Humans ; Laryngectomy ; instrumentation ; Surgical Staplers

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

BACKGROUND: Thoracoscopic bullectomy (VATS-B) is now the preferred treatment for spontaneous pneumothorax despite of higher recurrence rate than open thoracotomy. Several methods have been used to prevent this problem. The effectiveness of staple line reinforcement (SLR) in VATA-B using endostaplers was assessed by clinical and experimental study. MATERIAL AND METHOD: In experimental study, canine lungs were harvested immediately (group I, N=5) and 48 hours (group II, N=5) after stapling. The pressures at which initial air leaks occurred were measured. In clinical study from February 1997 to March 1999, 106 procedures in 104 patients undergoing VATS-B for spontaneous pneumothorax were classified into two groups according to the presence of SLR and were compared. RESULT: The average pressure of the initial air leakage was significantly higher in SLR than that of staples alone (18+/-1.6 vs 48+/-3 mm Hg in group I; 23.8+/-1.9 vs 54+/-4.6 mm Hg in group II, p<0.001). In the clinical data, there were significant differences seen in the duration of drainage, the total length of endostaplers used, and the duration of the postoperative hospital stay between patients with staple alone and patients with SLR (4.4+/-1.4 vs 3.1+/-1.1 days in duration of drainage, 92.3+/-28.1 vs 71.1+/-30.6 mm in total length of endostaplers used, 5.9+/-1.9 vs 4.6+/-1.7 days in postoperative hospital stays, p<0.001). CONCLUSION: SLR was effective for preventing prolonged air leakage and responsible for shorter hospital stays after VATS-B for the treatment of spontaneous pneumothorax.
Drainage ; Humans ; Length of Stay ; Lung ; Models, Theoretical ; Pneumothorax* ; Polytetrafluoroethylene* ; Recurrence ; Surgical Staplers ; Thoracoscopy ; Thoracotomy

BACKGROUND: Staple closure of bronchial stump was compared with manual suture closure among 100 cases of pneumonectomy during the recent 5-year period. We have reviewed the incidence of bronchpleural fistula between autosutured group and manual sutured group. MATERIAL AND METHOD: During the recent 5-year period, 100 patients underwent pneumonectomy at Hanyang University Hospital. Staple closure of bronchial stump was performed in 65 patients and manual suture in 35 patients. There were 55 males and 10 females in the autosutured group, and 26 males and 9 females in manual sutured group, which showed no significant statistical difference between the two groups. The mean ages of patients for autosutured group and manual sutured group were 56.7+/-10.3 years and 61.4+/-9.2 years, respectively, which showed no significant statistical difference between the two groups. There were 38 cases of left pneumonectomy and 27 cases of right pneumonectomy in autosutured group, and 22 cases of left pneumonectomy and 13 cases of right pneumonectomy in manual sutured group. There were 53 cases of malignancy and 12 cases of benign imflammatory disease in autosutured group, and 27 cases of malignancy and 7 cases of benign imflammatory disease in manual sutured group. RESULT: The incidence of bronchopleural fistula was 6.1% in autosutured group and 5.7% in manual sutured group. The incidence of other postoperative complication between the two groups showed no significant statistical difference. CONCLUSION: The incidence of bronchopleural fistula between autosutured group and manual sutured group was not different stastically. Both method for closure of bronchial stump can be performed in pneumonectomy.
Female ; Fistula* ; Humans ; Incidence ; Male ; Pneumonectomy* ; Postoperative Complications ; Surgical Staplers ; Sutures*

