Digestive tract reconstruction is the main part of gastrointestinal surgery. With the rapid development of technology and widely application in stapling device, more and more surgeons are using stapled anastomosis. Stapled anastomosis is associated with shorter operating time and hospital stay than hand-sewn anastomosis. However, it is not easy to select suitable ones from various staplers and use them correctly. Choice and reasonable application of staplers for anastomosis in gastrointestinal surgery are summarized and evaluated in this article.
Anastomosis, Surgical ; instrumentation ; Digestive System Surgical Procedures ; instrumentation ; Humans ; Surgical Staplers

A new anastomat for digestive tract operations, based on the magnetic compressive technique and mechanical transmission mechanism, is composed of a removable head and a reusable body. The head includes two parts: the proximal end can be fixed to the body, and the distal end could be used for performing a purse string suture. The procedure of anastomosis is similar to that of the stapler, and the anastomoses is established using a pair of magnetic rings. The instrument makes magnamosis more simple and feasible, and it would facilitate the clinical application. The body of the anastomat is reusable and the head could be replaced according to the clinical scenarios, these could reduce the medical cost. The magnetic rings would be excreted with the feces, and there is no foreign body response at last.
Anastomosis, Surgical ; instrumentation ; methods ; Gastrointestinal Tract ; surgery ; Humans ; Magnetics

This article introduces the basic structure, features and the priciples of a portable automatic pneumatic tourniquet and its prospects of applications.
Anastomosis, Surgical ; methods ; Automation ; Bandages ; Extremities ; surgery ; Hemostasis, Surgical ; instrumentation ; Humans ; Intraoperative Care ; Tourniquets

OBJECTIVETo evaluate the safety and efficacy of a novel nickel-titanium memory alloy compression anastomosis ring(CAR27) for colorectal anastomosis.

METHODSOne sigmoid cancer patient undergone lower anterior resection(LAR) received colorectal anastomosis with CAR27 on November 12, 2009. The following parameters were recorded during 4 weeks postoperative follow-up:colorectal anastomotic complication,first post-operation flatus and bowel movement, extrusion of ring device.

RESULTSThe total operation time was 42 minutes, including 11 minutes for colorectal anastomosis. The patient had flatus at the first day and began feeding at the second day postoperatively. The ring was expelled with stool at the 10th day postoperatively. Patient didn't have anastomotic complications such as leakage or obstruction during 1 month postoperative follow-up.

CONCLUSIONThis case study primarily indicates CAR27 is safe and feasible for colorectal anastomosis.

Anastomosis, Surgical ; instrumentation ; methods ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Middle Aged ; Nickel ; Rectum ; surgery ; Titanium

OBJECTIVETo summarize the experience in the application of circumcision anastomat in the treatment of phimosis and redundant prepuce in children.

METHODSA total of 551 children with phimosis or redundant prepuce were treated by circumcision from 2008 to 2010, 342 with circumcision anastomat and the other 209 by traditional circumcision. Their clinical data were retrospectively analyzed.

RESULTSCompared with traditional circumcision, circumcision with the anastomat showed the advantages of less operation time (P < 0.05), fewer complications, no need for dressing, and better cosmetic appearance, but it also exhibited the disadvantages of longer healing time (P < 0.05) and more obvious postoperative pain (P < 0.05).

CONCLUSIONCircumcision with the anastomat and traditional circumcision for the treatment of phimosis and redundant prepuce in children each have their own advantages and disadvantages, but the former is more advantageous and more feasible clinically.

Adolescent ; Anastomosis, Surgical ; Child ; Circumcision, Male ; instrumentation ; methods ; Humans ; Male ; Phimosis ; surgery ; Treatment Outcome

OBJECTIVE: To assess the safety and efficacy of gastrointestinal anastomosis with nickel titanium shape memory alloy compression anastomosis clip. METHODS: We randomized 51 patients to undergo gastrointestinal anastomosis with stapler (n=25) and nickel titanium compression anastomosis clip (n=26) respectively. The following parameters were recorded to evaluate the safety and efficacy: mean hospitalization time, anastomotic complication, first post-operation flatus and bowel movement, and extrusion of the clip. RESULTS: Anastomotic complications such as leakage, stenosis and obstruction were not observed in both groups. There were no significant differences in the first post-operation flatus time and bowel movement time between the 2 groups (P>0.05). The clip was expelled with stool within 9-15 d. CONCLUSION Compression anastomosis clip is safe and effective.
Anastomosis, Surgical ; instrumentation ; methods ; Anastomotic Leak ; prevention & control ; Digestive System Surgical Procedures ; methods ; Female ; Gastroenterostomy ; instrumentation ; methods ; Gastrointestinal Diseases ; pathology ; surgery ; Humans ; Male ; Nickel ; Surgical Staplers ; Titanium

OBJECTIVETo evaluate the curative effect of curved cutter stapler (Contour, Ethicon Endo-Surgery, Inc) in the ultra low anterior resection for low rectal cancer.

