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Purpose: Our aim was to develop a Kono-S anastomotic technique using surgical staplers. Methods: Two patients underwent stapled Kono-S anastomosis, one via abdominal and one transanal approach. Results: The approach for an abdominal and transanal stapled Kono-S anastomosis is detailed. Conclusion: The Kono-S anastomosis can be safely configured using common surgical staplers. [ABSTRACT FROM AUTHOR]

Background: At present, relatively few lung surgeries are performed without endostaplers. Although there are few staple-related adverse events, severe events must be shared to improve safety. Case presentation: A 74-year-old male suddenly collapsed and was transferred to the Emergency Rescue department. He had shock vitals and contrast-enhanced CT revealed extensive right hemothorax with contrast leakage. He lost consciousness and tension massive hemothorax was suspected. We performed emergency thoracotomy at two sites and were able to achieve hemostasis and save the patient. Upon examining the patient's medical history after his condition stabilized, it was revealed that he was a lung cancer patient who was taking ramucirumab and cilostazol. In addition, the CT scan taken one month before onset revealed the bleeding site of the fifth intercostal artery were almost contact with the staple line from a prior right spontaneous pneumothorax surgery that was performed 11 years previously, which was seemed to damage the intercostal artery. Conclusion: Despite the difficulty in achieving hemostasis due to drug administration history, we successfully treated a case of remote period massive hemothorax attributed to staples, thereby saving the patient. When using drugs that increase the risk of bleeding events, it may be important to consider the position of the staple line while assessing the risk. In the emergent or ICU setting, if the initial incision is not effective, the placement of a new second incision may be valuable. [ABSTRACT FROM AUTHOR]

The withdrawal and lateral holding properties of three types of plywood with one stapled as well as one-row multi-stapled joints were studied and compared. The results show that variations in plywood density have a significant effect on withdrawal strength and a relatively small effect on lateral holding strength. At four staples, the withdrawal strength of the eucalyptus plywood with a density of 0.59 g/cm3 is 1821 N, which is 21% higher than that of poplar plywood with a density of 0.51 g/cm3 at 1498 N and 32% higher than that of eucalyptus/poplar composite plywood with a density of 0.53 g/cm3 at 1275 N. In terms of lateral holding strength, eucalyptus plywood has a lateral holding strength of 1603 N 12% lower than the 1807 N of eucalyptus/poplar composite plywood and 10% lower than the 1761 N of poplar plywood. As the number of staples increased from 1 to 4 in increments of 1, the withdrawal strength of eucalyptus plywood continued to increase, while the nodal strengths of the poplar plywood as well as eucalyptus/poplar composite plywood did not differ significantly between 3 and 4 staples, and there is a significant increase in the lateral holding strength for all three plywood nodes. Equations for predicting the withdrawal and lateral holding strengths of one-row multi-stapled joints were derived separately. [ABSTRACT FROM AUTHOR]

Introduction: In carpal scaphoid fractures, the surgical treatment with screw is considered the gold standard; shape memory staple however presents substantial advantages. The authors report a study on unstable fractures of the scaphoid waist (type B1, B2, B5, according to Herbert classification) treated with shape memory staple on a large sample of patients, with the aim to confirm the usefulness of this method, the quality of reduction and fixation, the functional results, the time of union and the possible complications.Materials and Methods: A retrospective analysis of 131 patients with scaphoid waist fractures with minimum follow-up 1 year was performed. Staples were used in all cases; technical details are discussed. Outcome measures were: postoperative pain, flexion-extension wrist range, hand grip strength, radiographic consolidation, work absence. Herbert and Fisher Grading System was used to assess subjective, objective and radiographic results.Results: Consolidation was achieved in all cases of primary fractures (0-30 days) within three months after surgery, and within eight months in all but two cases of delayed unions (operated within 6 months of the injury). Pain was absent at follow-up in 79% of cases, never severe or unbearable, the average flexion-extension range achieved was 112°. Handgrip strength values were comparable to those of contralateral wrist in 75% of cases. Mean time lost at work was 7.4 weeks. No algo-distrophy or malunion were observed. Discussion CONCLUSIONS: Scaphoid waist fractures' treatment with shape memory staple should be considered as an excellent alternative to screw fixation. [ABSTRACT FROM AUTHOR]

