Staple line reinforcement
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This document discusses staple line reinforcement (SLR) options and whether they are useful in gastrointestinal surgery. It outlines the rationale for using SLR to prevent staple line leaks and bleeding. Several SLR products are described, including synthetic, biologic, and fibrin sealants. Studies comparing SLR products found some reduced bleeding and leaks compared to controls. However, SLR may increase risks of adhesions and strictures. More research is still needed to determine the cost-effectiveness of routine SLR use.
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This document discusses balloon-assisted coiling techniques for treating aneurysms. It notes that balloon-assisted coiling provides better immediate and follow-up occlusion rates compared to standalone coiling, though it may carry a higher risk of complications compared to standalone coiling. The document reviews the history and uses of balloon-assisted coiling, complications, techniques for different aneurysm situations, outcomes data on occlusion rates, and debates around its appropriate use compared to standalone coiling and stent-assisted coiling.
malas savs 2015
1) The Pythagoras trial evaluated the Aorfix endograft for EVAR in patients with severely angulated (over 90 degrees) proximal aortic necks. It found lower rates of major adverse events compared to open surgery.
2) The study found constant morphological changes in the aneurysm neck following EVAR, with the infrarenal aorta dilating more rapidly than the suprarenal aorta over 5 years.
3) Proximal neck dilation greater than 10% at 1mm below the distal renal artery was associated with increased risk of migration and sac expansion, while distal neck dilation did not significantly increase risks. Maintaining adequate oversizing may reduce neck dilation risks.
Carotid Artery Stending: A detailed approach
This document summarizes several clinical trials and registries comparing carotid artery stenting (CAS) to carotid endarterectomy (CEA) for treating carotid artery disease. It discusses trials including CAVATAS, SAPPHIRE, SPACE, EVA-3S, CREST, ACST-2, TACIT, and others. It also examines critical issues from the data like operator experience, outcomes in octogenarians, cognitive changes, protected vs. unprotected stenting, heterogeneity between trials, outcomes in high risk patients, impacts of the SPACE and EVA-3S trials, and optimization of medical therapy. The document aims to analyze the evidence from these sources to determine best practices for CAS versus CEA
Minimally invasive oesophagectomy
The document discusses minimally invasive oesophagectomy (MIO), which refers to a group of surgical techniques for removing the esophagus through smaller incisions than traditional open surgery. It notes that while MIO is becoming more common, no randomized clinical trials have directly compared outcomes of MIO versus open surgery. The document also outlines different technical approaches to MIO, variations in techniques for the gastric conduit and anastomosis, and the steep learning curve associated with MIO adoption. It raises questions about balancing access versus radicality in resection and identifies areas for continued development, such as vagal-sparing techniques and sentinel lymph node biopsy.
Endeavor IV-A Randomized Comparison of a Zotarolimus-Eluting Stent Endeavor...
- Endeavor IV was a randomized trial comparing the zotarolimus-eluting Endeavor stent to the paclitaxel-eluting Taxus stent.
- The primary endpoint was target vessel failure at 9 months, with a pre-specified non-inferiority margin of 3.8%.
- 1,548 patients at 80 sites in the US were randomized 1:1 to receive either the Endeavor or Taxus stent. Follow-up was planned through 5 years.
Jc14-12/2016-subharti dental collegeand hospital,Meerut
various human and animal study conducted to retrieve the data for the creastal bone loss in both study samples within different intervals of time.
Handbook of Endovascular Interventions
The document summarizes the history and current state of endovascular abdominal aortic aneurysm repair (EVAR). It describes how the first EVAR was performed in 1991 and since then the procedure and technology have greatly advanced. It provides details on patient anatomy considerations for EVAR eligibility, outlines management approaches for aneurysms of different sizes, and discusses factors involved in deciding between open surgery versus EVAR.
