PURPOSE: Hand-sewn anastomosis as the gold standard of vascular anastomosis cannot fully meet the requirements of vascular anastomosis in speed and quality. Various vascular couplers have been developed to ameliorate this situation. Most of them are mainly used for venous anastomosis rather than arterial anastomosis. Although it is generally acknowledged that in almost all operations involving vascular reconstruction, it is the arteries that need to be anastomosed faster and more accurately and not the veins. A dedicated device is needed for creating arterial anastomosis in an easy, timesaving, less damaging but reliable procedure. Therefore, we plan to develop a novel arterial coupler device and test pre-clinical safety and effectiveness. METHODS: In this cohort study, the rationality of this novel arterial coupler was preliminarily tested by finite element analysis before it was manufactured. Several factors restrict the use of vascular couplers in arterial anastomosis, such as arterial eversion, fixation, etc. The manufactured arterial couplers underwent in vitro and in vivo experiments. In vitro, isolated arteries of beagles were anastomosed with the assistance of an arterial coupler, and the anastomosed arteries were evaluated through anti-traction tests. In animal experiments, the bilateral femoral arteries of 5 beagles served as a control group. After dissection, the femoral artery on one side was randomly selected to be anastomosed with a quick arterial coupler (QAC) (QAC group), and the femoral artery on the other side was anastomosed by the same person using an end-to-end suture technique with a 6-0 Prolene suture (suture group). The bilateral femoral arteries of 5 beagles were used for coupler-assisted anastomosis and hand-sewn anastomosis in vivo, respectively. Success rate, blood loss, anastomotic time, clamp time, total operation time, and patency rate were recorded. The patency of anastomosed arteries was assessed using vascular Doppler ultrasound, electromagnetic flowmeter, and pathological examination (6 weeks after surgery). RESULTS: As a novel arterial coupler, QAC was successfully designed and manufactured by using poly lactic-co-glycolic acid raw materials and 3-dimensions printing technology. Its rationality was preliminarily tested through finite element analysis and related mechanical analysis methods. The isolated arteries were successfully anastomosed with the assistance of QAC in vitro testing, which showed good anti-traction properties. In animal studies, QAC-assisted arterial anastomosis has superior profiles compared to hand-sewn anastomosis in anastomotic time (7.80 ± 1.41 vs. 16.38 ± 1.04 min), clamp time (8.80 ± 1.41 vs. 14.14 ± 1.57 min), and total operation time (46.64 ± 2.38 vs. 51.96 ± 3.65 min). The results of electromagnetic flowmeter, vascular Doppler ultrasound, and pathological examination showed that QAC-assisted anastomotic arteries were superior to hand-sewn arteries in terms of postoperative blood flow (16.86 ± 3.93 vs. 10.36 ± 0.92 mL/min) and vascular patency in 6 weeks after surgery. CONCLUSION QAC is a well-designed and easily maneuverable device specialized for end-to-end arterial anastomosis. Application of this device may decrease thermal ischemia time and improve the patency of anastomotic arteries, thus, improving outcomes.
Animals ; Anastomosis, Surgical/instrumentation* ; Dogs ; Femoral Artery/surgery* ; Vascular Surgical Procedures/instrumentation* ; Finite Element Analysis

Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are significant. Endoscopic submucosal dissection (ESD) allows complete resection of residual gastric precancerous lesions, however it should be performed by the experienced endoscopists.
Anastomosis, Surgical ; adverse effects ; Bile Ducts ; injuries ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Fistula ; etiology ; therapy ; Duodenogastric Reflux ; diagnostic imaging ; etiology ; Endoscopy, Gastrointestinal ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastrectomy ; adverse effects ; Gastric Outlet Obstruction ; surgery ; Gastritis ; diagnosis ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Hemostasis, Endoscopic ; methods ; Hemostatics ; administration & dosage ; therapeutic use ; Humans ; Male ; Neoplasm Recurrence, Local ; surgery ; Postoperative Complications ; diagnosis ; therapy ; Precancerous Conditions ; surgery ; Pylorus ; innervation ; physiopathology ; surgery ; Stents ; Stomach Neoplasms ; complications ; surgery ; Treatment Outcome ; Vagus Nerve Injuries ; etiology ; surgery

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

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

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 26-yr-old male patient reported worsened dyspnea, dizziness one year after an emergency Bentall operation for type A aortic dissection. There was evidence of hemolytic anemia and aortogram revealed a significant stenosis at the distal anastomosis site. During the reoperation, we found the inner felt at the distal anastomosis was inverted causing a significant stenosis. The reoperation successfully resolved this problem. Here, we report a rare case of hemolytic anemia caused by an inverted inner felt after Bentall operation.
Acute Disease ; Adult ; Anastomosis, Surgical ; Anemia, Hemolytic/*diagnosis/*etiology/surgery ; Aneurysm, Dissecting/complications/*surgery ; Aortic Aneurysm/complications/*surgery ; *Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/*adverse effects/instrumentation ; Dizziness/etiology ; Dyspnea/etiology ; Echocardiography ; Humans ; Male ; *Postoperative Complications/surgery ; Reoperation ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVEThe authors report the newly developed reconstruction technique after laparoscopic total gastrectomy (LTG) or laparoscopic distal gastrectomy (LDG): intracorporeal circular stapling esophagojejunostomy(esophagojejunostomy) using the reverse puncture device(RPD).

METHODSAfter LTG or LDG, The anvil is then transorally inserted into the esophagus by using the RPD system. Double-stapling esophagojejunostomy with a circular stapler is performed intracorporeally, and the jejunal stump is closed with an Echelon.