One hundred gastric cancer patients who underwent total gastrectomy and Roux-en-Y, end-to-side esophagojejunostomy by using stapling devices were analyzed with regard to their operative results. The median time required for the anastomosis was 18 minutes (range of 15 to 45 minutes). A cartridge of 25 mm in diameter was preferred (85% of 25 mm vs. 15% of 28 mm). In 92 patients, procedures were uneventful. Intraoperative problems happened in 8 patients: Two misfirings of stapler due to mechanical problems, in 6 patients, doughnut tissues were incomplete. Mechanical problems were solved by a change of the stapler and for incomplete doughnut tissues, anastomosis was simply reinforced (2 cases) or reanastomosed with restaplings (4 cases). Anastomotic leakage occurred in 2 patients but it was seen only in radiological studies. During the follow up period, two cases of anastomotic stricture were found and they were treated with endoscopic dilatations. There was no operative mortality nor other complication. In addition, routine use of the Levin tube after total gastrectomy was appraised by comparing postoperative courses. Twenty patients were randomly divided into two groups; for 10 patients the Levin tube was removed at the recovery room and for another 10 patients the Levin tube was indwelled until peristalsis returned. Timing of the tube removal did not affect the duration of the hospital stay and starting day of oral intake. We think that the stapler, when properly used, can facilitate the esophagojejunostomy safely and routine use of the Levin tube after total gastrectomy may be unnecessary.
Adult ; Aged ; *Anastomosis, Roux-en-Y ; *Esophagostomy ; Female ; *Gastrectomy ; Human ; *Jejunostomy ; Male ; Middle Age ; *Surgical Staplers

BACKGROUND: The use of the stapler n esophageal reconstruction after esophageal resection for benign or malignant esophageal diseases has become popular because it has less leakage at the anastomotic site and shorter operation time than manual sutures. However, the use of classic circular stapler has some complications such as stenosis and dysphagia that requires additional treatment. Such complications are closely related to the inner diameter of the anastomotic sites. In this study, the diameter of anastomotic site was compared after the use of circular stapler(EEA) and straight endoscopic stapler(endo GIA). MATERIAL AND METHOD: The patients who received esophageal reconstruction by stapler from August 1995 to September 1997 were reviewed. The patients were divided into 2 groups. One group need the circular stapler, and the other group the straight endo GIA(14 cases with endo GIA 30mm, 24 with endo GIA 45mm). After a cervical esophago-enteric anastomosis, the stricture of anastomotic site and the incidence of dysphagia were compared between the 2 groups using an esophagography and the patient's symptoms. The follow-up period was 12months in average. RESULT: In the former group in which the circular stapler was used, 2 cases of anastomotic stenosis were reported. In comparison, none were reported in the latter group. Dysphagia were reported in 8 cases of the former group, and in 3 cases of the latter group(1 case in endo GIA 30 mm, 2 cases in endo GIA 45 mm). CONCLUSION: The use of endo GIA in esophago-enteric anastomosis resulted in a wider diameter of the anastomotic site, lesser stricture, and lesser incidence of dysphagia compared to the use of former circular stapler. Therefore, it is thought to be a better method in esophageal reconstructions.
Constriction, Pathologic ; Deglutition Disorders ; Esophageal Diseases ; Follow-Up Studies ; Humans ; Incidence ; Surgical Staplers ; Sutures

OBJECTIVETo investigate the safety and efficiency of the disposable circumcision suture device (DCSD) in the surgical treatment of phimosis and redundant prepuce.

METHODSWe randomly assigned 249 outpatients with phimosis or redundant prepuce to be treated with DCSD (n = 129) and by conventional circumcision (CC, n = 120), respectively. Then we compared the safety and efficiency of the two strategies.

RESULTSComparisons between DCSD and CC showed that the operation time was (4.02 +/- 0.69) vs (30.8 +/- 4.05) min, blood loss was (1.07 +/- 1.29) vs (8.72 +/- 2.15) ml, intraoperative pain score was 0.81 +/- 0.81 vs 2.42 +/- 1.15, 24-hour postoperative pain score was 1.84 +/- 1.02 vs 4.99 +/- 1.36, postoperative complication rate was 13. 95% (18/129) vs 9.17% (11/120), wound healing time was (13.99 +/- 9.06) vs (17.48 +/- 3.49) d, satisfaction with the penile appearance was 98.4% (127/129) vs 95% (109/120), and treatment cost was (2215.62 +/- 17.67) vs (576.47 + 15.58) Y RMB. DCSD exhibited obvious superiority over CC for shorter operation time, less blood loss, milder intraoperative pain, sooner wound healing, and better penile appearance, but it also had a higher rate of postoperative complications (P > 0.05) and involved more treatment cost than the latter (P < 0.05).

