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@#Objective To investigate the safety and feasibility of thoracoscopic lobectomy without mechanical suture. Methods The data of 28 consecutive patients (a non-mechanical suture group, 16 males and 12 females at age of 61.23±11.10 years) who underwent non-mechanical suture anatomic thoracoscopic lobectomy performed by the same surgeon from March 2015 to March 2018 were analyzed retrospectively, and 28 patients (18 males and 10 females at age of 59.45±13.39 years) who underwent completely anatomic thoracoscopic lobectomy with endoscopic stapler (a mechanical suture group) in the same period were matched. The clinical effectiveness of the two groups was compared. Results The operation time between the non-mechanical suture group (136.30±53.46 min) and the mechanical suture group (109.63±44.61 min) showed a statistical difference (P<0.05). While in term of intraoperative bleeding volume (65.00 mlvs. 50.00 ml), postoperative thoracic drainage time (3.73 days vs. 3.56 days), thoracic drainage volume (538.60 ml vs. 563.70 ml), postoperative hospital stay (5.58 days vs. 5.35 days) and postoperative complication rate (5/28 vs. 6/28), there was no statistical difference between the two groups. Hospitalization expense was significantly different between the two groups (35 438.30 yuan vs. 51 693.60 yuan). Conclusion Non-mechanical suture thoracoscopic anatomic lobectomy is safe and feasible, and can significantly reduce the medical cost but prolong the operation time.
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Objective To systematically evaluate the clinical effects of four treatments of pancreatic stump including stapler closure,hand-sutured closure,stapler with hand-sutured closure,and manual anastomosis on the prevention of postoperative pancreatic fistula after distal pancreatectomy.Methods Databases including PubMed,Embase,the Cochrane Library,CBM,CNKI,and VANFUN were searched for from January 1979 to January 2019 with the key words including "distal pancreatectomy,left pancreatectomy,distal pancreatic resection,left pancreatic resection,pancreatic fistula,fistula,leak,stapler,suture,anastomosis,胰腺远端切除 术,胰体尾切除术,闭合器,手工缝合,吻合,胰瘘”.Patients undergoing dissection of distal pancreas with Endo-GIA stapler were allocated into stapler group,patients undergoing hand-sutured closure of pancreatic stump after dissection of distal prancreas with electrotome or ultrasonic scalpel were allocated into hand-sutured closure group,patients undergoing dissection of distal pancreas with Endo-GIA stapler and hand-sutured closure of pancreatic stump were allocated into stapler with hand-sutured closure group,patients undergoing pancreaticojejunostomy or pancreatogastrostomy after dissection of distal pancreas were allocated into manual anastomosis group,respectively.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as odds ratio (OR) and 95％ confidence interval (95％ CI).The heterogeneity of the studies included was analyzed using the I2 test.Funnel plot was used to test potential publication bias if the studies included ≥ 5,and no test was needed if the studies included ＜5.Results (1) Document retrieval:a total of 10 available prospective studies were included.There were 1 363 patients,including 565 in the stapler group,484 in the hand-sutured closure group,182 in the stapler with hand-sutured closure group,and 132 in the manual anastomosis group.(2) Results of Meta-analysis.① There was no statistically significant difference in postoperative fistula after distal pancreatectomy between the stapler group and the handsutured closure group (OR =0.75,95％CI:0.45-1.25,P＞0.05).Further study showed that there was no statistically significant difference in the incidence of grade B and C postoperative fistula between the two groups (OR=0.45,95％CI:0.14-1.52,P＞0.05).The left-right asymmetry was presented in the funnel plot based on the 8 studies,suggesting that publication bias may exsited.② There was no statistically significant difference in postoperative fistula after distal pancreatectomy between the stapler group and the stapler with hand-sutured closure group (OR =0.96,95％ CI:0.48-1.91,P ＞ 0.05).③ There was no statistically significant difference in postoperative fistula after distal pancreatectomy between the stapler with hand-sutured closure group and manual anastomosis group (OR =0.80,95％ CI:0.49-1.32,P＞ 0.05).④ There was no statistically significant difference in postoperative fistula after distal pancreatectomy between the manual anastomosis group and the stapler group (OR=0.73,95％CI:0.39-1.34,P＞0.05).Further study showed that there was no statistically significant difference in the incidence of grade B and C postoperative fistula between the two groups (OR =0.60,95％CI:0.21-1.68,P＞0.05).The bilateral symmetry was presented in the funnel plot based on the 5 studies,suggesting that publication bias had little influence on results of Meta-analysis.⑤ There was no statistically significant difference in postoperative fistula after distal pancreatectomy between the manual anastomosis group and the handsutured closure group (OR=0.24,95％CI:0.08-0.74,P＜0.05).The bilateral symmetry was presented in the funnel plot,suggesting that publication bias had little influence on results of Meta-analysis.Conclusions Compared with hand-sutured closure,pancreaticojejunostomy or pancreatogastrostomy after distal pancreatectomy can help to reduce the incidence of postoperative pancreatic fistula.However,there was equivalent prevention value of stapler,hand-sutured closure,and stapler with hand-sutured closure for postoperative fistula after distal pancreatectomy.The manual anastomosis group has equivalent prevention value with stapler group.