A first ray dorsiflexion osteotomy is commonly performed for cavovarus foot correction. There are multiple techniques to fix this osteotomy, ranging from wires, screws, and plates or a combination of these. We present our results using a varisation staple (Biomet©) as an alternative fixation device. We performed a retrospective outcome analysis of a consecutive series of 10 cavovarus feet that underwent a dorsiflexion osteotomy (dorsal closing wedge) of the first metatarsal fixed with two varisation staples. The results were measured at a mean three monthly follow-ups and included union and complication rates, as well as clinical and radiographic assessment of cavus deformity correction. There was a 100% union rate with no complications or cases of delayed union. No metalwork removal was requested in any case at follow-up. First ray dorsiflexion osteotomies are most commonly fixed using a 3.5mm cortical screw. We demonstrate that our alternative and novel technique using varisation staples achieved a 100% union rate while avoiding the prominent hardware complications known to occur with cortical screws or plates. [ABSTRACT FROM AUTHOR]

BACKGROUND: Skin closure with surgical staplers has been widely used in total knee arthroplasty. In recent years, a new kind of skin closure tape has also achieved good results in total knee arthroplasty. There is no clear report on which method of skin closure is better. OBJECTIVE: To statistically analyzed the effect of two skin closure techniques in total knee arthroplasty. METHODS: The two researchers independently searched the relevant literature in PubMed, Cochrane library, EMBASE, Chinese Biomedicine Database, China National Knowledge Infrastructure, Wanfang Data and the VIP Chinese Sci-tech Journal Database. The retrieval time was from inception to April 2019. The literature was screened and finally included in the study. RESULTS AND CONCLUSION: A total of four studies were included, both of which were the literature in English. (1) In terms of the primary index, the re-admission rate of skin closure tape (RR=0.68, 95%Cl:0.49-0.95, P=0.03) could be reduced compared with the staple. However, there was no significant difference in the incidence of complications between the two (RR=0.85, 95%Cl:0.27-2.64, P=0.77). (2) In the aspect of secondary indexes, skin closure tape could relieve pain, save time and cost, and have good cosmetic effect though there was no significant difference in the removal time of dosed materials between the two. (3) Results indicated that according to the existing literature, compared with surgical staples, skin closure tape is a less painful skin closure method with fewer complications in total knee arthroplasty. Because of the limited sample size, more studies and longer follow-up time are needed to confirm this conclusion. [ABSTRACT FROM AUTHOR]

Purpose: Tibial-side avulsion injuries of the posterior cruciate ligament are rare injuries. In displaced fracture, the reduction and fixation is the treatment of choice, although the optimal surgical management has not yet been determined. The aim of this study was to evaluate the clinical, functional, and radiological outcome after an open reduction and internal fixation with staples of a posterior cruciate ligament tibial avulsion. Methods: A historical cohort of patients who underwent open reduction and internal fixation with staple due to a posterior cruciate ligament tibial avulsion were reviewed. Minimum follow-up was 2 years. Demographic, clinical, and radiological data, including stress X-ray, were analyzed. Also, International Knee Documentation Committee Score, Tegner Knee Score, Lysholm Knee Score, Short-Form Health Survey, and four-point Likert scale were evaluated. Results: Four males (57%) and 3 females (43%) were included in the final analysis. The mean age was 39 years (range 27–54). All patients had a fracture union. No implant migration was observed. Postoperative posterior drawer, reverse pivot shift, and varus/valgus stress were negative. In stress TELOS X-ray, no statistically significant differences were observed between the postoperative and contralateral knee. All evaluated scores had good or excellent results. Conclusions: Our study provides further evidence that the use of an open reduction and internal fixation with a staple could be a simple and reliable management for posterior cruciate ligament avulsion fractures of the tibia. In our study, the postoperative stress TELOS X-ray analyze showed a correct fixation and biomechanical function of the posterior cruciate ligament. [ABSTRACT FROM AUTHOR]

