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1.
Fibrin sealant in high-risk colonic anastomoses 总被引:7,自引:0,他引:7
The use of fibrin sealant has been advocated to enhance the healing of high-risk intestinal anastomoses. Colonic anastomoses were performed in 162 rats randomly assigned to four groups: control animals with or without fibrin sealant applied to the anastomosis and steroid-treated animals with or without fibrin sealant. At five days postoperatively, the use of steroids alone significantly reduced the anastomotic bursting pressure (ABP) and enhanced abscess and adhesion formation. The addition of fibrin sealant to the anastomosis in steroid-treated animals did not improve ABP and, in fact, further increased abscess formation. In control animals, the use of fibrin sealant also reduced ABP and enhanced abscess and adhesion formation. By ten days, there was no difference in ABP among the groups, and the rate of abscess formation was reduced in all groups. These findings indicated that short-term treatment with steroids delayed colonic anastomotic healing. Fibrin sealant did not enhance the integrity of these high-risk anastomoses. The present data do not support the use of fibrin sealant in high-risk colonic anastomoses. 相似文献
2.
Background: Excluding pulmonary embolism, anastomotic leak is the leading cause of death and major morbidity in patients undergoing
open or laparoscopic gastric bypass operations. We observed a number of these leaks (11 out of 1,120 MicropouchSM gastric bypass [MGB] patients; 0.9%). The majority (80%) required emergency laparotomy and drainage, massive fluid resuscitation,
and aggressive nutritional support. Therefore, we designed a 2-year, prospective study to determine the therapeutic efficacy
of vapor-heated fibrin sealant to prevent anastomotic leaks at the gastro-jejunostomy (GJS) site. Methods: Between April,
2000 and March, 2002, 738 patients underwent a primary (n=671) or revisionary (n=67) MGB procedure.The gastric reservoir was
limited to the cardia of the stomach. Vapor-heated fibrin glue 1 cc was applied circumferentially to a 12-mm, non-banded GJS
anastomosis. Once activated, fibrin sealant polymerized into a soft, closely adherent gel. No omental patch was used to cover
the fibrin-sealed anastomosis. Results: Of 738 patients, 2 required emergency laparotomy for leaks and 2 for adhesive bands
that contributed to a distal small bowel obstruction.There were no anastomotic leaks at the fibrin-sealed GJS sites. No gastro-gastric
or gastro-enteric fistulas were recorded. Conclusion. Fibrin sealant applied to the GJS site appears to have eliminated anastomotic
leaks in our MicropouchSM gastric bypass patients. These results suggest that fibrin glue application may contribute to "leak prophylaxis" in patients
undergoing open Rouxen-Y gastric bypass. Glue placements may also benefit patients undergoing a laparoscopic Roux-en-Y procedure,
wherein anastomotic leaks have been reported early in the learning curve. 相似文献
3.
D. Wiedemann D. Vill N. Bonaros G. Laufer T. Schachner A. Kocher 《European Surgery》2011,43(5):309-314
BACKGROUND: Surgical site wound complications following cardiothoracic surgery are associated with increased costs, morbidity,
and mortality. Several factors have been shown to be associated with an increase in deep and superficial wound healing problems.
Recent publications have suggested protective effects of topical autologous blood components with regard to wound healing
disturbances after various surgical procedures. The aim of this retrospective analysis was to assess the impact of autologous
fibrin glue on surgical site complications in high-risk coronary artery bypass graft patients. METHODS: 1394 consecutive patients
who underwent CABG surgery from a single centre were included in the study. Autologous fibrin glue was used in 122 patients
(8.8%) with elevated risk for wound complications according to institutional guidelines. The demography of both groups was
compared and the following outcome variables were analyzed: deep sternal wound infection, sternal re-wiring, bleeding, re-
exploration rate, and the use of a vacuum assisted closure system. RESULTS: No treatment-related adverse events were noted.
The group of patients who received autologous fibrin sealant had significantly higher BMI levels, included more diabetics
and repeat cardiac procedures and they underwent percutaneous coronary intervention more often. Furthermore, they were more
likely to receive bilateral mammary artery grafts. Despite the high-risk profile of the Fibrin glue group rates of revision,
deep sternal wound healing problems tended to be lower than in the control group. CONCLUSIONS: In our experience autologous
fibrin glue does not invoke any adverse events and serves as a useful adjunct to haemostasis in cardiac surgery. However,
the incidence of wound disturbances was similar in both arms of the study. In light of the ever-increasing clinical use a
prospective randomized controlled trial examining the impact of autologous fibrin glue is warranted. 相似文献
4.