RESULTSThere was no intraoperative complication or conversion to open surgery, the mean operation time was 155 min and blood loss was 75 ml. Postoperative fluorography revealed no anastomosis leakage or stenosis Patients resumed an oral liquid diet on postoperative day 2, and discharged at day 8.

CONCLUSIONSWe have successfully performed LTG or LDG, reconstruction using our technique in 18 patients without any anastomosis complications. We believe that our procedure is a safe and reliable reconstruction method, which is especially useful in obese patients, in whom conventional extracorporeal anastomosis is often difficult.

Anastomosis, Surgical ; Anastomotic Leak ; Esophagectomy ; Esophagoplasty ; Esophagus ; surgery ; Gastrectomy ; Humans ; Jejunostomy ; Jejunum ; Laparoscopy ; instrumentation ; Operative Time ; Punctures ; Reconstructive Surgical Procedures ; Stomach ; surgery ; Stomach Neoplasms ; Surgical Stapling

OBJECTIVETo investigate the efficacy and safety of the domestic biofragmentable anastomotic ring (BAR) from Hangzhou in the intestinal anastomosis.

METHODSA total of 134 patients who underwent intestinal anastomosis from February 2010 to April 2011 in the First Municipal People's Hospital of Guangzhou and the First Affiliated Hospital of Zhejiang University were randomized into two groups. The Valtrac BAR from USA was employed in the control group while the experimental group used domestic BAR. The operative performance of the BARs, as well as the patients vital signs and bowel function, complications, fragmentation status of the rings were compared between two groups.

RESULTSNo significant difference was found between two groups in the operative performance, the fragmentation status of the BARs, the temperature, blood pressure, heart rate, and bowel function (P>0.05).

CONCLUSIONThe domestic BAR possesses similar safety and efficacy with the Valtrac BAR in intestinal anastomosis.

Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; instrumentation ; Female ; Humans ; Intestines ; surgery ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the value of employing the small intestinal feeding tube in treating high position intestinal obstruction of newborn infant.

METHODFive newborn infants (3 males and 2 females; 1 premature infant and 4 fully-mature infants; 2 had membranous atresia of duodenum, 1 had annular pancreas, and 2 had proximal small intestine atresia; 1 infant had malrotation). The duodenal membrane-like atresia and the blind-end of small intestine were removed and intestinal anastomosis was performed, which was combined with intestinal malrotation removal. Before the intestinal anastomosis surgery, the anesthetist inserted via nose a 6Fr small intestinal ED tube, made by CREATE MEDIC CO LTD of Japan[

REGISTRATION NUMBERthe State Food and Drug Administration-instrument (Im.) 2007-NO.2661620]. Twenty-four hours after surgery, abdominal X-ray plain film was taken and patients were fed with syrup; 48 hours later, formula milk was pumped or lactose-free milk amino acids were given by intravenous injection pump through the feeding tube. The amount of milk and fluids was gradually increased to normal amount according to the condition. In initial 3 days the intravenous nutrition was given and one week after operation, the infants were fed through mouth in addition to pumping milk through the tube and stopped infusion. Ten to 22 days after operation, the tube was removed and the infant patients were discharged.

RESULTAll the five infants showed that the feeding through the nutrition tube was accomplished and the time of venous nutrition was reduced and fistula operation was avoided. None of the infants on question was off the tube and no jaundice exacerbation was found and the liver function was also found normal. At the very beginning, the tube was occasionally blocked by milk vale in one infant and after 0.9% sodium chloride solution flushing patency restored. After that, the feeding tube was washed once with warm water after feeding. In one infant vomiting occurred due to enough oral milk. The photograph of upper gastrointestine did not show anastomomotic stricture or fistula, or intestinal obstruction. After pulling out the tube, the symptoms disappeared and then the patient was discharged. One child was found to have diarrhea with no lactose nutrition liquid and given compound lactic bacteria preparations for oral administration, the symptom disappeared. In the 5 cases, the shortest hospital stay was 10 days and the longest was 22 days, the average stay was 16 days. Three to 5 days after operation the weight restored to birth weight, the weight had increased, when discharged, to an average of 5.5 g (kg·d).

CONCLUSIONThe small intestinal feeding tube was very effective for the postoperative nutrition maintenance of high position intestinal obstruction in newborn infants.

Anastomosis, Surgical ; Enteral Nutrition ; instrumentation ; methods ; Female ; Humans ; Infant, Newborn ; Intestinal Atresia ; surgery ; Intestinal Obstruction ; surgery ; Intestine, Small ; abnormalities ; surgery ; Intubation, Gastrointestinal ; instrumentation ; methods ; Length of Stay ; Male ; Nose ; Postoperative Care ; methods ; Retrospective Studies ; Time Factors ; Weight Gain

OBJECTIVE: To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). MATERIALS AND METHODS: From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. RESULTS: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 +/- 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 +/- 0.40 g/dL) to post-enteral feeding (3.7 +/- 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). CONCLUSION: Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.
Adult ; Aged ; Anastomosis, Surgical ; Anastomotic Leak/radiography/*therapy ; Decompression, Surgical/instrumentation ; Drainage/instrumentation ; Enteral Nutrition/instrumentation ; Esophageal Neoplasms/*surgery ; Esophagectomy ; Female ; Fluoroscopy ; Humans ; Intubation, Gastrointestinal/*methods ; Male ; Middle Aged ; Postoperative Complications/*radiography/*therapy ; Radiography, Interventional/*methods ; Retrospective Studies ; Stomach Neoplasms/*surgery