Purpose: The anterior cruciate ligament (ACL) reconstruction is one of the most performed and successful orthopaedic procedures. The results are considered independent by the choice of the graft and the fixation devices. A growing interest on resorbable non-metallic fixation devices versus standard metallic fixation devices has been noted over recent years with few clinical experiences reported in the literature. The aim of this study is to compare the clinical and radiological outcomes of patients undergoing ACL reconstruction using autologous hamstring tendons with tibial fixation by a centrally placed resorbable screw and sheath to a combination of an eccentrically placed resorbable interference screw and supplementary staple fixation.Methods: Ninety patients undergoing an isolated, single-bundle, primary ACL reconstruction with autologous hamstring tendons, using the same femoral fixation, were randomized to a tibial fixation with a centrally placed resorbable screw and sheath, BioIntrafix (group A), or an eccentrically placed resorbable interference screw, BioRCI, and two non-resorbable staples (group B). The latter has represented for many years our standard fixation method. Clinical evaluations (KOOS, IKDC, KT-2000™ side-to-side difference) and radiological analyses were conducted in both groups with a minimum follow-up of 2 years.Results: We assisted in a satisfactory pain relief and functional improvements, without significant clinical and radiological differences in both groups. No further surgery was needed in patients with the screw/sheath tibial fixation. Seven patients with the screw/staples tibial fixation needed the surgical removal of the fixation devices due to pes anserinus irritation or local infection years after the index operation. Other parameters such as the tunnel enlargement were not statistically different in the two groups.Conclusions: Good clinical and radiological outcomes of ACL reconstruction by a screw/sheath tibial fixation have been reported showing comparable results with respect to screw/staples fixation. There were no failures associated with loss of fixation with either of tibial fixation methods. A fewer number of surgical removals of tibial devices were also recorded in patients treated by the screw/sheath fixation system, related to the absence of local intolerance or infection compared to subjects with a standard tibial fixation. [ABSTRACT FROM AUTHOR]

Background: The incisional surgical site infection (SSI) is an extremely common complication following open abdominal surgery and imposes a considerable treatment and cost burden.Method: We conducted a multicenter open-label randomized controlled trial at three Tokyo Metropolitan medical institutions. We enrolled adult patients who underwent either an elective or an emergency open laparotomy. Eligible patients were allocated preoperatively to undergo wound closure with either subcuticular sutures or staples. A central Web-based randomization tool was used to assign participants randomly by a permuted block sequence with a 1:1 allocation ratio and a block size of 4 before mass closure to each group. The primary endpoint was the occurrence of a superficial SSI within 30 days after surgery in accordance with the Centers for Disease Control and Prevention criteria. This trial was registered with UMIN-CTR as UMIN 000004836 ( http://www.umin.ac.jp/ctr ).Results: Between September 1, 2010 and August 31, 2015, 401 patients were enrolled and randomly assigned to either group. One hundred and ninety-nine patients were allocated to the subcuticular suture and 202 patients to the staple groups (hereafter the "suture" and "staple" group, respectively). Three hundred and ninety-nine were eligible for the primary endpoint. Superficial SSIs occurred in 25 of 198 suture patients and in 27 of 201 staple patients. Overall, the rate of superficial SSIs did not differ significantly between the suture and staple groups.Conclusion: Subcuticular sutures did not increase the occurrence of superficial SSIs following open laparotomies mainly consisting of clean-contaminated surgical procedures. The applicability of the wound closure material and method is likely to depend on individual circumstances of the patient and surgical procedure. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical efficacy between subcuticular sutures and staples for skin closure after cesarean delivery.Methods: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science were searched. Only RCTs comparing subcuticular sutures to staples following cesarean delivery were included. The primary outcome was the incidence of wound complications, consisting of wound infection, wound separation, hematoma and seroma. Risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) was calculated.Results: Ten RCTs were included in this analysis. Subcuticular sutures were associated with significantly decreased incidence of wound complications compared to staples (RR 1.88, 95% CI 1.45-2.45). The operation time was significantly shortened when closure with staples was performed (MD -8.66 min, 95% CI -10.90 to -6.42). The two groups were comparable regarding cosmetic outcome at 6-8 weeks postoperatively, whereas subcuticular sutures were associated with a better cosmesis at 6-12 months postoperatively. There were no significant differences between groups in terms of hospital stay, postoperative pain and patient satisfaction.Conclusions: Compared with staples following cesarean delivery, subcuticular sutures are associated with decreased risk of wound complications and better long-term cosmetic outcome, but slightly prolong duration of surgery. [ABSTRACT FROM AUTHOR]

