China
Africa
Explore chapters and articles related to this topic
Urologic Involvement
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Jörg Keckstein, Gernot Hudelist, Simon Keckstein
Mobilization of the ureter proximally and distally is essential for a tension-free anastomosis. The segment of the ureter must be resected safely in healthy tissue. It makes sense to cystoscopically place the double-J (DJ) catheter already before resection of the segment. The laparoscopic transabdominal insertion of the DJ catheter into the two stumps after resection of the segment can be very tricky and complicated. It is essential that the two ureteral stumps can be brought together without tension. To widen the circumference of the ureteral wall to be adapted for the anastomosis, both stumps are ‘spatulated', i.e., enlarged by means of a 4–7 mm incision in the longitudinal direction of both ureteral stumps (Figure 12.12), offset by 180 degrees. The anastomosis is performed with approx. 5–6 interrupted stitches (Monocryl® 5-0 by Ethicon) to guarantee water tightness. The stitches should be placed mainly through the adventitia and lamina muscularis (Figures 12.12–12.15).
Acute Care Emergency Surgery
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Marcelo A. F. Ribeiro, Mansoor Khan
Handsewn anastomosis:After placing crushing bowel clamps across the colon, the rectum, and subsequent resection, place non-crushing clamps straight across the colon and the rectum to divide them. There are three types of anastomosis that can be created: end-to-end, end-to-side, or side-to-side.To aid approximation, place 3–0 single-layer in the corners of the bowel. Make a single layer continuous 3–0 suture, beginning with the posterior row and making sure not to strangle them. Then, remove the occluding clamps to allow blood flow to return to the ends of the bowel.After the anastomosis is done, it can be tested for any leaks by placing the patient in the reverse Trendelenburg position and filling the pelvis with saline. Using a 60 mL syringe after clamping the colon proximal to the air, and, the surgeon inflates the colon with air, and the area is checked for adequate distention and the presence of bubbling.
General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
How does an anastomosis heal? Talk me through the various stagesCollagen is vital in determining intestinal wall strengthAnastomoses heal in a series of overlapping phasesLag phase: (day 0–4) in which the acute inflammatory response clears the wound of all debrisProliferative: (days 3–14) in which fibroblasts proliferate and immature collagen is laid downRemodelling/maturation phase (day 10 onwards) in which collagen remodels
Impact of patients’ gender on microvascular lower extremity reconstruction
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Nicholas Moellhoff, P. Niclas Broer, Paul I. Heidekrueger, Milomir Ninkovic, Denis Ehrl
Patients’ medical records and hospital files were screened retrospectively. Data analysis included demographics, patient characteristics, perioperative details, postoperative complications, and free flap outcome. Patients’ preoperative physiological status was assessed according to the American Society of Anesthesiologists (ASA) Classification of Physical Status [14]. Surgical complications were divided into major and minor complications. Major complications were defined as total flap loss, partial flap loss of more than 10%, as well as revision surgery due to vascular compromise (arterial or venous thrombosis) or hematoma. Minor complications were defined as partial flap loss of less than 10%, wound dehiscence, skin graft failure and wound infection. Patients were followed up for three months. A separate analysis was performed for anterolateral thigh (ALT) and gracilis muscle flaps, the most commonly used flap types for defect reconstruction in the study population. Complications were also evaluated with regard to the type of anastomosis utilized (end-to-end vs. end-to-side).
Can maneuverability in the robot assisted laparoscopic stapler during ileoileal anastomosis compensate for shorter stapler length? – A randomized experimental porcine study
Published in Scandinavian Journal of Urology, 2021
Pernille Skjold Kingo, Gitte Wrist Lam, Jørgen Bjerggaard Jensen
Re-establishment of bowel continuity is imperative when constructing urinary diversion in patients given an ileal conduit or neobladder after radical cystectomy. The risks of complications and sequelae following radical cystectomy are considerable whether you use the open or robot assisted laparoscopic approach [1,2]. Although rare, anastomotic dehiscence is one of the most serious complications [3]. However, a less recognized but most likely a more common problem is relative stenosis of the bowel anastomosis if construction of the lumen is too small. This can lead to prolonged ileus in the postoperative phase and long-term bowel problems. The construction of intestinal anastomosis has evolved remarkably over the years, from hand sewn to stapled anastomoses and from open to robotic assisted laparoscopic (RAL) technique. Nowadays, the intestinal anastomosis is performed with minimal morbidity and mortality [4]. Construction of a stapled side-to-side anastomosis allows for a faster and better anastomosis according to leak rates and a faster learning curve compared to a hand sewn end-to-end anastomosis [5–8]. Thus, side-to-side anastomosis allows for the creation of a large diameter of anastomosis. However, proper handling of the bowel and staplers with a certain length are important in order to prevent strictures of the bowel [5].
Heterotopic gastric mucosa and intestinal atresia in a neonate
Published in Baylor University Medical Center Proceedings, 2021
Rachel Thompson, Sarah Glogowski, Alexia Ghazi, James Davis
A 2.3 kg black female was born at 35 weeks’ gestation. An ultrasound at 33 weeks’ gestation demonstrated an enlarged proximal small bowel and stomach concerning for intestinal atresia. A contrast study conducted on day of life 1 demonstrated proximal jejunal atresia (Figure 1a) prompting immediate operative exploration. Intraoperative findings included a type 1 atresia 8 cm from the ligament of Treitz. The distal bowel was investigated, revealing no further atretic segments or masses. Resection and anastomosis were performed. The anastomosis was tested and was found to be widely patent. On pathologic microscopic evaluation, sections showed scattered islands of gastric foveolar epithelium and mildly thickened muscularis propria. In conjunction with the clinical assessment, the overall gross and microscopic findings were compatible with gastric heterotopia in a setting of jejunal atresia (Figure 1b).