Sliding, absorbable, reinforced ring and an axially driven stent placement device for sutureless fibrin glue gastrointestinal anastomosis.
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.
Detweiler
M B
MB
Crozer-Chester Medical Center, Upland, PA 19013, USA.
Verbo
A
A
Kobos
J W
JW
Granone
P
P
Picciocchi
A
A
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
D015718:Fibrin Tissue Adhesive