Technical Aspects in Esophageal Lengthening: An Investigation of Traction Procedures and Suturing Techniques in Swine

Sochaczewski, Christina Oetzmann von; Lindner, Andreas; Lang, Hauke; Heimann, Axel; Muensterer, Oliver J.

doi:10.1055/s-0038-1676506

Cited by 11 publications

(7 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The main assumption in this study is that the higher traction force we can apply without destroying the tissue, the more effective the elongation would be. Previous studies compared anastomotic sutures and constant versus intermittent traction on swine esophagi 9 , 10 . This is the first study to examine and directly compare different esophageal traction sutures as well as expand the knowledge on elongation and intermittent traction.…”

Section: Discussionmentioning

confidence: 99%

Biomechanics of esophageal elongation with traction sutures on experimental animal model

Toczewski

Gerus

Kaczorowski

et al. 2022

Sci Rep

View full text Add to dashboard Cite

Esophageal elongation is one of the methods of long gap esophageal atresia treatment. The aim of the study was to determine the best type of traction suture for esophageal lengthening on an animal model. White Pekin Duck’s esophagi were used as a model (fresh-frozen and thawed). The esophagus was cut in half, then both ends were sutured together and extended on a tensiometer. Tested sutures involved simple suture, suture aided by a single or double clip, and suture aided by pledget (10 samples each). Constant and 2 methods of intermittent traction were also compared. The histological study showed similarities between duck’s and newborn’s esophagus. The highest maximal force was achieved with pledget suture (F = 8.59 N ± 1.45 N), then with double clip (F = 5.74 N ± 1.29 N) and the lowest with single suture (F = 3.80 N ± 0.54 N) (p < 0.001). Pledget suture also allowed for the greatest elongation (p < 0.01). Intermittent traction results in better elongation at the same breaking strength as constant traction (p < 0.05) if traction is maintained during breaks. Reinforced sutures (pledget or double clip) should be taken into consideration in internal traction. When performing traction sutures, it is worth step by step carefully tightening the sliding knot in short periods before its final binding.

show abstract

Section: Discussionmentioning

confidence: 99%

Biomechanics of esophageal elongation with traction sutures on experimental animal model

Toczewski

Gerus

Kaczorowski

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Data are presented as medians with interquartile ranges. Correlation analyses were conducted using Spearman’s ρ , whose 95% confidence intervals were calculated using bootstrapping with 10,000 repetitions [ 27 , 28 ] via the spearman.ci-function from the RVAideMemoire-package (version 0.9-75) [ 29 ]. Posthoc-power was calculated using the power2 × 2-function from the exact2 × 2-package (version 1.6.5) [ 30 ].…”

Section: Methodsmentioning

confidence: 99%

Paediatric surgical trials, their fragility index, and why to avoid using it to evaluate results

2022

Self Cite

View full text Add to dashboard Cite

Background The fragility index has been gaining ground in the evaluation of comparative clinical studies. Many scientists evaluated trials in their fields and deemed them to be fragile, although there is no consensus on the definition of fragility. We aimed to calculate the fragility index and its permutations for paediatric surgical trials. Methods We searched pubmed for prospectively conducted paediatric surgical trials with intervention and control group without limitations and calculated their (reverse) fragility indices and respective quotients along with posthoc-power. Relationships between variables were evaluated using Spearman’s ρ. We also calculated S values by negative log transformation base-2 of P values. Results Of 516 retrieved records, we included 87. The median fragility index was 1.5 (interquartile range: 0–4) and the median reverse fragility index was 3 (interquartile range: 2–4), although they were statistically not different (Mood’s test: χ2 = 0.557, df = 1, P = 0.4556). P values and fragility indices were strongly inversely correlated (ρ = − 0.71, 95% confidence interval: − 0.53 to − 0.85, P < 0.0001), while reverse fragility indices were moderately correlated to P values (ρ = 0.5, 95% confidence interval: 0.37–0.62, P < 0.0001). A fragility index of 1 resulted from P values between 0.039 and 0.003, which resulted in S values between 4 and 8. Conclusions Fragility indices, reverse fragility indices, and their respective fragility quotients of paediatric surgical trials are low. The fragility index can be viewed as no more than a transformed P value with even more substantial limitations. Its inherent penalisation of small studies irrespective of their clinical relevance is particularly harmful for paediatric surgery. Consequently, the fragility index should be avoided.

show abstract

“…Diagnoses and procedures were compared between sexes with the Mann–Whitney-Wilcoxon U -test. As regular confidence intervals require a normal distribution of data, bias-corrected accelerated bootstrap confidence intervals with 10,000 repetitions [ 24 , 25 ] have been calculated using the smean.cl.boot -function from the Hmisc-package (version 4.4-0) [ 26 , 27 ] for point estimates and for mean differences by bootstrapping the mean differences using the two.boot -function from the simpleboot-package (version 1.1-7) [ 28 ] to supply it to the boot.ci -function from the boot-package (version 1.3-24) [ 29 ]. We accounted for multiple testing by using the Benjamini-Hochberg-procedure [ 30 , 31 ].…”

Section: Methodsmentioning

confidence: 99%

Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Contrary to adult inguinal hernia surgery, large-scale investigations using registries or administrative data are missing in paediatric surgery. We aimed to fill this gap by analysing German administrative hospital data to describe the current reality of inpatient hernia surgery in children. Methods We analysed aggregated data files bought from the German federals statistics office on hospital reimbursement data separately for principal diagnoses of inguinal hernia in children and for herniotomies in inpatients. Developments over time were assessed via regression and differences between groups with nonparametric comparisons. Results Principal diagnoses of hernias were decreasing over time with the exception of male bilateral and female bilateral incarcerated hernias in the first year of life which increased. The vast majority of operations were conducted via the open approach and laparoscopy was increasingly only used for females older than 1 year of age. Recurrent hernia repair was scarce. Rates of inguinal hernia repair were higher in both sexes the younger the patient was, but were also decreasing in all age groups despite a population growth since 2012. The amount of inguinal hernia repairs by paediatric surgeons compared to adult surgeons increased by 1.5% per year. Conclusions Our results corroborate previous findings of age and sex distribution. It demonstrates that inpatient hernia repair is primarily open surgery with herniorrhaphy and that recurrences seem to be rare. We observed decreasing rates of hernia repairs over time and as this has been described before in England, future studies should try to elucidate this development. Level of evidence III.

show abstract

Technical Aspects in Esophageal Lengthening: An Investigation of Traction Procedures and Suturing Techniques in Swine

Cited by 11 publications

References 19 publications

Biomechanics of esophageal elongation with traction sutures on experimental animal model

Biomechanics of esophageal elongation with traction sutures on experimental animal model

Paediatric surgical trials, their fragility index, and why to avoid using it to evaluate results

Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

Contact Info

Product

Resources

About