The Experts below are selected from a list of 26265 Experts worldwide ranked by ideXlab platform
R. J. Donnelly - One of the best experts on this subject based on the ideXlab platform.
-
Stapler design and strictures at the esophagogastric anastomosis
The Journal of thoracic and cardiovascular surgery, 1996Co-Authors: R. G. Berrisford, R. D. Page, R. J. DonnellyAbstract:Abstract An apparent reduction in the rate of benign anastomotic stricture after stapled esophagogastrectomy prompted us to review the results obtained with different stapling devices since 1988. We present a retrospective review of 125 consecutive patients undergoing esophageal resection for malignancy with stapled intrathoracic anastomoses. Benign anastomotic stricture was deemed present when a patient required endoscopic dilatation to treat postoperative dysphagia. We found no difference in risk factors not related to Stapler size (tumor histologic characteristics, adjuvant therapy) between patients with stricture and patients without stricture. Event-free survival was compared for different Stapler diameters as well as for different Stapler designs. We found that Staplers of smaller diameter were associated with significantly more strictures ( p
Rina Tsutsui - One of the best experts on this subject based on the ideXlab platform.
-
superficial surgical site infection in hepatobiliary pancreatic surgery subcuticular suture versus skin staples
Journal of Gastrointestinal Surgery, 2018Co-Authors: Koichi Tomita, Naokazu Chiba, Shigeto Ochiai, Kei Yokozuka, Takahiro Gunji, Kosuke Hikita, Yosuke Ozawa, Masaaki Okihara, Toru Sano, Rina TsutsuiAbstract:Postoperative superficial surgical site infection is a major complication in hepatobiliary-pancreatic surgery. We aimed to compare the efficacy of subcuticular sutures versus staples for skin closure in preventing superficial surgical site infection in hepatobiliary-pancreatic surgery. Consecutive patients who underwent hepatobiliary-pancreatic surgery at our hospital from October 2006 to March 2011 and from April 2012 to March 2015 were reviewed retrospectively. Superficial surgical site infection incidence was evaluated in patients who received subcuticular sutures and those who received staples for skin closure. Propensity score matching analysis was used to adjust bias from confounding factors. A total of 691 patients were included. Patients with skin staple closures (n = 346) were compared with patients with subcuticular suture closures (n = 345). After a propensity score matching analysis, a significant difference in superficial surgical site infection incidence was found between the skin Stapler group (11.3%) and subcuticular sutures group (2.6%). The same comparison was performed by a subgroup analysis and supported this finding in patients after hepatectomy without biliary reconstruction, pancreatoduodenectomy, or open laparotomy surgeries and in patients with body mass index < 25. Subcuticular suturing after hepatobiliary-pancreatic surgery was more efficacious in reducing postoperative superficial surgical site infection incidence than staples for skin closure.
Michel Gagner - One of the best experts on this subject based on the ideXlab platform.
-
laparoscopic liver resection when to use the laparoscopic Stapler device
Hpb, 2008Co-Authors: Andrew A Gumbs, Brice Gayet, Michel GagnerAbstract:Minimally invasive hepatic resection was first described by Gagner et al. in the early 1990s and since then has become increasingly adopted by hepatobiliary and liver transplant surgeons. Several techniques exist to transect the hepatic parenchyma laparoscopically and include transection with Stapler and/or energy devices, such as ultrasonic shears, radiofrequency ablation and bipolar devices. We believe that coagulative techniques allow for superior anatomic resections and ultimately permit for the performance of more complex hepatic resections. In the stapling technique, Glisson's capsule is usually incised with an energy device until the parenchyma is thinned out and multiple firings of the Staplers are then used to transect the remaining parenchyma and larger bridging segmental vessels and ducts. Besides the economic constraints of using multiple Stapler firings, the remaining staples have the disadvantage of hindering and even preventing additional hemostasis of the raw liver surface with monopolar and bipolar electrocautery. The laparoscopic Stapler device is, however, useful for transection of the main portal branches and hepatic veins during minimally invasive major hepatic resections. Techniques to safely perform major hepatic resection with the above techniques will be described with an emphasis on when and how laparoscopic vascular Staplers should be used.
