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Objective:To investigate the clinical efficacy of modified biliary-intestinal anasto-mosis by pancreaticoduodenectomy and influencing factors of postoperative biliary leakage.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopatholo-gical data of 165 patients with benign and malignant diseases around the ampullary who underwent pancreaticoduodenectomy in the Affiliated Hospital of Inner Mongolia Medical University from June 2014 to October 2020 were collected. There were 92 males and 73 females, aged (59±10)years. Of the 165 patients, 44 patients undergoing modified biliary-intestinal anastomosis within pancreatico-duodenectomy were divided into the modified group, and 121 patients undergoing traditional biliary-intestinal anastomosis within pancreaticoduodenectomy were divided into the traditional group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and postoperative situations; (3) analysis of influencing factors of biliary leakage after pancreaticoduodenectomy. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.05. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Univariate analysis was conducted using the corresponding statistical methods based on data type. All indicators in univariate analysis were included in multivariate analysis. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 165 patients, 72 cases were successfully matched, including 36 cases in the modified group and 36 cases in the traditional group, respectively. The elimination of jaundice, preoperative reduction of jaundice and hypertension confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. All patients in the two groups underwent surgery successfully. The operation time, postoperative pathological type (lower bile duct cancer, pancreatic head cancer, pancreatic cystic tumor, chronic pancreatitis, duodenal cancer), time of no drainage fluid in the drainage tube around biliary-intestinal anastomosis were 371(270,545)minutes, 6, 12, 1, 2, 15, (12±7)days in patients of the modified group, versus 314(182,483) minutes, 13, 14, 1, 4, 4, (16±8)days in patients of the traditional group, showing significant differences in the above indicators between the two groups ( Z=-3.54, χ2=10.01, t=-2.34, P<0.05). Cases with postoperative grade A biliary leakage was 0 in patients of the modified group, versus 6 in patients of the traditional group, showing a significant difference between the two groups ( P<0.05). Cases with postoperative grade B biliary leakage, cases with postoperative grade B pancreatic fistula, cases with postoperative bleeding, cases with abdominal infection, cases with incision infection, cases with delayed gastric emptying, cases undergoing unplanned readmission were 1, 0, 1, 4, 1, 5, 1 in patients of the modified group, versus 0, 1, 2, 5, 2, 5, 2 in patients of the traditional group, showing no significant difference in the above indicators between the two groups ( P>0.05). Cases with postoperative grade A pancreatic fistula, cases with overall complications, cases with Clavien-Dindo grade Ⅰ-Ⅱ complications, cases with Clavien-Dindo grade Ⅲ-Ⅳ complications were 6, 12, 6, 6 in patients of the modified group, versus 7, 14, 8, 6 in patients of the traditional group, showing no significant difference in the above indicators between the two groups ( χ2=0.09, 0.24, 0.36, 0.00, P>0.05). None of patient in the two groups had postoperative grade C biliary leakage and postoperative grade C pancreatic fistula. (3) Analysis of influencing factors of biliary leakage after pancreaticoduodenectomy. Results of multivariate analysis showed that preoperative reduction of jaundice and traditional biliary-intestinal anastomosis were independent risk factors for biliary leakage after pancreaticoduodenectomy ( odds ratio=11.37, 12.27, 95% confidence interval as 1.76-73.35, 1.14-131.23, P<0.05). Conclusions:Compared with traditional biliary-intestinal anastomosis, modified biliary-intestinal anastomosis within pancreaticoduodenectomy is safe and feasible. Preoperative reduction of jaundice and traditional biliary-intestinal anastomosis are independent risk factors for biliary leakage after pancreaticoduodenectomy.
