ObjectiveTo evaluate the effect on complication after esophagectomy by comparing the different methods of anastomosis (cervical versus thoracic anastomosis). MethodsWe searched the following databases including PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, VIP and Wanfang database to identify randomized controlled trials (RCTs) of cervical versus thoracic anastomosis for esophagectomy patients from establishment of each database to October 30, 2014. Quality of the included RCT was evaluated. Meta-analysis was conducted by using RevMan 5.2 software. ResultsWe finally identified 4 RCTs involving 267 patients. In terms of the postoperative complication, the incidence of anastomotic leakage (RR=3.83, 95%CI 1.70 to 8.63, P=0.001) with cervical anastomosis was significantly higher than that of the patients with thoracic anastomosis. However, there was no statistical difference in incidence of anastomotic stricture (RR=1.04, 95%CI 0.62 to 1.76, P=0.87), pulmonary complication (RR=0.73, 95%CI 0.27 to 1.91, P=0.52), and mortality (RR=0.89, 95%CI 0.40 to 1.97, P=0.77) between cervical and thoracic anastomosis. ConclusionCompared with thoracic anastomosis, the method of cervical anastomosis is associated with a higher incidence of anastomotic leakage. But there are many unclear factors about anastomotic stricture, pulmonary complication and mortality, further measurement should be taken.
OBJECTIVE: To review the methods of end-to-side anastomosis in repair of peripheral nerve injury and to analyze the difficulty faced. METHODS: By index of recent literature, the kind of experimental model, observation criteria and the clinical data were collected and analyzed. RESULTS: For different methods of end-to-side anastomosis in repair of peripheral nerve defect, the clinical outcomes were reported differently. The clinical application was fewer. There was lack of case summary and assessment criteria. CONCLUSION: The superiority of end-to-side anastomosis made it necessary to further study the mechanism and improvement of quality.
ObjectiveTo evaluate the short- and mid-term outcomes of sequential anastomosis and simple anastomosis of saphenous vein in off-pump coronary artery bypass grafting.MethodsThe clinical data of 438 patients who underwent sequential anastomosis of saphenous vein and 165 patients who underwent simple anastomosis of saphenous vein from 2015 to 2018 in Daxing Teaching Hospital were retrospectively analyzed. After propensity score matching, 130 pairs of patients were included in the sequential anastomosis group [78 males and 52 females, aged 60 (52, 68) years] and simple anastomosis group [80 males and 50 females, aged 61 (52, 70) years]. The short- and mid-term clinical outcomes were compared.ResultsThe two propensity score-matched groups had similar baseline clinical data. No significant difference was found between sequential anastomosis and simple anastomosis groups in the in-hospital outcomes, including in-hospital death (1.5% vs. 1.5%, P=1.000), the incidence of complications (4.6% vs. 6.2%, P>0.05), and the mean flow of grafts (30.0±11.8 mL/min vs. 28.0±9.5 mL/min, P=0.597). The operation time of the sequential anastomosis group was shorter than that of the simple anastomosis group (142.5±21.2 min vs. 186.3±27.6 min, P<0.001). The drainage of the sequential anastomosis group was less than that of the simple anastomosis group (204.7±39.6 mL vs. 271.3±48.3 mL, P<0.001). The follow-up time was 12-60 (28.3±8.9) months, during which the mortality of the two groups was not statistically different (3.2% vs. 4.0%, P=0.796).ConclusionThe saphenous vein sequential anastomosis of saphenous vein is superior to the simple anastomosis. Sequential anastomosis technique can reduce aortic anastomosis, shorten operation time, and reduce bleeding drainage during off-pump coronary artery bypass grafting. The short- and mid- term clinical effects are satisfactory.
Objective To evaluate the preliminary the therapeutic effect of the aortic proximal anastomosis device applied in coronary artery bypass grafting (CABG), and further to assess its safety and feasibility. Methods From January 2006 to May 2007， 50 patients underwent CABG were received the aortic proximal anastomosis device ［Novare Enclose Ⅱ device (Novare Surgical System, Cupertino, CA)］, in which 16 were underwent in onpump CABG and 34 in offpump CABG(OPCAB). The age was 56.2±18.7years(from 55 to 80 years), and there were 38 males and 12 females. Preoperative complications included hypertension in 28 cases, diabetes in 17 cases, old myocardial infarction 18 cases and old cerebral infarction in 15 cases. A total of 175 proximal anastomoses were performed (3.2±1.3), among which there were 152 vein, 12 free left internal mammary artery (LIMA) and 11 radial artery anastomoses. Results Intraoperative transient graft flow meter revealed a satisfactory blood flow. There were no device related complications, and there was no hospital death. 2 cases needed chest re-exploration for hemostasis, 2 cases needed tracheostomy for respiratory insufficiency, and 1 case needed hematodialysis for renal inadequacy caused by diabetic nephropathy. All this 5 patients got recovered and discharged after active treatment. There were no cerebra related complications and no severe cardiac accidents. Follow-up 1 to 3 months after surgery via telephone or letter revealed a 100% survival rate and a 100% exemption rate of cardiac accident. Conclusion Preliminary clinical application of the Novare Enclose Ⅱ device is safe and efficient, but its middle and longterm effect remains to be further observed.
