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Purpose: Gastrointestinal disorders frequently necessitate surgery involving intestinal resection and anastomosis formation, potentially leading to severe complications like anastomotic leakage (AL) which is associated with increased morbidity, mortality, and adverse oncologic outcomes. While extensive research has explored the biology of anastomotic healing, there is limited understanding of the biomechanical properties of gastrointestinal anastomoses, which was aimed to be unraveled in this study. Methods: An ex-vivo model was developed for the biomechanical analysis of 32 handsewn porcine end-to-end anastomoses, using interrupted and continuous suture techniques subjected to different flow models. While multiple cameras captured different angles of the anastomosis, comprehensive data recording of pressure, time, and temperature was performed simultaneously. Special focus was laid on monitoring time, location and pressure of anastomotic leakage (LP) and bursting pressures (BP) depending on suture techniques and flow models. Results: Significant differences in LP, BP, and time intervals were observed based on the flow model but not on the suture techniques applied. Interestingly, anastomoses at the insertion site of the mesentery exhibited significantly higher rates of leakage and bursting compared to other sections of the anastomosis. Conclusion: The developed ex-vivo model facilitated comparable, reproducible, and user-independent biomechanical analyses. Assessing biomechanical properties of anastomoses offers an advantage in identifying technical weak points to refine surgical techniques, potentially reducing complications like AL. The results indicate that mesenteric insertion serves as a potential weak spot for AL, warranting further investigations and refinements in surgical techniques to optimize outcomes in this critical area of anastomotic procedures. [ABSTRACT FROM AUTHOR]

Aim: The Kono‐S anastomosis was introduced as a possible solution to the high surgical recurrence rates in Crohn's disease. However, this technique is known to be challenging, which is why it was originally performed in an extracorporeal setting. The aim of this case series was to assess safety, in terms of intra‐/postoperative complications, and feasibility, in terms of successful performance of anastomosis, of a robot‐assisted intracorporeal Kono‐S anastomosis. Method: This is a prospective single‐centre consecutive case series. Patients were considered eligible if they were diagnosed with refractory Crohn's disease with significant bowel stenosis of the terminal ileum. All patients underwent robot‐assisted intracorporeal Kono‐S anastomosis. Perioperative care was provided according to the Enhanced Recovery After Surgery® protocol. Follow‐up for postoperative complications was 30 days. Results: Twenty patients were included, of whom 11 (55%) were men. The median age was 30 years [interquartile range (IQR) 22–51 years] and the median BMI was 25 kg/m2 (IQR 19–28 kg/m2). Intracorporeal Kono‐S anastomosis was successfully performed in all cases. The median operating time was 155 min (IQR 144–176 min) and the median length of stay was 3 days (IQR 1–5 days). No conversions or 30‐day mortality were observed. One patient experienced anastomotic leakage, which was treated with radiologically guided drainage. A total of three patients experienced postoperative complications in the first 30 days. Conclusion: Performance of intracorporeal robot‐assisted Kono‐S anastomosis seems safe and feasible in this case series for Crohn's disease. Since this is a first case series, further research is required to confirm results in a larger population‐based cohort. [ABSTRACT FROM AUTHOR]

Background and aims. To emphasize the importance of laboratory dissections in perfecting surgical techniques. In this paper, we describe the technical details on rabbit dissection for practical applications. Methods. Four New Zealand rabbits were distributed into two groups and underwent anastomosis between the Facial Nerve and Ansa Cervicalis (group 1) and between the Facial Nerve and Hypoglossal Nerve (group 2). They were clinically and neurophysiologically evaluated after ten weeks. Electroneurography with skin electrodes were used to identify the motor activity of the involved muscles and nerves. Facial and ipsilateral tongue reinnervation was analyzed 40 weeks after anastomosis. Evoked electromyographic muscle tension was used to evaluate facial and tongue reinnervation. Results. Facial and ipsilateral tongue reinnervation was analyzed 40 weeks after anastomosis. Recorded evoked potentials showed improvement in facial reinnervation in all four rabbits. Rabbits undergoing FN-HN anastomosis still showed ipsilateral lingual paresis, based on EMG tests. The survival rate was 100%. Conclusions. The laboratory dissection plays a crucial role in training surgical specialists to achieve favorable patient outcomes. Both types of anastomosis can be used to achieve facial reinnervation; however, it is imperative to prevent ipsilateral lingual paralysis that may arise from using the hypoglossal nerve. [ABSTRACT FROM AUTHOR]

Background: The use of coupler devices has become mainstream in microsurgical end-to-end venous anastomoses (EEA) for free flaps in head and neck reconstruction. Reports about end-to-side venous anastomoses (ESA) using a coupler are scarce, though. Methods: The surgical technique of end-to-side anastomosis using a coupler device is described. End-to-side anastomoses and end-to-end anastomoses with a vascular coupler are compared with respect to postoperative vascular complications. Results: 124 patients were included, 76 with EEA, 48 with ESA. Postoperative venous complications occurred in 5.3% and 2.1%, respectively. Conclusions: ESA is a valuable alternative to EEA when using a coupler device providing more flexibility to the surgeon. [ABSTRACT FROM AUTHOR]

Background: The surgical procedure for laparoscopic right colectomy (LRC) is not standardized. Some published studies show the superiority of ileocolic anastomosis (IIA), but the evidence so far is insufficient. This study aimed to investigate the potential advantages in postoperative recovery and safety of IIA in LRC. Methods: A total of 114 patients who underwent LRC with IIA (n = 58) or extracorporeal ileocolic anastomosis (EIA, n = 56) between January 2019 and September 2021 were enrolled. We collected certain factors as clinical features, intraoperative characteristics, oncological outcomes, postoperative recovery, and short-term outcomes. Our primary outcome was time to gastrointestinal (GI) function recovery. Secondary outcomes were postoperative complications within 30 days, postoperative pain, and length of hospital stay. Results: Faster GI recovery and less postoperative pain were observed in patients with IIA compared to EIA [time to first flatus: (2.4 ± 0.7) vs (2.8 ± 1.0) days, p < 0.01; time to liquid intake: (3.5 ± 0.7) vs (4.0 ± 1.1) days, p = 0.01; postoperative visual analogue scale score: (3.9 ± 1.0) vs (4.3 ± 0.6), p = 0.02]. No significant differences were detected in oncological outcomes or postoperative complications. IIA, rather than EIA, tended to be performed in patients with higher body mass index [(23.93 ± 3.52) vs (22.36 ± 2.87) kg/m2, p = 0.01]. Conclusions: IIA is associated with faster GI function recovery and less postoperative pain and may be more favorable for obese patients. [ABSTRACT FROM AUTHOR]

The novel use of magnetic force to optimize modern surgical techniques originated in the 1970s. Since then, magnets have been utilized as an adjunct or alternative to a wide array of existing surgical procedures, ranging from gastrointestinal to vascular surgery. As the use of magnets in surgery continues to grow, the body of knowledge on magnetic surgical devices from preclinical development to clinical implementation has expanded significantly; however, the current magnetic surgical devices can be organized based on their core function: serving as a guidance system, creating a new connection, recreating a physiologic function, or utilization of an internal–external paired magnet system. The purpose of this article is to discuss the biomedical considerations during magnetic device development and review the current surgical applications of magnetic devices. [ABSTRACT FROM AUTHOR]