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Objective Aiming at improving biomechanical strength of the anastomotic stoma as well as reducing tissue thermal damage, a novel radiofrequency (RF) tissue welding electrode was developed. Methods A novel electrode with a hollow structure on the surface ( the plum electrode) was designed and the ring electrode was used as control group to conduct the welding of intestinal tissues based on RF energy. Biomechanical properties of anastomotic stoma were studied by shear test and burst pressure test. The tissue thermal damage during welding was investigated by finite element electro-thermal-mechanical multi-field coupling simulation analysis and thermocouple probe, and the tissue microstructures were also studied. Results Under 120 W RF energy, 8 s welding duration and 20 kPa compression pressure, the anastomotic stoma had the optimal biomechanical properties. Compared with the ring electrode group, biomechanical strength of the anastomotic stoma in plum electrode group was higher, with the shear strength and burst pressure increasing from (9. 7±1. 47) N, (84. 0±5. 99) mmHg to (11. 1±1. 71) N, (89. 4±6. 60) mmHg, respectively. There was a significant reduction in tissue thermal damage, and intact and fully fused stomas could be formed in anastomotic area. Conclusions The proposed novel electrode could improve biomechanical strength of the anastomosis as well as reduce tissue hermal damage, thus achieve better fusion. The research result provide references for realizing the seamless connection of human lumen tissues
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Objective The ileum of porcine intestines with radiofrequency (RF) energy was fused through a novel linkage-type pressure controlled electrode, so as to verify feasibility and security of intestinal reconstruction in the RF energy tissue fusion technology. Methods Fresh porcine intestines were fixed on negative electrode in the order of ‘mucosa-serosa’, and then different compressive pressures （497，796，995，1 194，1 492 kPa）and RF energy were applied to the tissues through positive electrode of pressure cone to complete intestinal anastomosis. Biomechanical properties of the fused area were studied by tensile strength and bursting pressure test, and the thermal diffusion and tissue microstructure also studied. ResultsThe anastomotic tensile strength and bursting pressure could reach （8.73±1.11） N and （8.29±0.41） kPa, respectively, when the energy output power, pressure and welding time were 160 W, 995 kPa and 13 s, respectively, and an intact microstructure with little free collagen in the fused area could be observed. Conclusions The technology of RF energy-based tissue fusion could accomplish fast and stable intestinal tract reconstruction, showing great potential in clinical application. It is of great significance to shorten the operation time, simplify the operation process and improve the operation quality.
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Objective To compare and discuss the clinical application effect of the end-to-end anastomosis of pancreatic and intestinal anastomosis,binding type of pancreatic and intestinal anastomosis,end-to side pancreatic duct anastomosis and modified pancreatic duct jejunum anastomosis.Methods Collected pancreatoduodenectomy in 95 cases,the end-to-end pancreatico duodenal sleeve type anastomosis in 23 cases,binding type pancreatic enteric anastomosis in 18 cases,end to side pancreaticojejunostomy anastomosis in 28 cases,improvement of the pancreatic duct jejunum end to side anastomosis in 26 cases,compared with four groups of patients with pancreatic enteric anastomosis time and postoperative complications.Results Anastomosis time:A group (34.0 ± 4.6) min,B group (31.0±5.8) min,C group (32.0 ±6.3) min,D group (14.0 ±4.2) min(P=0.037,P＜0.05).And the incidence rate of postoperative pancreatic fistula,bile leakage,abdominal cavity or digestive tract bleeding had no significant difference (P ＞ 0.05).Improvement of the pancreatic tube jejunum end to side coincident with a low incidence of pancreatic fistula,but different pancreatic enteric anastomosis way pancreatic fistula rate difference was not statistically significant,improvement of the pancreatic duct and jejunum mucosa end side group pancreatic enteric anastomosis anastomosis time significantly shorter in the three groups,the difference was statistically significant (P ＜ 0.05).Conclusion Improvement of pancreatic duct jejunum end to side anastomosis with short operation time,low incidence of pancreatic fistula,and the operation is simple and practical,safe.
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Objective To explore the efficacy of Chen's cholangiojejunostojmy for tumors around biliary-intestinal anastomosis.Methods The clinical data on 11 patients operated from Jan 2012 to Dec 2014 were retrospectively analyzed.Results All these 11 patients underwent Chen's cholangiojejunostomy.The postoperative liver function significantly improved,and the symptoms of jaundice completely disappeared after operation [ALT (182.0 ±110.6) U/L vs (68.3±33.3) U/L,TBil (316.9 ±153.9) μmol/L vs (60.3 ± 25.8) μmol/L,DBil (184.1 ± 89.6) μmol/L vs (28.6 ± 12.4) μmol/L,P ＜ 0.01;AST (195.5 ± 206.9) U/L vs (48.6 ± 21.2) U/L,GT (806.7 ± 480.0) U/L vs (204.0 ± 99.1) U/L,ALP (612.8 ±424.6) U/L vs (277.5 ± 68.7) U/L,P ＜ 0.05].The level of CA19-9 also significantly decreased [(1 369.75 ± 1 812.18) kU/L vs (71.0 ± 46.5) kU/L,P ＜ 0.05].There were no significant differences in the CA125,CA15-3,CEA levels [CA125 (35.3 ± 26.0) kU/L vs (29.4 ± 23.5) kU/L,CA15-3 (19.4±12.3) kU/L vs (17.9±10.7) kU/L,CEA (8.4 ±7.7) μg/L vs (7.8 ±6.6) μg/L,P ＞ 0.05].There was no perioperative death.All the patients had a smooth perioperative recovery,except in 1 patient who developed bile leakage and another patient who had episodic attacks of cholangitis.There were no recurrent or metastatic tumors detected on follow-up.Conclusion Chen's cholangiojejunostomy was effective in the treatment of bile duct obstruction caused by tumors around biliary-intestinal anastomosis.
