Preventive esophagomyobronchoplasty as a method to prevent the failure of the bronchial stump in pneumonectomy for lung cancer

Aim. Comparative analysis of insufficiency rate of bronchial stump sutures in pneumonectomy for lung cancer, depending on suturing techniques. Methods. A patented technique for bronchial stump suturing has been introduced into the practice of the GOBUZ clinic Novgorod Regional Clinical Hospital based on the Department of thoracic surgery since 2015 for pneumonectomy for lung cancer. Before the introduction of the developed technique, various generally accepted methods of bronchial stump forming were used (mechanical suture, manual suture, their combination, bronchial stump coverage with mediastinal pleura, pericardial flap). A retrospective analysis of 173 case histories and operational protocols of patients with lung cancer who underwent pneumonectomy was carried out for the failure of bronchial stump sutures when using conventional suturing techniques between 2010 and 2014 (the first group of patients). We also performed a retrospective and prospective analysis of 204 case histories and operational protocols of patients in a similar clinical group when using a patented suturing technique between 2015 and 2020 (the second group of patients). Statistical analysis was carried out by using Statistica 10.0 software (StatSoft, Inc. 2011). The qualitative and quantitative indicators were analyzed by using the Pearsons 2-test with Yatess correction. Results. A retrospective analysis shows that the failure rate in the use of generally accepted bronchial stump suturing techniques for 20102014 was 10.4%. After the implementation of the method of preventive esophagobronchomyoplasty, complications as bronchial stump suture failure were not detected in any case between 2015 and 2020. Conclusion. The study shows high efficiency, a decrease in the incidence of complications as the failure of bronchial stump sutures in the use of the developed method of preventive esophagomyobronchoplasty in pneumonectomy for lung cancer.

Application of double layered end-to-end anastomosis with continuous manual suture for completing digestive tract reconstruction in totally laparoscopic distal gastrectomy

Background We retrospectively reviewed and consecutively collected the clinical data of distal gastric cancer patients who received surgical treatment, and we discuss the safety and feasibility of double layered end-to-end anastomosis with continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy. Methods We reviewed the clinical data of 41 patients with distal gastric cancer from the gastroenterology department of the Second Affiliated Hospital of Dalian Medical University, from September 2018 to August 2019, who underwent totally laparoscopic distal gastrectomy. During the operation, the method of double layered end-to-end anastomosis with continuous manual suture was used for Billroth type I anastomosis to complete digestive tract reconstruction. All patients have been given a follow-up visit and gastroscopy three months after the operation. The peri-operative clinical information and postoperative follow-up information were collected for analysis, and the clinical application value was evaluated. Results General information: male(n = 27), female(n = 14), age = 65.02(SD 9.94) years, and BMI = 23.52(SD 2.56) kg/m2, Tumor location: antrum(32,78.0%), angle (6,14.6%), and body (3,7.3%). Clinical stage: I (27, 65.9%), II (7, 17.1%), and III (7, 17.1%). Operative information: operation time = 154.51(SD 33.37) min, anastomosis time = 26.88(SD 5.11) min; intraoperative bleeding = 66.34(SD 48.81) ml; first postoperative ambulation Median = 1(IQR 0) d, first postoperative flatus Median = 3(IQR 2) d, first postoperative diet Median = 3(IQR 1) d, postoperative hospital stay Median = 7(IQR 2) d, and total hospitalization cost = 10,935.00(SD 2205.72)USD. Differentiation degree: high and high-moderate (3,7.32%), moderate and poor-moderate (24, 58.54%), poor differentiation (14, 34.15%), dissected lymph nodes Median = 31(IQR 17), and positive lymph nodes Median = 0(IQR 1). Pathological stage: IA (20, 48.78%), IB (3, 7.32%), IIA (4, 9.76%), IIB (5, 12.20%), IIIA (1, 2.44%), IIIB (3, 7.32%), and IIIC (5, 12.20%). Complications (n = 4): lung infection (1, 2.44%), anastomotic leakage (1, 2.44%), and gastroparesis (2, 4.88%). Conclusion It is safe and feasible in clinical treatment to apply the method of double layered end-to-end anastomosis with continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy.

