Modern surgery for ulcerative colitis.

Ulcerative colitis (UC) is a chronic inflammatory disorder of poorly understood aetiology. While medical treatment is first-line management, approximately 10% of patients with UC will require a colectomy either as an emergency or elective procedure. There are multiple surgical options available in the current era and the choice of operation(s) is highly dependent on the clinical presentation, patient preference and individual surgeon or institutional practice. We present a review of modern surgical practices in ulcerative colitis, addressing some current controversies and diversities.

Three-point stapled fixation technique to manage ileostomy spout retraction.

This paper details a technique to manage non-fixed stomal retraction using a using a non-cutting linear stapler.

Evolution in the surgical management of hemorrhoidal disease.

Hemorrhoidal disease is a very common condition requiring surgical management in approximately 10% of cases. Despite its long history and high prevalence, we are still trying to identify the best treatment. Earlier surgical approaches were soon abandoned and now only detain an historic significance. For long, proctologists have given their preference to hemorrhoidectomy that was gradually perfected through the years. The true innovation came in 1937, with the famous Milligan-Morgan hemorrhoidectomy, still one of the leading interventions for treatment of hemorrhoids. Less fortune encountered alternative techniques, such as the Whitehead hemorrhoidectomy, and closed and semi-closed techniques. Later on, the advent of a new concept of the pathogenesis of hemorrhoidal disease has brought to the development of stapled prolassectomy techniques. This approach has encountered both supporters and detractors between the experts in this field and has received a strong impulse by the emerging trend towards "day-surgery". Today the search for the best surgical technique for hemorrhoidal disease is far from being over and witnesses the introduction of new techniques for hemorrhoidal dissection. The choice of the best strategy remains in the hands of the clinician in the modern conception of tailored surgery. KEY WORD: Hemorrhoidal disease, Hemorrhoidectomy, Milligan-Morgan hemorrhoidectomy.

Current Developments and Unusual Aspects in Gastrointestinal Surgical Stapling.

Stapling devices are used in gastrointestinal, gynecologic, thoracic, and many other surgeries to resect organs, transect tissues, and anastomose different structures. These devices became widely accepted standard practice in many gastrointestinal operations, especially since the successful advent of minimally invasive surgery. Despite the relevant advantages related to the use of a surgical stapler, we must also consider that these instruments may be at risk of failure. When any component fails, the patient is at risk of operative morbidity. Gastrointestinal surgical stapling technique still needs refinement in order to increase its reliability. Staple line reinforcement has been widely used and seems to effectively reduce anastomotic complications. Literature provides us with examples of studies supporting both bleeding and leakage reduction after staple line reinforcement, but high-quality evidence is not available to date. Semi-absorbable and nonabsorbable materials have been the earliest available. The use of bioabsorbable staple line reinforcement materials has recently become more widespread, and these materials are more widely used these days. Powered staplers were made available to the market some time ago and represent a rather unheard of aspect of endosurgical stapling. Despite powered staples being supposedly convenient compared with manual ones only one relevant article was found when searching the U.S. National Library of Medicine for "powered stapler." New surgical stapling devices are constantly developed and introduced on the market. Results with such devices depend on the stapler features but also surely vary according to the surgeon experience.

A revolutionary design change to improve stapler safety.

BACKGROUND: Postoperative staple line leaks and bleeding are the most common reasons for complications in surgical procedures that involve organ resection, such as sleeve gastrectomy. Increasing the safety of these operations requires improving the instruments (endostaplers or endocutters) used for stapling and sectioning the tissues. METHODS: We present a new prototype stapler for marketing in resection surgery, especially designed for the sleeve gastrectomy. RESULTS: We suggest that the medical instrument industry creates devices in which the channel along which the knife blade runs is located asymmetrically. This would allow more staples to be placed on the side of the gastric remnant, thus improving the sealing and hemostasis of the suture line and reducing the number of complications for patients as a result. CONCLUSIONS: The application of new concepts in medical surgical devices can improve the safety of the procedures in our patients.

Population-based study of trends, costs, and complications of weight loss surgeries from 1990 to 2002.

OBJECTIVE: To describe the trends, costs, and complications associated with weight loss surgery (WLS). RESEARCH METHODS AND PROCEDURES: Wisconsin inpatient hospital discharge data from 1990 to 2003 were used for analysis. A WLS case was defined as anyone with a WLS-related procedure code and a primary diagnosis of morbid obesity. Charges were inflation-adjusted to 2001 constant dollars; complications were defined on the basis of readmission, extended length of stay, repeat surgical procedures, or death. RESULTS: The number of WLSs increased from 269 in 1990 to 1992 to 1,884 in 2000 to 2002 (rate ratio = 4.6). Increases in WLSs were greatest among those 50 to 59 years of age (rate ratio = 6.4), women (rate ratio = 6.8), and blacks (rate ratio = 20.0). Between the two periods, inflation-adjusted WLS charges increased 12-fold, and the inflation-adjusted charge per procedure doubled, despite a decreased length of stay. For 2000 to 2002, 23.3% of WLS patients had either an extended length of stay or readmission within 30 days, 7.4% required a repeat surgical procedure, and 0.7% died. DISCUSSION: In Wisconsin, the rate and costs of WLSs have increased dramatically, and the incidence of postoperative complications was high. The epidemic of obesity in the United States makes it imperative to better assess the cost-effectiveness of WLS and to improve its safety.