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Objective To evaluate the effect and feasibility of balloon dilatation for treatment of anastomotic stricture after biliary-intestinal anastomosis with percutaneous transhepatic cholangial drainage( PTCD) .Methods A total of 23 pa-tients with anastomotic stricture after biliary-intestinal anastomosis who had undergone PTCD+balloon dilatation were ana-lyzed retrospectively between Mar 2009 to Dec 2011.The patency of bile duct, jaundice index and liver function were recor-ded.Results PTCD+balloon dilatation was completed successfully in all cases, and a metallic stent was implanted in one case.Anastomotic stricture, postoperative jaundice index and liver function were improved significantly after operation.No serious complications occurred.Conclusion PTCD+balloon dilatation has good curative effect on anastomotic stricture. The complication rate is low.It is a safe, feasible and effective minimally invasive treatment.
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Estomas intestinais consistem na exteriorização do íleo ou cólon para o meio externo através da paredeabdominal. Anastomoses intestinais são suturas entre dois segmentos do tubo digestivo para areconstituição do trânsito intestinal. Tipos, classificação, indicações, complicações e a técnica sãodiscutidos.
Intestinal stomas consist of ileum or colon exteriorization through the abdominal wall. Intestinal anastomosisare sutures between two segments of the digestive tract to replenish the intestinal tract. Types,classification, indications, complications, and techniques will be discussed.
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Anastomosis, Surgical , Colostomy , Surgical Stomas , IleostomyABSTRACT
Demostrar que la ingesta precoz de líquidos por vía oral no produce aumento de la opresión intraluminal sobre la línea de sutura en las anastomosis intestinales y por lo tanto no es causa de dehiscencia de la misma, aunado que este hecho produce una estancia hospitalaría menor del paciente. Un estudio prospectivo con 21 cerdos a quienes se les practicará resección y anastomosis T-T, sometidos a una presión intraluminal de líquidos VIT y VID, con un protocolo de seis cirugías en 18 días y estudio de la anastomosis resecada en microscopia óptica y electrónica. Unidad de Investigación Quirúrgica de la Escuela de Medicina José María Vargas, Facultad de Medicina UCV. La ingesta precoz de alimentos y líquidos no es causa de dehiscencia en anastomosis intestinales con tránsito intestinal normal. Los resultados preliminares de este estudio apuntan a que la ingesta precoz de líquidos no es causa de dehiscencia en anastomosis intestinales.
Demostrate that early fluid intake vía oral produces no increase of pressure intraluminal on the suture line in the intestinal anastomoses, and therefore is not cause of dehiscence of the same, combining this fact produces a smaller hospital stay of the patient. A prospective study with 21 pigs to who they shall resection and under pressure T-T, anastomoses VIT and VID, liquids with a protocol of six surgeries in 18 days intraluminal and study the resected anastomoses in optical microscopy and electronics. Research Surgical Unit of the Escuela de Medicina José María Vargas, Facultad de Medicina UCV: Early lood and fluid intake is nor cause of intestinal anastomoses dehiscence with normal intestinal transit. The preliminary results of this study suggest that early fluid intake is not cause of dehiscence in intestinal anastomoses.