Early and long-term results after Soave-Boley operation as the surgical treatment of colon agangliosis in children

Introduction. Сolon agangliosis (CA) belongs to a group of severe congenital malformations of the colon that can only be treated by surgical approach. The Soave-Boley technique is one of the most physiological and technically acceptable among pediatric surgeons from from all over the world. Aim – evaluate the early and long-term results of surgical treatment of CA in children by Soave-Boley method. Materials and methods. We analysed surgical treatment of 774 children with various forms of CA aged from birth to 18 years for the period from 1980 to 2020, using the Soave-Boley method by the formation of the primary colo-anal anastomosis by manual (suture) and mechanical (stapler) method. Results. All patients survived. Early postoperative surgical complications were seen in 19 (2.45%) of 774 children operated by Soave-Boley method: in 15 – after the formation of the primary colo-anal anastomosis by manual (sutures) method and 4 – after the imposition of a colo-anal anastomosis by mechanical (stapler) method. Long-term postoperative complications were noted in 15 (1.94%) of 774 children operated by Soave-Boley method: 14 – with a manual (suture) and 1 – with a mechanical (stapler) colo-anal anastomosis. Re-operation was successfully performed in 30 (3.87%) patients with reconstructing colo-anal anastomosis manually with Soave-Boley method after initial correction of CA in other clinics by other methods. Periodic episodes of soiling were seen in the remote period in 47 (6.07%) of 774 operated children which was treated conservatively. The success of the Soave-Boley technique is confirmed by a much lower number of early (2.45%) and long-term (1.94%) postoperative surgical complications, compared with those after the use of other methods of open surgical correction – 17.52% and 16.35%, respectively. Conclusions. Soave-Boley operation with colo-anal anastomosis by manual (suture) and mechanical (stapler) methods in comparison with other methods is the most effective method of radical correction of CA as open surgical approach in children of different age groups as single staged or double staged interventions. According to the technical capabilities and results of the early and long period, the Soave-Boley technique with colo-anal anastomosis by manual (ligature) method is the operation of choice for both primary and re-surgical correction of CA compared to any other methods. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. No conflict of interest was declared by the authors. Key words: agangliosis, colon, children, surgical treatment, results.

Manual Sutureless Cataract Surgery (MSCS) in Patients with Pseudo-Exfoliation

Purpose: To document the complications of Manual suture-less cataract surgery in eyes with pseudo-exfoliation. Study Design: Interventional case series. Place and Duration of Study: Naseer memorial hospital, Dadyal, Azad Jammu Kashmir, from 4 July 2017 to 3 July 2019. Methods: One hundred and fifty patients with pseudo-exfoliation (PEX) and cataract were selected by convenient sampling. Patients with systemic diseases, history of trauma, intraocular pressure ≥15 mm Hg on Applanation tonometry and any other associated ocular disease for example retinal detachment or retinal disease, previous history of glaucoma or narrow/closed angle on Gonioscopy were excluded from the study. Dark brown cataracts were also excluded. Pseudo-exfoliation was diagnosed on slit lamp on the basis of presence of dandruff like material on the pupil and the anterior lens capsule. The patients underwent manual suture less cataract surgery under local anesthesia Intraoperative and post-operative complications were noted. first day postoperatively. The collected data and analyzed using statistical package for social sciences (SPSS) version 21 for analysis. Results: The study group consisted of 64% males and 36% females with mean age of 65 ± 15.32 years. The most common difficulty encountered was poor pupil dilatation in 37.3% cases followed by Zonular dehiscence in 7.3%. On the first post-operative day, the most common complication was intraocular lens decentration in 2.6% of the cases. Conclusion: Pupils of patients with pseudo-exfoliation dilate poorly and makes surgery difficult. With good pupillary dilatation, careful capsulorhexis and minimal stress on the zonules, MSCS can be safely performed in eyes with cataract and PEX. Key Words: Pseudo-exfoliation, Cataract, Pupil.