METHODSClinic data of 56 patients with low rectal cancer from Dec. 2005 to Sep. 2006 were reviewed retrospectively. After total mesorectal excision (TME) and lateral lymph node dissection (LLD) in 56 cases, the rectal (anal) remnant was cut and closed with curved cutter stapler (Contour), and preserved for ultra low colo-rectal (anal) anastomoses with 33 mm straight intraluminal stapler.

RESULTSThere was no operational death and the mean hospitalization time was (11.2+/-3.2) days. The incidence rate of postoperative complications in 1 month was 3.57% (2/65). Both of the cases were anastomotic leakage. One was cured by surgical drainage, the other combining with rectal vaginal fistula was cured by transverse colostomy.

CONCLUSIONCurved cutter stapler has the advantages of complete cutting, safe closure and low anastomotic leakage rate in the process of ultra low anterior resection for low rectal cancer.

Adult ; Aged ; Anastomosis, Surgical ; instrumentation ; methods ; Female ; Humans ; Middle Aged ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; pathology ; Retrospective Studies ; Surgical Equipment

OBJECTIVETo compare the associated anastomotic complication of cervical esophagogastric anastomosis between stapled and hand-sewn anastomosis in minimally invasive esophagectomy(MIE).

METHODSClinical data of 203 patients with esophageal cancer receiving combined thoracoscopic and laparoscopic esophagectomy with anastomosis in the neck in our hospital from January 2010 to November 2013 were retrospectively analyzed. All the patients were divided into stapled group(104 patients) and hand-sewn group(99 patients). The incidence of anastomotic leakage and anastomotic stricture between these two groups were compared.

RESULTSThere were no significant differences between two groups in gender, age, body mass index, total protein, albumin, and neoadjuvant chemotherapy(all P>0.05). There was no significant difference between the two groups in the incidence of anastomotic leakage [6/104(5.77%) vs. 3/99(3.03%), P>0.05], while the difference in the incidence of anastomotic stricture was significant [10/104(9.62%) vs. 2/99(2.02%), P<0.05]. The time of anastomosis, dieting and hospital stay was (15.5±5.0) min, (5.0±2.8) d and (18.3±5.9) d in stapled group, which was significantly shorter than (28.0±4.5) min, (5.9±1.2) d and (21.8±4.2) d in hand-sewn group(all P<0.05).

CONCLUSIONIn the minimally invasive esophagectomy, stapled cervical esophagogastric anastomosis is simple and precise, but it is associated with increased risk of anastomotic stricture, therefore the type of anastomosis should be chosen based on the conditions of the patient.

Anastomosis, Surgical ; Anastomotic Leak ; etiology ; Constriction, Pathologic ; etiology ; Esophageal Neoplasms ; surgery ; Esophagectomy ; instrumentation ; methods ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; instrumentation ; methods ; Retrospective Studies ; Sutures ; Treatment Outcome

OBJECTIVETo search for a safe and convenient surgical method for management of urethral disruption.

METHODSWe performed urethral realignment for 18 cases of posterior urethral disruption and 4 cases of ruptured bulbous urethra using the urethral guidance probe following bladder puncture stoma.

RESULTSUrethral realignment was accomplished in 21 of the cases, 18 under epidural and 3 under local anesthesia, with the mean blood loss of 20 ml and the average operation time of 18 minutes. Open surgery was necessitated in 1 case due to the complication of bladder rupture. Routine postoperative urethral dilation extended for 3 months, and all the cases were followed up for 3 to 24 months. The maximum urine flow rate was 15-22 ml/s in 13 cases and 10-14 ml/s in 7. One case received urethral anastomosis 3 months later because of urethrostenosis.

CONCLUSIONSUrethral realignment with the urethral guidance probe is a safe, convenient and effective surgical strategy for the management of urethral disruption.

Adolescent ; Adult ; Anastomosis, Surgical ; instrumentation ; methods ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Urethra ; injuries ; surgery ; Young Adult

OBJECTIVETo evaluate the feasibility and safety of nickel-titanium compression anastomosis ring (CAR27) in colorectal anastomosis after low anterior rectal resection in animal models.

METHODSEnd-to-end colorectal anastomosis was performed using CAR27 in 6 experimental pigs after resection of the middle and lower third of the rectum. The animals were observed postoperatively for up to 56 days. Five pigs were sacrificed at day 14 and the other at day 56. Distance from anal verge to anastomosis and anastomotic circumference were measured. Histopathologic examination was performed.

RESULTSThe median distance from anal verge was 5.3(4-6) cm. No anastomotic leak or other complications were observed. All the pigs recovered and gained weight. In 5 animals sacrificed at day 14, the mean circumference of the anastomosis was 6.8(6.5-7.0) cm, and histopathological examination showed mild inflammatory reaction and fibrosis. In the one sacrificed at day 56, the circumference expanded to 9.3 cm, and no inflammation and fibrosis were observed. Minor adhesion was noticed in only one pig, while smooth and intact serosa in the anastomosis was seen in the rest of the animals.

CONCLUSIONCAR27 is a promising device for mid and low colorectal anastomosis.

Anastomosis, Surgical ; instrumentation ; Animals ; Female ; Male ; Models, Animal ; Nickel ; Rectal Neoplasms ; surgery ; Rectum ; surgery ; Swine ; Swine, Miniature ; Titanium