The anastomosis between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) courses along half of the lateral wall of the maxillary sinus. Risk of injury to the anastomosis between PSAA and IOA during surgical procedures has been reported. The aim of the present study was to carry out a systematic review and meta-analysis to determine the frequency, location, and diameter of the anastomosis between PSAA and IOA in imaging studies (cone-beam computed tomography, spiral cone-beam computed tomography, and computed tomography). A search was carried out in the PubMed, EMBASE, and LILACS. Original works were included reporting imaging studies to analyze the frequency, location, and diameter of the anastomosis in humans. The risks of bias were analyzed using the AQUA tool. Generalized linear mixed models were used to estimate the frequency and the 95% CI in the meta-analysis. The variance in prevalence estimates was stabilized by logit transformation. The qualitative analysis included 49 studies with 10,837 patients. The frequency of the anastomosis between PSAA and IOA was 74% (prediction interval 0.20–0.97%). The anastomosis was most frequently located in the intraosseous region (60.0%), followed by the submembranous region (33.0%), and least frequently in an extraosseous location (5.0%). Arteries with diameter of 1.0–1.9 mm were most frequent (32.0%), followed by arteries with diameter less than 1 mm (23.0%); a small number with diameter greater than 2 mm was recorded (4.0%). These data can be used as a reference to help surgeons when planning interventions in the lateral wall of the maxillary sinus. Registration number: INPLASY, number 202120071. [ABSTRACT FROM AUTHOR]

Background: Despite considerable progress in surgical techniques, anastomotic leak (AL) is a common complication after gastrointestinal surgery. Stem cells are a promising therapy to improve healing and have been used in gastrointestinal anastomoses. In this study, we perform a systematic review and meta-analysis to evaluate the efficacy of stem cell therapies in preventing ALs among animal studies. Methods: A systematic review of the literature was performed by searching PubMed, Web of Science, and the Cochrane Library. We considered all anastomoses of the gastrointestinal tract (excl. biliary) from the esophagus to the rectum. Outcomes included AL rates on postoperative day (POD) 7 and the latest time point reported. Results: Fourteen studies were identified, evaluating stem cells in gastrointestinal anastomoses, of which 1 was on esophageal, 2 on gastric, 2 on small intestinal, and 9 on colorectal anastomoses. Meta-analysis did not show significant differences in AL rates on POD 7 (odds ratio [OR] 0.34, 95% confidence interval [CI]: 0.04–3.15, p = 0.248, I2 = 34.1%, 95% CI: 0–75.2%, Q = 6.07, df = 4, p = 0.194), but there was a nonsignificant trend for lower AL rates at the latest time point reported (OR 0.28, 95% CI: 0.08–1.01, p = 0.052, I2 = 34%, 95% CI: 0–70.8%, Q = 10.6, df = 7, p = 0.157). Conclusion: Stem cell therapy may be associated with lower AL rates in gastrointestinal anastomoses, though meta-analysis is severely inhibited by heterogeneous study design. More studies are needed to determine the therapeutic potential of stem cells. [ABSTRACT FROM AUTHOR]

Background  Uterine transplantation (UTx) is acknowledged to be on the second (2A) of five steps of development in accordance with the staging system for the evaluation of surgical innovations. Accordingly, we aimed to systematically review the available evidence of the surgical techniques and outcomes of UTx in terms of graft survival. Methods  A comprehensive search was conducted across PubMed Medline, Cochrane-EBMR, Scopus, Web of Science, and CENTRAL through November 2020. Results  Forty studies, reporting 64 recipients and 64 donors, satisfied inclusion criteria. The surgical time and the estimated blood loss were 515 minutes and 679 mL for graft procurement via laparotomy, 210 minutes and 100 mL for laparoscopic-assisted graft harvest, and 660 minutes and 173 mL for robotic-assisted procedures, respectively. Urinary tract infections (n  = 8) and injury to the urinary system (n  = 6) were the most common donor complications. Using the donor's internal iliac system, two arterial anastomoses were performed in all cases. Venous outflow was accomplished through the uterine veins (UVs) in 13 cases, a combination of the UVs and the ovarian/uteroovarian veins (OVs/UOVs) in 36 cases, and solely through the OVs/UOVs in 13 cases. Ischemia time was 161 and 258 minutes when using living donors (LD) and deceased donors (DD), respectively. Forty-eight uteri were successfully transplanted or fulfilled the purpose of transplantation, 41 from LDs and 7 from DDs. Twenty-five and four live childbirths from LDs and DDs have been reported, respectively. Conclusion  UTx is still experimental. Further series are required to recommend specific surgical techniques that best yield a successful transplant and reduce complications for donors and recipients. [ABSTRACT FROM AUTHOR]

Introduction: Intracorporeal esophagojejunostomy is a technically demanding procedure, with many challenges. This study presents the anastomotic and technical complications associated with the mis‐insertion of a linear stapler into the esophageal submucosal layer and the recovery procedure for this complication. Materials and Surgical techniques: Of 100 intracorporeal esophagojejunostomy cases from 2017 to 2020, this complication occurred in three cases—one during functional end‐to‐end anastomosis and two during the overlap method. To recover, the residual esophageal mucosa was incised from the entry point to the top of the incomplete staple line, which was then reinforced by suturing in full thickness, including the incised mucosa. After reinforcement, the common stab incision was closed by the linear stapler or handsewn. As a result, none of the patients developed anastomotic leakage or stenosis. Discussion Mucosal dissection and suturing for recovery for the anastomotic site may be an option to address cases of mis‐insertion of a linear stapler into the submucosal layer. [ABSTRACT FROM AUTHOR]

Anastomosis is a term which means a connection between two tubes or branched passages.Veins and arteries connect to transport blood in the body and this connection is natural anastomosis Whenever a blood vessel becomes blocked anastomosis is a backup pathway for blood flow. As the number of patients with chronic organ failure is increasing there is also a rapid increase in the demand for organ transplantation. As a result of a complicated mechanisms in different studies, activation of some factors including FLT1 (Fms Related Receptor Tyrosine Kinase 1), macrophages, fibroblast, hypoxia, platelet drive growth factor, fibrin-based tissue,mature vessel networks,VEGF( Vascular endothelial growth factor) and mechanical processes are been inducing factors for vascular anastomosis. Certainly, vascular anastomosis models are necessary for in vitro vascular anastomosis formation to cover vessels with perivascular cells in a microfluidic device or discover new surgery techniques. In this study, an attempt was made to collect effective factors in inducing vascular anastomosis. [ABSTRACT FROM AUTHOR]

Practical training models can be a viable and effective educational tool that allows surgeons to acquire specific surgical techniques or skills. However, a suitable animal training model for reconstruction after a pancreaticoduodenectomy (PD) has not yet been reported. Therefore, we explored the feasibility and safety of establishing an animal training model for digestive tract reconstruction after a simulated PD using mongrel dogs. We used the anatomical similarity between the canine and human digestive tract to simulate the digestive tract reconstruction after pancreatoduodenectomy. A hepatobiliary surgeon performed simulated PD digestive reconstructions on 6 mongrel canines. Pancreaticojejunostomy (PJ), biliary-enteric anastomosis (BEA), and jejuno-jejunal anastomosis (JJ) were performed sequentially. The survival rate, surgical operation time, complications, body weight changes, gross specimen, and pathological examination of the anastomotic region were observed 30 days after surgery. The survival rate 30 days after surgery was 100%. Total mean operative time was 230.5 ± 39.7 min. The operative time for PJ, BEA, and JJ was calculated as 21.5 ± 7 min, 21.7 ± 8.7 min, and 13.2 ± 1.8 min, respectively. An incision infection occurred in 1 case (16.7%); there was 1 case of ascites (16.7%), and 1 case of vomiting (16.7%). The total protein and total bilirubin indicators of the 6 dogs and the serum amylase index of 5 dogs 30 days postoperatively were within the normal range. The 6th dog's serum amylase was approximately double the normal value, possibly due to pancreatitis. Observing the gross specimen, the mucosa of the anastomosis was intact and smooth. Masson staining showed that the bile duct and jejunum anastomosis, the pancreas, and jejunum of the 6 canines were all integrated with rich collagen. Establishing an animal model for digestive tract reconstruction after a simulated PD in canines is feasible and safe. [ABSTRACT FROM AUTHOR]

