STI Volume 31

 

$195.00

Surgical Technology International 31

 

Surgical Technology International Vol. 31 contains 59 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.

 

December-2017- ISSN:1090-3941

 

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both electronic and print versions

 

General Surgery

Clinical and Patient-Reported Outcomes after Absorbable Strap Fixation for Ventral Hernia Repair
Heather Bougard, MBChB, FCS(SA), Head of Clinical Unit: Surgery, Sven Bringman, MD, PhD, Associate Professor, Senior Consultant, William W. Hope, MD, Associate Professor of Surgery, Jay A. Redan, MD, FACS, Past President of Society of, Laparoendoscopic Surgeons, Carl Doerhoff, MD, FACS, Clinical Assistant/Professor of Surgery, Michal Chudy, MD, General & Laparoscopic Surgery Consultant, Christine Romanowski, MD, Clinical Development, Peter Charles Jones, MSc, Consultant Statistician

 

Abstract


Introduction: Various mesh fixation methods are employed by surgeons during ventral hernia repair. These may include tacks, straps, sutures, glue, or a combination of methods. One of these choices is an absorbable fixation device, Securestrap® (Ethicon Inc., Somerville, New Jersey), consisting of an absorbable copolymer barbed U-shaped strap with a spring-loaded deployment system.
Materials and Methods: The International Hernia Mesh Registry is a prospective multi-center registry, designed to collect longitudinal data on hernia repair methods, products, and outcomes. Patients complete the Carolinas Comfort Scale™ (CCS) (The Charlotte-Mecklenburg Hospital Authority, Charlotte, North Carolina) pre-operatively, and at one month, six months, and 12 months post-operatively. Symptomatic patients defined as responding >1 to any CCS™ question. Statistical comparison of symptom frequency was made with the McNemar test and Kaplan Meier methods to determine the recurrence rate up to 365 days.
Results: Patients were enrolled at 16 centers. Data was available on 100 of the 203 patients at six months and on 119 patients at 12 months. Demographics: mean age of 52.7 (13.2 standard deviation[ SD]); mean body mass index (BMI) of 33.2 (7.5 SD) kg/m²; 64.3% having a BMI over 30kg/m2; male patients 47.4%; 16.7% for recurrent hernias. Mesh fixation with straps alone in 48.3% of cases or straps and sutures in 51.7% of cases. Percentage of patients with symptomatic pain decreased slightly from baseline to one month (70.0 vs. 60.6, p=0.0782) and significantly from one month to six months (60.6% symptomatic vs. 23.2%; p=0.0004). From six months to twelve months, the change in percentage of symptomatic patients was not significant (23.2% vs. 28.7%; p=0.8084). Similar results were observed with symptomatic CCS™ movement limitations. Overall recurrence rate at 12 months was 4.72% (2.39%–9.22%).
Conclusion: Mesh fixation with straps with or without additional sutures is associated with significant improvements in patient-reported pain and movement limitation from baseline to six months post-operative.

925

28-09-2017

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AbsorbaSeal™ Vascular Closure Device: A Novel Device for Hemostasis Following Interventional Peripheral Vascular Procedures
Emily Benham, MD, Surgical Resident, Koen Deloose, MD, Head of Vascular Surgery Department, Joren Callaert, MD, Surgeon, Marc Bosiers, MD, Surgeon, Tiffany Cox, MD, Surgical Fellow, Amy Lincourt, PhD, Director of Research, B. Todd Heniford, MD, FACS, Chief

 

