Compression pre-stapler firing and post-ignition wait during sleeve gastrectomy: a prospective randomized trial

ABSTRACT BACKGROUND: Insufficient research exists on the stapling technique in and duration of laparoscopic sleeve gastrectomy (LSG). OBJECTIVES: This study aimed to assess the clinical outcomes using a 30-second precompression and post-firing waiting time without extra support for the stapling line. DESIGN AND SETTINGS: Randomized controlled prospective study at a university hospital. METHODS: This study included 120 patients treated between January 2022 and February 2023. The patients were divided into the non-waiting group (T0) and waiting group (T1), each with 60 patients. Perioperative complications were analyzed using statistical tests. RESULTS: The waiting group (T1) showed a significant reduction in the number of intraoperative bleeding points requiring intervention compared with the non-waiting group (T0) (81 versus 134, P < 0.05). In T0, postoperative C-reactive protein (CRP) levels increased (P < 0.05) and hemoglobin levels decreased significantly (P <0.05). The study recorded 22 postoperative complications, accounting for 18.3% of all cases during the 30-day postoperative period. CONCLUSIONS: The study concluded that the 30 sec + 30 sec stapling technique reduces perioperative bleeding, length of stay, and serious complication rates and is practical and effective for LSG. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov with registration code NCT05703035; link: https://clinicaltrials.gov/ct2/show/NCT05703035.

Meta-analysis of manual suture versus mechanical anastomosis in esophagojejunostomy after total gastrectomy / 中国基层医药

Objective:To systematically evaluate manual suture versus mechanical anastomosis in esophagojejunostomy, two methods of digestive tract reconstruction after laparoscopic total gastrectomy. Methods:A computer-based online search of PubMed, CBM, Wanfang database and CNKI database was performed to retrieve clinical studies related to manual suture (manual suture group) and mechanical anastomosis (mechanical anastomosis group) in esophagojejunostomy after laparoscopic total gastrectomy published between January 2015 and October 2020. The quality of eligible literature was evaluated and data were extracted for meta-analysis using Review Manager 5.4 software.Results:Four clinical studies involving 746 patients were included in the final analysis. Meta-analysis results revealed that there was no significant difference in operative time between manual suture and mechanical anastomosis methods [ MD = 8.32, 95% CI (-5.94, 22.57), P > 0.05]. The intraoperative blood loss in manual suture group was significantly less than that in mechanical anastomosis group [ MD = -9.54, 95% CI (-15.54, -3.55), P < 0.05]. The time to exhaust in the manual suture group was shorter than that in the mechanical anastomosis group [ MD = -0.38, 95% CI (-0.59, -0.18), P < 0.05]. The length of hospital stay in the manual suture group was less than that in the mechanical anastomosis group [ MD = -0.88, 95% CI (-1.23, -0.54), P < 0.05]. The incidence of anastomotic leakage in the manual suture group was significantly lower than that in the mechanical anastomosis group [ OR = 0.23, 95% CI (0.06, 0.93), P < 0.05]. The incidence of anastomotic stenosis in the manual suture group was significantly lower than that in the mechanical anastomosis group [ OR = 0.14, 95% CI (0.04, 0.54), P < 0.05]. Conclusion:After total gastrectomy, continuous suture of oesophago-jejuno ends with barbed threads under laparoscopy is safer and less expensive and needs less time to postoperative recovery and shorter length of hospital stay compared with mechanical anastomosis.

The efficacy of single channel endoscopic purse-string sutures with hemostatic dips and endoloops for the peptic ulcer bleeding / 中国医师杂志