Pharyngeal closure after a total laryngectomy: mechanical versus manual technique

ObjectiveTo verify the main advantages and drawbacks of mechanical suturing for pharyngeal closure after total laryngectomy versus a manual suturing technique.MethodsA retrospective review was carried out of 126 total laryngectomies performed between 2008 and 2018. Manual closure was performed in 80 cases (63.5 per cent) and mechanical suturing was performed in 46 cases (36.5 per cent).ResultsMechanical suturing was used significantly more frequently in patients with: glottic tumours (p = 0.008), less local tumour extension (p = 0.017) and less pre-operative morbidity (p = 0.014). There were no significant differences in the incidence of pharyngocutaneous fistula between the manual suture group (16.3 per cent) and the mechanical suture group (13.0 per cent) (p = 0.628). None of the patients treated with mechanical suturing had positive surgical margins. Cancer-specific survival for the mechanical suture group was higher than that for the manual suture group (p = 0.009).ConclusionMechanical suturing of the pharynx after total laryngectomy is an oncologically safe technique if used in suitable cases.

Application of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy

Background Retrospectively register the clinical data of distal gastric cancer patients who received surgical treatment, discuss the safety and feasibility of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy. Methods Review the clinical data of 41 patients with distal gastric cancer from the gastroenterology department of the Second Affiliated Hospital of Dalian Medical University, from September 2018 to August 2019, were accepted the totally laparoscopic distal gastrectomy. During the operation, the method of double needle-double layer continuous manual suture was used for Billroth I type anastomosis to complete digestive tract reconstruction. The peri-operative clinical information and postoperative follow-up information were collected for analysis, and the clinical application value was evaluated. Results General Information: Male (n = 27),Female(n = 14)༌Age(65.02 ± 9.94)years, BMI(23.52 ± 2.56)kg/m2; Tumor location: Antrum(32,78.0%), Angle (6,14.6%), Body (3,7.3%); Clinical stage: I (27,65.9%), II (7,17.1%), III (7,17.1%); Operative information: Operation time (154.51 ± 33.37)min, Anastomosis time (26.88 ± 5.11) min; Intraoperative bleeding (66.34 ± 48.81) ml; First postoperative ambulation (1.07 ± 0.26) d, First postoperative flatus(3.07 ± 1.08)d, First postoperative diet(3.41 ± 1.07)d༌Postoperative hospital stay(8.76 ± 6.64)d, Total hospitalization cost (70804.00 ± 14282.05)RMB yuan; Differentiation degree: High and high-moderate(3,7.32%), Moderate and poor-moderate (24,58.54%)༌Poor differentiation (14,34.15%); Dissected lymph node (32.76 ± 13.16), Positive lymph node (2.39 ± 4.06); Pathological stage: IA (20,48.78%), IB (3,7.32%), IIA (4,9.76%), IIB (5,12.20%), IIIA (1,2.44%), IIIB (3,7.32%), IIIC (5,12.20%); Complications(n = 4): Lung infection(1,2.44%)༌Anastomotic leakage (1,2.44%༉༌Gastroparesis (2,4.88%༉; Conclusion It is safe and feasible in clinical treatment to apply the method of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy.

The application of a vascular closure device for closing a gastrostomy opening used for procedural access