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Animals , Anastomosis, Surgical/methods , Intestine, Small/anatomy & histology , Intestine, Small/surgery , Intestine, Small/pathology , Swine/anatomy & histology , Surgical Wound Dehiscence/etiology , Surgical Wound Dehiscence/veterinary , Veterinary Medicine , Models, BiologicalABSTRACT
Objetivo: Avaliar, experimentalmente, os efeitos da mucosectomia química sobre a cicatrização de anastomosescolônicas. Metodologia: Estudou-se 17 ratos Wistar machos divididos nos seguintes grupos: A (n=12), anastomose colônica; B (n=13), anastomose colônica após mucosectomia. A mucosectomia foi realizada através da introdução de um bastão de nitrato de prata a 10%, durante um minuto, através das duas bocas a serem anastomosadas, e as anastomoses realizadas em plano únicototal, evertente, com fio polivicril 6-0 em pontos separados. Os animais foram estudados após 7 dias (6 do grupo A1 e 6 do grupo B1) e 14 dias (7 do grupo A2 e 6 do grupo B2) da cirurgia, e realizadas observações macroscópicas da presença de aderências, fístulas (saída de secreção através da anastomose ou teste da pressão de ruptura igual a zero), estenose (dilatação intestinal proximal à anastomose), abscessos peri-anastomóticos e peritonite. Foi também avaliada a pressão de ruptura das anastomoses e histologia das anastomoses. Os resultados qualitativos foram avaliados pelo teste do Qui-quadrado (com correção de Yates) e osquantitativos através do teste de Kruskall-Wallis, sendo considerados significativos valores de p<0,05. Resultados: Nenhum dos animais estudados apresentou fístulas. A incidência de aderências peri- anastomóticas não foi diferente entre os grupos (A1=100%, B1=100%, p=N.S.; A2=75%, B2=50%, p=N.S.). Houve semi-obstrução da anastomose em 25% dos animais do grupo A1, 50% daqueles do grupo B1, 25% dos animais do grupo A2 e 50% dos animais do grupo B2, sem diferença significativa entre os grupos.A pressão de ruptura, em mmHg, foi de 27,0 ± 4,5 no grupo A1, 34,5 ± 2,0 no grupo B1, 28,9 ± 4,2 no grupo A2 e 24,0 ± 3,4 no grupo B2, com aumento significativo no grupo B1 quando comparados aos grupos A1 (p=0,03) e B2 (p=0,02)...
Objective: To evaluate, experimentally, the effects of chemical mucosectomy on colon healing in rats. Methods: We studied 17 male Wistar rats divided into following groups: A (n=12), colonic anastomosis; B (n=13), colonic anastomosis after use of 10% silver nitrate. The mucosectomy in group B was made by means introduction of 10% silver nitrate pencil into anastomotic surfaces during 1 minute in an extension of 0.5 cm. The anastomosis was made in single plane with evertent sutures of polyvicryl 6-0 in separated sutures. The animals were evaluated in the seventh postoperative day (A1, 6 of the group A and B1, 6 of the group B) and fourth postoperative day (A2, 7 of the group A and B2, 6 of the group B). The anastomosis was evaluated in macroscopic aspect (adherence, fistula, stenosis, perianastomotic abscesses, peritonitis), rupture pressure (mmHg) and histology (inflammatory infiltrate). The data were analysed by Chi-square test (qualitative data) and ANOVA (quantitative data), and considered significative values of p<0.05. Results: None animal presented fistula. The incidence of adherence was no different among the groups. (A1=100%, B1=100%, p= NS; A2=75%, B2=50%, p= NS). There were anastomosis partial obstruction in 25% of group A1, 50% inB1, 25% in A2 and 50% in B2, without significant differences among the groups. The rupture pressure was 27,0 ± 4,5 in A1 group, 34,5 ± 2,0 in B1 group, 28,9 ± 4,2 in A2 group and 24,0 ± 3,4 in group. There was an significant increase in pressure rupture in B1 group when compared with A1 group (p=0,03) and B2 group (p=0,02). Conclusion: The chemical mucosectomy with silver nitrate was not associated with increase in postoperative cicatricial complications in wound colon healing in rats. There was, however, an increase in anastomosis strength in early period of the cicatricial process, without influence in latter period.