Objective To investigate the efficacy and safety of single-channel endoscopic nylon rope combined with hemostatic clip suture in the treatment of peptic ulcer and bleeding.Methods Patients in our hospital due to peptic ulcer bleeding and hospitalization emergency electronic endoscopy from January 1st,2001 to July 1st,2017 were enrolled in the study.They were treated the single-channel endoscopic nylon rope combined with hemostatic clip suture.The basic information,clinical data,surgical records combined and retrospective analysed.Results 16 patients were included in the study.Among all the patients,peptic ulcer was located in 6 cases of gastric angle,3 cases of gastric antrum,3 cases of gastric body,2 cases of duodenal bulb and stomach.Ulcer maximum 40 mm × 25 mm,an average of (23.0 ± 6.0) mm.All ulcer wounds in patients underwent single-channel endoscopic nylon rope combined with hemostatic clip pouch suture were completely closed,including 1 case of duodenal ulcer patients after bleeding,achieved hemostasis successfully when turned into our hospital intervention.The remaining 15 cases were no longer bleeding.1 cases of gastric antral and 1 cases of stomach were diagnosed as moderately differentiated adenocarcinoma and they received endoscopic resuscitation after successful elective surgery gastric antral cancer radical surgery.Conclusions Single channel endoscopic nylon rope combined with hemostatic clip sacking is a safe and effective method for the treatment of giant peptic ulcer and bleeding.It is worthy of clinical manifestation,especially for those with deep and perforated ulcer.

Application of the cold cutting technique in transumbilical single-incision laparoscopic liver resection / 中华肝胆外科杂志

Objective To study the application of the cold cutting technique in transumbilical sin gle-incision laparoscopic liver resection (TUSI-LLR),and to evaluate its feasibility and treatment results.Methods The clinical data of 35 patients with liver lesions treated by transumbilical single-incision laparoscopic liver resection from 2013 to 2017 were retrospectively analyzed in Shengjing Hospital of China Medical University.In all these patients,the liver parenchyma was transected with the cold cutting technique.The operation time,intraoperative blood loss,postoperative complications,time to remove abdominal drain,and total hospital stay in the patients were analyzed.Results 11 of the 35 patients were male.The average age was (49.9 ± 10.8) years.The average body weight was (63.2 ± 11.1) kg.The diagnoses were hemangiomas in 18 patients,hepatolithiasis in 5 patients,malignant hepatocellular tumors in 5 patients,focal nodular hyperplasia in 3 patients,and others in 4 patients.There were 22 left lateral sectionectomies,2 left hemihepatectomies,11 wedge resections (8 in the left and 3 in the right).The operations were all successfully performed,with no conversion to conventional laparoscopic hepatectomy or open surgery.The average operation time was (112.2 ±51.0) minutes,and the intraoperative blood loss was (105.4 ±70.1) ml.No patients required intraoperative blood transfusion.The average surgery cost was (36 336.7 ± 5 938.2) yuan.All patients recovered well,with no postoperative hemorrhage,bile leakage,or incisional wound infection.The average time periods for removal of the abdominal drain,and hospital stay were (4.5 ± 1.2) days and (5.2 ± 1.4) days,respectively.All the 35 patients were followed up (1 ～ 3 months),with no patients complaining of abdominal distension or abdominal pain.Conclusions The cold cutting technique in transumbilical single-incision laparoscopic liver resection was safe and feasible.Its benefits included the operative speed,the small amount of intraoperative blood loss and the rapid postoperative recovery of the patients.

Hemorroidopexia por grampeamento parcial: aspectos clínicos e impacto sob a fisiologia anorretal / Partial stapled hemorrhoidopexy: clinical aspects and impact on anorectal physiology

RESUMO Objetivo: avaliar o impacto na fisiologia anorretal da hemorroidopexia por grampeamento parcial, das complicações relacionadas à técnica cirúrgica, dor e sangramento pós-operatório e recidiva de doença hemorroidária após um ano de cirurgia. Métodos: estudo prospectivo, descritivo, em pacientes consecutivos, portadores de doença hemorroidária do tipo mista ou interna, com componente interno classificado como grau III ou IV, submetidos à hemorroidopexia por grampeamento parcial. Resultados: foram estudados 17 pacientes, dos quais 82% apresentavam hemorroidas internas grau III, e 18% grau IV. A média de tempo operatório foi de 09:09 minutos (07:03 a 12:13 minutos). A mediana de dor no pós-operatório imediato avaliada pela escala numérica de dor foi de 1 (0 a 7). A mediana de retorno ao trabalho foi de nove dias (4 a 19). Nenhum paciente apresentou estenose de canal anal e 76% ficaram satisfeitos com a cirurgia com 90 dias de pós-operatório. Comparando-se os dados manométricos pré-operatórios e após 90 dias, nenhuma das variáveis avaliadas apresentou diferença com significância estatística. Não houve recidiva da doença hemorroidária com um ano de acompanhamento pós-operatório. Conclusão: a hemorroidopexia por grampeamento parcial não demonstrou impacto na fisiologia anorretal, apresentando baixos níveis de complicações e de dor pós-operatória, e sem recidivas após um ano de acompanhamento.