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Objective To evaluate the efficacy of circinal stapled suture and manual suture in cervical esophagogastric anastomosis in esophageal resection.Methods The clinical data of 187 patients with esophageal cancer who were admitted to the Cancer Hospital of Sichuan Province from January 2010 to January 2012 were retrospectively analyzed.All the patients were divided into the stapled suture group (98 patients) and manual suture group (89 patients).The time of anastomosis,operation time,time for dieting,duration of hospital stay,the incidence of postoperative complications and positive rate of esophageal remnant cancer cells of the 2 groups were compared.All data were analyzed using the t test or chi-square test.Results The time of anastomosis,operation time,time for dieting and duration of hospital stay were (7.8 ± 1.4) minutes,(227 ± 60) minutes,(6.3 ± 0.9) days and (14 ±4)days in the stapled suture group,which were significantly shorter than (28.5 ±2.3)minutes,(301 ±81)minutes,(8.4 ± 1.0)days and (22 ±9) days in the manual suture group (t =75.44,7.14,7.71,7.41,P ＜0.05).The incidence of anastomotic fistula was 1％ (1/98) in the stapled suture group,which was significantly lower than 8％ (7/89) of the manual suture group (P ＜ 0.05).The incidence of anastomotic stricture was 5％(5/98) in the stapled suture group,which was lower than 7％ (6/89) in the manual suture group,but no significant difference was detected (P ＞0.05).The positive rate of esophageal remnant cancer cells was 0(0/98),which was signifiantly lower than 4％ (4/89) in the manual suture group (P ＜0.05).Conclusion Circinal stapled suture in esophagogastric cervical anastomosis not only reduce the time of anastomosis,operation time and duration of hospital stay,but also decrease the incidence of anastomotic fistula and the positive rate of esophageal remnant cancer cells.
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OBJETIVO: Os autores apresentam um estudo observacional, transversal, comparando a anastomose manual com a anastomose mecânica para reconstrução do trânsito digestivo em Y de Roux em pacientes submetidos à gastrectomia total para câncer gástrico. MÉTODOS: O estudo foi realizado no Hospital Governador Israel Pinheiro, no período de janeiro de 1997 a março de 2002. Um total de 40 pacientes neste período foram submetidos à gastrectomia total com reconstrução em Y de Roux. O Grupo I formado por 16 pacientes foi submetido à anastomose mecânica e o grupo II por 24 pacientes foi submetido à anastomose manual. Os dois grupos foram comparados quanto à incidência de complicações pós-operatórias, necessidade de re-operação, alta hospitalar e mortalidade per e pós-operatória. RESULTADOS: Quanto às complicações relacionadas à anastomose, fístula e abscesso intra-abdominal, elas ocorreram em nove pacientes do grupo com anastomose manual e em nenhum paciente no grupo com anastomose mecânica. (p= 0,006). A morbidade e a permanência hospitalar pós-operatória foram maiores no grupo submetido à sutura manual. Houve um óbito em cada grupo e 37 por cento dos pacientes em cada grupo não apresentaram quaisquer tipos de complicações. CONCLUSÃO: Considerando a fístula e o abscesso intra-abdominal juntamente como complicações da anastomose esôfago-jejunal, os resultados deste estudo sugerem uma maior viabilidade da sutura mecânica.
BACKGROUND: The authors report a observational study comparing the surgical outcomes in patients underwent total gastrectomy for gastric cancer and Roux-en-Y end-to-end esophagojejunostomy. METHODS: A mechanical EEA stapler or conventional manual suturing was used. The study was realized in Israel Pinheiro Governor Hospital from January 1997 to May 2002. The surgical outcomes of 16 patients in whom stapling was used (stapler group) and 24 patients in whom manual suturing was done (manual group) were compared. They were: complications incidence, re-operation, hospital stay and mortality. RESULTS: In each group, 37 percent of patients did not have any kind of complications. About anastomotic complications (leakage and intraabdominal abscess), there was 9 in manual group and anyone in mechanical group (p=0,006). Morbidity and hospital stay were higher in manual group. There was one obit in each group. CONCLUSION: Surgical complications, morbidity and hospital stay were higher in manual group. This study suggest a higher viability of mechanical suturing.
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0.05).Anastomotic inflammatory reaction occurred in 2 patients(3.2%) in BAR group and 13 patients(20.0%) in manual group.The difference was statistically significant(P