In surgical operations, anastomoses are often preferred for the functionality of the gastrointestinal tract. It has been well known that anastomotic leakages are one of the most serious complications causing high mortality and morbidity. In this experimental study, bacterial cellulose was used to prevent leakage after colon anastomosis as a wound healing agent. The preventive effects of bacterial cellulose, which is often preferred in surgical interventions, on colon leakage were investigated. In our study, colonic anastomosis was performed on 20 Sprague-Dawley rats. In the control group, primary anastomosis was performed on 10 animals. In the experimental group, primary anastomosis followed by cellulose cover along the anastomosis line was performed on 10 animals. After 7 days, anastomotic bursting pressure was measured and histopathological examinations were performed. According to the findings of our study, the bursting pressure increased with bacterial cellulose application. On the other hand, histopathological examinations, bacterial cellulose group showed a significant increase in the fibroblast density, eosinophil density, and collagen density. As a result, bacterial cellulose has been shown to accelerate wound healing mechanically and histopathologically. In our study, it has been demonstrated that bacterial cellulose can be used as a physical barrier with biological properties to prevent leakage after colon anastomosis. Besides, our study will shed light on the advanced clinical studies to be conducted on the effect of bacterial cellulose preventing anastomotic leakage, and we claim that bacterial cellulose may be used for this purpose in the near future. [ABSTRACT FROM AUTHOR]

Background: Equine small intestinal resection and anastomosis is a procedure where optimizing speed, without compromising integrity, is advantageous. There are a range of different needle holders available, but little is published on the impact surgical instrumentation has on surgical technique in veterinary medicine. The objectives of this study were to investigate if the needle holder type influences the anastomosis construction time, the anastomosis bursting pressure and whether the bursting pressure is influenced by the anastomosis construction time. Single layer end-to-end jejunojejunal anastomoses were performed on jejunal segments harvested from equine cadavers. These segments were randomly allocated to four groups. Three groups based on the needle holder type that was used: 16.5 cm Frimand (Group 1), 16 cm Mayo-Hegar (Group 2) or 20.5 cm Mayo-Hegar (Group 3) needle holders. One (Group 4) as control without anastomoses. Anastomosis construction time was recorded. Bursting pressure was determined by pumping green coloured fluid progressively into the lumen whilst recording intraluminal pressures. Maximum pressure reached prior to failure was recorded as bursting pressure. Construction times and bursting pressures were compared between needle holder, and the correlation between bursting pressure and construction time was estimated. Results: Construction times were not statistically different between groups (P = 0.784). Segments from Group 2 and Group 3 burst at a statistically significantly lower pressure than those from Group 4; P = 0.031 and P = 0.001 respectively. Group 4 and Group 1 were not different (P = 0.125). The mean bursting pressure was highest in Group 4 (189 ± 61.9 mmHg), followed by Group 1 (166 ± 31 mmHg) and Group 2 (156 ± 42 mmHg), with Group 3 (139 ± 34 mmHg) having the lowest mean bursting pressure. Anastomosis construction time and bursting pressure were not correlated (P = 0.792). Conclusions: The tested needle holders had a significant effect on bursting pressure, but not on anastomosis construction time. In an experimental setting, the Frimand needle holder produced anastomoses with higher bursting pressures. Further studies are required to determine clinical implications. [ABSTRACT FROM AUTHOR]

Introduction: Microsurgery is a surgical technique that uses optical magnification as well as specific instruments to address necessary reconstructive procedures in different medical specialties. The apprenticeship of this technique requires overcoming a steep learning curve. There is a need for standardization of the training criteria in microsurgery. The International Microsurgery Simulation Society (IMSS) was born in 2011, since then its main objective has been to connect the main international specialists and educators of this sub-specialty to share and discuss the ethical and scientific basis of preclinical microsurgery teaching.Methods: In order to achieve a consensus on the minimum standards for the organization of basic microsurgery training courses, the requirements for a microsurgical anastomosis global rating scale and minimum thresholds for training, a total of nineteen independent global experts participated in a formal consultative consensus development program. The agreement criteria for each statement was established when consensus of 65-100% was reached.Results: There have been established six recommendations concerning minimum standards for a basic microsurgery course, one recommendation in relation to minimum thresholds for training and four recommendations regarding the global rating scale as gold standard for a microsurgical anastomosis assessment. The eleven defined recommendations reached the agreement threshold of 65-100%.Conclusions: The development of this consensus sets the minimum recommended requirements for conducting basic microsurgery training courses, as well as suggestions for objective assessment of the learning curve and skills of trainees. [ABSTRACT FROM AUTHOR]

A 17-year-old, female cockatiel (Nymphicus hollandicus) was presented for a 1-week history of respiratory distress. The clinical signs were consistent with tracheal obstruction; therefore, an air sac cannula was placed to reduce respiratory compromise. Radiographic images of the patient revealed a round, intraluminal, soft tissue opacity in the trachea. The obstruction could be visualized via transtracheal illumination, but tracheoscopy was not feasible because of the size of the patient. Attempts to manually extirpate the obstruction were unsuccessful, and the trachea subsequently avulsed in the midcervical region. Tracheal resection and anastomosis was performed, and the obstruction was removed with the associated tracheal ring. The patient recovered uneventfully and was doing well at follow-up evaluations at 9 days, 24 days, and 10 months after the surgical procedure. The histologic diagnosis was ossifying myelolipoma arising from bone marrow within the tracheal ring. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic right hemicolectomy (LRHC) is increasingly performed for the treatment of right colon disease. Nevertheless, standardization of the surgical technique regarding the performance of intracorporeal (IC) or extracorporeal (EC) anastomosis is lacking. The purpose of this study was to compare short-term postoperative outcomes in patients who had laparoscopic right colectomy either with IC or EC. Methods: This was a retrospective, non-randomized and multicenter study conducted from January 2005 to December 2015 on the CLIMHET study group cohort from five tertiary centers in France. Data were collected for all patients with LRHC to compare patient characteristics, intraoperative data and postoperative outcomes in terms of medical and surgical complications, duration of hospitalization and mortality. A multivariate analysis was performed to compare the results in the two groups. Results: Of the 597 patients undergoing LRHC, 150 had IC and 447 had EC. The incidence of medical complications (cardiac, vascular, and pulmonary complications) was lower in the IC group than in the EC group (13 vs 20%, p = 0.049). This difference remained significant in multivariate analysis after adjusting to field characteristics and patient histories (p = 0.009). Additionally, a shorter hospital stay (7 vs 8 days, p = 0.003) was observed in the IC group as compared to the EC group. This difference remained significant in favor of the IC group in multivariate analysis (p = 0.029). There was no difference between the groups as regards: surgical complications (p = 0.76), time of mobilization (p = 0.93), reintervention rate (p = 1) and 90-day mortality (p = 0.47). Conclusions: Our results show that IC anastomosis in LRHC is associated with fewer medical complications and shorter hospital stays compared to EC anastomosis. [ABSTRACT FROM AUTHOR]