A 66-year-old man with postsigmoidectomy status for colon cancer received laparoscopic partial hepatectomy due to a hepatic mass with employing titanium clips were for a vascular clamp. Histological examination showed liver metastasis from sigmoid colon cancer. Twenty-nine months after the partial hepatectomy, a mass developed on the stump at the hepatic resection. Laparoscopic left lateral segmentectomy was conducted under suspicion of cancer recurrence and an automatic titanium stapling device was used. The macroscopically cut surface of the liver showed a grey-white solid nodule measuring 23 x 20 mm and involving metal clips. The nodule was consistent with granuloma microscopically. Twenty-three months after the segmentectomy, a mass reappeared on the hepatic radial margin and an open left lateral hepatic lobectomy was performed because of its growth tendency. Histopathological examination revealed granuloma similar to the previous instance. Since these nodules formed a granulomatous lesion surrounding metal staples/clips and evidence of caseous necrosis was lacking, granuloma due to surgical staples/clips was suspected. Sporadic case reports of postoperative pulmonary granuloma at the staple line have been published previously, but there are no articles detailing a case involving hepatic granuloma. We present our case as the first report of postoperative staple-line hepatic granuloma. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare the morbidity, functional results and quality of life after laparoscopic promontofixation for the cure of genital prolapsed according with the type of fixation of the posterior mesh. Patients and method: From 2001 to 2009, 89 patients with genital prolapse of grade greater than or equal to 2 (POP-Q classification) were operated on by laparoscopy including 47 patients with the suture of the posterior mesh (group suture) and 39 patients with staplin (group staples). Complications per- and postoperative were assessed. Quality of life was evaluated using the questionnaires Pelvic Floor Distress Inventory (PFDI 20), Pelvic Floor Impact Questionnaire (PISQ 7) and Pelvic Organ Prolaps/Urinary Incontinence Sexual Questionnaire (PISQ 12). Results: Except for the mean parity that was higher in the group staples, no difference was found between the groups in the mean age, prior surgery, and genital prolapsed stage. Operating time was shorter in the group staples (P =0.005). No difference was found between the groups in the rate of intra- and postoperative complications. Hospital stay was shorter for the group staples (P =0.007). No difference between the groups was found in de novo symptoms, as well as in the improvement of quality of life. Conclusion: Our results support that stapling of the posterior mesh for the laparoscopic promontofixation is associated with decrease in operating time and hospital stay compared to the suture without affecting functional results and quality of life. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study is to compare the syndesmotic screw versus the staple in stabilization of the syndesmotic diastasis in unstable ankle fractures. Seventy-six patients with unstable ankle fractures (grades 3 or 4 Lauge-Hansen) and diastasis of the inferior tibiofibular syndesmosis underwent surgical treatment aiming for anatomical reduction and stable fixation. The syndesmotic diastasis was stabilized by one of two methods; in the first group (38 patients) it was stabilized with a screw; in the second group the syndesmosis was stabilized with a steel staple. The mean follow up period was 34.8 months and the mean age was 35.1 years. No recurrence of diastasis was detected in either group, chronic pain in the region of the syndesmosis was elicited in 65% of the first group compared with 5% in the second. Heterotrophic ossification was found in the region of the syndesmosis in 50% of the first group and in 5% of the second. Tibiofibular synostosis occurred at the site of the screw in one case in the first group. A broken screw complicated the first group in one case and a broken staple in the second group. The staple does not interfere with the kinematics of the ankle, it allows early mobilization and weight bearing and minimizes the possibility of heterotrophic ossification which causes chronic pain in the region of the syndesmosis. It is therefore considered as the superior alternative in stabilization of the syndesmotic diastasis. [Copyright &y& Elsevier]