-
Perioperative outcome of laparoscopic left lateral liver resection is improved by using a bioabsorbable staple line reinforcement material in a porcine model
Surgical Endoscopy, 2008Co-Authors: Esther C. J. Consten, Gregory F. Dakin, Jan-lukas Robertus, Sergio Bardaro, Luca Milone, Michel GagnerAbstract:Hypothesis Laparoscopic liver surgery is significantly limited by the technical difficulty encountered during transection of substantial liver parenchyma, with intraoperative bleeding and bile leaks. This study tested whether the use of a bioabsorble staple line reinforcement material would improve outcome during stapled laparoscopic left lateral liver resection in a porcine model. Study design A total of 20 female pigs underwent stapled laparoscopic left lateral liver resection. In group A ( n = 10), the stapling devices were buttressed with a bioabsorbable staple line reinforcement material. In group B ( n = 10), standard laparoscopic Staplers were used. Operative data and perioperative complications were recorded. Necropsy studies and histopathological analysis were performed at 6 weeks. Data were compared between groups with the Student’s t -test or the chi-square test. Results Operating time was similar in the two groups (64 ± 11 min in group A versus 68 ± 9 min in group B, p = ns). Intraoperative blood loss was significantly higher in group B (185 ± 9 mL versus 25 ± 5 mL, p
Michael D. Goodman - One of the best experts on this subject based on the ideXlab platform.
-
Assessment of a novel Stapler performance for laparoscopic sleeve gastrectomy.
Surgical endoscopy, 2020Co-Authors: Christen E. Salyer, Anthony Spuzzillo, Devin Wakefield, Dina Gomaa, Jonathan R. Thompson, Michael D. GoodmanAbstract:Optimal Stapler selection during laparoscopic sleeve gastrectomy requires careful balance between tissue compression, hemostasis, and mechanical integrity. Junctions along a staple line can further increase the risks of technical or mechanical staple line failures. The aim of this study was to compare two commonly utilized laparoscopic linear gastrointestinal Staplers (Ethicon, Medtronic) with a novel linear Stapler (Titan) designed to perform a sleeve gastrectomy with a single Stapler firing. Excised gastric remnants from laparoscopic sleeve gastrectomy were utilized and tissue thickness was measured from fundus to antrum. An optimized experimental staple line was then created. The greater curve remnant was insufflated to determine the staple line burst pressure and location. The doubly stapled (clinical and experimental) gastric specimen underwent staple analysis for junctional location, malformation, and height. The Titan Stapler withstood a significantly higher burst pressure than both Ethicon and Medtronic linear cutting Staplers. While the Medtronic and Ethicon Staplers had a similar percentage of staples in junctions, the Titan Stapler has no junctions. In considering the formation of all staples outside of junctions, the Medtronic and Titan Staplers had no difference in percentage of malformed staples, while the Ethicon Stapler had a significantly higher percentage. Additionally, there were no differences in mismatch between staple height and tissue thickness between experimental groups. The Titan Stapler conveys the mechanical benefits of higher burst pressure with the advantage of single load functionality. This single staple load eliminates staple line junctions without sacrificing the integrity of staple formation.
R. G. Berrisford - One of the best experts on this subject based on the ideXlab platform.
-
Stapler design and strictures at the esophagogastric anastomosis
The Journal of thoracic and cardiovascular surgery, 1996Co-Authors: R. G. Berrisford, R. D. Page, R. J. DonnellyAbstract:Abstract An apparent reduction in the rate of benign anastomotic stricture after stapled esophagogastrectomy prompted us to review the results obtained with different stapling devices since 1988. We present a retrospective review of 125 consecutive patients undergoing esophageal resection for malignancy with stapled intrathoracic anastomoses. Benign anastomotic stricture was deemed present when a patient required endoscopic dilatation to treat postoperative dysphagia. We found no difference in risk factors not related to Stapler size (tumor histologic characteristics, adjuvant therapy) between patients with stricture and patients without stricture. Event-free survival was compared for different Stapler diameters as well as for different Stapler designs. We found that Staplers of smaller diameter were associated with significantly more strictures ( p