Purpose: To describe our experience and analyze the outcomes of robot-assisted laparoscopic ureteral reimplantation (RALUR) and conventional laparoscopic ureteral reimplantation (LUR) in treating benign distal ureteral stricture (DUS).Material and Methods: Patients who underwent RALUR or LUR for DUS were retrospectively analyzed. All surgeries were performed by transperitoneal approach in a refluxing manner. Baseline characteristics, history of previous abdominal surgery, operative profile and follow-up data were collected and analyzed.Results: Among 68 patients with DUS, 62 were diagnosed with unilateral DUS, including 28 patients underwent RALUR. The mean operative time of the RALUR group was 2.44 ± .45 hours, while the mean operative time of the LUR group was 3.09 ± .74 hours (P < .001). The average suturing time of LUR (39.59 ± 3.78 min) is about 2 times that of RALUR (20.04 ± 3.5 min) (P < .001). The success rate of the RALUR group and the LUR group were 89.3% and 82.4% respectively (P = .494). In multiple linear regression model, the modality of surgery was the only variable that influences operative time (Beta = -.964, P < .001), suturing time (Beta = -1.899, P < .001) and hemoglobin decline (Beta = -.611, P = .020).Conclusion: Basically, the postoperative outcomes are similar but robotic surgery offers a quicker surgery and anastomosis. [ABSTRACT FROM AUTHOR]

Background: Colorectal anastomotic complications are dreaded and dramatically affect outcomes. Causes are multifactorial, with the size of the end-to-end anastomosis (EEA) stapler a modifiable factor and potential target for risk reduction. Our goal was to examine the impact of the EEA stapler size on the risk of anastomotic complications in left-sided colorectal resections. Methods: A prospective divisional database was reviewed for consecutive elective left-sided resections with a colorectal anastomosis using an EEA stapler from January 2013 May 2018 inclusive. Patients were stratified into 25–29 mm or 30–33 mm cohorts. Patient and disease demographics, operative variables, and postoperative outcomes were evaluated. The main outcome measures were the rate and factors associated with anastomotic complications. Results: Four hundred seventy-three cases were evaluated, 185 (39.1%) were in the 25–29 mm group and 288 (60.9%) in the 30–33 mm group. Patients were comparable in demographics and operative variables. More males were anastomosed with the 30–33 mm than with the 25–29 mm stapler (57.6% vs 28.6%, p < 0.01). Significantly more patients developed an anastomotic stricture with the 25–29 mm than with the 30–33 mm staplers (7.1% vs. 2.1%; p = 0.007). There was no significant difference in leak rates or reoperation/interventions between groups. On logistic regression, neither gender, operative indication nor approach were associated with anastomotic leak, readmission, or reoperation/intervention. Stapler size remained significantly associated with stricture (p = 0.032). Conclusions: The 25–29 mm EEA staplers were associated with an increased rate of anastomotic stricture compared to 30–33 mm staplers in left-sided colorectal anastomoses. As stapler size is a simple process measure that is easily modifyable, this is a potential target for improving anastomotic complication rates. Further controlled trials may help assess the impact of stapler size on improving patient and quality outcomes. [ABSTRACT FROM AUTHOR]

Mastery of the microsurgical anastomosis is an indispensable component of neurosurgical training. However, in many resource-limited countries, the training, materials, and equipment to obtain these surgical and decision making skills are severely lacking. This study aimed to compare different suturing techniques for microvascular anastomosis and to complete a comparative assessment of the performance of a young neurosurgeon when using the various techniques. We compared 3 end-to-end suturing techniques for microvascular anastomosis: interrupted suturing, continuous suturing, and a 2-octyl-cyanoacrylate–based lid technique using an umbilical artery model. We assessed the subjective difficulty of the suturing technique, the time needed to perform the procedure, and the flow rate and leakage of the vessel after each technique. This study was designed to use materials that would be available in developing countries. Surgical apparatus used, such as operating microscopes, were first-generation technology, and testing procedures were designed for neurosurgical residents in developing countries. The mean times to complete the anastomosis were 20.7 ± 7.7 minutes for the interrupted technique, 26.4 ± 7.7 minutes for the continuous technique, and 12.5 ± 2.5 minutes for the lid technique; these values were significantly different (P < 0.01). The differences among the 3 techniques in leakage and flow rates and subjective difficulty in performance were not significant. Suturing time was the only statistically significant difference among the 3 anastomotic techniques, with the lid technique apparently the quickest to perform. Such techniques can be designed to assess microsurgical abilities and help neurosurgery residents in developing countries improve their surgical skills and techniques. [ABSTRACT FROM AUTHOR]

Surgical therapy for adenocarcinoma of the esophagogastric junction II requires distal esophagectomy, in which a transhiatal management of the lower esophagus is critical. The 'dorsal track control' (DTC) maneuver presented here facilitates the atraumatic handling of the distal esophagus, in preparation for a circular-stapled esophagojejunostomy. It is based on a ventral semicircular incision in the distal esophagus, with an intact dorsal wall for traction control of the esophagus. The maneuver facilitates the proper placement of the purse-string suture, up to its tying (around the anvil), thus minimizing the manipulation of the remaining esophagus. Furthermore, the dorsally-exposed inner wall surface of the ventrally-opened esophagus serves as a guiding chute that eases anvil insertion into the esophageal lumen. We performed this novel technique in 21 cases, enabling a safe anastomosis up to 10 cm proximal to the Z-line. No anastomotic insufficiency was observed. The DTC technique improves high transhiatal esophagojejunostomy. [ABSTRACT FROM AUTHOR]

Biomedical imaging devices that utilize the optical characteristics of hemoglobin (Hb) have become widespread. In the field of gastroenterology, there is a strong demand for devices that can apply this technique to surgical navigation. We aimed to introduce our novel multispectral device capable of intraoperatively performing quantitative imaging of the oxygen (O 2) saturation and Hb amount of tissues noninvasively and in real time, and to examine its application for deciding the appropriate anastomosis point after subtotal or total esophagectomy. A total of 39 patients with esophageal cancer were studied. Tissue O 2 saturation and Hb amount of the gastric tube just before esophagogastric anastomosis were evaluated using a multispectral tissue quantitative imaging device. The anastomosis point was decided depending on the quantitative values and patterns of both the tissue O 2 saturation and Hb amount. The device can instantaneously and noninvasively quantify and visualize the tissue O 2 saturation and Hb amount using reflected light. The tissue Hb status could be classified into the following four types: good circulation type, congestion type, ischemia type, and mixed type of congestion and ischemia. Postoperative anastomotic failure occurred in 2 cases, and both were mixed cases. The method of quantitatively imaging the tissue O 2 saturation and Hb level in real time and noninvasively using a multispectral device allows instantaneous determination of the anastomosis and related organ conditions, thereby contributing to determining the appropriate treatment direction. [ABSTRACT FROM AUTHOR]

Purpose: To compare open surgical anastomotic revision with endourological techniques for the treatment of ureteroenteric strictures in patients with urinary diversions. Methods: All records of patients treated for ureteroenteric strictures in our clinic between 1989 and 2016 were retrospectively reviewed. In 76 patients, 161 completed procedures were analyzed: 26 open revisions vs. 135 endourological treatments, including balloon dilation, Wallstent and/or laser vaporization. Results: Median follow-up was 34 months. At 60 months, patency rates were 69% (95% CI 52–92%) after open vs. 27% (95% CI 19–39%) after endo-treatment (p = 0.003); median patency duration was 15.5 vs. 5 months, respectively (p = 0.014). Eventually, 15% of patients required open surgery after primary endo-treatment and 21% received endoscopic re-treatment after primary open surgery. Cox regression analysis revealed no confounding factors among the risk factors added to the model. Complication rates were higher after open surgery (27% Clavien 2, 12% Clavien 3–4 vs. 5% Clavien 1–2, 3% Clavien 3, p = 0.528). Median postoperative hospital stay was 14 days (open) vs. 2 days (endo), p < 0.001. Mean estimated glomerular filtration rate improved with + 17 (open) vs. + 8.1 (endo), p = 0.024. Renal function was compromised in 8% of patients in the open surgery group vs. 6% in the endo-treatment group. Conclusions: In these patients, in terms of patency and patency duration, open surgery was superior to endourology. Nevertheless, endourological treatments offer a safe and less-invasive alternative to delay or avoid open surgery, especially in patients who are unfit for open surgery. [ABSTRACT FROM AUTHOR]