ABSTRACT Objective: to evaluate the impact of partial stapled hemorrhoidopexy on anorectal physiology, the complications related to this surgical technique, pain, postoperative bleeding and recurrence of hemorrhoidal disease one year after surgery. Methods: this is a prospective, descriptive study in consecutive patients with mixed or internal hemorrhoidal disease, the internal component being classified as grade III or IV, undergoing partial stapled hemorrhoidopexy. Results: we studied 17 patients, 82% of them with internal hemorrhoids grade III and 18% grade IV. The mean operative time was 09:09 minutes (07:03 to 12:13). The median pain in the immediate postoperative period evaluated by the numerical pain scale was one (0 to 7). The median time to return to work was nine days (4 to 19). No patient had anal stenosis and 76% were satisfied with the surgery 90 days postoperatively. When comparing the preoperative manometry data with that measured 90 days after surgery, none of the variables studied showed statistically significant difference. There was no recurrence of hemorrhoidal disease with one year of postoperative follow-up. Conclusion: partial stapled hemorrhoidopexy showed no impact on anorectal physiology, presenting low levels of complications and postoperative pain, without recurrence of hemorrhoidal disease in one year of follow-up.

Intracorporeal esophagojejunostomy using hemi-double-stapling technique after laparoscopic total gastrectomy in gastric cancer patients

PURPOSE: To present the feasibility and safety of Roux-en-Y esophagojejunostomy using hemi-double-stapling technique after laparoscopic total gastrectomy. METHODS: We reviewed the outcomes from 58 consecutive patients with gastric cancer who underwent laparoscopic total gastrectomy. The clinicopathological characteristics including postoperative complications were examined. RESULTS: The mean age and body mass index were 57.3 ± 9.7 years and 23.7 ± 2.6 kg/m², respectively. The mean overall total operation was 199.8 ± 57.0 minutes. Intraoperative blood loss was 81.6 ± 56.3 mL and there was no open conversion. The patients' hospital stay was a mean 9.6 ± 2 days. The mean proximal margin of the specimens was 2.7 ± 1.8 cm. There were 3 cases (5.1%) of anastomosis leakage, but all were controlled successfully by endoscopic stent. CONCLUSION: The circular HDST technique is simple and reliable without any significant demerits with respect to safety concerns or difficulty of operation.

Clinical study of laparoscopic repair of inguinal hernia by laparoscopic anterior approach with non sta-pling device / 实用医学杂志

Objective To study clinical effect after laparoscopic abdominal preperitoneal inguinal hernia repair methodwithout stapler. Methods 80 cases of inguinal hernia(hospitalized from February 2015 to January 2017)were divided into two groups according to the random number table method ,with 40 patients in each group. Traditional laparoscopic peritoneal inguinal hernia repair method was applied in the control group. Free stapler group received free stapler laparoscopic preperitoneal inguinal hernia repair treatment method. Operation time , amount of bleeding during surgery , the average hospitalization time after operation , the total cost of hospitalization,postoperative pain score,postoperative recovery activities time,patients′satisfaction,operation effusion after operation occurred scrotal hematoma and other complications were comparedbetween the two groups of patients. Results In free stapler group,patients′ satisfaction rate was significantly higher than the control group (P 0.05). Conclusion Operation time and amount of bleeding were similar between traditional laparoscopic transabdominal preperitoneal inguinal hernia repair method and free stapler in laparoscopic transabdominal preperitoneal inguinal hernia repair.Clinical effect of free stapler in laparoscopic transabdominal preperitoneal inguinal hernia repair proves to be effective with less complications ,less pain, faster postoperative recovery, and can reduce the cost of treatment.Free stapler in laparoscopic transabdominal preperitoneal inguinal hernia repair has satisfactory cosmetic results and was well received by patients,worthy of promotion.

