title: Sliding, absorbable, reinforced ring and an axially driven stent placement device for sutureless fibrin glue gastrointestinal anastomosis.
abstract: Reduced blood flow of from 43 to 71% has been reported in sutured and stapled anastomoses. The sutureless sliding, absorbable, intraluminal, nontoxic stent (SAINT)-fibrin glue anastomotic method, which clamps the stump margins between 2 dissolving surfaces, includes only two stages of temporary compression (about 6 min total using 4 IU/mL thrombin) during the glue application in order to promote vascularization. A SAINT placement device (SAINT-PD) was introduced to facilitate low rectal anastomoses. Morphohistologic results from limited trials using fibrin glue with an untied sutureless stapler technique and a prototype non-gear-driven SAINT-PD, neither having the two dissolvable clamping surfaces of the SAINT, showed a 29 and 25% incidence of intraluminal tissue ridges, respectively. Since these tissue ridges could result in subclinical dilatation or frank stenosis, and the more extensive SAINT trials had an 8% incidence of tissue ridges, redesign of the SAINT-PD was undertaken. Consequently, to improve the anastomotic quality of the SAINT-PD, the sliding absorbable reinforced ring (sucrose base) acting as the second dissolvable surface for the SAINT-PD and a new axially controlled geared SAINT-PD design are described.
authors.affiliation: Crozer-Chester Medical Center, Upland, PA 19013, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Detweiler
authors.forename: A
authors.initials: A
authors.lastname: Verbo
authors.forename: J W
authors.initials: JW
authors.lastname: Kobos
authors.forename: P
authors.initials: P
authors.lastname: Granone
authors.forename: A
authors.initials: A
authors.lastname: Picciocchi
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation* / Q000379:methods; D000818:Animals; D004064:Digestive System / Q000098:blood supply; D013505:Digestive System Surgical Procedures; D015718:Fibrin Tissue Adhesive; D007511:Ischemia / Q000601:surgery; D008422:Materials Testing; D015607:Stents; D013552:Swine
chemical_list: D015718:Fibrin Tissue Adhesive