The efficacy of fibrin sealant in prevention of anastomotic leak after laparoscopic gastric bypass 总被引:3,自引:0,他引:3
Nguyen NT Nguyen CT Stevens CM Steward E Paya M 《The Journal of surgical research》2004,122(2):218-224
BACKGROUND: Anastomotic leak after laparoscopic gastric bypass (GBP) can result in significant morbidity, mortality, and consumption of healthcare resources. Fibrin sealant has been used clinically in the prevention of leak; however, its efficacy has not been clearly demonstrated. The aims of this study were to (1) develop an iatrogenic leak model in swine, (2) examine the efficacy of fibrin sealant in sealing iatrogenic anastomotic leak, and (3) review our experience with the use of fibrin sealant in 66 patients who underwent laparoscopic GBP. METHODS: This study was performed in three phases. In phase 1, laparoscopic gastrojejunostomy was performed in adult swine with iatrogenic disruption of the anastomotic staple line. The size of disruption was sequentially increased (6- to 12-F opening) until a leak model was developed. In phase 2, 16 animals underwent laparoscopic gastrojejunostomy with a 12-F disruption of the anastomosis; 10 animals (study group) had fibrin sealant (Tisseel VH) applied on the disrupted anastomosis and 6 animals (control group) did not receive fibrin sealant. Animals were sacrificed on postoperative day 5 or earlier if peritonitis developed and were examined for sealing of the anastomotic disruption and the presence of intraabdominal abscess. In phase 3, the outcome of 66 consecutive patients who underwent laparoscopic GBP with fibrin sealant applied at the gastrojejunostomy was reviewed. RESULTS: In phase 1, an anastomotic leak model was developed with a 12-F disruption of the staple line. In phase 2, two control animals required early sacrifice for bile peritonitis; three control animals had intraabdominal abscess discovered at sacrifice and one animal did not have any evidence of intraabdominal abscess or leak. Of the 10 animals in the study group, all survived until sacrifice and none of these animals had evidence of intraabdominal abscess or persistent leak. Therefore, 83% of animals in the control group developed either leak or abscess compared to 0% in the study group (P < 0.01, Fisher's exact test). Clinically, no leak or intraabdominal abscess developed in 66 patients who underwent laparoscopic GBP with the use of fibrin sealant. CONCLUSIONS: An anastomotic leak model was developed in swine with disruption of the stapled gastrojejunostomy to a 12-F opening. The use of fibrin sealant significantly reduces leak and abscess complication. Our results support the tissue sealing property of fibrin sealant and its use on high-risk gastrointestinal anastomosis. 相似文献
5.
Does fibrin glue sealant decrease the rate of pancreatic fistula after pancreaticoduodenectomy? results of a prospective randomized trial 总被引:9,自引:0,他引:9
Despite substantial improvements in perioperative mortality, complications, and specifically the development of a pancreatic
fistula, remain a common occurrence after pancreaticoduodenectomy. It was the objective of this study to evaluate the role
of fibrin glue sealant as an adjunct to decrease the rate of pancreatic fistula after pancreaticoduodenectomy. One hundred
twenty-five patients were randomized after pancreaticoduodenal resection only if, in the opinion of the surgeon, the pancreaticojejunal
anastomosis was at high risk for development of a pancreatic anastomotic leak. After completion of the pancreaticojejunal
anastomosis, the patients were randomized to topical application of fibrin glue sealant to the surface of the anastomosis
or no such application. The primary postoperative end points in this study were pancreatic fistula, total complications, death,
and length of hospital stay. A total of 59 patients were randomized to the fibrin glue arm, whereas 66 patients were randomized
to the control arm and did not receive fibrin glue application. The pancreatic fistula rate in the fibrin glue arm of the
study was 26% vs. 30% in the control group (p = not significant [NS]). The mean length of postoperative stay for all patients randomized was similar (fibrin glue = 12.2
days, control = 13.6 days) and the mean length of stay for patients in whom pancreatic fistula developed was also not different
(fibrin glue = 18.9 days, control = 21.7 days). There were no differences with respect to total complications or specific
complications such as postoperative bleeding, infection, or delayed gastric emptying. These data demonstrate that the topical
application of fibrin glue sealant to the surface of the pancreatic anastomosis in this patient population undergoing high-risk
pancreaticojejunal anastomosis did not reduce the incidence of pancreatic fistula or total complications after pancreaticodudodenectomy.