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Rats , Adenomatous Polyposis Coli , Anastomosis, Surgical , Colonic Pouches , Fistula , Intestinal PolyposisABSTRACT
Isobutyl-2-cyanoacrylate (Group I) and n-butyl- FONT FACE="Symbol">a /font> -cyanoacriylate (Group II) were tested in two groups of dogs: Group I=13 dogs and Group II=12 dogs that had intestinal laterolateral anastomosis.The anastomosis were avaluated on days: 4, 14 and 28 after surgery. Adhesions between omentum and the surgical wall wound were grossly in both groups. Regarding the presence of adhesions comparing the two groups with unpaired t test, the difference between the Group I and II is not significant (p=0,3624). Histology revealed inflammation and granuloma on the anastomosis with the adhesive inside of it both with isobutyl-2-cyanoacrylate and n-butyl- FONT FACE="Symbol">a /font> -cyanoacriylate
Testou-se em 25 cães a aplicação do isobutil-2-cianoacrilato (Grupo I) e n-butil- FONT FACE="Symbol">a /font> -cianoacrilato (Grupo II) para anastomose intestinal látero-lateral. As anastomoses foram avaliadas aos quatro, 14 e 28 dias de p.o. Observou-se macroscópicamente aderência entre o epiploo e a ferida cirúrgica da parede abdominal em ambos os grupos. Comparando os Grupos I e II através o teste t não pareado, estatisticamente não apresentaram diferença significativa (p=0,3624). Ao exame histológico notou-se reação inflamatória, granuloma e no seu interior presença do adesivo
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In consideration of the potential deleterious effects of blood transfusion, the effect of acute anemia on the healing of both small (SI) and large intestinal (LI) anastomoses was evaluated. Thirty-six white rabbits underwent resection of both the mid-ileum and the distal colon with primary anastomosis of each. One and two weeks post operation, all anastomoses were assessed by anastomotic bursting pressure (ABP) and histologic evaluation utilizing a modified Erhlich/Hunt scale with grading of the WBC influx, blood vessel ingrowth, fibroblast proliferation, and collagen deposition. Results were analyzed using oneway analysis of variance (ANOVA) and the Chi-Square approximation with p<0.05 being considered significant. The SI ABP, reported in mmHg SE, of the anemic rabbits was decreased at one week vs. the controls (234 mmHg 17 vs. 201 mmHg 16), reaching significance at two weeks (190 mmHg 6 vs. 257 mmHg 17). A decreased LI ABP was found at one week, though not quite reaching singnificance (p=0.06). Recovery to control values occurred by two weeks. Histologic assessment (anemia vs. control) demonstrated a uniform decrease in WBC infiltration, reaching significance in the LI group at two weeks. Blood vessel ingrowth was likewise depressed, but did not achieve significance. The collagen contents of both the SI and the LI groups at two weeks decreased, as were the SI fibroblast proliferation at one week (p<0.05). This study demonstrates that severe, acute anemia in rabbits undergoing intestinal anastomoses severely alters histologic parameters in both the SI and the LI anastomoses while decreasing the overall strength of the SI anastomoses.
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Rabbits , Anemia , Blood Transfusion , Blood Vessels , Collagen , Colon , FibroblastsABSTRACT
BACKGROUND: It is commonly accepted that the Gambee suture is a precise and reliable suturing method in the anastomosis of the intestine, especially in the aspect of the exact apposition of the submucosal layer. Generally, Gambee suturing technique requires much time and effort, as well as complicated actions and skills. For this reason, the Gambee suture is avoided by many surgeons. PURPOSE: Nahm-gun Oh has devised a U-shaped needle, which can prevent submucosal tearing of the posterior bowel wall, owing to the short distance between its both ends. As a result, an operator to perform a Gambee stitch more easily, safely. This study was undertaken to evaluate the usefulness, reliability of the U-shaped needle. METHODS: The clinical analysis was made on 104 cases with Gambee anastomosed colo rectal disease who have been admitted and operated at the Department of Surgery, Pusan National University Hospital, from January, 1996 to December, 1997 and the disease and patients status, operative procedure, postoperative complication, needle holder grasping count according to anastomosis level of 104 cases were analyzed. RESULTS: Gambee anastomosis was performed in 71 cases(68.3%) of colorectal cancers and 33 cases(31.7%) of nonmalignant colorectal diseases. Postoperative complication was 20 cases(19.2%) and 2 cases(1.9%) of anastomotic site leaks were observed. In aspect of needle holder grasping according to anastomosis level, U-shaped needles allow for an entire Gambee suture from one fixed grasp, while the common half-circled suturing needle requires at least 2 or 3 different grasping positions of the needle holder. In case of anterior bowel wall anastomosis, undesirable slipping-off of the submucosal tissue was founded. Authors also suggest a hook-style barb tip so that barb tip should prevent the slipping-off. CONCLUSION: The half-ellipsed or half-track needle can prevent submucosal tearing of the posterior bowel, owing to the short distance between its both ends. Barb feature on the suturing needle tips will be able to prevent slipping-off of the submucosa contralateral from the needle holder during an entire Gambee stitch on the anterior bowel wall. We recommended, based on our results, with U-shaped suturing needle, as well as barb-tip needle feature, operators can save a lot of time and effort formerly required by other common needle in Gambee suture.
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Humans , Colorectal Neoplasms , Hand Strength , Intestines , Lower Gastrointestinal Tract , Needles , Postoperative Complications , Rectal Diseases , Surgical Procedures, Operative , SuturesABSTRACT
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