Objective To compare the therapeutic effect of new “One-Stitch” ureterovesical anastomosis to that of the classic Lich-Gregoir method. Methods From January 2002 to December 2004, 445 patients suffering from uremia due to chronic nephritis were treated with renal transplantation. Among them, 121 patients were operated with our new modified ureteroneocystostomy technique (the new One-Stitch group), and 324 patients were operated with Lich-Gregoir technique (the Lich-Gregoir group). In the new One-Stitch group, there were 79 males and 42 females, aged 20-62 years (35.7 years on average). The course of the disease was 2-11 years (2.7 years on average). In the Lich-Gregoir group, there were 211 males and 113 females, aged 19-65 years (33.9 years on average). The disease course was 1-14 years (2.3 years on average). There was no significant difference between the two groups in age, proportion of genders, primary diseases and course of the disease (P gt; 0.05). The operative time, the ureteral compl ications and non-ureteral compl ications were compared between the two groups after the renal transplantation. Results The operative time for the new One-Stitch and Lich-Gregoir techniques was (8.7 ± 1.1) minutes and (22.4 ± 5.1) minutes, indicating the difference was significant (P lt; 0.05). All recipients were followed up for 3-5 years. In the new One-Stitch group, there were 5 patients with leakage of urine, 15 with gross hematuria, 4 with ureteral obstruction and 28 with urinary system infection. Symptomatic vesicoureteral reflux and stone formation were not observed in this group. In the Lich-Gregoir group, there were 17 patients with leakage of urine, 12 with gross hematuria, 13 with ureteral obstruction, 86 with urinary system infection, 6 with symptomatic vesicoureteral reflux and 2 with stones. In the new One-Stitch group, the incidence rate of compl ications of gross hematuria was 12.4%, which was significantly different from 3.7% in the Lich-Gregoir group (P lt; 0.05). The incidence rates of ureteral compl ications in the Lich-Gregoir and the new One-Stitch groups were 19.8% and 15.4%, respectively. The difference was not significant (P gt; 0.05). There was no significant difference between the two groupsin incidence rate of urinary system infection, delayed recovery of kidney function after kidney transplantation and rejectionreaction (P gt; 0.05). Conclusion The new One-Stitch group has no significant difference in ureteral compl ications ompared with the Lich-Gregoir group, and has become a preferential ureterovesical reimplantation technique because of its simple and has convenient operation.
Objective To explore the clinical effects of ileus tube in treatment of colonic obstruction caused by colorectal carcinoma. Methods Thirtytwo colorectal carcinoma patients with colonic obstruction admitted to our hospital from December 2005 to December 2008 were given onestage radical excision and anastomosis after transnasal or transanal placement of ileus tube for colonic decompression and drainage. Results Combined placement of transnasal and transanal ileus tube was successfully carried out in 19 cases, while the other 13 cases were treated only with transnasal ileus tube. Abdominal pain and distention of all cases were relieved 12-36 h after tube placement, while those of 26 cases disappeared 48-96 h later. Compared with before tube placement, abdominal circumferences of all cases were significantly reduced after tube placement, the mean reduction rate was (81.3±19.6)% vs. 100% (t=3.586, P=0.02). All cases were successfully treated by onestage radical excision and anastomosis 5-7 d after placement, and no serious complications such as peritoneal infection, anastomotic leakage etc. were found. Conclusion Preoperative intubation of ileus tube can enhance the therapeutic effects of onestage radical excision and anastomosis in patients with colorectal carcinoma combined with colonic obstruction.
Objective To evaluate the safety and effect of seromuscular layer anastomosis in small intestinal suture. Methods Forty patients with hepatobiliary and pancreatic diseases undergoing biliojejunostomy or cystojejunostomy were randomly divided into seromuscular layer anastomosis group (n=20) and two-layer anastomosis group (n=20) before operation， which received Roux-en-Y end-to-side jejunal seromuscular layer anastomosis and two-layer anastomosis, respectively. Intestinal anastomotic complications and other indexes such as anus venting time were recorded in each group. Results Neither group had intestinal anastomotic complications such as leakage, stricture, obstruction and hemorrhage. Time of venting to normal were (3.6±0.9) d and (3.6±0.8) d in seromuscular layer and two-layer anastomosis group respectively, there was no significant difference between them (Pgt;0.05). Conclusion Seromuscular layer anastomosis is a safe and effective method of small intestinal anastomsis.