There seems to be no benefit regarding the use of this substance in this setting.
Presented at the Forty-Fifth Annual Meeting of the Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May
15–19, 2004 (oral presentation).
This work was supported in part by the Haemacure Company and Baxter Health Care. 相似文献
6.
Background
The aim of this study was to evaluate whether the use of fibrin glue as a sealant over an anastomosis is a risk factor for anastomotic leakage after laparoscopic rectal cancer surgery.Methods
Prospective data were collected from 223 patients with rectal cancer who underwent laparoscopic resection without defunctioning stoma.Results
A total of 104 patients underwent laparoscopic rectal resection, followed by the application of fibrin glue over the stapled anastomosis, while 119 underwent surgery alone. No difference in clinically significant leakage was observed between the fibrin and the nonfibrin groups (5.8% vs 10.9%, P = .169). In multivariate analysis, extraperitoneal tumor location and operation duration >220 minutes were independently associated with anastomotic leakage.Conclusions
Significant predictors of anastomotic leakage include extraperitoneal tumor location and operation length >220 minutes. Fibrin glue application over the stapled anastomosis was not found to be significantly associated with anastomotic leakage. 相似文献7.
Marcela C. Ramirez Joaquin Rodriguez Flora Varghese William H. Atkinson Daniel Rhodes M. Hassan Rajab Richard Symmonds 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2010,14(3):358-363
Background:
Roux-en-Y gastric bypass (RYGBP) is the most common procedure for weight loss surgery but has multiple complications. This study evaluates the use of reinforced circular staplers (RCS) and their effects on reducing gastrojejunal anastomotic complications.Methods:
We conducted a retrospective chart review from January 2007 to November 2008. Laparoscopic RYGBP were performed in 287 patients. A comparison was made of the complications with and without the use of reinforced circular staplers. The comparison was between a nonreinforced circular stapler (NRCS) group comprising 182 patients and an RCS group comprising 105 patients.Results:
Complications at gastrojejunal anastomosis were experienced by 15.3% of the patients; 9.5% were in the RCS group and 18.7% were in the NRCS group (P=0.026). Neither group had anastomotic leaks. Bleeding rate was 4.8% in the RCS group vs. 6.6% in the NRCS group. Ulcers occurred in 2.9% of the RCS group vs. 6.0% of the NRCS group. Stricture rate was 1.9% in the RCS group vs. 6.6% in the NRCS group.Conclusion:
The application of RCS reduced the incidence of gastrojejunal anastomotic complications. Patients are twice as likely to develop complications when no RCS device is used (95% CI 1.03, 4.623). Therefore, it is beneficial to utilize RCS for the gastrojejunal anastomosis in RYGBP procedures. 相似文献8.
PURPOSE: We assessed whether fibrin sealant promotes early catheter removal after pendulous urethral reconstruction. MATERIALS AND METHODS: Between 1997 and 2003, 43 men with complex stricture disease underwent pendulous urethral reconstruction by a single surgeon (AFM). In 18 consecutive cases with a mean stricture length of 7.24 cm from 2000 to 2003 fibrin sealant was applied over a ventral onlay anastomosis performed with running 5-zero polydiaxanone suture. Results were compared with those in 25 men who underwent the procedure without fibrin sealant from 1997 to 2000, who served as a control group (mean stricture length 8.30 cm, p = 0.418). Catheter duration was recorded after anastomosis integrity was radiographically confirmed. RESULTS: All 18 patients with sealant were completely healed within 14 days, which was significantly shorter than in controls (p <0.001). In the sealant group increased stricture length was associated with longer catheter time (p = 0.677). Our impressions were that patient satisfaction was enhanced by early catheter removal, and postoperative penile edema and ecchymosis were decreased in the fibrin sealant group. CONCLUSIONS: Fibrin sealant appears to promote early catheter removal and enhanced wound healing after pendulous urethral reconstruction. 相似文献
9.