We describe a low-cost model for training vascular surgical techniques. The model is constructed from cylindrical latex balloons filled with gelatin and fixed to a board for support. Arterial sutures, end-to-side and end-to-end anastomoses, patch, vascular shunt placement, and thromboembolectomy were simulated. [ABSTRACT FROM AUTHOR]

Background: Various methods of reconstruction after laparoscopic distal gastrectomy (LDG) have been developed and reported. In open gastrectomy, gastroduodenostomy or gastroenterostomy is often performed with the hand-sewn technique. Therefore, hand-sewn anastomosis was performed through a small incision in LDG. The aim of this study was to evaluate the feasibility and safety of LDG with hand-sewn anastomosis.Methods: Between June 2009 and December 2015, we assessed 263 consecutive patients who underwent LDG in our institution. In all patients, the reconstruction procedures were performed extracorporeally with the hand-sewn technique. The clinical characteristics, surgical outcomes, and operation cost related to anastomosis were evaluated and compared with the other methods.Results: The average operation time was 157.5 minutes, and average blood loss was 38.8 mL. The types of reconstruction were Billroth I, 95 cases (36.1%); Billroth II, 165 cases (62.7%); and Roux-en-Y, 3 cases (1.1%). The overall incidence of postoperative complications (Clavien-Dindo classification≧Grade II) was 8.0%. Anastomotic leakage was observed in 1 patient (0.4%) and anastomotic bleeding and anastomotic stenosis in 2 patients each (0.8%). There was no postoperative mortality. The cost of the absorbable threads used in anastomosis is less than the cost of a linear or circular stapler, which is often used in intracorporeal anastomosis.Conclusion: This procedure is similar to conventional open surgery, and it is feasible, safe, and cost-effective. In addition, in an institution that plans to introduce LDG, the use of our method during the introductory phase of LDG has many advantages. [ABSTRACT FROM AUTHOR]

Background: Despite standardized techniques, anastomotic complications after colorectal resection remain a challenging problem. Among those, anastomotic stricture is a debilitating outcome which often requires multiple interventions and which is prone to recur. The present series investigates the long-term results of endoscopic balloon dilation for stenotic colorectal anastomosis.Methods: Consecutive patients from a single institution who presented with an anastomotic stenosis after a colorectal resection were identified using a prospective clinical database. Medical records were systematically reviewed to detail patients' outcomes.Results: Over 17 years (1988-2015), 2361 consecutive patients underwent a colorectal anastomosis. Of those, 76 patients (3.2 %) suffered a symptomatic anastomotic stenosis within a median of 5 months (interquartile range (IQR) 2-13) of the index procedure. All stenoses were primarily treated by endoscopic balloon dilation. Median follow-up was 11 years (IQR 7-14). In half the patients, one to two attempts at endoscopic balloon dilation definitively relieved the stenosis. Overall, the median number of endoscopic balloon dilation required was 3 (IQR 2-3). Recurrence rates at 1 year, 3 year, and 5 year were 11, 22, and 25 %, respectively. Median time to recurrence was 12 months (IQR 3-24). Ultimately, two patients (2.6 %) underwent an operation due to failure of endoscopic treatment. All other patients (97.4 %) were treated successfully with endoscopic balloon dilation. A total of 12 patients (15.7 %) suffered a complication from endoscopic dilation. Of those, 11 were minor bleeding and one was a perforation at the level of the anastomosis. All complications were managed conservatively, and no emergency procedure was required as a consequence of attempted endoscopic balloon dilation.Conclusion: Endoscopic balloon dilation is a safe approach to effectively relieve an anastomotic stenosis following a colorectal resection. [ABSTRACT FROM AUTHOR]

Transanal total mesorectal excision (TaTME) is a novel approach pioneered to tackle the challenges posed by difficult pelvic dissections in rectal cancer and the restrictions in angulation of currently available laparoscopic staplers. To date, four techniques can be employed in order to create the colorectal/coloanal anastomosis following TaTME. We present a technical note describing these techniques and discuss the risks and benefits of each. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Anastomotic airway complications give rise to morbidity and mortality after lung transplantation. Knowledge about contributing factors helps in adopting diagnostic and therapeutic strategies. Systematic endoscopic description and classification play a key role. METHODS: A retrospective analysis of all bronchial anastomoses between 2005 and 2013 was performed to assess anastomotic complications and associated variables. Treatment modalities and outcome of endobronchial and surgical interventions are reported. RESULTS: The prevalence of anastomotic airway complications in our cohort was 11%. Contributive factors were all recipient-dependent: microbial infection during the first postoperative trimester [odds ratio (OR) 3.4 (2.1-5.5); P < 0.0001], recipient age [OR 3.0 (1.3-7.1); P = 0.01], right-sided anastomosis [OR 2.5 (1.4-3.3); P = 0.001], the presence of microbiological colonization prior to transplantation [OR 1.8 (1.1-3.1); P = 0.02] and ... during the first 72 h after transplantation [OR 1.6 (1.1-2.7); P = 0.04]. Seventy-five percent of cases were managed conservatively, of which 93% evolved clinically favourable during follow-up. Our data support the use of the proposed MDS classification and show that MDS class M3b, D2x, Sxe or higher are associated with an increased intervention rate. CONCLUSION: Anastomotic airway complications remain an important issue after lung transplantation. The identified risk factors may play a role in the pathophysiology of anastomotic complications. The indication for endobronchial intervention should be carefully considered based on endoscopic classification since most cases resolve or stabilize over time. [ABSTRACT FROM AUTHOR]

Patients with altered anatomy such as a Roux-en-Y anastomosis often present with various pancreaticobiliary problems requiring therapeutic intervention. However, a conventional endoscopic approach to the papilla is very difficult owing to the long afferent limb and acute angle of a Roux-en-Y anastomosis. Balloon-assisted enteroscopy can be used for endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered anatomy. We experienced six cases of Roux-en-Y anastomosis with biliary problems, and attempted ERCP using single balloon enteroscopy (SBE). SBE insertion followed by replacement with a conventional endoscope was attempted in five of six patients. The papilla was successfully approached using SBE in all cases. However, therapeutic intervention was completed in only three cases because of poor maneuverability caused by postoperative adhesion. We conclude that in patients with Roux-en-Y anastomosis, the ampulla can be readily accessed with SBE, but longer dedicated accessories are necessary to improve this therapeutic intervention. [ABSTRACT FROM AUTHOR]

Background and aims: Extended left hemicolectomy might be necessary for several indications. Once the resection is completed, it would be difficult or impossible to anastomose the transverse colon to the rectum due to the difficulty in mobilizing the transverse colon to reach for a tension-free rectal anastomosis. The aim of this report is to present the 'Flip-Flop' technique to overcome this challenging situation. The procedure is based on a surgical technique published in the early 1960s to avoid permanent stoma after proctectomy and consists of changing the location of the right colon to reach the rectum. Methods: Clinical parameters, surgical aspects, and postoperative outcome of patients that underwent the flip-flop procedure following an extended left colectomy in our medical service was reviewed. Results: Three patients underwent a flip-flop procedure after an extended left colectomy performed for various reasons. The surgical technique is detailed in a step by step manner. Patients had uneventful postoperative recovery with an adequate functional outcome. Conclusions: We believe that this approach should be revived and be considered also in cases when the full length of the rectum is preserved to avoid ileo-rectal anastomosis or a high-tension colocolonic anastomosis. Popularization of this surgical solution among surgeons is highly important. [ABSTRACT FROM AUTHOR]

