Background: Staple line reinforcement material has been demonstrated to raise the burst pressure threshold after linear intestinal stapling. Numerous bioprosthetic materials have been utilized in surgical practice. Po...Background: Staple line reinforcement material has been demonstrated to raise the burst pressure threshold after linear intestinal stapling. Numerous bioprosthetic materials have been utilized in surgical practice. Porcine urinary bladder matrix (ACell, Inc.) is an extracellular matrix material derived from porcine bladder used to reinforce surgically repaired soft tissue, and facilitate the body’s regenerative capacity. Objective: This study represents the first evaluation of urinary bladder matrix in gastrointestinal staple line reinforcement. Methods: Pathogen-free pigs underwent midline laparotomy under general anesthesia. Small intestinal division was performed with an endoscopic linear stapler. Nineteen intestinal divisions were performed with urinary bladder matrix staple line reinforcement, and twenty divisions were unreinforced. Staple lines were then subjected to burst pressure analysis by intraluminal infusion of dyed Krebs solution at an infusion rate of 20 ml·min-1 under manometric monitoring. Upon visible staple line extravasation, intraluminal pressure was recorded. Results: Intestinal staple lines reinforced with urinary bladder matrix exhibited significantly higher burst pressure threshold (p < 0.05). Reinforced staple lines had an average burst pressure of 99 ± 33 mmHg, compared to 61 ± 37 mmHg for unreinforced staple lines. Conclusion: Staple line reinforcement using urinary bladder matrix acutely improves burst pressures of intestinal staple lines when compared with unreinforced staple lines. Its regenerative properties may confer a long-term advantage to staple line reinforcement. These findings, along with previous findings of constructive remodeling in the presence of urinary bladder matrix in treatment of the gastrointestinal system, suggest that UBM may serve a role in gastrointestinal staple line reinforcement.展开更多
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective and well-accepted procedure for the treatment of morbid obesity but has complications such as stenosis of the gastroenteroanastomosis (GE), GE ...Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective and well-accepted procedure for the treatment of morbid obesity but has complications such as stenosis of the gastroenteroanastomosis (GE), GE leak, surgical site infection, and stapling malfunction. This study evaluated the efficiency of weight loss and the incidence of short- and mid-term postoperative complications in patients undergoing LRYGB in which anastomosis was performed using a linear stapler (LSA) or a circular stapler (CSA). Methods: Prospective observational study conducted between April 2016 and March 2019. The data were extracted from a hospital database that includes patients undergoing LRYGB in two different GE techniques, assessing postoperative complications and excess body weight loss. Results: Data from 457 patients were analyzed, of which 216 were in the LSA group and 241 were in the CSA group. There were four cases (1.7%) of GE stenosis in the CSA group and only one (0.5%) in the LSA group. Stapler malfunction occurred in both groups: CSA (0.4%) and LSA (0.5%), and a GE leak developed only in the CSA group (0.4%). Surgical site infection was found in five patients in the CSA group (2.1%) and two in the LSA group (0.9%). No statistical difference was found between the two groups in any of the variables analyzed (p > 0.05). Conclusions: Both stapling techniques resulted in a similar loss of excess body weight during the follow-up period. Although the LSA group had fewer total complications, these were not statistically significant, which substantiates the fact that both techniques are safe and feasible, provided they are performed by a surgeon with a long learning curve in laparoscopic bariatric surgery.展开更多
文摘Background: Staple line reinforcement material has been demonstrated to raise the burst pressure threshold after linear intestinal stapling. Numerous bioprosthetic materials have been utilized in surgical practice. Porcine urinary bladder matrix (ACell, Inc.) is an extracellular matrix material derived from porcine bladder used to reinforce surgically repaired soft tissue, and facilitate the body’s regenerative capacity. Objective: This study represents the first evaluation of urinary bladder matrix in gastrointestinal staple line reinforcement. Methods: Pathogen-free pigs underwent midline laparotomy under general anesthesia. Small intestinal division was performed with an endoscopic linear stapler. Nineteen intestinal divisions were performed with urinary bladder matrix staple line reinforcement, and twenty divisions were unreinforced. Staple lines were then subjected to burst pressure analysis by intraluminal infusion of dyed Krebs solution at an infusion rate of 20 ml·min-1 under manometric monitoring. Upon visible staple line extravasation, intraluminal pressure was recorded. Results: Intestinal staple lines reinforced with urinary bladder matrix exhibited significantly higher burst pressure threshold (p < 0.05). Reinforced staple lines had an average burst pressure of 99 ± 33 mmHg, compared to 61 ± 37 mmHg for unreinforced staple lines. Conclusion: Staple line reinforcement using urinary bladder matrix acutely improves burst pressures of intestinal staple lines when compared with unreinforced staple lines. Its regenerative properties may confer a long-term advantage to staple line reinforcement. These findings, along with previous findings of constructive remodeling in the presence of urinary bladder matrix in treatment of the gastrointestinal system, suggest that UBM may serve a role in gastrointestinal staple line reinforcement.
文摘Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective and well-accepted procedure for the treatment of morbid obesity but has complications such as stenosis of the gastroenteroanastomosis (GE), GE leak, surgical site infection, and stapling malfunction. This study evaluated the efficiency of weight loss and the incidence of short- and mid-term postoperative complications in patients undergoing LRYGB in which anastomosis was performed using a linear stapler (LSA) or a circular stapler (CSA). Methods: Prospective observational study conducted between April 2016 and March 2019. The data were extracted from a hospital database that includes patients undergoing LRYGB in two different GE techniques, assessing postoperative complications and excess body weight loss. Results: Data from 457 patients were analyzed, of which 216 were in the LSA group and 241 were in the CSA group. There were four cases (1.7%) of GE stenosis in the CSA group and only one (0.5%) in the LSA group. Stapler malfunction occurred in both groups: CSA (0.4%) and LSA (0.5%), and a GE leak developed only in the CSA group (0.4%). Surgical site infection was found in five patients in the CSA group (2.1%) and two in the LSA group (0.9%). No statistical difference was found between the two groups in any of the variables analyzed (p > 0.05). Conclusions: Both stapling techniques resulted in a similar loss of excess body weight during the follow-up period. Although the LSA group had fewer total complications, these were not statistically significant, which substantiates the fact that both techniques are safe and feasible, provided they are performed by a surgeon with a long learning curve in laparoscopic bariatric surgery.
