Bile Duct Replacement Using Bovine Pericardial Patch Graft: an Experimental Study

PURPOSE: The repair of common bile duct injuries is a complex procedure that has a significant rate of postoperative morbidity and mortality. The aim of this study was to demonstrate the usefulness of the bovine pericardial patch (BPP) graft for replacement of the bile duct. METHODS: In this study, BPP with Indermil glue was used to evaluate the effectiveness, morphological changes, early complications and changes of BPP's character. Four male pigs weighing 30~40 kg each were used in the study. We attached a BPP on the small size defected common bile duct (CBD) surface of one pig with using Indermil glue. Another pig's segment of the CBD was resected and the biliary tract was replaced by a tube formed from BPP. After 2 weeks, these animals were sacrificed and we analyzed the patch attachment, the cholangiography and morphological changes. RESULTS: We made a tube-like form from BPP with Indermil; we put it into saline (NaCl 0.9%), gastric juices and bile for 2 weeks to test the changes of the material and the strength of the attachment. Nothing changed, and the attachment remained secure. After 2 weeks these animal were sacrificed and the patch attachment was evaluated by cholangiography and the morphological changes. One significant adhesion with fibrosis in surrounding tissue was noted with obstruction of the CBD. CONCLUSION: These observations suggest that BPP with Indermil glue may well be an acceptable membrane in CBD replacement.

The Repair of Alimentary Tract Wall with Bovine Pericardium Patches and Glue? A Pilot Study

OBJECTIVE: To test the efficacy and possibility of bovine pericardial patch (BPP) for the repair of full-thickness defects in alimentary tract wall with Indermil(R) glue. BACKGROUND: There is a recent report of the successful replacement of duodenal wall with patches of ePTFE. This finding requires confirmation, Repair of other segments of the abdominal intestinal tract also merit further study. The repair of perforations of the gastrointestinal tract remain challenging. METHODS: In this study, BPP with Indermil(R) glue was used to evaluate the effectiveness, strength, adhesion formation, morphological changes, early complications and change of BPP character. We attached a BPP on the peritoneal surface of three pigs with Indermil(R) glue. After 3 weeks these animals were sacrificed and we analyzed the patch attachment. RESULTS: We made a tubelike form with BPP and Indermil(R); put it in saline (NaCl 0.9%), gastric juices and bile for 2 weeks to test the changes in the material and the strength of the attachment. Nothing changed, The attachment remained secure. We tested the BPP with glue attached to the alimentery tract and liver surface. There were no patch failures. For the next study we attached a BPP on the peritoneal surface. After 3 weeks these animal were sacrificed and the patch attachment was evaluated. One significant adhesion with fibrosis in surround tissue was noted. In this animal more Indermil(R) glue was used. Serosal surface healings was complete in all animals at 3 weeks. CONCLUSION: These observations suggest that BPP with Indermil(R) glue may well be an acceptable membrane for at least temporary replacement of the peritoneral surface. Further study is required.

Laparoscopic Enucleation of a Pancreatic Mucinous Cystadenoma

We report a case of a 52-year-old man in whom a cystic pancreatic tumor was successfully removed by laparoscopic enucleation. The patient had a followup CAT-scan for a resolving right upper lobe pneumonia which demonstrated a unilocular hypodense 3.9x2.2 cm sized cyst in the uncinate process of the pancreas. He had a laparoscopic biliopancreatic diversion with duodenal switch in July 2002, and also had laparoscopic cholecystectomy for cholelithiasis in December 2003. Laparoscopic intraoperative ultrasonography revealed a solitary cystic tumor in the inferior portion of pancreatic head. Laparoscopic enucleation of the tumor was performed using Ultracision(R) between the cyst outer wall and the normal pancreatic parenchyma. The operative time was 160 minutes, the estimated blood loss was 20 ml, and there were no perioperative complications. The patient's postoperative course was uneventful, and he was discharged on the first postoperative day. The histopathologic diagnosis showed a mucinous cystadenoma. We reported a new technique for safe management of small cystic tumors located on surface of the pancreas.