Upadhyaya VD Gopal SC Gangopadhyaya AN Gupta DK Sharma S Upadyaya A Kumar V Pandey A 《World journal of surgery》2007,31(12):2412-2415
Objective The aim of this study was to characterize a successful approach for the management of infants with long-gap esophageal atresia
(EA) with tracheoesophageal fistula (TEF). The goal was to preserve the native esophagus and minimize the incidence of esophageal
anastomotic leaks using fibrin glue as a sealant over the esophageal anastomosis.
Method A total of 52 patients were evaluated in this study. Only patients in whom, gap between the two ends of the esophagus was
≥ 2 cm were selected during January 2005 to January 2007. Patients were divided in two groups on the basis of block randomization.
Group A comprised the patients in whom fibrin sealant was used as reinforcement on a primary end-to-end esophageal anastomosis;
in group B, fibrin glue was not used. The two groups were compared in terms of esophageal anastomotic leak (EL), postoperative
esophageal stricture (ES), and mortality. The statistical analysis was done using Fisher’s exact test and the chi-squared
test.
Result The number of anastomotic leaks in group A (glue group) was about one-fifth that in group B (no glue group). The incidence
of ES was almost twice as high in group B as in group A. The mortality rate was almost threefold higher in group B (no-glue
group). The higher incidence of EL and ES in group B compared to group A was statistically significant.
Conclusion Thus, fibrin glue when used as an adjunct to esophageal anastomosis for primary repair of long-gap EA with TEF appears safe
in the clinical setting and may lower the chances of esophageal leak and anastomosis-site strictures. Hence, it can diminish
the mortality and morbidity of these patients. 相似文献
10.
Anna R. Ibele Frank P. Bendewald Samer G. Mattar Daniel T. McKenna 《Obesity surgery》2014,24(7):1052-1056
Background
Anastomotic leak at the gastrojejunostomy is a life-threatening complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). Fibrin sealants have been used as topical adjuncts to reduce leaks at the gastrojejunostomy. Our clinical observations suggest that an unintended consequence may be the promotion of anastomotic stricture. We hypothesized that the use of fibrin sealant at the gastrojejunostomy in patients undergoing LRYGB decreases the incidence of anastomotic leak but increases the incidence of clinically significant stricture.Methods
Following institutional review board approval, medical records of patients undergoing LRYGB by two surgeons at a single institution over a 5-year period were retrospectively reviewed. Preoperative demographics and postoperative complication rates including incidence of gastrojejunostomy leak and endoscopically diagnosed stricture requiring dilation within 1 year of surgery were recorded.Results
Four hundred twenty-five patients had fibrin sealant routinely applied to their gastrojejunostomy site and 104 did not. Four leaks occurred in the sealant group and two leaks occurred in the control group (p?=?0.2). Of patients who received sealant, 1.6 % needed postoperative blood transfusion compared to those 1.6 % of patient who did not receive sealant (p?=?0.05). There was a significantly increased rate of strictures requiring dilation in the sealant group (11.3 % compared to 4.8 % stricture rate in patients who did not receive sealant, p?=?0.04).Conclusions
In our experience, the use of fibrin sealant at linear stapled gastrojejunostomy site during LRYGB increases the incidence of clinically significant postoperative stricture and does not reduce the incidence of anastomotic leak. 相似文献11.
Sealing effect of fibrin glue on the healing of gastrointestinal anastomoses: implications for the endoscopic treatment of leaks 总被引:3,自引:2,他引:1
Background The adoption of advanced laparoscopic techniques for complex surgical procedures has raised the concern that the leak rate
might be higher than for open surgery, particularly in the surgeon's early experience or in difficult cases. In this study,
the sealing effect of fibrin glue on leaking gastrointestinal anastomoses was evaluated in an experimental swine model.
Methods A standardized gastrojejunostomy was performed on 20 female pigs (mean weight, 47.7 ± 5.7 kg). A leak was created on the anterior
surface of the anastomosis. The animals were randomized to either fibrin glue or no treatment of the leak. Clinical conditions
and vital signs, including body temperature, heart rate and, respiratory rate, were collected three times a day. Preoperative
and postoperative complete and differential blood count and lactate dehydrogenase levels were determined. Postmortem analysis
was performed when the animals were killed.