Objective: To study the feasibility of applying the Perclose ProGlide vascular closure device (PPVCD) in vitro for closing a gastrostomy opening for procedural access in the swine stomach in order to prevent peritoneal leakage. Methods: The study included four experimental groups: one manual suture (n = 10), two manual sutures (n = 10), one PPVCD suture (n = 10), and two PPVCD sutures (n = 5). In the two PPVCD sutures group, the “pre-close” technique was used. The leak pressure was measured, and statistical analysis was conducted to compare the leak pressures among the experimental groups. Results: The gastrostomy openings were successfully closed in all experimental groups. The median (range) values of leak pressure (mmHg) for each experimental group were as follows: one manual suture, 86.0 (75.0–110.0); two manual sutures, 98.5 (44.0–130.0); one PPVCD suture, 96.5 (56.0–119.0); and two PPVCD sutures, 98.0 (66.0–104.0). The Mann–Whitney U test revealed no statistically significant difference in leak pressure between the manual (n = 20) and PPVCD (n = 15) suture groups. The Kruskal–Wallis test revealed no statistically significant difference in leak pressure among the four experimental groups. The Bonferroni post hoc test also revealed no statistically significant difference in the pairwise comparisons among the groups. Conclusion: Application of PPVCD is feasible for the closure of gastrostomy openings in an animal model and is as effective as a manual suture. Advances in knowledge: In our in vitro study, percutaneous closure of gastrostomy opening using PPVCD was possible; animal survival studies and development of specific devices are needed before clinical application.

COMPARATIVE ANALYSIS OF LATE RESULTS OF CERVICAL ESOPHAGOGASTRIC ANASTOMOSIS BY MANUAL AND MECHANICAL SUTURE IN PATIENTS SUBMITTED TO ESOPHAGEAL MUCOSECTOMY THROUGH ADVANCED MEGAESOPHAGUS

ABSTRACT Background: Among the anastomoses of the gastrointestinal tract, those of the esophagus are of special interest due to several anatomical or even general peculiarities. Aim: Evaluate retrospectively the results comparing mechanical vs. manual suture at cervical esophagogastric anastomosis in megaesophagus treatment. Methods: Were included 92 patients diagnosed with advanced megaesophagus with clinical conditions to undergo the surgery. All underwent esophageal mucosectomy, performing anastomosis of the esophagus stump with the gastric tube at the cervical level. In order to make this anastomosis, the patients were divided into two groups: group A (n=53) with circular mechanical suture, lateral end; group B (n=39) with manual suture in two sides, lateral end. In the postoperative period, an early evaluation was performed, analyzing local and systemic complications and late (average 5.6 y) analyzing deglutition. Results: Early evaluation: a) dehiscence of esophagogastric anastomosis n=5 (9.4%) in group A vs. n=9 (23.0%) in group B (p=0.0418); b) stenosis of esophagogastric anastomosis n=8 (15.1%) in group A vs. n=15 (38.4%) in group B (p=0.0105.); c) pulmonary infection n=5 (9.4%) in group A vs. n=3 (7.6%) in group B (p=1.0000.); d) pleural effusion n=5 (9.4%) in group A vs. n=6 (15.4%) in group B (p<0.518). Late evaluation showed that 86.4-96% of the patients presented the criteria 4 and 5 from SAEED, expressing effective swallowing mechanisms without showing significant differences among the groups. Conclusion: Cervical esophagogastric anastomosis by means of mechanical suture is more proper than the manual with lower incidence of local complications and, in the long-term evaluation, regular deglutition was acquired in both suture techniques in equal quality.

Ileocecal Fistula Caused by Multiple Foreign Magnetic Bodies Ingestion

The incidence of accidental foreign body (FBs) ingestion is 100,000 cases/year in the US, with over than 80% of cases occurring in children below 5 years of age. Although a single FB may pass spontaneously and uneventfully through the digestive tract, the ingestion of multiple magnetics can cause serious morbidity due to proximate attraction through the intestinal wall. Morbidity and mortality depend on a prompt and correct diagnosis which is often difficult and delayed due to the patient's age and because the accidental ingestion may go unnoticed. We report our experience in the treatment of an 11-year-old child who presented to the emergency department with increasing abdominal pain, vomiting, diarrhea, and fever. Surgery evidenced an ileocecal fistula secondary to multiple magnetic FB ingestion with attraction by both sides of the intestinal wall. A 5-centimeter ileal resection was performed, and the cecal fistula was closed with a longitudinal manual suture. The child was discharged at postoperative day 8. After one year, the patient’s clinical condition was good.