Carotid artery stenting basics
This document discusses carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CEA) for treatment of carotid artery stenosis. It provides details on patient selection criteria and describes the CAS procedure, including diagnostic arteriography, embolic protection device placement, stent placement, and post-procedure care. Several major clinical trials are summarized that demonstrated CAS to be non-inferior to CEA for reducing risk of stroke in both symptomatic and asymptomatic patients.
carotidarterystenting-181220042512.pdf
This document discusses carotid artery stenting as an alternative to carotid endarterectomy for treating carotid artery stenosis. It provides details on:
1) Clinical trials that have established carotid stenting as an equivalent option to carotid endarterectomy for reducing risk of stroke, with some trials finding stenting superior for certain patient groups.
2) Guidelines from organizations like the ACC/AHA that recommend carotid stenting as a Class I or IIa option for symptomatic and select asymptomatic patients.
3) The procedure of carotid artery stenting, including patient preparation, diagnostic arteriogram, techniques for embolic protection and stent placement.
Esophageal motor abnormalities in patients with scleroderma heterogeneity, ri...
Esophageal motor abnormalities in patients with scleroderma heterogeneity, ri...lissett tarira cerezo
This study characterized esophageal motor function in 200 patients with systemic scleroderma (SSc) using high-resolution manometry and compared findings to 102 control patients. The study found:
1) Esophageal motor abnormalities varied significantly among SSc patients, with absent contractility being most common (56%) but normal motility observed in 26%.
2) The classic pattern of absent contractility and hypotensive esophagogastric junction pressure was only seen in 33% of SSc patients.
3) Severe esophageal dysmotility, as indicated by absent contractility, was associated with longer disease duration, interstitial lung disease, and worse gastrointestinal symptoms.
4) Patients withA technical modification of carotid endarterectomy experience with 400 pati...
This document discusses techniques for carotid endarterectomy based on the experience of 400 patients. It finds that eversion carotid endarterectomy had a lower restenosis rate of 1.7% compared to 9.3% for primary closure and 6.5% for patch angioplasty. Additionally, eversion carotid endarterectomy had a faster mean operative time of 31 minutes compared to 39 minutes for primary closure and 46 minutes for patch angioplasty. Finally, a study of over 1,900 carotid endarterectomies found primary closure was associated with significantly higher risks of perioperative stroke at 5.6% and stroke or death at 6.0% compared to 2.2-2.5% for
Ac joint
This document discusses the classification and treatment of acromioclavicular (AC) joint dislocations. It classifies AC joint injuries using the Rockwood classification system, which involves 6 types of injuries based on the degree of ligament disruption and bone displacement. For types 1 and 2 injuries, conservative treatment with rest, ice, and sling is usually recommended. Treatment for type 3 injuries is controversial but often involves initial conservative treatment with possible later surgery. Surgical treatment is described for more severe injuries. Overall, the document indicates that outcomes are often comparable between conservative and surgical treatment, but surgery carries higher risks of complications.
RCT on base tie in lap appendecomy.pptx
This study aimed to compare outcomes of different techniques for closing the appendix stump during laparoscopic appendectomy (L-APPE). In a randomized clinical trial, 180 patients undergoing L-APPE for uncomplicated acute appendicitis were assigned to have their appendix stump closed using an endoloop, Hem-o-lok clips, or stapler. The stapler group had a significantly longer operative time and higher rate of intraoperative complications compared to the other groups. Postoperative complication rates were low across groups but costs were highest for the stapler technique. Hem-o-lok clips resulted in the shortest operative time and lowest costs, making them a reasonable option for appendix stump closure during L-
The hybrid vascular e ptfe graft as an alternative for hemodialysis access
The hybrid vascular ePTFE graft is proposed as an alternative for difficult hemodialysis access cases. It combines an ePTFE graft with a covered nitinol stent to create a sutureless venous anastomosis. This is aimed at improving graft patency by reducing intimal hyperplasia. The initial experience with the hybrid graft shows it can be used safely and effectively to establish access in complex patients with few alternative options. Further studies are still needed to determine if it provides long term patency results superior to other grafts.
Application Brief: Abdominal Aortic Aneurysm
Abdominal Aortic Aneurysm (AAA) is a serious and potentially fatal disease that is prevalent in the older population. Scientists are making use of animal models to study the progression of this disease and the effects of therapeutic interventions over longitudinal studies.