Background: Ozone is a three-oxygen molecule (O3). Ozone therapy (OT) is systematically effective when pathological inflammatory and immunologic processes are activated. Among of these conditions are wound healing, macular degeneration related to aging, and conditions that are ischemic or infectious. Aims: The aim of this study was to determine the effects of OT on wound healing of intestinal anastomosis in the presence of peritonitis in a rat model. Study Design: Animal experimentation. Methods: A total of 40 Wistar albino rats were randomized into four groups (n=10) including: sham (S), peritonitis (P), ozone 0 (O0), and ozone 24 (O24). In group S, only cecal dissection was carried out. The S group had only a cecal dissection and intestinal anastomosis performed, but no peritonitis. In all other groups, cecal ligation and puncture (CLP) followed the cecal dissection to induce bacterial peritonitis. 24 h after puncture, a cecal resection and ileocolic anastomosis were performed. In group P, 24 h after CLP, a cecal resection and ileocolic anastomosis were performed and no ozone was administered. In group O0, immediately after the anastomosis, and in group O24, starting 24 hours after the anastomosis, an intraperitoneal 1 mg/ kg/day ozone administration was applied for seven days. On the seventh day the animals were sacrificed, the anastomotic bursting pressures (BP) and the hydroxyproline values of the anastomotic tissues were measured, and histopathologic examination of the anastomotic segment was carried out. Results: The highest BP was in group S, with 211±23.13 mmHg. The mean BP of group P was 141±56.25 mmHg, which was significantly lower than in the other two peritonitis groups that received ozone therapy, group O0 and O24, where it was 192±22 and 166±45 mmHg, respectively (p<0.05). The difference in the BP between groups O0 and O24 was not statistically significant (p>0.05). Histopathologic analyses of the anastomotic segments determined there was significantly more oedema and necrosis in the control group rats, and collagen deposition in the anastomotic tissue was significantly higher in the ozone-treated groups on postoperative day 7. Hydroxyproline levels were significantly higher in groups O0 and O24 compared to the peritonitis group (P). Conclusion: Ozone therapy has a beneficial effect on anastomotic healing of the colon in the presence of peritonitis. [ABSTRACT FROM AUTHOR]

Surgical technique and technology frequently coevolve. The brief history of blood vessel anastomosis is full of famous names. While the techniques pioneered by these surgeons have been well described, the technology that facilitated their advancements and their inventors deserve recognition. The mass production of laboratory microscopes in the mid-1800s allowed for an explosion of interest in tissue histology. This improved understanding of vascular physiology and thrombosis laid the groundwork for Carrel and Guthrie to report some of the first successful vascular anastomoses. In 1916, McLean discovered heparin. Twenty-four years later, Gordon Murray found that it could prevent thrombosis when performing end-to-end anastomosis. These discoveries paved the way for the first-in-human kidney transplantations. Otolaryngologists Nylen and Holmgren were the first to bring the laboratory microscope into the operating room, but Jacobson was the first to apply these techniques to microvascular anastomosis. His first successful attempt in 1960 and the subsequent development of microsurgical tools allowed for an explosion of interest in microsurgery, and several decades of innovation followed. Today, new advancements promise to make microvascular and vascular surgery faster, cheaper, and safer for patients. The future of surgery will always be inextricably tied to the creativity and vision of its innovators. [ABSTRACT FROM AUTHOR]

Bilioenteric anastomosis strictures are a serious complication of biliary surgery, and often result in recurrent cholangitis, choledocholithiasis, biliary cirrhosis, and hepatic failure. Bilioenteric reconstructive surgery is the standard treatment of choice for such complications. However, percutaneous transhepatic cholangioscopy (PTCS), also known as per-oral endoscopic-guided intervention, is a less invasive procedure that is becoming an increasingly popular alternative. This review describes the PTCS procedure (including the preparation process), as well as the diagnostic and therapeutic role of PTCS in bilioenteric anastomosis strictures. [ABSTRACT FROM AUTHOR]

Evaluation of various methods of biliary enteric anastomosis in benign biliary diseases (BBD). A surgeon operating for BBD needs to improve the internal drainage of bile to prevent stasis and its back-pressure effects. This is best obtained by biliary enteric anastomosis. A total of 121 cases of biliary enteric anastomosis in BBD were included in this study. The postoperative course and long-term outcome were studied prospectively. In the choledochoduodenostomy group, there were no leaks, no restrictures, and no mortality. Five (10.41 %) patients had cholangitis attacks and 2 (4.17 %) patients had sump syndrome. The choledochojejunostomy group had no leaks, no restrictures. Two (7.14 %) patients had repeated cholangitis and 2 (7.14 %) patients had sump syndrome, no mortality. The hepaticojejunostomy group had 3 cases of anastomotic leak of which 2 healed spontaneously and 1 needed resurgery. There was restricture in 2 cases, in which resurgery was successful-one death, no cholangiocarcinoma. Biliary enteric anastomosis is a safe and effective method for the management of BBD. The method should be selected according to the disease pathology and patient characteristics. [ABSTRACT FROM AUTHOR]

Objective: Posterior urethral strictures are difficult cases to treat for urologists. Anastomotic open urethroplasty is the major surgical treatment option, and various modifications/manipulations to the procedure have been recommended in the literature. We aimed to assess the advantages of performing antegrade endoscopy through the suprapubic cystostomy tract during perineal urethroplasty. Material and methods: Thirty-six perineal urethroplasties combined with suprapubic cystoscopy were performed in 33 adult male patients between 2005 and 2011. Pre-and peri-operative records of the patients were evaluated, with a particular focus on suprapubic cystoscopy findings during urethroplasty. Results: The mean patient age was 41 years, and the mean lesion length was 2.6 cm (range 1-10 cm). Lesions were secondary to pelvic trauma in 21 patients, to a history of prostatic surgery in 8 patients, and to other miscellaneous causes in the 4 remaining patients. In 23 cases with normal bladder necks, the anastomosis was created under the guidance of antegrade cystoscopy with fluoroscopy. In 10 cases, stiff guide wires or paddles were used in addition to endoscopic light to identify the correct anastomosis site. In two procedures, fistula openings were identified during endoscopy, and fistula repair was performed along with anastomosis. In one case involving the longest lesion with involvement of the bladder neck, a combined perineal-transpubic urethroplasty was performed. The mean follow up duration was 19 (3-38) months. The overall success rate was 91%, and the re-operation rate was 9%. Conclusion: Suprapubic cystoscopy is an easy-to-perform adjunctive modality in perineal urethroplasty. This method provides the benefits of supplementary endoscopic findings and feasibility of certain maneuvers that facilitate debridement and anastomosis formation concurrent with perineal urethroplasty. [ABSTRACT FROM AUTHOR]

The correct suture technique for anastomoses of the gastrointestinal (GI) tract is a major task in the daily practice of surgery and a basic requirement for a successful operation. This article provides an overview of the surgical principles and techniques involved in the creation of intestinal anastomoses, including the differentiated use of various suturing aids in the GI tract. Hand sewn and stapled anastomotic techniques are illustrated and discussed. The ongoing discussion and question as to which technique is best for GI anastomoses remains unanswered as there is no obligatory standard, even though the requirements are well defined. An ideal anastomosis should fulfil the following criteria: it must be well vascularized, safe, tension-free and spillage from the operation field should be avoided. [ABSTRACT FROM AUTHOR]