Modern Treatment of Early Gastric Cancer: Comparison between Laparoscope Assisted vs Hand-Assisted Laparoscopic Distal Gastrectomy vs Open Distal Gastrectomy

Recently detection of early gastric cancer (EGC) has been increasing and the treatment strategies for gastric cancer have been changing. The purpose of this study was to compare clinical outcomes between laparoscopically assisted (LADG) and hand-assisted laparoscopic gastrectomy (HALDG) and open distal gastrectomy for early gastric cancer. This review is directed toward providing gastric surgeons with recent advances in the treatment of EGC. We investigated the English language literature for the past 12 years through computer searches which focused on : 1) Patient demographics, 2) Operation time, 3) Intra-operative blood loss, 4) Depth of invasion, 5) CBC, 6)Weight loss, 7) Analgesic requirement, 8)Time NPO, 9) Length of hospital stay, 10) Tumor stage, 11) Lymph node (LN) dissection, 12) Position of LN resected, 13) Complications. Improved operative techniques and surgical instrumentation have facilitated the development of minimally invasive gastric cancer surgery. The short-term benefits of laparoscopic gastrectomy included less surgical trauma, less pain, rapid return of gastrointestinal function, and shorter hospital stay, with no change in operative outcome. Laparoscopic gastrectomy was better accepted by the patients as a good procedure and promptly brought the patients back to their previous lifestyle and activities of daily living. But the advantages of HALDG for gastric cancer, extended lymph node dissection and intracorporeal anastomosis are feasible and easier with the presence of the internal hand. The hand-assisted laparoscopic (HALDG) method reported the best results in lymph node dissection. This method is an alternative to total laparoscopic radical gastrectomy. LADG and HALDG, when compared with conventional open gastrectomy, have several advantages. When performed by a skilled surgeon, LADG and HALDG are safe and useful techniques for patients with early-stage gastric cancer. Their appropriateness for gastric cancer surgery require further study.

Living donor renal transplantation : Hand-assisted laparoscopic donor nephrectomy is superior to laparoscopic donor nephrectomy / 中国微创外科杂志

Objective The aim of this case-control study was to compare hand-assisted laparoscopic donor nephrectomy (HALDN) and laparoscopic donor nephrectomy (LDN) evaluating donor and recipient outcomes. Methods A review of data from all LDNs and HALDNs conducted at the Mount Sinai Medical Center from October 1996 to February 2001 was undertaken. In October 1996, LDN was started. In June 1999, the technique changed from LDN to HALDN. Results HALDN was associated with significant shorter operating times((211?7)min vs (257?5) min, P

Mesh wrapping of gastric pouch in obesity treatment: An experimental study / 中国微创外科杂志

Objective To describe the feasibility of surgical wrapping of gastric pouch with a polytetrafluoroethylene(PTFE) mesh for preventing the dilatation of the gastric pouch in obesity treatment.Methods The procedure was performed in 3 fresh-frozen cadavers(

Potential of surgeny for curing type 2 diabetes mellitus / 中国微创外科杂志

Objective To review the effect of morbid obesity surgery on type 2 diabetes mellitus, and to analyze data that might explain the mechanisms of action of these surgeries and that could answer the question of whether surgery for morbid obesity can represent a cure for type 2 diabetes in nonobese patients as well. Background Data Diabetes mellitus type 2 affects more than 150 million people worldwide. Although the incidence of complications of type 2 diabetes can be reduced with tight control of hyperglycemia,current therapies do not achieve a cure. Some operations for morbid obesity not only induce significant and lasting weight loss but also lead to improvements in or resolution of comorbid disease states, especially type 2 diabetes. Methods The authors reviewed data from the literature to address what is known about the effect of surgery for obesity on glucose metabolism and the endocrine changes that follow this surgery. Results Series with long-term follow-up show that gastric bypass and biliopancreatic diversion achieve durable normal levels of plasma glucose, plasma insulin, and glycosylated hemoglobin in 80% to 100% of severely obese diabetic patients, usually within days after surgery. Available data show a significant change in the pattern of secretion of gastrointestinal hormones. Case reports have also documented remission of type 2 diabetes in nonmorbidly obese individuals undergoing biliopancreatic diversion for other indications. Conclusions Gastric bypass and biliopancreatic diversion seem to achieve control of diabetes as a primary and independent effect, not secondary to the treatment of overweight. Although controlled trials are needed to verify the effectiveness on nonobese individuals, gastric bypass surgery has the potential to change the current concepts of the pathophysiology of type 2 diabetes and, possibly, the management of this disease.