Suturing, Stapling, and Tissue Adhesion

Giles, David; Talbot, Ethan

doi:10.1016/b978-0-323-40232-3.00085-6

Cited by 4 publications

(8 citation statements)

References 58 publications

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“…While the anti-fibrotic effect of some interventions such as hyaluronic acid–based films, reduce the quality of wound healing [ 38 ] and promote fistula formation [ 39 ], the tensile strength of caecal tissue treated with Def-Chitogel in the present study was not compromised.…”

Section: Discussionmentioning

confidence: 76%

Prevention of adhesions post-abdominal surgery: Assessing the safety and efficacy of Chitogel with Deferiprone in a rat model

et al. 2021

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Introduction Adhesions are often considered to be an inevitable consequence of abdominal and pelvic surgery, jeopardizing the medium and long-term success of these procedures. Numerous strategies have been tested to reduce adhesion formation, however, to date, no surgical or medical therapeutic approaches have been successful in its prevention. This study demonstrates the safety and efficacy of Chitogel with Deferiprone and/or antibacterial Gallium Protoporphyrin in different concentrations in preventing adhesion formation after abdominal surgery. Materials and methods 112 adult (8–10 week old) male Wistar albino rats were subjected to midline laparotomy and caecal abrasion, with 48 rats having an additional enterotomy and suturing. Kaolin (0.005g/ml) was applied to further accelerate adhesion formation. The abrasion model rats were randomized to receive saline, Chitogel, or Chitogel plus Deferiprone (5, 10 or 20 mM), together with Gallium Protoporphyrin (250μg/mL). The abrasion with enterotomy rats were randomised to receive saline, Chitogel or Chitogel with Deferiprone (1 or 5 mM). At day 21, rats were euthanised, and adhesions graded macroscopically and microscopically; the tensile strength of the repaired caecum was determined by an investigator blinded to the treatment groups. Results Chitogel with Deferiprone 5 mM significantly reduced adhesion formation (p<0.01) when pathologically assessed in a rat abrasion model. Chitogel with Deferiprone 5 mM and 1 mM also significantly reduced adhesions (p<0.05) after abrasion with enterotomy. Def-Chitogel 1mM treatment did not weaken the enterotomy site with treated sites having significantly better tensile strength compared to control saline treated enterotomy rats. Conclusions Chitogel with Deferiprone 1 mM constitutes an effective preventative anti-adhesion barrier after abdominal surgery in a rat model. Moreover, this therapeutic combination of agents is safe and does not weaken the healing of the sutured enterotomy site.

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Section: Discussionmentioning

confidence: 76%

Prevention of adhesions post-abdominal surgery: Assessing the safety and efficacy of Chitogel with Deferiprone in a rat model

et al. 2021

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“…Critical to this process is restoration of the inner mucus layer. Crypt goblet cells secrete a viscous mucus layer that serves as an important inner protective layer of the mucus layer of the intestinal tract separating the commensal bacterial flora of the microbiome from the epithelium and healing anastomosis [9][10][11]. One of the major concepts recently introduced regarding anastomotic healing has been the revelation of local changes in the microbiome.…”

Section: Physiology Of Anastomotic Healingmentioning

confidence: 99%

“…Interestingly, bowel transected by a stapler is closed without inversion. Studies generally showed equivalency in leak; therefore, the everted sutured anastomosis generally has been abandoned [9].…”

Section: Sutured Anastomosismentioning

confidence: 99%

“…In terms of tissue purchase, in addition to Lembert's emphasis on the serosa, Halsted highlighted the importance of the submucosal layer in intestinal suturing [9]. He showed that this layer offered the greatest collagen content and the highest degree of inherent tensile strength compared to the other layers.…”

Section: Sutured Anastomosismentioning

confidence: 99%

“…Optimal size of recommended purchase varies and may not be well-founded. A range from 3 to 4 mm has been offered and one should take into consideration the caliber of the bowel lumen and thickness of tissues [1,9]. There remain multiple types of suture techniques involving the type of bite.…”

Section: Sutured Anastomosismentioning

confidence: 99%

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Anastomotic Construction

Vargas

Margolin

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Anastomotic construction represents a fundamental and essential skill restoring intestinal continuity and preserving bowel function and continence.• It encompasses a broad range of methods and configurations and can be performed utilizing a spectrum of operative platforms. • While anastomosis may be a heterogeneous endeavor, consistent fundamental principles must be preserved in all its forms. • Stapling technologies represent a challenge for surgeon knowledge and understanding their use in clinical practice given the numerous innovations and specific tissuedevice interactions. • Colonic mobilization techniques bringing bowel into proximity to the distal limb while preserving blood supply represents an essential and critical skill for anastomotic construction. Surgeons must be familiar with advanced techniques for mobilization to achieve anastomosis.

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Injectable Self-Healing First-Aid Tissue Adhesives with Outstanding Hemostatic and Antibacterial Performances for Trauma Emergency Care

Hao

Yuan

Deng

et al. 2022

ACS Appl. Mater. Interfaces

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Soft-tissue trauma emergency caused by natural disasters and traffic accidents is highly prevalent, which can result in massive bleeding, pathogen infection, and even death. Although numerous tissue adhesives can bind to tissue surfaces and cover wounds, most of them still have several deficiencies, including long gelation time, poor adhesive strength, and anti-infection, making them inappropriate for use as first-aid bandages. Herein, injectable and self-healing four-arm-PEG-CHO/polyethyleneimine (PEI) tissue adhesives as liquid first-aid supplies are developed via the dynamic Schiff base reaction for trauma emergency. It is found that the prepared hydrogel adhesives exhibit short and controlled gelation time (9∼88 s), strong adhesive strength, and excellent antibacterial ability. Their hemostatic and antimicrobial performances can be tailored by the mass ratio of four-arm-PEG-CHO/PEI. Moreover, in vitro biological assays display that the developed tissue adhesives possess satisfactory cyto/hemocompatibility. Importantly, in vivo the designed adhesives show fast hemostatic capacity and excellent anti-infection as compared to commercial Prontosan gel. Thus, this work indicates that the four-arm-PEG-CHO/PEI first-aid tissue adhesives display great potential for wound emergency management.

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Suturing, Stapling, and Tissue Adhesion

Cited by 4 publications

References 58 publications

Prevention of adhesions post-abdominal surgery: Assessing the safety and efficacy of Chitogel with Deferiprone in a rat model

Prevention of adhesions post-abdominal surgery: Assessing the safety and efficacy of Chitogel with Deferiprone in a rat model

Anastomotic Construction

Injectable Self-Healing First-Aid Tissue Adhesives with Outstanding Hemostatic and Antibacterial Performances for Trauma Emergency Care

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