Comparative effect of dorsal slit circumcision and disposable circumcision suture device / 中华全科医师杂志

Objective To compare the safety and effectiveness of disposable circumcision suture device (DCSD) with conventional circumcision in surgical treatment of phimosis and redundant prepuce . Methods One hundred and sixty one patients with phimosis or redundant prepuce were randomly assigned to be treated by circumcision using disposable circumcision suture device ( DCSD group , n =89 ) or conventional circumcision (CC group,n =72),respectively.Results The operation time was (3.8 ± 0.5)min in DCSD group and (31.6 ±2.7)min in CC group (F=71.21,P=0.000),blood loss was 1.0(0.9, 1.2)ml in DCSD group and 6.2(5.7, 7.0)ml in CC group (Z =-10.90,P=0.000).There were no significant differences in intraoperative pain score (1.4 ±0.6 vs.2.9 ±0.8, F=2.08, P=0.151) and wound healing time [(14.0 ±1.3) vs.(16.8 ±2.1) d, F=0.10, P=0.754] between two groups.There was no need to change the dressing for patients in DSCD group 3 days after the operation , while patients in CC group changed dressing 3 times after the operation .No significant differences in postoperative complication rate [10%(9/89) vs.4%(3/72),χ2 =2.04,P=0.153] and satisfaction rate with the penile appearance [98%(87/89) vs.94%(68/72), χ2 =0.47,P=0.494] were found between two groups .Conclusion DCSD exhibits superiority over CC for shorter operation time and less blood loss in circumcision .

Relationship between the Characteristics of Staplers and Malformation of Staples.

The “Type of Article” of this paper is “Letter to the Editor”. This paper discuses about: “Relationship between the Characteristics of Staplers and Malformation of Staples”. No formal abstract is available. Readers are requested to read the full article.

Conquest of the Weak Point of the Side-to-side Anastomosis: The Novel Technique that Can Reinforce a Weak Point with Stapling.

Introduction: The improvement of stapling devices has been remarkable. As the stapler evolved from two lines to three lines of staples, the lateral strength of the anastomosis increased. However, the strength of the crotch did not change and the crotch remains the weak point of the side-to-side anastomosis. We previously reported the weakness of the crotch and the reinforcement method with animal model [1,2]. Technique: We describe our novel technique to reinforce the crotch using a physician-modified stapling device. A stapler with three rows of staples per side is arranged on a 6 cm segment using an EndoGIA Reinforce. Polymer felt is attached to both the cartridge fork and anvil fork of the stapler. The felt is then trimmed, as a length of 2 cm is sufficient for reinforcement of the crotch. Results: With this method, we can reinforce the weak point of the side-to-side anastomosis at the same time as the anastomosis. Conclusions: This method is a simple and novel technique to reinforce the crotch of a side-to-side anastomosis.

Comparison of different types of catheter treatment of anastomotic ring canalicular effect / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the comparison of different types of catheter treatment of anastomotic ring canalicular effect. METHODS:Retrospective analysis. A total of 114 cases 114 eyes were randomly selected between May 2013 to May 2015 jointly admitted to Huizhou Huizhou City People's Hospital and the Central People's Hospital of canalicular patients in accordance with the agreement of the annular catheterization divided into three groups, group A of annular nasal lacrimal duct catheterization in 36 eyes, group B for the whole nasal lacrimal annular catheterization in 33 eyes, group C between the upper annular tears point catheterization 45 eyes. Through the A, B, C three groups after 1, 3wk, 1, 3mo and 1y follow-up were analyzed to compare. RESULTS:Group A of 31 eyes were cured, improved in 2 eyes, 3 eyes, the effective rate was 91. 7%;group B, 27 cases were cured, improved in 3 eyes, 3 eyes, the effective rate was 90. 9%;group C, 40 cases were cured, improved in 2 eyes, 3 eyes, the effective rate was 93. 3%. A, B, C three groups efficiency pointless difference (P=0. 124). Eye Effect: A, B, C meaningful difference among the three groups(F=36. 578; P=0.002), Group A scored the highest score of a minimum group C, respectively( 3. 5±0. 8 ) and ( 2. 3±0. 7 ); comparison meaningless difference between group a and group B( t=0. 086, P>0. 05 ); Group A and C and comparison of differences between group C and group B have the significance ( t = 15. 241, t = 17. 472; P 0. 05 ); comparing the differences between the Groups A and B and between Group A and C were significance(t=26. 362, t=27. 532; P CONCLUSION: Similar to A, B, C three groups of treatment efficacy, patient lacrimal functional recovery is safe and effective, which the group C treatment, during treatment and less material and fewer postoperative complications in patients, it is worth promotion.