Arterial revascularization during liver transplantation is normally achieved by anastomosing the graft hepatic artery to the largest artery available at the recipient pedicle-either the common hepatic artery (CHA) or an accessory right hepatic artery (RHA) originating from the superior mesenteric artery (SMA). When a small caliber RHA is present, the artery is ligated and a single anastomosis with the CHA is performed. In the absence of a vascular reconstruction of the graft, the gastroduodenal artery is usually ligated as well. In this article, we describe a new type of arterial anastomosis in the case of a small accessory RHA and/or severe graft hepatic artery atherosclerosis that is commonly seen in elderly donors. To our knowledge, these are the first cases reported in the literature. This technique can be easily performed without increasing the arterial revascularization time or increasing the risk of complications associated with arteriosclerotic arteries. A 12-month follow-up revealed excellent function of the liver grafts. [ABSTRACT FROM AUTHOR]

Exact knowledge of the topographical anatomy of the arterial vascular system is the basis for all access routes. This article describes the most important assess routes in the neck and torso regions and gives an overview of the basic principles of the surgical technique with respect to suture material, suture technique, anastomotic technique and the atraumatic preparation of the anastomosis region. The article makes no claims to completeness because this would overstretch the limits but refers in particular to the references listed. [ABSTRACT FROM AUTHOR]

The problem of size discrepancy between vessels during microvascular procedures is well known. Inability to successfully overcome this problem can lead to turbulent flow at the anastomotic site with consequent thrombosis. Various techniques have been described to overcome this problem. We describe two techniques that have been used for over two decades in our institution. Both these techniques enable the surgeon to overcome far more significant size mismatches than other available techniques while still allowing for end-to-end anastomosis. [ABSTRACT FROM AUTHOR]

Background: Alterations of thyroid hormones in colorectal surgery were previously studied. The aim of the present study was to determine the effects of triiodothyronine (T3) supplementation on anastomotic healing after segmental colectomy. Material and Methods: Thirty male Wistar albino rats were divided into sham (n = 6), control (n = 12), and experimental (n = 12) groups. Sham group rats were immediately sacrificed after segmental colonic resection. Control and experimental group rats underwent resection and anastomosis. Experimental group rats received a single dose of T3 (400 μg/100 g) in postoperative day 1. Half of both control and experimental group rats were sacrificed on postoperative d 3 and the remaining half were sacrificed on postoperative d 7. Hydroxiproline (HP), myeloperoxidase (MPO), thyroid stimulating hormone (TSH), free T3 (FT3), and free thyroxine (FT4) levels, bursting pressure, and histologic analyses of the anastomotic segments were compared. Results: FT3 levels significantly decreased in control groups rats compared with the sham group (P < 0.01). However, T3 hormone given rats had no decline in FT3 levels. Anastomotic bursting pressure was significantly higher in the experimental group rats on postoperative d 7 (P = 0.015). Histopathologic analyses of the anastomotic segments determined significantly more severe edema and necrosis in control group rats (P < 0.05). Collagen deposition in the anastomotic tissue was significantly higher in experimental group rats on postoperative d 7 (P = 0.015). Conclusion: Anastomosis after colon resection is associated with decreased FT3 level. T3 supplementation ameliorates the reduction in FT3 and seems to provide constructive therapeutic effects on anastomotic healing. [ABSTRACT FROM AUTHOR]

Objective: This study was performed to compare stapled and hand sewn techniques for esophagogastric anastomosis on esophagus cancer surgery. The study was focused on to the effect of esophagogastric anastomosis techniques on mortality, morbidity, median operation and hospitalization time. Material and Methods: A retrospective study was undertaken in 60 patients with eosophagial cancer who underwent resection and anastomosis. Twenty eight patients were operated with transhiatal (48%) and others with transthoracic (54%) approach. Patients were classified to perform stapled anastomosis (Group 1) and hand sewn anastomosis (Group 2). Hand sewn anastomosis technique was performed in 43 (72%) and stapled anastomosis technique was performed in 17 cases (% 28). Results: The groups were similar regarding age, sex, ASA scores, tumor localization and stage, for the operative approach. Major morbidity was present in 5 patients (30%) in Group 1 and 19 patients (44%) in Group 2. The number of anastomosis leaks was 4 in Group 1 (23%) and 6 in Group 2 (14%). Mortality was encountered in 1 patient in Group 1 (6%) and 5 patients in Group 2 (11%). The mean hospital stay was determined to be 18.4 ± 11.8 days for Group 1 and 16.33 ± 8.1 days for Group 2. No statistically significant difference was found between the groups regarding major morbidity, mortality and mean hospital stay (p>0.05). Conclusion: In our study, the techniques of anastomosis via hand sewn or stapled were not found to be superior to one another. The practice and skill of the surgeon should be determinant about the application of the methods. [ABSTRACT FROM AUTHOR]

The clinical outcome of anastomotic leakage in colorectal and coloanal anastomoses necessitates a loop stoma for fecal diversion. Controversy remains of the most suitable position of the stoma. In this respect a loop ileostomy or loop colostomy can be performed. The aim of this study was to determine the advantages and disadvantages of both surgical strategies from the literature and to derive possible recommendations. Both methods provide a good operative outcome with low complication rates. Overall there is a trend towards ileostomy because of lower complication rates after stoma creation and the incidence of sepsis and stoma prolapse in particular is significantly reduced after ileostomy. Concerning stoma reversal both methods seem to be equivalent. As long as no large evidenced-based, randomized studies are available loop ileostomy seems to be the most appropriate surgical procedure. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the learning effects of a surgical skills course focussed on theoretical knowledge, anastomosis techniques and practical suturing skills in digestive surgery. One hundred eight participants of a 1-week skills course, comprising practical exercises in conventional and laparascopic digestive surgery, were asked to complete questionnaires (self-evaluation and course evaluation) and a theoretical knowledge test prior to the beginning (tp1) and at the end of the course (tp2). Thirty-six randomly selected participants performed a handsewn anastomosis at tp1 and at tp2, whereby the respective performance of each participant was recorded on video film and awarded a comparative rating (points score). In regard to course expectations, 93.52% of the participants had expressed the objective to acquire knowledge in the field of standard surgical techniques, and 71.30% aimed to brush up their existing knowledge and skills. In this respect, participants' satisfaction at tp2 was recorded as high to very high. Confidence to carry out simple and more complex anastomosis was significantly increased ( p < 0.001) at tp2. A significantly higher intestinal suture score (11.94 vs. 9.75) was attained at tp2 in a shorter time (176.22 vs. 277.11 s). The reduction in the time needed to complete the given task was accompanied by a corresponding improvement in the quality ( p < 0.001). Surgical skill courses constitute an effective component of surgical training with a sustained impact and, therefore, should be integrated into a future curriculum. [ABSTRACT FROM AUTHOR]

Background: Extracellular matrices have proven potential for in vivo tissue regeneration at gastrointestinal luminal organs. In this study, small intestinal submucosa (SIS) was tested as a sealant for colonic anastomoses in a rodent model.Methods: In the rodent model, standard colonic anastomoses in the control group (CG; n = 30) and anastomoses sealed by omentum (n = 30) were compared to SIS-sealed anastomoses in the study group (SG; n = 30). After 4-, 30-, and 90-day macroscopic and microscopic healing, bursting pressure and anastomotic stricture rate were evaluated.Results: The rate of anastomotic dehiscence was 1/10 after 4 days and 0/10 after 30 and 90 days in all groups. In the SG, the bursting pressure was significantly increased after 4 days compared to CG (148 +/- 9 vs. 108 +/- 8 mmHg; p > 0.05). Histologically, after 4 days of neovascularization, fibroblast ingrowth and collagen deposition were significantly increased in SG compared to CG. After 30 days, nonsignificant differences were noted in all three parameters. Adhesion rate and anastomotic stricture rate were not significantly affected by SIS sealing after 4, 30, and 90 days.Conclusion: Especially in the critical phase of anastomotic healing up to day 4, anastomotic healing was improved by SIS sealing. SIS sealing did not cause long-term complications. [ABSTRACT FROM AUTHOR]