Results Clinical signs of peritonitis developed in the control animals by the second or third postoperative day. Findings that confirmed
the presence of an anastomotic leak at the postmortem examination were the presence of food or gastrojejunal juices in the
abdominal cavity, a localized abscess, or a positive air leak test. Fibrin glue treatment prevented the development of peritonitis
in all the animals. Complete sealing of the leak was observed on postoperative day 7 in all treated animals, except one in
which an asymptomatic contained leak developed. The postoperative total white blood count was significantly increased in the
untreated group (24.69 ± 5.5 vs 12.74 ± 3.7 103/ul p < 0.001, paired t-test), as compared with the treated group (15. 55 ± 2.4 vs 14.89 ± 2.7 103/ul; p = 0.24).
Conclusion In this study, fibrin glue showed reproducible sealing effects on leaking gastrojejunal anastomoses. Fibrin glue application
may be a valuable approach for the treatment of gastrointestinal anastomotic leaks.
2004 Oral Presentation at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in
Denver, CO, USA. 相似文献
12.
Hemostatic effectiveness of fibrin glue derived from single-donor fresh frozen plasma 总被引:1,自引:0,他引:1
A Dresdale F O Bowman J R Malm K Reemtsma C R Smith H M Spotnitz E A Rose 《The Annals of thoracic surgery》1985,40(4):385-387
Fibrin glue derived from pooled human blood is an effective sealant for high-porosity vascular grafts and a valuable topical hemostatic agent in heparinized patients. Use of this agent in the United States is prohibited because of potential transmission of hepatitis B, acquired immunodeficiency syndrome, and other serologically transmitted illnesses. We have developed a cryoprecipitation technique that allows preparation of fibrin glue from single-donor fresh frozen plasma. Use of this agent presumably entails no greater risk of disease transmission than intravenous administration of single-unit fresh frozen plasma. This report describes our early clinical experience with this material. Fibrin glue was used as a sealant for porous woven Dacron tubular prostheses and cardiovascular patches in 19 patients. The fibrin glue sealant has also been employed to control bleeding from needle holes and small anastomotic tears in 22 patients. No patient in this series had a bleeding complication from a suture line or graft treated with fibrin glue. This experience indicates that like fibrin glue from pooled blood, fibrin glue from single-donor plasma is effective as a graft sealant and topical hemostatic agent. Preparation of fibrin glue from single-donor plasma is simple and economical, and may provide cardiothoracic surgeons in the United States with a widely available, valuable hemostatic adjunct. 相似文献
13.
Although linear surgical staple line reinforcement has been shown to increase anastomotic tensile strength in animal models and reduce the incidence of staple line bleeding and anastomotic leaks in colorectal surgery, the benefits of staple line reinforcement on circular stapled anastomoses in bariatric surgery remain unreported in the literature. The purpose if this study was to compare the incidence of anastomotic bleeding, leak, and stricture in patients undergoing laparoscopic gastric bypass with circular staple line reinforcements with those with no circular staple line reinforcements. Since May 2006, 138 consecutive patients (Group B) have undergone laparoscopic Roux-en-Y divided gastric bypass with a 25-mm circular stapled gastrojejunal anastomosis using GORE SEAMGUARD bioabsorbable circular staple line reinforcement (CBSG) with a mean follow up of 9 months. The incidence of anastomotic bleeding, leak, and stricture was compared with 255 similar patients (Group A) who underwent surgery before May 2006 without gastrojejunal reinforcement with a mean follow up of 22 months. The rates of anastomotic bleeding, leak, and stricture for Group B versus Group A were 0.7 per cent versus 1.1 per cent (P = 0.64); 0.7 per cent versus 1.9 per cent (P = 0.34); and 0.7 per cent versus 9.3 per cent (P = 0.0005), respectively. The use of CBSG reduced the incidence of anastomotic stricture by 93 per cent and the incidence of a composite end point of all anastomotic complications by 85 per cent. Our results indicate that the use of circular staple line reinforcement at the gastrojejunal anastomosis in patients undergoing laparoscopic gastric bypass significantly decreases the incidence of anastomotic stricture and a composite end point of all anastomotic complications. On this basis, strong consideration should be given to the routine use of CBSG staple line reinforcement in patients undergoing laparoscopic divided gastric bypass with a circular stapled gastrojejunal anastomosis. 相似文献
14.