Tratamento de hérnias da linha média do abdome com uso de grampeador endoscópico para fechamento da linha média / Treatment of mid-line abdominal wall hernias with the use of endo-stapler for mid-line closure

INTRODUÇÃO: A cirurgia minimamente invasiva modificou a maneira de analisar e dissecar os tecidos nos procedimentos cirúrgicos. No entanto, a vantagem deste método é limitada na parede abdominal, devido à falta de desenvolvimento de tecnologias e movimentos articulados para seu emprego nesta região, exigindo a necessidade de investimentos e de tempo para a solidificação. Esta abordagem para reparo operatório da parede abdominal é baseada nos princípios Rives-Stoppa. TÉCNICA: Com o paciente em decúbito dorsal, uma pequena incisão supra-púbica é feita e o espaço pré-peritoneal é alcançado e insuflado. Após os trocárteres serem colocados, o saco peritoneal é dissecado e a cavidade abdominal é atingida acima da linha arqueada. As bainhas posteriores do músculo reto do abdome são liberadas e um grampeador linear é colocado em ambos os lados e acionado, restituindo a linha média e criando um espaço retromuscular, onde a tela é colocada e fixada. CONCLUSÃO: O método é viável, fácil de realizar e reprodutível, economizando tempo e com resultado funcional satisfatório.

INTRODUCTION: Minimally invasive videosurgery has modified anatomy dissection of diseases that are treated operatively. However, the benefit of this method has been delayed due to the lack of development of technologies and articulated movements for the abdominal wall, demanding the need for investments and time for solidification. This approach to repair the abdominal wall is based on the Rives-Stoppa principles. TECHNIQUE: With the patient in supine position, a small supra pubic incision is done and the pre-peritoneal space is achieved and inflated. After the trocars are placed, the peritoneal sac is dissected and the abdominal cavity is entered, above the arcuate line. The posterior rectus sheath is liberated and a linear stapler is placed in both sides and fired, creating a midline and a retromuscular space, where the mesh is placed and fixed. CONCLUSION: The method is feasible, easy to perform, reproducible, saves time and with a good functional result.

Evaluation of the damage caused by clamping or section of cervical sympathetic nerve in rabbits / Avaliação do dano causado pela clipagem ou secção do nervo simpático cervical em coelhos

PURPOSE: To study the macro and microscopic evaluation of the damage caused by clamping or section of cervical sympathetic nerve in rabbits, quantifying the collagen in the lesions. METHODS: Twenty rabbits were divided into two groups of ten, doing in group 1 (section) section of the right cervical sympathetic nerve, while in group 2 (clipping) clipping of the nerve. All rabbits were induced to death on the seventh day after surgery. The macroscopic variables were: consequences of nerve lesion, clip appearance, presence of infection and adhesions around the nerve. Microscopy used hematoxylin-eosin staining to evaluate the stages and the degree of inflammation and necrosis, and F3BA Picrosirius red staining to quantify collagen. Mann-Whitney test was used for comparisons of collagen types I and III between groups. Fisher exact test analyzed the macroscopic variables, the degree of inflammation and necrosis. RESULTS: There was no discontinuity of nerve injury in the clipping group, as well as the clip was closed in all animals. The presence of severe adhesions was significantly higher in the clipping group (p<0.05). There was no significant difference on other variables macroscopically analyzed. There was no significant difference between groups regarding the type of inflammatory process and its intensity, as well as the presence of necrosis and collagen deposition in the nerves. CONCLUSIONS: In the macroscopic evaluation, the section caused discontinuity, which did not occur in the clamping group; there was no development of local infection; the clipping of the cervical sympathetic nerve was linked to the presence of a greater number of adhesions in comparison to the section group. Microscopically, no difference existed in relation to the type and intensity of inflammation reaction between the groups; occurred predominance of chronic and severe inflammation on the specimens; the necrosis was noticed equally in both groups; there was predominance of type I collagen deposition in relation to type III in both groups.