Treatment planning
The document discusses dental implant treatment planning and considerations. It notes that proper diagnosis, history taking, treatment planning, investigations, biomechanical factors and system requirements are important. Key factors in treatment planning include a patient's oral hygiene, medical conditions, dental condition, occlusion, age and finances. Clinical, radiographic and laboratory investigations are outlined. Guidelines are provided for optimal implant positioning and limitations on cantilevers and adjacent pontics. Risk factors for implant failure and the influence of implant diameter and length on stress distribution are examined through studies. All-on-4 treatment is discussed and a study shows three implant restorations may not adequately support occlusal loads while four implants with a 10mm cantilever can properly resist loading
Similar to Staple line reinforcement (20)
Endeavor IV-A Randomized Comparison of a Zotarolimus-Eluting Stent Endeavor...
Endeavor IV-A Randomized Comparison of a Zotarolimus-Eluting Stent Endeavor...
Jc14-12/2016-subharti dental collegeand hospital,Meerut
Jc14-12/2016-subharti dental collegeand hospital,Meerut
Esophageal motor abnormalities in patients with scleroderma heterogeneity, ri...
Esophageal motor abnormalities in patients with scleroderma heterogeneity, ri...
A technical modification of carotid endarterectomy experience with 400 pati...
A technical modification of carotid endarterectomy experience with 400 pati...
The hybrid vascular e ptfe graft as an alternative for hemodialysis access
The hybrid vascular e ptfe graft as an alternative for hemodialysis access
More from Congreso Internacional Cirugía Bariátrica y Metabólica
Presentation nuciba
Este documento presenta a NUCIBA, una asociación de nutricionistas especializadas en cirugía bariátrica en Argentina. Proporciona detalles sobre los miembros fundadores, las diferentes regiones del país en las que operan y sus actividades, que incluyen reuniones anuales, guías alimentarias y un sitio web.
Factores que comprometen la esterilidad d eproductos médicos
Factores que comprometen la esterilidad d eproductos médicosCongreso Internacional Cirugía Bariátrica y Metabólica
Este documento describe los factores que comprometen la esterilidad de los productos médicos y las mejores prácticas para prevenir la contaminación. Explica que una correcta limpieza, empaquetado, manipulación, transporte, almacenamiento y uso son esenciales para mantener la esterilidad desde el quirófano hasta el paciente. También enfatiza la importancia de la participación de todo el personal para asegurar procesos estériles que protejan la seguridad de los pacientes.Sleeve gastrectomy in patients with bmi
Sleeve gastrectomy has been shown to be an effective bariatric procedure for weight loss and resolution of comorbidities like diabetes. While initially used for patients with BMI over 35, recent evidence suggests sleeve gastrectomy may be appropriate for some patients with a BMI under 35. A study of over 450 patients in Brazil with a mean BMI of 29 who underwent sleeve gastrectomy and ileal interposition for diabetes found no mortality, low complications, and resolution of diabetes in the majority of patients. The author concludes it makes sense to offer sleeve gastrectomy to appropriately selected patients with a BMI under 35 given its safety profile and outcomes.
Short and long term results of gastric bypass
Gastric bypass surgery results in significant and long-lasting weight loss and health improvements according to multiple studies:
- A study of over 57,000 patients found that gastric bypass led to an average 65% excess weight loss that was maintained at 49% excess weight loss after 14 years.
- A Swedish study found an average weight loss of over 30% of initial body weight 10 years after gastric bypass or other bariatric surgeries compared to continued obesity in control patients.
- Studies show gastric bypass reduces the risk of death by 89% over 5 years compared to continued obesity and resolves or significantly improves obesity-related conditions like type 2 diabetes in a high percentage of patients.
Protect your team from lawsuits
This document provides tips for managing the risk of lawsuits related to bariatric surgery practices. It discusses the importance of thorough patient screening, both medically and psychosocially, as well as documenting decision making processes. It emphasizes aligning patient expectations through comprehensive education and informed consent procedures. The document also addresses issues like disclosing financial relationships, managing patient dissatisfaction, tracking complaints, conducting crucial conversations with difficult patients, and dismissing patients when needed. The overall message is that careful screening, education, documentation, and communication can help reduce the risk of legal claims.