CONCLUSIONThe disposable circumcision suture device affords ideal clinical effects and therefore deserves clinical popularization.

Circumcision, Male ; instrumentation ; Disposable Equipment ; Follow-Up Studies ; Humans ; Male ; Phimosis ; surgery ; Surgical Staplers ; Treatment Outcome

OBJECTIVETo evaluate the efficacy and safety of circumferential mucosectomy procedure for treatment of prolapsed hemorrhoids (PPH).

METHODSFrom June 2001 to June 2003, 74 patients (27 men and 47 women) with an average age of 57 years (ranging from 31 to 80 years), with prolapsed hemorrhoids III - IV degree underwent PPH using a circular stapler.

RESULTS69 (93.2%) patients were fully satisfied with results. Two patients underwent simultaneous rectal polypectomy along with PPH hence required analgesic treatment for 5 days. Three patients experienced bleeding during or after operation, 1 case bleeding was due to ulcerative hemorrhoid, while the bleeding the remaining 2 cases was (bleeding about 300 ml) caused by insufficient anastomosis, thus extending operating time to 1 hour. The average operation time (70 patients) was 13 minutes (range 10 - 15 minutes). The mean hospitalization was 3.5 days (2 - 4 days), with exception of 2 patients lasting 1 week.

CONCLUSIONPPH is a safe, effective and rapid method for treatment of prolapsed hemorrhoids, The procedure causes minimal pain with decreased complications.

Adult ; Aged ; Aged, 80 and over ; Digestive System Surgical Procedures ; instrumentation ; Female ; Hemorrhoids ; surgery ; Humans ; Male ; Middle Aged ; Surgical Staplers

We have invented a barrel-shape suturing-aid apparatus with a light source on one side and a trapzoid cranny for suturing on the other side. There are many advantages proved by clinical practices in applying the suturing-aid apparatus: 1. to increase the suturing speed and relieve the pains of patients; 2. to avoid the infection of HBV by blood and crossinfection; 3. to improve the illumination condition and avoid no suturing of the hurt tissue.
Delivery, Obstetric ; Equipment Design ; Female ; Humans ; Lacerations ; surgery ; Surgical Staplers ; Surgical Stapling ; instrumentation ; methods ; Vagina ; injuries ; surgery

OBJECTIVETo evaluate the value of using a linear stapler device for the closure of the pharynx during total laryngectomy.

METHODSSixteen total laryngectomies were performed between August 2010 and December 2011, during the operation, the TA 60 linear stapler was used for pharyngeal closure. Among these patients, two patients had the history of pre-operative radiotherapy, four patients recurred after radiotherapy, ten patients were treated for the first time. 100 ml methylene blue was injected into the newly closed laryngopharyngeal cavity through the nasopharyngeal breather pipe for checking up whether it was watertight or not.

RESULTSAmong the sixteen patients, methylene blue leakage from the mucosal joint of the gular cavity closed by the stapler were not found in fifteen patients, it was only found in one patient. The transudatory places were sutured with absorbable Vicryl sutures. This patient healed well without pharyngocutaneous fistula. Negative surgical margins were achieved in all patients. No patient needed to be transferred to open surgery. Using a linear stapler device in total laryngectomy, 45 minutes could be saved as compaired to manual suture. One patient developed a light pharyngocutaneous fistula. The incidence of pharyngocutaneous fistula was 6.25% (1/16).

CONCLUSIONSThis stapled closed technique for pharyngoplasty is efficient, eliminates the risk of wound contamination, saves operation time and decreases the incidence of pharyngocutaneous fistula. This technique can be recommended as alternative for repairing the pharynx in patients undergoing total laryngectomy.

Aged ; Aged, 80 and over ; Female ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; instrumentation ; methods ; Male ; Middle Aged ; Surgical Staplers