OBJETIVO: Estudar a lesão provocada pela secção e pela clipagem no nervo simpático cervical de coelhos, avaliando-se a macroscopia, microscopia e quantificando-se o colágeno nas lesões. MÉTODOS: Foram utilizados 20 coelhos, distribuídos em dois grupos de dez, sendo nos animais do grupo 1 (secção) realizada secção do nervo simpático cervical direito, enquanto nos do grupo 2 (clipagem) realizada a clipagem desse nervo. Todos os coelhos foram induzidos à morte no sétimo dia de pós-operatório. As variáveis macroscópicas avaliadas foram: presença de lesão de descontinuidade do nervo, aspecto do clipe, presença de infecção e de aderências ao redor do nervo. A microscopia com hematoxilina-eosina foi feita para avaliar as fases, o grau do processo inflamatório e a presença de necrose; a coloração de Picrosirius red F3BA quantificou o colágeno. Utilizou-se o teste de Mann-Whitney nas comparações dos colágenos tipo I e tipo III entre os grupos. As variáveis macroscópicas, o grau do processo inflamatório e presença de necrose foram analisadas pelo teste de Fisher. RESULTADOS: Não houve lesão de descontinuidade do nervo no grupo clipagem, assim como o clipe encontrou-se fechado em todos os animais desse grupo. A presença de aderências intensas foi significativamente maior no grupo clipagem (p<0,05). Não houve diferença significativa quanto às demais variáveis analisadas macroscopicamente. Não houve diferença significativa entre os grupos quanto ao tipo de processo inflamatório e sua intensidade, assim como quanto à presença de necrose e ao depósito de colágeno nos nervos. CONCLUSÕES: Na avaliação macroscópica, a secção causou lesão de descontinuidade, o que não ocorreu na clipagem; não houve desenvolvimento de infecção local; a clipagem do nervo simpático cervical foi associada à presença de maior quantidade de aderências em relação à secção. Na avaliação microscópica reconheceu-se não haver diferença no tipo e na intensidade do processo inflamatório entre os grupos; ocorreu predomínio de processo inflamatório crônico e acentuado; as necroses ocorreram igualmente em ambos os grupos; houve predomínio de depósito de colágeno tipo I em relação ao tipo III em ambos os grupos.

TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial / Procedimento TRREMS (reparo transanal de retocele e mucosectomia retal com um grampeador circular): estudo multicêntrico prospectivo

CONTEXT: Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. OBJECTIVE: To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. METHODS: It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7 percent) and grade 3 (73.3 percent) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0 percent) and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months. RESULTS: All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3 percent) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6 percent). Forty-nine patients (65.3 percent) required 1 hospitalization day, the remainder (34.7 percent) 2 days. Postoperatively, 3 (4.0 percent) patients complained of persistent rectal pain and 7 (9.3 percent) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). Postoperative cinedefecography showed residual grade I anorectoceles in 8 (10.6 percent). The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSION: Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment of anorectocele associated with mucosa prolapse. The stapling technique is low-cost as requires the use of a single circular stapler.