Mendoza 2011 tips para un correcto bypass gástrico
Mendoza 2011 tips para un correcto bypass gástricoCongreso Internacional Cirugía Bariátrica y Metabólica
El documento proporciona consejos sobre el bypass gástrico, una cirugía compleja asociada con complicaciones. Reconocer, tratar y minimizar las complicaciones es importante. Las complicaciones pueden deberse a factores técnicos, la experiencia quirúrgica o factores del paciente como comorbilidades. La aplicación de una técnica quirúrgica estandarizada es crucial para minimizar las complicaciones.Length of roux
This document discusses how the length of the Roux limb in gastric bypass surgery may impact outcomes. It notes that while longer Roux limbs between 150-200 cm do not significantly impact weight loss, even more distal bypass with Roux limbs of only 50-75 cm from the ileocecal valve can cause greater weight loss but also increases risks of nutritional deficiencies. The document reviews evidence from studies comparing standard to longer or more distal Roux limb lengths and their effects on weight loss and complications.
Outcomes of conversions in bariatric surgery mendoza 2011
Outcomes of conversions in bariatric surgery mendoza 2011Congreso Internacional Cirugía Bariátrica y Metabólica
Revisional bariatric surgery rates are increasing as more primary bariatric surgeries are performed. Common causes of failure include non-compliance with lifestyle changes and weight regain. Evaluation of failed patients includes assessing compliance and reviewing anatomy with imaging and endoscopy. Revisional options depend on the cause of failure and may include converting to Roux-en-Y gastric bypass, sleeve gastrectomy, or adding a gastric band. Outcomes of revisional surgery show around a 50% excess weight loss with some increased risks of complications compared to primary surgery. Careful patient selection and counseling are important for success.Importancia del soporte nutricional post by pass gastrico
Importancia del soporte nutricional post by pass gastricoCongreso Internacional Cirugía Bariátrica y Metabólica
El documento destaca la importancia del soporte nutricional después de la cirugía de bypass gástrico para tratar la obesidad morbida. Explica que una evaluación nutricional completa es necesaria antes de la cirugía y que la suplementación vitamínica y mineral es fundamental después de la cirugía para prevenir deficiencias. La autora concluye enfatizando la necesidad de un seguimiento nutricional cuidadoso de los pacientes después del bypass gástrico.Future trends in global healthcare
Future trends in global healthcare will see rising costs become unsustainable, leading to reforms. Reimbursements are expected to decrease by 10% over the next decade as risk shifts from payers to providers. Payment will differ based on outcomes, satisfaction, and access. To prepare, providers must drive down costs, improve outcomes, and diversify revenue through clinical integration and managing episodes of care across larger systems. The creation of true healthcare systems is needed to efficiently standardize processes and align incentives to manage costs and risk.
Cuando hablamos de conversión
Este documento trata sobre la cirugía revisional y de conversión en cirugía bariátrica. Explica que la cirugía de revisión se realiza para corregir complicaciones de una cirugía previa, mientras que la conversión implica cambiar el tipo de cirugía bariátrica realizada originalmente. Luego discute las indicaciones, morbilidad y mortalidad de estas cirugías, concluyendo que la cirugía revisional puede lograr efectivas bajas de peso y que debe considerar factores anatómicos, fisiológicos y ps
Hipoglucemia post by pass gástrico
The document discusses hypoglycemia after gastric bypass surgery and various potential mechanisms and treatments. It notes a 0.2% incidence of hypoglycemia-related hospital admissions after gastric bypass. Various molecular mechanisms are proposed for how gastric bypass could lead to hypoglycemia, including increased insulin secretion and sensitivity as well as persistent beta cell mass expansion. The document outlines medical and surgical treatment options for hypoglycemia, including dietary changes, medications, increasing restriction or reversing the bypass, and pancreatectomy as a last resort.