Postoperative anastomotic hemorrhage is a relatively rare complication, but it is lethal if not treated immediately. Of 1400 patients with gastric cancer who underwent gastrectomy between September 2002 and December 2007, postoperative anastomotic hemorrhage was observed in 6 patients. The surgical procedures, bleeding sites, methods of hemostasis, and clinical courses of these 6 patients were analyzed. Of the 1400 patients, 878, 72, and 450 underwent distal, proximal, and total gastrectomy, respectively. The bleeding sites were as follows: transection line of the stomach using a linear stapler ( n = 1); gastroduodenostomy using a circular stapler ( n = 3); gastrojejunostomy by hand-suture ( n = 1); and esophagojejunostomy using a circular stapler ( n = 1). Five patients achieved complete hemostasis with endoscopic treatment. One patient underwent re-operation for anastomotic hemorrhage without endoscopic therapy. Two patients had delayed gastric emptying, and one patient developed an intraabdominal abscess after hemostatic treatment. Postoperative anastomotic hemorrhage is an infrequent but potentially life-threatening complication. Endoscopy appears to be useful for both the confi rmation of bleeding and therapeutic intervention. [ABSTRACT FROM AUTHOR]

To evaluate retinal reperfusion, anastomosis, and compensation following radial optic neurotomy for ischemic nonperfused central retinal vein occlusion. Prospective, non-comparative, interventional case series of 13 patients with ischemic, nonperfused central retinal vein occlusion who underwent decompression surgery with a radial optic neurotomy and adjunctive intraocular triamcinolone. Patients were followed for 1 year after surgery, and were analyzed in the preoperative and postoperative stages determining: visual acuity by ETDRS chart (LogMar) and retinal thickness with optical coherence tomography. Fluorescein angiography was performed at regular intervals to evaluate the capillary perfusion grade. Intraocular pressure was measured and fundus was examined. Visual acuity and retinal thickness improved in 10/13 (77%) patients after surgery at 1-year follow-up. Adequate retinal reperfusion was achieved in ten of the 13 eyes. Acute reperfusion occurred in six eyes within 2 weeks of surgery and a shunt vessel at the optic disk developed in four eyes within 4 months. In the remaining three eyes, retinal reperfusion was not observed by fluorescein angiography. No complications were noted in any of the patients. Surgical decompression promoted mechanical reperfusion of the occluded vessel in 10/13 (77%) cases. In 6/13 patients (46%) reperfusion occurred within 2 weeks of surgery, and in 4/13 patients (31%) collateral vessels formed within 4 months. [ABSTRACT FROM AUTHOR]

Background: Tricuspid regurgitation (TR) is a relatively common abnormality in normal adults as well as after orthotopic heart transplantation (OHT). A few studies have shown reduction in the incidence of TR after OHT by total bicaval surgical anastomosis technique. Other studies reported no significant difference in the rates of TR between the standard and bicaval techniques. Objective: Evaluate and compare the degree of TR after OHT by standard and bicaval anastomosis techniques. Method: Echocardiograms from the first 56 consecutive patients that had the total bicaval surgical technique performed were retrospectively reviewed and compared with the last 57 consecutive patients who had the standard biatrial technique performed. Patients with adequate two-dimensional and Doppler echocardiograms were included. Results: No statistical difference was observed for each grade of TR at both early and late time points. No significant difference was observed between the TR velocities of both biatrial and bicaval anastomosis patients at different periods. Conclusion: There appears to be no difference between the TR severity and TR velocity at early and late time points regardless of anastomotic technique. (Echocardiography 2010;27:1-4) [ABSTRACT FROM AUTHOR]

Abstract: Background: Adequate experience is necessary for microneurosurgery; however, the development of less invasive therapies may contribute to a reduction in the clinical case volume of beginning neurosurgeons. Microsurgical training with rats, which enables operators to experience the dissecting process, has an advantage compared with the training reported previously. We demonstrate our microsurgical training method for anastomoses in rats with emphasis on dissecting technique. Methods: Retired Wistar rats were used. The NIH guidelines for the care and use of laboratory animals were followed. The training was performed in cervical and femoral region. The anastomosis between the artery and the vein is used in the current study. Result: The most important point of this training is the process. Making a sufficient working space for bypass surgery is more important than making an anastomosis itself. For these purposes, “looking carefully” and “treating only the bleeding point” are indispensable. “Stripping” the surrounding connective tissues to expose the vessels is also useful. In anastomoses, first stitch must always be initiated with the presumption that the suture will be difficult to stitch. Otherwise, the operator may be forced to abandon the procedure at the end. Another important point is the need for equality between anastomotic planes of the donor and recipient. Conclusion: For favorable working space, every tissue and structure to be dissected must be unfolded. Without proper retraction, a favorable operative space will never be visualized. The continuation of practice in these steps will dramatically improve the operative view through the microscope. [Copyright &y& Elsevier]

Abstract: Purpose: Anastomotic complications following lung transplantation (LuTx) have been described in up to 15% of patients. Challenging to treat, they are associated with high morbidity and a mortality rate of 2–5%. The aim of this study was to analyze the incidence of complications in a consecutive series of bronchial anastomosis after LuTx at our center and to delineate the potential risk factors. Methods: Between 1992 and 2007, 441 bronchial anastomoses were performed in 235 patients. Indications for transplantation were cystic fibrosis (35.7%) emphysema (28.1%) pulmonary fibrosis (12.8%) and pulmonary hypertension (7.7%). There were 206 sequential bilateral and 28 single transplants including lobar engraftments in 20 cases. The donor bronchus was shortened to the plane of the lobar carina including the medial wall of the intermediate bronchus. Peribronchial tissue was left untouched. Anastomosis was carried out using a continuous absorbable running suture (PDS 4/0) at the membranous and interrupted sutures at the cartilaginous part. Six elective surveillance bronchoscopies were done monthly during the first half-year post-LuTx, with detailed assessment of the pre- and post-anastomotic airways. Results: One-year survival since 2000 was 90.5%. In all 441 anastomoses performed, no significant dehiscence was observed. In one patient, a small fistula was detected and closed surgically on postoperative day five. Fungal membranes were found in 50% of the anastomoses at 1 month and in 14% at 6 months. Discrete narrowing of the anastomotic lumen without need for intervention was found in 4.9% of patients at 1 month and in 2.4% at 6 months. Age, cytomegalovirus status, induction therapy, immunosuppressive regimen, ischemic time, and ventilation time had no influence on bronchial healing. Conclusions: Clinically relevant bronchial anastomotic complications after LuTx can be avoided by use of a simple standardized surgical technique. Aggressive antibiotic and antifungal therapy might play an important supportive role. [Copyright &y& Elsevier]

Extracorporeal membrane oxygenation (ECMO) is generally used as a last resort to provide cardiopulmonary support in patients whose advanced cardiac or respiratory failure does not respond to less invasive treatments. Lower-limb ischemia secondary to the large diameter of the arterial cannula is one of ECMO's major limitations: in patients who have small-caliber arteries, the cannulas can reduce native blood flow. The creation of a T-graft--a well-described technique to avoid limb ischemia--enables flow into the ECMO cannula without jeopardizing blood flow to the limb. However, leaving the graft exposed through an open groin wound can result in dislodgment, and it increases the risk of infection. We describe our modification of a conventional T-graft in an 18-year-old woman who had systolic heart failure, acute respiratory distress syndrome, and small-caliber femoral vessels. We tunneled a polytetrafluoroethylene graft inside a Dacron graft, then ran the combined graft through a subcutaneous tunnel similar to that created for a peripheral bypass. Thus, the graft was protected from environmental exposure and the risk of infection. Our technique seems safer and more secure than the original T-graft technique, and we recommend its consideration during ECMO cannulation. [ABSTRACT FROM AUTHOR]