Gagarine A Urschel JD Miller JD Bennett WF Young JE 《The Journal of cardiovascular surgery》2003,44(6):771-773
AIM: Air leaks are a common cause of morbidity and prolonged hospital stay after pulmonary lobectomy. We reviewed our experience with intraoperative fibrin glue to determine if it reduced air leak and improved patient outcomes. METHODS: Records of patients undergoing pulmonary lobectomy for benign or malignant disease over a 4-year period (1998-2001) were reviewed. Data was collected on age, sex, pulmonary function, pulmonary pathology, use of fibrin glue, duration of chest tube drainage, length of hospital stay, and postoperative complications. RESULTS: Three hundred and sixty patients underwent lobectomy. Fibrin glue was used intraoperatively to seal air leaks in 102 of the 360 patients (study group: 102;control group: 258). Fibrin glue was used at the discretion of the surgeon, with some surgeons using it routinely. The groups did not differ in age (p=0.29), sex (p=0.42), FEV1 (p=0.57), or pathology (p=0.08). There were no differences in outcomes such as operative mortality (study: 2 of 102, control 6 of 258, p=0.85), empyema (study: 0 of 102, control: 3 of 258, p=0.55), prolonged (>7 days) air leaks (study: 10 of 20; control: 20 of 258, p=0.71), or length of hospital stay (study: 6.3+/-2.5 days, control:7.7+/-7.2 days, p=0.83). The use of fibrin glue was associated with a reduction in the duration of chest tube intubation (study: 4.1+/-3.2 days, control: 5.5+/-3.8 days, p=0.001). CONCLUSION: Patients treated intraoperatively with fibrin glue had a significantly shorter duration of chest tube intubation after pulmonary lobectomy than those treated conventionally. However, the use of fibrin glue did not significantly influence more clinically relevant outcomes such as length of hospital stay and incidence of prolonged (>7 days) air leaks. 相似文献
15.
Background: With increasing performance of Roux-en-Y gastric bypass (RYGBP), the postoperative complications are becoming
more apparent. Gastrojejunal anastomotic strictures develop in 4.7 to 27% of patients undergoing laparoscopic RYGBP. This
paper details two endoscopic techniques for dilating gastrojejunal anastomotic strictures. Methods: 3 patients developed gastrojejunal
anastomotic strictures. In each patient, the operating surgeon performed a diagnostic upper endoscopy, followed by stricture
dilatation using either Savary or balloon method. Results: Patients lost a mean weight of 42 kg (range 33-50 kg) before definitive
stricture treatment. Once adequately dilated, all patients received an excellent symptomatic result. Conclusions: For the
treatment of gastrojejunal anastomotic strictures, both Savary and balloon dilatation have been efficacious and easy to perform.
The endpoint for stricture dilatation is 12 mm or slightly larger. The operating surgeon should acquire a working knowledge
of these techniques. 相似文献
16.
INTRODUCTION: Several methods have been proposed to achieve a watertight dural closure, including the use of fibrin sealant to reinforce sutures. We propose a fast technique using oxidized cellulose and fibrin glue to achieve firm and watertight closure of minor dural defects in supratentorial cranial surgery. TECHNICAL NOTE: Oxidized cellulose is cut to the shape of the dural defect and applied as an onlay graft. Fibrin sealant is then applied over the cellulose and the dural margins defect. The web conformation of oxidized cellulose avoids adhesion of fibrin glue to the underlying cortical surface of the brain. This technique has been applied in 45 of 467 supratentorial craniotomies during two consecutive years. The procedure was performed in few seconds. Postoperatively, three patients developed subgaleal fluid collection, which resolved conservatively in two cases. There were no other complications or reoperations. CONCLUSION: We used a piece of oxidized cellulose, reinforced by fibrin glue, as a sutureless graft with more ease and less technical demand than other techniques. The reported technique is a fast and valid alternative to small dural defect closure methods. 相似文献
17.
Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined Vicryl plug and fibrin glue 总被引:7,自引:0,他引:7
Background The incidence of clinically relevant anastomotic leaks after upper gastrointestinal surgery is approximately 4% to 20%, and the associated mortality is up to 80%. Depending on the clinical presentation, the treatment options include surgery, conservative treatment with or without external drainage or endoscopic treatment.Methods This report presents nine cases of anastomotic leaks or fistulae after surgery for upper gastrointestinal cancers that were treated by insertion of a Vicryl plug and sealing with fibrin glue. Under sedation, all nine patients underwent endoscopic lavage of the cavity at the site of anastomotic leakage. The entrance to the cavity then was filled with Vicryl mesh and sealed off with fibrin glue. After the procedure, the patients underwent endoscopy and a water-soluble contrast study for assessment of the result.Results Seven of the nine patients had complete healing of the anastomotic leak or fistula after one to two endoscopic treatments. In one case, the treatment failed immediately because of a large and direct tracheoesophageal fistula. Another patient experienced recurrent intrathoracic abscesses after initial technical success.Conclusions Postoperative upper gastrointestinal fistulas or anastomotic leaks can be managed successfully with little morbidity by means of endoscopic insertion of Vicryl mesh with fibrin glue, thereby avoiding repetitive major surgery and its associated risks. 相似文献
18.
Johnson C Lee Jason Teitelbaum Josh K Shajan Aparajit Naram Jerome Chao 《CANADIAN JOURNAL OF PLASTIC SURGERY》2012,20(3):178-180
BACKGROUND:
Seroma formation is one of the most common complications following abdominoplasty. Fibrin sealant/glue has shown mixed results in seroma prevention when used in a variety of procedures. Limited information is available on its effectiveness during postbariatric abdominoplasty.METHODS:
A retrospective chart analysis of 65 consecutive patients who underwent postbariatric abdominoplasty over a course of 16 months by a single surgeon was performed. Two sequential groups either receiving or not receiving fibrin sealant treatment were defined. Seroma formation and initial 24 h drain output volumes were recorded.RESULTS:
Three patients in group 1 (9.1%) receiving fibrin sealant developed seroma. Twelve patients in group 2 (28.1%) not receiving fibrin sealant developed seroma; this was statistically significant (P=0.006). Twenty-four hour drain output was also statistically different, with higher initial output in the fibrin sealant group (222.2 mL versus 140.0 mL; P=0.047).CONCLUSION:
Fibrin sealant was a useful adjunct during surgical wound closure and significantly decreased seroma formation in patients undergoing postbariatric abdominoplasty. 相似文献19.
Stojanović M Jeremic M Stojanović P Stojiljković M Gmijović D Stanojković Z Savić V Djordjević V Cvetković Z Kostov M Colović R 《Acta chirurgica Iugoslavica》2002,49(1):39-45
The aim of this study was to test the protective effects of fibrin sealing on the pancreatico-jejunostomy (PJA), the high-risk anastomosis following pancreas head resection. Experimental study was performed on the mongrel dogs, divided in two groups (20 animals each): Experimental group-with end to end "dunking" PJA, protected by temporary occlusion of the pancreatic duct with fibrin sealant/Tissucol/Immuno Ag/, while control group was without any protective procedure. The animals were followed 5 months in order to study: protective effects of such procedure on the PJA quantified with the percent of anastomotic leakage, effects of the exocrine secretion and effects the endocrine function Results: PJA leakage occurred in 13.33% in control group. No leakage was registered in experimental group. Biochemical, histological and electron microscopic study showed slight transitory elevation of amylase levels. Fibrin glue plug was dissolved and pancreatic juice output was reestablished 12th days postoperatively. Long term follow-up showed no damages of the endocrine and exocrine pancreas. Pancreatic duct occlusion with fibrin glue appeared to be an useful method in the prevention of pancreatico-jejunostomy leakage, without negative effects on the exocrine and endocrine pancreas. 相似文献
20.
Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the USA. Anastomotic leak is one of the devastating
complications in this operation. By using fibrin sealant around the anastomosis, surgeons can achieve better hemostasis around
the suture-line and prevent or decrease the incidence of anastomotic leaks. This paper discusses the biological and clinical
evidence for use of fibrin sealant in laparoscopic gastric bypass. 相似文献