Sutureless colic anastomoses with cyanoacrylates

BACKGROUND AND AIMS. The present research project has been made mainly with the idea of comparing the tensile strength values and histological answers of three types of colon anatomises: sutured with silk and sutureless anastomoses with 2-octylcyanocrylate and N-butyl-2-cyanoacrylate. METHODS. 112 Wistar rats distributed into three groups of 35 animals and a last control group of 7 have been used for this. Group 1: silk, group 2: 2-octyl-cyanocrylate, group 3: N-butyl-2-cyanoacrylate, group 4: Control group. The following surgical interventions were practiced on them: A cross section of the colon, followed by: group 1: an end-to-end discontinuoussuture anastomoses with Silk; group 2: sutureless anastomoses with 2-octyl-cyanocrylate; group 3: sutureless anastomoses with N-butyl-2-cyanoacrylate. On the 10th, 20th, 30th, 40th and 50th days we proceeded to measure the anastomoses' tensile strength value for each series. In the same period of time we carried out the following anatomic-pathological determinations: a) sharp inflammation; b) oedema; c) non-specific chronic inflammatory infiltrate; d) granulomatous inflammatory infiltrate to foreign bodies; e) fibrosis. RESULTS. The results obtained indicate a greater anastomoses' tensile strength for group 2 and 3. The anatomic-pathological values show a better response to anastomoses with adhesives than with conventional sutures. CONCLUSIONS. All these experimental results lead us to conclude that the cyanocrilates used to carry out sutureless anastomoses may be an alternative to the handmade conventional anastomoses. Moreover they are easy to be implemented (AU)

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Experimental study of sutureless colorectal anastomosis.

BACKGROUND/AIMS: The present research project has been made mainly with the idea of comparing the tensile strength values and histological answers of three types of colon anastomosis: sutured with silk 5/0; polyglycolic acid 5/0; and sutureless anastomosis with human fibrin gum. METHODOLOGY: One hundred and five (105) Wistar breath rats allocated into 3 groups of 35 animals were used to implement this experimental research project: silk, polyglycolic acid and human fibrin gum. Furthermore, each group was subdivided in 5 series respectively to carry out an experimental study on the tensile strength parameter and anatomic-pathological determinations on the 10th, 20th, 30th, 40th and 50th day after the surgical intervention. The following surgical interventions were practiced on them: A cross section of the colon, followed by: group 1: an end-to-end discontinuous suture anastomosis with Silk; group 2: an end-to-end discontinuous suture anastomosis with polyglycolic acid; group 3: sutureless anastomosis with human fibrin gum. On the 10th, 20th, 30th, 40th and 50th days we proceeded to measure the anastomosis' tensile strength value for each series. We used a tensile strength apparatus and waited until the break down of the suture sample took place and wrote down the value, in g/cm, given by the voltmeter at that moment. RESULTS: The results obtained indicate that anastomosis made in group 1 (silk) lasted longer to the tensile strength apparatus; followed by those practiced in group 2 (polyglycolic acid); and finally anastomosis carried out in group 3 (human fibrin gum). However in the anastomotic process carried out with the human fibrin gum the healing started from the 10th day. In the same period of time we carried out the following anatomic-pathological determinations: a) sharp inflammation; b) edema; c) non-specific chronic inflammatory infiltrate; d) granulomatous inflammatory infiltrate to foreign bodies; e) fibrosis. CONCLUSIONS: The results show a better answer for anastomosis made with human fibrin gum than those carried out with the two other suture materials. This conclusion is based on the facts that the human fibrin gum used to carry out sutureless anastomosis during this research project generated a lower sharp inflammation and speediness in its absorption; absence of granular reaction to a foreign body; a minor or non-existent edema at all; as well as a good fibrous healing speediness process. Therefore, all these experimental results lead us to conclude that the human fibrin gum used to carry out sutureless anastomosis may be an alternative to the handmade conventional anastomosis. Moreover they are easy to be implemented.

[Duodenal adenocarcinoma in celiac disease with late diagnosis and treatment]. / Adenocarcinoma duodenal en enfermedad celíaca de diagnóstico y tratamiento tardíos.

It seems to be a link between small intestine cancer and celiac disease. We describe here a patient who developed a duodenal carcinoma fifteen years after the celiac disease diagnosis. Tumor endoscopic study and biopsy sampling are the more useful diagnostic approach. This is usually difficult because the lesion is very small or there are rests of food biding the lesion. Poor clinical layout and a later diagnosis favour the development of metastasis. A wide segmental resection including lymph nodes is the best therapy for tumors of the second and third duodenal segments.

[Left splanchicectomy with videothoracoscopy for the control of pain in cancer of the esophagogastric union with invasion of the celiac plexus]. / Esplacnicectomía izquierda videotoracoscópica para el control del dolor en el cáncer de unión esofagogástrica con invasión del plexo celíaco.

Blockade of the celiac plexus and the splanchnic nerves to combat abdominal pain can be achieved by percutaneous injection of local anesthetics or alcohol, or by thoracotomy. We describe the technique for performing splanchnicectomy with video-thoracoscopy in palliative surgery for cancer of the esophagogastric union, discussing the excellent results obtained immediately in 2 patients.

[Postoperative gastritis due to alkaline reflux. Our results]. / Gastritis postquirúrgica por reflujo alcalino. Nuestros resultados.

We present the results of a retrospective study carried out on 23 patients with alkaline gastric reflux (AGR) verified through endoscopy, biopsies and Tc99m HIDA, which were operated on in our department with Y of Roux, Braun, Henley as the correction techniques of this pathology. The criteria of surgical indications were evaluated in these patients as also the results obtained in reference to residual symptoms and changes in the histologic and gammagraphic patterns.

Liver, spleen and kidney cultures in different conditions of splenic preservation.

The appearance of the postsplenectomy syndrome has made investigators focus all attention on the immunitary aspects that could change following a splenic extirpation. Besides this, bacterial clearance has been considered fundamental in this pathology. We present an experimental study comparing liver, spleen and kidney cultures in different conditions of splenic preservation, including autotransplantation, and with sepsis induced by the inoculation of capsulated Escherichia coli. The majority of tissue cultures were positive, showing, in must cases, a statistical correlation between the number of microorganisms in each organ for every animal. This confirms that all three organs act alike, as bacterial filters.

Avaliacao qualitativa do refluxo entero-gastrico com o emprego de Tc99 HIDA. / Quantitative evaluation of entero-gastric reflux with the use of Tc99 HIDA

Os autores utilizaram o Tc99 HIDA para evidenciar o refluxo entero-gastrico em 24 pacientes, seis assintomaticos e 18 submetidos previamente a cirurgia por ulceras gastroduodenais, por varias tecnicas (vagotomia troncular e piloroplastia, gastrectomia com reconstrucao e BI e BII). Nos controles nao observaram refluxo em nenhum caso. Nos pacientes previamente operados observaram refluxo em sete dos 18 pacientes estudados.Concluem que o metodo e de facil realizacao, sem morbidade na serie e de boa resolucao na evidenciacao do refluxo entero-gastrico