Abstract


Introduction: Vascular closure devices (VCDs) are designed to achieve rapid hemostasis during percutaneous coronary and peripheral vascular procedures. Studies demonstrate that VCDs improve time to hemostasis (TTH) and time to ambulation (TTA) in comparison to standard manual compression. The available products, however, typically have 13–17 steps in their application, often require hemostatic collagen or other agents as part of the process, and can result in significant scarring at the puncture site that can impact future access. The aim of this study was to investigate the performance of a three-step, novel VCD for access site TTH, short-term and long-term histology, and a first-in-man clinical study.
Materials and Methods: This study evaluated AbsorbaSeal™ (CyndRx, LLC, Brentwood, Tennessee), a simple, three-step, VCD with bio-absorbable components. Following an institutional review board (IRB) approval, a 6-F sheath was placed directly into the porcine aorta, AbsorbaSeal™ was used to seal the puncture site, and a measure of total time of deployment (TTD) and TTH was performed, as well as histologic evaluation at 30, 60, and 180 days.
A complement activation test was performed to determine the potential for activation of the complement system as a mediator of inflammation. The test was performed by directly incubating the VCDs AbsorbaSeal™ and Angio-Seal™ (Terumo Interventional Systems, Tokyo, Japan) in human serum. Serum samples were removed after 30, 60, and 90 minutes and tested for the presence and amount of complement protein SC5b–9.
In the first in-man trial, the device was deployed in anticoagulated patients undergoing interventional vascular procedures. The TTH, estimated blood loss, patient pain scores, and procedural and follow-up complications were recorded.
Results: In the acute and chronic porcine studies, TTD averaged 25 seconds (17–29 seconds). Vascular control was immediate, yielding a TTH of effectively zero seconds. Histologic evaluation demonstrated complete endothelial coverage of the device by 30 days without evidence of bleeding, clotting, or inflammation. At 60 days, the significant mass of the device had dissolved and normal appearing collagen surrounded the devices with essentially no inflammatory response. By six months, all but one microscopic segment of one of the devices had been absorbed with normal appearing vascular endothelium, and no, or minimal, scarring appreciated. The complement test demonstrated that the AbsorbaSeal™ had similar, or lower, complement concentrations than the negative controls and significantly less than Angio-Seal™. This supported the histologic findings of minimal to no inflammation.
The VCD was deployed in 20 patients undergoing interventional vascular procedures. The mean TTH was 2.3 ± 1.5 minutes. Estimated blood loss was 11.7 mL ± 3.5 mL, and no significant hematoma was noted. Post-procedure pain scores were low, with a mean of 1.4 ± 0.8 on a 0–10 pain rating scale. There were no perioperative complications and no adverse events at follow-up. Conclusions: The AbsorbaSeal™ is safe and simple to use for vascular closure after interventional vascular procedures with favorable outcomes including a short TTH, minimal procedural blood loss, low postoperative pain scores, and no perioperative complications or adverse effects. Histologic evaluation reveals rapid device absorption and little scar formation both short- and long-term. A direct study of complement activation supports that AbsorbaSeal™ evokes a minimal inflammatory response that is significantly less than Angioseal.

882

18-06-2017

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Minimally-Invasive Myotomy: Percutaneous Laparoscopic Surgical Approach for Achalasia
Lavinia Alessandra Barbieri, MD, General Surgeon, Davide Bona, PhD, Professor, Director, Alberto Aiolfi, MD, General Surgeon, Giancarlo Micheletto, PhD, Professor, Director, Marta Cavalli, MD, General Surgeon, Day and Week Surgery Division, Francesca Lombardo, MD, General Surgeon, Piero Giovanni Bruni, MD, General Surgeon, Giampiero Campanelli, PhD, Full Professor/Director

 

Abstract


The laparoscopic approach of the upper gastrointestinal tract is considered the gold standard for the treatment of functional benign esophageal disorders since 1990. In recent years, many efforts have been made to minimize the abdominal wall’s trauma to reduce postoperative pain and to obtain a prompt return to daily activities, as well as improve cosmetic results of surgery. The progressive development of novel surgical devices has allowed for the introduction of new minimally-invasive surgical techniques. Criticism of the single-incision laparoscopic surgery includes a modification of surgical technique and an increased incidence of wound-related complications, such as infections and incisional hernia. We present our early experience using the new MiniLap® Percutaneous Surgical System (Teleflex Incorporated, Wayne, Pennsylvania) to perform a two-trocars laparoscopic percutaneous-assisted esophageal Heller myotomy. We demonstrate that the use of percutaneous instruments was not inferior in terms of clinical outcomes as compared to the standard technique, while improving cosmetic results and reducing trocar-related abdominal pain.