CONTEXTO: Como a anoretocele está sempre associada a prolapso mucoso e/ou intussuscepção retal, foi desenvolvida uma técnica cirúrgica grampeada, utilizando somente um grampeador mecânico. OBJETIVO: Demonstrar os resultados do estudo multicêntrico que realizou o tratamento cirúrgico de pacientes com anorretocele associado a prolapso mucoso, utilizando o reparo transanal da retocele e mucosectomia com grampeador circular mecânico. MÉTODO: Foram incluídos 75 pacientes, média de idade 49,6 anos, com sintomas de evacuação obstruída, apresentando escore médio de constipação de Wexner de 16 e diagnóstico de anorretocele grau II (26.7 por cento), grau III (73,3 por cento) associado a prolapso mucoso e intussuscepção (52 por cento). Todos foram avaliados com exame proctológico, defecografia, manometria anorretal e tempo de trânsito colônico. O procedimento cirúrgico foi realizado por 14 cirurgiões e consiste na remoção manual da parede do reto no local da retocele e mucosectomia circunferencial com um grampeador circular mecânico. O seguimento médio foi de 21 meses. RESULTADOS: Os pacientes apresentavam sintomas de evacuação obstruída, mesmo após tratamento clinico. O tempo operatório médio foi de 42 minutos. Houve sangramento transanal na linha de sutura em 13 (17,3 por cento) pacientes, sutura grampeada incompleta em 2 (2,6 por cento) e dor retal persistente em 3 (4,0 por cento). O tempo médio de internação hospitalar foi de 1 dia em 49 (65,3 por cento) e 2 dias em 34,7 por cento. Ocorreu redução na linha de sutura em 7 (9,3 por cento), sendo necessário estricturotomia cirúrgica sob anestesia (n = 1), utilizando "hot biopsy" (n = 3) e dilatação anal (3). Defecografia no pós-operatório demonstrou anorretocele residual grau I em 8 (10.6 por cento). O escore de constipação de Wexner reduziu 16 para 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSÃO: O resultado do estudo multicêntrico demonstrou que a técnica cirúrgica apresentada é segura e efetiva para tratamento da anorretocele associada a prolapso mucoso. Apresenta baixo custo pois utiliza um grampeador circular mecânico.

A comparative clinical study on procedure for prolapse and heamorroids and straight-needle handsewing hemorroidepexv for the treatment of grade Ⅲ - Ⅳ heamorrhoids / 中华普通外科杂志

ObjectiveTo compare the short-term and long-term results of hand-sewing heamorroidpexy(HHP) and procedure for prolapse and heamorroids(PPH) in the treatment of grade Ⅲ and Ⅳ heamorrhoids.MethodsEight hundred patients were randomly divided into two groups receiving PPH (n =415) and HHP( n =385 ) respectively.The operative result including postoperative pain,prolapse,total expense,time to return normal work,percentage of satisfaction and other complications were compared between the two groups.ResultThe time of resuming normal work in HHP group was (5.2±2.3) d,in PPH group was ( 10.2 ±2.4) d,P =0.038.Postoperative visual analogue scale ≥5 was found in 45 cases ( 12.1％ ) in HHP group,and in 128 cases(31.8％ ) in PPH group,P =0.018.HHP group was superior to PPH group in patients' satisfaction,inhospital cost,complications,and recurrence,all P ＜ 0.05.Patients were followed up for more than 2 years,long term complication of bleeding,prolapse and anastomtic structure developed less frequently in HHP group than in PPH group (x2 =4.25,P ＜ 0.05 ).ConclusionsHHP is a safe and effective treatment for heamorroids(gradeⅢ - Ⅳ ) with the advantages of less postoperative pain,quicker recovery,lower expenses,shorter hospital stay and higher satisfactory rate.

Laparoscopically total extraperitoneal inguinal hernia repair: mesh stapling fixation versus no fixation / 中华普通外科杂志

Objective To assess the safety and effectiveness of laparoscopically total extraperitoneal (TEP) repair using two mesh cross and overlap without stapler technique and to discuss the cause of main complications. Methods In this study 243 cases of inguinal hernia were randomly divided into two groups. One group underwent two meshes cross and overlap no fixation TEP, the other underwent a single mesh stapling fixation TEP. The average postoperative follow-up was ( 28 ± 6 ) months. For comparing the effect of the two approaches, statistical analysis including the χ2 test and Student's t test was carried out where appropriate. A p value of less than 0. 05 was considered statistically significant. Results The recurrence rate for the mesh no fixation group ( 1.9% ) did not increase when compared to mesh fixation group( 2. 9% ) ( P ＞ 0. 05 ). The overall postoperative complication rate or individual complication rate was not significantly different between the two groups. Conclusions Laparoscopically total extraperitonealrepair(TEP) using two mesh cross and overlap no fixation technique is safe and reliable.