During thoracic operations, surgical staplers resect cancerous tumors and seal the spared lung. However, post-operative air leaks are undesirable clinical consequences: staple legs wound lung tissue. Subsequent to this trauma, air leaks from lung tissue into the pleural space. This affects the lung's physiology and patients' recovery. The objective is to biomechanically and visually characterize porcine lung tissue with and without staples in order to gain knowledge on air leakage following pulmonary resection. Therefore, a syringe pump filled with air inflates and deflates eleven porcine lungs cyclically without exceeding 10 cmH 2 O of pressure. Cameras capture stereo-images of the deformed lung surface at regular intervals while a microcontroller simultaneously records the alveolar pressure and the volume of air pumped. The raw images are then used to compute tri-dimensional displacements and strains with the Digital Image Correlation method (DIC). Air bubbles originated at staple holes of inner row from exposed porcine lung tissue due to torn pleural on costal surface. Compared during inflation, left upper or lower lobe resections have similar compliance (slope of the pressure vs volume curve), which are 9% lower than healthy lung compliance. However, lower lobes statistically burst at lower pressures than upper lobes (p- value<0.046) in ex vivo conditions confirming previous clinical in vivo studies. In parallel, the lung deformed mostly in the vicinity of staple holes and presented maximum shear strain near the observed leak location. To conclude, a novel technique DIC provided concrete evidence of the post-operative air leaks biomechanics. Further studies could investigate causal relationships between the mechanical parameters and the development of an air leak. • Air leaks at staple holes of inner row from exposed lung tissue due to torn pleura, on costal surface. • Compared to upper lobes, lower lobes burst at lower pressures in ex vivo conditions. • Left upper or lonwer lobe resections have similar compliance results but lower than healthy lung. • Observed leak site corresponds to zones of maximum principal strain at the staple line. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the wound complication rates and patient satisfaction for subcuticular suture vs staples for skin closure at cesarean delivery. Study Design: This was a randomized prospective trial. Subjects who underwent cesarean delivery were assigned randomly to stainless steel staples or subcuticular 4.0 Monocryl sutures. The primary outcomes were composite wound complication rate and patient satisfaction. Results: A total of 435 patients were assigned randomly. Staple closure was associated with a 4-fold increased risk of wound separation (adjusted odds ratio [aOR], 4.66; 95% confidence interval [CI], 2.07–10.52; P < .001). Having a wound complication was associated with a 5-fold decrease in patient satisfaction (aOR, 0.18; 95% CI, 0.09–0.37; P < .001). After confounders were controlled for, there was no difference in satisfaction between the treatment groups (aOR, 0.71; 95% CI, 0.34–1.50; P = .63). Conclusion: Use of staples for cesarean delivery closure is associated with an increased risk of wound complications. Occurrence of a wound complication is the most important factor that influenced patient satisfaction. [ABSTRACT FROM AUTHOR]