Ureteral repair with titanium staples: comparison with suture closure.

OBJECTIVES: Vascular closure staple (VCS) clips made of titanium were initially developed for microvascular anastomoses with little knowledge of their effectiveness in larger tubular tissue structures. This study compares VCS clips and sutures in the closure of longitudinal ureterotomy incisions. METHODS: In 9 pigs, 1-cm-long anterior, longitudinal ureterotomy incisions were randomly assigned to closure with either 4-0 interrupted polyglactin sutures or VCS clips. RESULTS: Clip closure was significantly faster (74+/-28 versus 534+/-182 seconds). All 18 ureters were patent and without signs of leakage, calculus formation, or stenoses after 3 months. Clip closure resulted in slightly but not statistically significantly less narrowing of the duct lumen, but there was no difference in wall thickness at the repair site. At histologic examination, all 18 incisions healed without signs of acute inflammation or marked fibrosis. CONCLUSIONS: Ureterotomy closure with VCS clips results in wound healing that is as effective as suture closure, with a comparable degree of narrowing. The time required for clip closure is only about 1/7 that required for suture closure.

Arterial reconstruction with vascular clips is safe and quicker than sutured repair.

BACKGROUND: Non-penetrating, arcuate-legged vascular-closure staple clips made of titanium were initially developed for microvascular anastomoses with little experience of their use in larger vessels. The purpose of this study was to compare vascular-closure staple clips to sutured anastomoses in common iliac arteries in a porcine model. METHODS: In an experimental study, transected iliac arteries on both sides of 11 pigs were randomly assigned to end-to-end anastomosis performed with vascular-closure staple clips or interrupted 6-0 polypropylene sutures. Angiographic, macroscopic and microscopic results were assessed after 2 months. RESULTS: There was no significant difference in the patency rate, tensile strength of the anastomoses, vessel diameter at the repair site, intimal thickness or wall thickness of the arteries after either method of closure. The mean (s.d.) clamp time was 19.8 (6.1) minutes for clip repair, and 36.0 (6.9) seconds for suture repair (P < 0.001). The times required for the reconstruction of the anastomoses were 17.4 (6.1) and 35.5 (7.1) minutes, respectively (P < 0.001). CONCLUSIONS: Arterial anastomoses performed with vascular-closure staple clips are faster than sutured anastomoses, and result in comparable wound healing when assessed for patency, tensile strength, degree of narrowing and intimal reaction.

A quick and simple method to close vascular, biliary, and urinary tract incisions using the new Vascular Closure Staples: a preliminary report.

Traditional suture reconstruction of tubular organs creates a perforating needle injury, leaves suture material on the endothelial or mucosal surfaces, and is cumbersome when done endoscopically. One alternative method of reconstruction of tubular organs could use the new nonpenetrating clip to create an everted closure. In five pigs, a longitudinal incision of the infrarenal aorta, inferior vena cava, left ureter, gallbladder, and the common bile duct (in two) was closed with Vascular Closure Staples (VCS-clips). Four weeks after surgery, all ten blood vessels remained patent with no thrombosis. There was a well-healed wound with continuous intimal layer. The ureteral, gallbladder, and common bile duct wounds healed without leakage or obstruction in all animals. There was complete mucosal bridging of the wound, although in some specimens one or two clips were exposed to the lumen. The VCS-clips are easily and quickly applied and are safe insofar as can be determined by short-term follow-up.

Some effects of Bunnell suture on otherwise uninjured tendons in subhuman primates.

An experimental study was performed in rhesus monkeys (M. mulatta) to examine the contribution of Bunnell tendon suture to the production of postoperative tendon adhesions. It was found that Bunnell suture used with atraumatic technique caused a significant depression of in vitro tendon surface plasminogen activator activity, allowing the in vivo persistence and fibrous organization of fibrinous postoperative adhesions to sutured areas. Bunnell suture also produced coagulation necrosis of the sutured area of tendon. Collagen, which replaced the destroyed areas, was oriented randomly and frequently was continuous with surface tendon adhesions to surrounding connective tissues. Bunnell suture appears to be a cause of tendon adhesions in subhuman primates. The importance of fibrin and depressed local fibrinolysis in the relationship of tendon ischemia and adhesion formation is discussed.

A physiologic basis for the adhesion-free healing of deperitonealized surfaces.

PIP: Male albino rats were used in this experimental study designed to determine the physiological basis for the formation of peritoneal adhesions postoperatively, and hence to discover a physiological basis for adhesion-free healing after abdominal surgery. Recent evidence had shown that failure of the peritoneal fibrinolytic system may be the important etiological factor in postoperative adhesion formation; hence, the working hypothesis was that adhesion formation could be explained by alterations of intrinsic peritoneal fibrinolytic mechanisms. All rats underwent repeated biopsy to obtain control determinations of plasminogen activator activity (PAA), and then 70 animals had 2 by 2 cm areas of parietal peritonium resected to a thin layer of adherent underlying muscle on the abdominal wall on both sides of the original midline incision. On 1 side, the perioneal patch was immediately sutured back in place as an avascular, free graft. On the other, the raw peritoneal defect was left unrepaired. In 40 of these 70 rats, polyethylene patches were used to cover the peritoneal graft and defect. Animals were sacrificed in groups of 10 at various intervals postoperation to determine PAA and adhesion formation. 24 hours postoperatively, mean graft PAA had decreased to one-sixth the control value (P .001). Similar wide discrepancies were seen through 96 hours postoperation (all statistically significant at P .001). PAA was unchanged in controls. 96 hours postoperation, adhesions to the parietal defects had completely disappeared in 8 of 10 animals, yet all of the grafts remained covered by dense adhesions. By 2 weeks, all deperitonealized wounds showed complete absence of adhesions, compared with dense adhesions on the graft wound.^ieng

Direct influence of endotoxin on cellular respiration.

Hepatocyte oxygen consumption was evaluated in vitro in 70 rabbits. In selected instances, Escherichia coli endotoxin was added to a chamber containing either rabbit hepatocytes or hepatocyte homogenates. Endotoxin directly depressed the respiration of intact rabbit hepatocytes. Endotoxin also decreased the oxygen consumption of hepatocyte homogenates. The intact cell membrane is not an effective barrier to the deleterious effect of endotoxin. A patient in a state of endotoxic shock, in addition to having a hemodynamic derangement, probably has circulating toxins that directly render cellular oxidative phsophorylation less efficient.

Surgical trauma and pericardial fibrinolytic activity.

Fibrinolytic activator activity was identified in canine pericardium by fibrin slide and fibrin slide and fibrin plate techniques and shown to be sighnificantly decreased following trauma. Cotton sponge abrasion, heating, drying and use of electrocautery and DC electro-shock significantly decreased pericardial fibrolytic activity. Operative decreases in pericardial fibrinolytic activator activity may be significant in the etiology of postoperative pericardial adhesions and constrictive pericardial syndromes.