Change in Effective Leg Length after Angular Deformity Correction by Hemiepiphyseal Stapling

BACKGROUND: The hemiepiphyseal stapling has both positive and negative effects on effective leg length. The purpose of this study was to analyze change in effective leg length after angular correction by hemiepiphyseal stapling, and to validate in clinical cases. METHODS: Mathematical analysis of a hemiepiphyseal stapling model was conducted. The induced formula was validated in 6 cases fulfilling the assumptions of the model. Anatomical parameters involved in this formula were measured in additional 21 cases undergoing hemiepiphyseal stapling or hemiepiphysiodesis. RESULTS: Effective leg length increased or decreased according to three parameters in this model: 1) limb length distal to the operated physis (L), 2) width of the operated physis (d), and 3) the amount of angular deformity to be corrected (theta). Actual change in effective leg length of 6 cases similar to this model coincided with the predicted change at least in its direction. L/d ratio was 4.82 +/- 0.51. CONCLUSIONS: Considering the narrow range of the L/d ratio, hemiepiphyseal stapling is likely to decrease effective leg length if the amount of angular correction is less than 10degrees, whereas to increase it if the amount of angular correction is larger than 16degrees. This should be taken into consideration when selecting the surgical method for angular deformity correction in skeletally immature patients.

Application of double stapling device in anus-preserving operation of low rectal cancer / 中国基层医药

Objective To investigate the role of double stapling device in anus-preserving operation of low rectal cancer. Methods Retrospective study was used to analyze the experience of double stapling device in anus-preserving operation of low rectal cancer for 79 patients between March 1999 to March 2003. Results 79 cases in the group all had the radical resection, no patient died. Complications included anastomosis fistula in 2 patients(2.5%),anastomosis stenosis in 3 patients(3.8%). The defecation function after surgery,the patients who received colonic Jpouch or transverse coloplasty pouch were much better than those not did. Five years survival rate 63.3 %, anastomosis recurrence rate 10.1% and recurrence rate in the pelvic soft tissue was 5.1%. Conclusion Anus-preserving operation of low rectal cancer can accomplished with double stapling device,and five years survival rate and local recurrence rate did not effect. Colonic J-pouch or transverse coloplasty pouch is good for improving the defecation function after anus-preserving operation.

Value of double stapling technique with curved cutter stapler in low colorectal anastomosis / 上海第二医科大学学报

Objective To evaluate the value of double stapling technique with curved cutter stapler in colorectal anastomosis,especially in low colorectal anastomosis. Methods The clinical data of 168 cases of rectal carcinomas treated with double stapling technique with curved cutter stapler were retrospectively reviewed.The intraoperative condition,postoperative complications and findings during follow up were analysed. Results During the operations,the processes of closure and anastomosis of all the patients were satisfactory,and no operative death occurred.After the operations,4 cases(2.4%) had anastomotic leakage,3 cases(1.8%) had anastomotic bleeding,and 2 cases(1.2%) had rectovaginal fistula.All the complications were cured.There was no anastomotic stricture. Conclusion Double stapling technique with curved cutter stapler may help to accomplish low colorectal anastomosis which is a difficult task for handed suture.

Step-by-step Management and Treatment Outcome of Bleeding Control for Anastomosis Site after Low Anterior Resection with Double Stapling Technique

PURPOSE: This study reviews our experience with a step- by-step management approach of increasing aggressiveness and evaluates the treatment outcome for intraluminal hemorrhage. METHODS: The study group was comprised of patients who had experienced intraluminal hemorrhage after a low anterior resection with the double stapling technique from 1999 to 2003. The choice of management was selected according to our step-by-step management protocol, and the outcomes were evaluated for each step, lincluding mortality and complications. RESULTS: Nine patients (6 males and 3 females, mean age 55 years) were identified, the mean volume of packed RBC transfusion was 2 pints, and the mean distance of the anastomotic site from the anal verge was 6 cm. The median stapler size was 31 mm. The first step was cold saline irrigation and drainage; four of 9 patients were controlled. The second step was retention enema with topical hemostatics; one of remaining 5 patients stopped bleeding. The third step was colonoscopic hypertonic saline injection around the bleeding site with direct colonoscopic electrocauterization, two of remaining 4 patients were controlled. The last step was suturing the bleeding site through the anus, the remaining 2 patients stopped bleeding. One of the 9 patients developed leakage from the anastomotic site after the last step management, three of the 9 patients had long standing ileus, and one of the 9 patients developed acute renal failure after a massive transfusion. There were no postoperative deaths. CONCLUSIONS: It is safer and easier to control bleeding with step-by-step management system of increasing aggressiveness.