Objective To summarize the anatomical types of the concomitant veins of deep inferior epigastric artery and the corresponding choice of anastomosis methods, and to evaluate the indications and safety of various methods. MethodsBetween October 2015 and June 2021, 296 female patients received breast reconstruction with autologous free lower abdominal flap, including 154 cases of immediate breast reconstruction and 142 cases of delayed breast reconstruction. The average age of the patients was 36.5 years, ranged from 26 to 62 years. Unilateral free deep inferior epigastric artery perforator flap transplantation was performed in 172 cases, and unilateral free muscle-sparing rectus abdominis myocutaneous flap transplantation was performed in 124 cases. The internal thoracic vessels were selected as the recipient vessels in all cases. The length of vascular pedicle ranged from 9.5 to 13.0 cm, with an average of 11.2 cm. The concomitant veins of deep inferior epigastric artery included three anatomical types: one-branch type in 26 cases (8.8%), two-branch type in 180 cases (60.8%), and Y-shaped structure in 90 cases (30.4%). Anastomosis of inferior epigastric artery was performed with the proximal end of internal thoracic artery, while that of vein should be adjusted according to the diameter, length, wall thickness, and branches of the vein. The specific classification of venous anastomosis included: ① The sole concomitant vein of deep inferior epigastric artery was anastomosed with the internal mammary vein (26 cases); ② The two concomitant veins of deep inferior epigastric artery were anastomosed with the internal mammary vein respectively (151 cases); ③ The larger one of two concomitant veins of deep inferior epigastric artery was anastomosed with the internal mammary vein, and the other one was ligated and discarded (29 cases); ④ The two concomitant veins of deep inferior epigastric artery were Y-shaped, and the common trunk segment was directly anastomosed with the internal mammary vein (31 cases); ⑤ The smaller branch of the concomitant veins of Y-shaped structure was ligated, and the thicker branch was anastomosed with the internal mammary vein (17 cases); ⑥ The concomitant veins of Y-shaped structure were anastomosed with the internal mammary veins respectively (42 cases). Results Among the patients who underwent venous anastomosis according to scheme ④, 3 cases had venous crisis of flap after operation, of which 1 case was successfully rescued by emergency exploration; the other 2 cases had flap necrosis, of which 1 case survived after being repaired by pedicled latissimus dorsi flap, and 1 case closed the wound directly. Flaps with other venous anastomosis protocols survived completely. All 296 patients were followed up 12-70 months, with an average of 37.5 months. The reconstructed breast has good shape, good elasticity, and no skin flap contracture. The donor site of the flap only left linear scar, and the abdominal wall function was not affected. ConclusionThe method of direct anastomosis of concomitant veins of deep inferior epigastric artery with Y-shaped structure is relatively risky, and the vessels are prone to be twisted and compressed, leading to the occurrence of venous crisis. It can improve the safety of surgery if only one large vein is anastomosed or two veins are separated to anastomose respectively.
Objective To assess the effectiveness and safety of hand-suture vs. stapling anastomosis in esophagogastrostomy. Methods The following databases such as CBM (1978 to February 2012), VIP (1989 to February 2012), CNKI (1994 to February 2012), WanFang Data (1980 to February 2012), The Cochrane Library, PubMed (1966 to February 2012), EMbase (1974 to February 2012), and relevant webs of clinical trials were searched to collect the randomized controlled trials (RCTs) and quasi-RCTs about hand-suture vs. stapling anastomosis in the incidence of anastomotic leakage following esophagogastrostomy. Moreover, relevant references and grey literature were retrieved on web engines including Google Scholar and Medical Martix, and the Chinese periodicals e.g. Chinese Journal of Oncology were also handsearched. According to the inclusion and exclusion criteria, the literature, was screened, the data were extracted, and the quality of the included studies was assessed. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 9 RCTs involving 2 202 patients were included. The result of meta-analysis was as follows: the incidence of anastomotic leakage in the stapling anastomosis group was lower than that in the hand-suture anastomosis group (OR=0.43, 95%CI 0.26 to 0.71, Plt;0.01). Conclusion Stapling anastomosis is superior to hand-suture anastomosis in reducing the incidence of anastomotic leakage following esophagogastrostomy. For the limited quality and quantity of the included studies, this conclusion has to be further proved by more high-quality studies.
Objective To compare the effectiveness between a new hand-sewn intestinal anastomosis and stapled anastomosis during Roux-en-Y anastomosis of gastric cancer. Methods Retrospectively, we collected 200 gastric cancer patients who underwent radical distal or total gastrectomy from January 2014 to June 2017 in our hospital, and divided them into observation group (new hand-sewn anastomosis, n=100) and control group (stapled anastomosis, n=100) according to the type of anastomosis. The time and cost taken to perform the anastomosis, the incidence of postoperative complications (including anastomotic leakage, bleeding, and stenosis), and hospital stay were compared. Results The cost of anastomosis in the observation group was significantly lower than that of the control group [(194.1±13.5) RMB vs (5 270.3±852.7) RMB, P<0.001], and the time taken to perform was just slightly longer in the observation group [(8.34 ± 0.65) minvs (8.29±0.61 ) min, P=0.540], additionally the incidences between the observation group and the control group, in regards to anastomotic bleeding [0 (0/100) vs 3% (3/100), P=0.246], leakage [0 (0/100) vs 1% (1/100), P=1.000], stenosis [0 (0/100) vs 2% (2/100), P=0.497], and hospital stay [(18.8±7.4) d vs (19.2±6.2) d, P=0.175], showed no significant difference between the 2 groups. Conclusion The new hand-sewn anastomosis technology is safe and effective, easy to learn, and it can save money and time, which is worth promoting.