Shahjahan Aslam
Keyword(s):  
Male Circumcision ◽  
Wound Closure ◽  
Suture Technique ◽  
Complication Rates ◽  
Continuous Suture ◽  
Single Institution ◽  
Closure Technique ◽  
Level Of Evidence ◽  
Operative Complications ◽  
Low Incidence

Male circumcision is an extremely common urological procedure worldwide, with many variations in technique. Despite the large volume there is a low incidence of complications associated with circumcisions, with the majority being Clavien-Dindo I or II. In this study, we analyse the outcomes and complication rates associated with a continuous wound closure following a male circumcision. Methods: In a urology department from a single institution, 201 male circumcisions with a continuous wound closure were performed in a 4-year period. Outcomes were analysed retrospectively looking at postoperative complications and readmissions to hospital via our clinical portal. Results: No patients had complications that required admission or re-operation at our institution. Conclusion: No major post-operative complications were observed from our cohort. There were also no documented admissions back to our institution with wound healing complications. However, a limitation is that Clavien-Dindo I and II complications and treatment at general practitioner surgeries were not captured and may not accurately represent our complication rates quoted. Nevertheless, we can conclude from these data that closure for a circumcision using a continuous suture technique gives favourable outcomes with acceptable complication rates. Level of evidence: Not applicable for this multicentre audit.

Comparison of the healing status in suture-less end-to-end intestinal anastomosis using TachoSil with classic two-layer anastomosis in rats

2019 ◽  
Vol 29 (2) ◽  
pp. 463-467
Author(s):  
Hadi Hadavi ◽  
Bahram Pourseidi ◽  
Shahriar Dabiri ◽  
Mohammadreza Ghasemian Moghaddam ◽  
Alireza Amirbeigi ◽  
...  
Keyword(s):  
Intestinal Anastomosis ◽  
End To End

scholarly journals ASEPTIC END-TO-END INTESTINAL ANASTOMOSIS

1928 ◽  
Vol 87 (6) ◽  
pp. 861-866 ◽  
Author(s):  
James K. Shen
Keyword(s):  
Intestinal Anastomosis ◽  
End To End

scholarly journals Management and Outcomes of Malformations Associated with Intestinal Malrotations in Newborns: About 5 Cases

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Monsoïa Gildas Yassegoungbe ◽  
Médard Ayawo Guedenon ◽  
Géraud Garcia Philemon Satingo Segbedji ◽  
Codjo Serge Metchihoungbe ◽  
Mahussi Henok Orion Akokpe ◽  
...  
Keyword(s):  
Intestinal Anastomosis ◽  
Intestinal Atresia ◽  
The Other ◽  
Intestinal Loop ◽  
Jejunal Atresia ◽  
Ladd Procedure ◽  
Embryonic Life ◽  
End To End ◽  
Multiple Intestinal Atresia ◽  
Fatal Complications

Bowel malrotation is an abnormality in the rotation of the primary intestinal loop during embryonic life. It is a severe abnormality exposing the patient to fatal complications. We report here a series of five patients presenting digestive malrotation with various malformative associations. The first three cases are multiple intestinal atresia on incomplete common mesentery. They underwent an intestinal anastomosis: end-lateral duodeno-ileal for one and end-to-end jejuno-jejunal for the other two with Ladd procedure. In the latter two cases, the omphalocele was the associated malformation; complications such as rupture of the omphalocele with intestinal perforation for one and occlusion by strangulation at the level of the neck for the other were recorded. Ileal resection removing the perforation with end-to-end ileo-ileal anastomosis was performed for the first, while reduction of strangulation at the origin of the occlusion was sufficient for the second. The LADD procedure was the complementary gesture in all cases. The outcome was favorable in 3 cases; two of the newborns who had jejunal atresia died, one on day 5 in a picture of acute respiratory distress, the other on day 6 in a picture of disseminated intravascular coagulation.

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