931

6-11-2017

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Over-Sewing of Staple Line in Laparoscopic Sleeve Gastrectomy: Initial Experience of a Comparative Study
Giorgio Lisi, MD, Resident, Roberto Rossini, MD, Medical Staff, Irene Gentile, MD, Medical Staff, Giacomo Ruffo, MD, Head

 

Abstract


Introduction: The main drawback of laparoscopic sleeve gastrectomy (LSG) is the severity of postoperative complications. Staple line reinforcement (SLR) is strongly advocated. Recently, over-sewing has been proposed as a cost-effective and helpful method for reinforcing the staple line. The purpose of this study was to report our initial experience with LSG comparing over-sewing over the entire staple line with the upper-third staple line.
Materials and Methods: All obese patients seen at Negrar Sacro Cuore, Don Calabria Hospital were entered into our prospective database and were retrospectively evaluated. Complications (divided as major complications: leaks and bleeding; and minor complications: dysphagia, esophagitis, and reflux disease) and reoperations were recorded for all patients. Complications were graded according to the Clavien classification system.
Results: From February 2015 to March 2016, 30 patients underwent LSG. Patients were divided in two groups according to over-sewing: Group A—over-sewing over the entire staple line; and Group B upper-third over-sewing. Mean total operative time was longer in Group A—90 minutes—compared with 85 minutes in Group B. In regard to minor complications, we reported one esophagitis and two cases of dysphagia in Group B and one dysphagia in Group A. Gastroesophageal reflux was higher in Group B than in Group A (3 vs. 1, p=0.149). Three major complications were observed (10%): two bleeding and one hematoma in Group B and no major complications occurred in Group A. All major complications were conservatively treated. No leaks were reported in both groups. No mortality was observed.
Conclusions: Over-sewing of the staple line was associated with fewer leaks but no conclusions can be drawn regarding the effects of over-sewing on staple line bleedings. Before standardizing surgical techniques further, trials are necessary to improve our knowledge about over-sewing in LSG.

886

30-06-2017

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Right-Sided versus Left-Sided Colectomies for Cancer: Surgical Outcomes and Novel Considerations
Matteo Lavazza, MD, Consultant General Surgeon, Stefano Rausei, MD, PhD, Consultant General Surgeon, Georgios D. Lianos, MD, Consultant General Surgeon, Vincenzo Pappalardo, MD, Consultant General Surgeon, Department of Surgery, Francesco Frattini, MD, Consultant General Surgeon, Gianlorenzo Dionigi, MD, FACS, Full Professor in General Surgery, Domenico Iovino, MD, Resident Doctor in General Surgery, Francesca Rovera, MD, Associate Professor in General Surgery, Luigi Boni, MD, FACS, Associate Professor in General Surgery

 

Abstract


Introduction: The aim of this study is to compare short-term outcomes of right versus left colectomies performed as a form of cancer treatment.
Materials and Methods: This study includes 305 consecutive patients with adenocarcinoma treated by laparoscopic or open colectomy. Right colectomy has been compared with left colectomy. The study endpoints were the first flatus day, the first evacuation day, the first day of postoperative solid oral diet intake, and the postoperative hospital stay length.
Results: There were 140 (45.9%) right colectomies and 165 (54.1%) left colectomies performed. The cut-off values for the considered (median) endpoints were three, five, four, and eight days, respectively. The first day of postoperative solid oral diet intake and the length of postoperative hospital stay are significantly associated with the type of resection.
Conclusions: The colon cancer patients treated by right-sided colectomy assumed a solid oral diet and presented a longer postoperative hospital stay compared with the patients treated by left-sided colectomy.

895

24-07-2017

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Topographical Variations between Splenic Flexure and Spleen: A Study with CT Image-Based Reconstruction
Dr. Matteo Lavazza, MD, Consultant General Surgeon, Dr. Stefano Rausei, MD, PhD, Consultant General Surgeon, Dr. Vincenzo Pappalardo, MD, Consultant General Surgeon, Dr. Davide Inversini, MD, Resident Doctor in General Surgery, Dr. Monica Mangini, MD, Consultant Radiologist, Dr. Anna Maria Ierardi, MD, Consultant Radiologist, Dr. Angkoon Anuwong, MD, Consultant General Surgeon, Dr. Hoon Yub Kim, MD, Consultant General Surgeon, Prof. Gianpaolo Carrafiello, MD, Full Professor in Radiology, Prof. Gianlorenzo Dionigi, MD, FACS, Full Professor in General Surgery

 

Abstract


Introduction: An issue that is seldom seen in the literature relates the detailed relationship of the splenic flexure (SF) and the spleen—both carefully examined—with a prospective approach in patients undergoing computer tomography (CT) scan.
Materials and Methods: SF localization has been searched and examined in 120 consecutive CT scans. Several different variables (age, gender, BMI, indication of CT scan, etc.) have been considered. In cooperation with the Radiology Division, we brought to completion a dedicated topographic outline, with the purpose of providing a detailed classification for SF localization.
Results: The SF lies, in 52% of cases, in what we called the inferior (I) position, below the spleen. Other categories of our classification were anterior (A) and posterior (P) positions, which were found respectively in 42% and 8% of analyzed cases.
Considering all the variables given, we did not find any significant statistical correlation (p > 0.05). Conclusions: This study was carried out to classify types of SF in terms of its positional relationship with the spleen. We investigated 120 CT scans and classified the SF into three types, according to its localization: inferior (I), anterior (A), and posterior (P) types. A better understanding of the anatomic variability in SF may be useful for minimizing complications and performing an accurate surgical dissection.

896

21-07-2017

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Gastric Leaks after Sleeve Gastrectomy: Focus on Pathogenetic Factors
Francesco Frattini, MD, Consultant, Roberto Delpini, MD, General Surgery Resident, Davide Inversini, MD, Resident Doctor in General Surgery, Vincenzo Pappalardo, MD, Consultant, Stefano Rausei, MD, PhD, Consultant, Giulio Carcano, MD, Full Professor of Surgery

 

Abstract


As reported by The International Federation for the Surgery of Obesity (IFSO) worldwide survey on bariatric surgery, sleeve gastrectomy has become the second most performed bariatric/metabolic procedure in the world just after gastric bypass.
If we consider complications, despite a recent systematic review and meta-analysis that reported a substantial decrease in sleeve gastrectomy complication rates, leaks after sleeve gastrectomy still rate between 0 and 18%. Unlike the leaks of other types of gastrointestinal surgery, leaks after sleeve gastrectomy are challenging in diagnosis and treatment and can lead to sepsis, multiple organ failure, and even death.
A standardized algorithm of diagnosis and management is still lacking. Current classification of gastric leaks is based on the time of onset and clinico-pathological aspects. Nonetheless, none of the largest series in literature report the pathogenesis of gastric leaks.
Given this paucity of evidence-based data and the lack of defined guidelines, we try to examine and consider the pathogenetic factors of gastric leak to implement better treatments and predict outcomes.

908

16-09-2017

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Bariatric Surgery and Infertility: A Prospective Study
Vincenzo Consalvo, MD, Surgeon, Antonio Canero MD, PhD, Surgeon, Vincenzo Salsano, MD, Director

 

Abstract


Background: Obesity is a worldwide disease affecting 13% of the world’s adult female population. The reasons and the fetal risk are still unclear. The effect of weight loss as a result of bariatric surgery seems to induce an improvement in fertility in obese women. The main purpose of this prospective study is to demonstrate if there is an association between bariatric surgery-induced weight loss and an improvement in the fertility of women at reproductive age. Materials and Methods: From June 2013 to April 2016, all bariatric female patients from our institutes were prospectively evaluated for suitability in this study. A pool of 52 eligible patients was extracted from our database in the recruitment period. Of these, 28 underwent bariatric surgery and 24 did not. Both groups were observed for two-year follow-up. During follow-up, anthropometrics parameters, blood analysis, and comorbidities were checked and a gynaecological consultation was prescribed. Results: Fifty participants were studied. Twenty-seven successfully underwent bariatric surgery with a percentage of excess weight loss (EWL) >70% at 24 months, while 23 accepted the observation and control for 24 months as an integral part of the pre-surgical bariatric program. The contingency table analysis showed an extremely significant association (P<0.0001) between exposition (bariatric surgery) and event (pregnancy), with a relative risk (RR) = 15.33 and confidence interval (CI) 95%=2.213 to 106.26. Conclusions: Bariatric surgery improves fertility in obese women at two years’ postoperative. Every obese woman with difficulties becoming pregnant should undergo a bariatric surgery consultation. Further studies are necessary to confirm our results.

950

9-12-2017

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