Aspectos paar decidir una conversión
The document discusses revisional bariatric surgery options for patients who experience weight regain or inadequate weight loss after an initial Roux-en-Y gastric bypass procedure (RYGBP). It reviews various surgical techniques for revising the gastric pouch size and shape, lengthening or shortening the Roux limb, and adding an adjustable gastric band. A summary of the author's experience with 212 revisional surgeries found that patients experienced significant additional weight loss, though complication rates were high at 26%. Most patients reported being satisfied with the results of revisional surgery.
Anastomosis pre o retro cólica
Este documento compara las técnicas antecolica y retrocolica para el bypass gástrico laparoscópico. Resume varios estudios que muestran una mayor incidencia de hernias internas con la técnica retrocolica. También encuentra menos problemas de estenosis y obstrucción intestinal con la técnica antecolica, posiblemente debido a menos tensión en la anastomosis. Concluye que ambas técnicas son seguras si se cierran todos los espacios herniogénicos, pero la antecolica puede evitar ciertas complic
Resultados de la cirugía metabólica
Metabolic surgery alters levels of gut hormones like ghrelin, GLP-1, PYY, and PP in ways that reduce appetite and food intake. The mechanisms are not fully understood but involve signaling from the gut to the brain. While weight loss provides benefits, metabolic surgery also improves insulin resistance and diabetes independent of weight through these gut hormone changes and reprogramming of eating behavior and metabolism.
Opciones quirúrgicas válidas r cohen
The document discusses potential novel gastrointestinal procedures for treating type 2 diabetes in patients with low BMI, including duodenal-jejunal bypass and ileal transposition with or without duodenal exclusion. It reviews the outcomes of these procedures in clinical studies showing glycemic control, weight loss, and low complication rates. The author argues that duodenal exclusion may have antidiabetic effects and that duodenal-jejunal bypass via sleeve gastrectomy deserves further study in randomized controlled trials compared to Roux-en-Y gastric bypass and medical treatment for type 2 diabetes patients with BMIs between 26-35.
Teorias del mecanismo endocrino en cir bar
(1) El documento discute los mecanismos hormonales por los cuales la cirugía bariátrica, especialmente el bypass gástrico, puede resolver la diabetes tipo 2. (2) Presenta varias hipótesis, incluyendo que los cambios en las hormonas gastrointestinales en el intestino proximal y distal podrían explicar los efectos. (3) Los resultados presentados sugieren que los cambios a corto y largo plazo en hormonas como GLP-1, GIP y glucagón apoyan parcialmente la hipótesis del intestino distal pero no la
Errores y aciertos de la cirugía metabólica
1. O documento discute os acertos e erros da cirurgia metabólica para o tratamento da obesidade e diabetes, incluindo mecanismos de ação e estudos clínicos.
2. Também aborda a importância de entender a fisiopatologia da diabetes e trabalhar em equipe multidisciplinar com endocrinologistas.
3. Argumenta que o IMC não deve ser o único critério para indicação cirúrgica, já que não prediz o risco metabólico individual nem garante sucesso da cirurgia.
Efectos metabólicos del by pass gástrico
The document discusses various metabolic effects and mechanisms of action of Roux-en-Y gastric bypass (RYGB) surgery based on several studies. It finds that RYGB is effective at inducing weight loss and remission or improvement of type 2 diabetes in both short and long term follow-ups. The surgery increases insulin secretion and sensitivity through multiple mechanisms such as stimulating incretin hormones like GLP-1 and PYY, as well as changes in adipokines, vagal tone, intestinal gluconeogenesis, and other factors. RYGB is also found to have durable effects, good safety profile, and reproducibility across studies.
Evaluacion y preparacion psicologica en cirugia metabolica
Evaluacion y preparacion psicologica en cirugia metabolicaCongreso Internacional Cirugía Bariátrica y Metabólica
Este documento describe la evaluación psicológica y preparación de pacientes con diabetes y obesidad para cirugía metabólica. Explica que la evaluación psicológica analiza la historia del paciente, sus hábitos, emociones y apoyo social. La preparación educa al paciente sobre la cirugía, sus riesgos y expectativas para ayudarlos a enfrentar emocionalmente el proceso. Incluye dos casos de pacientes que experimentaron mejorías significativas en su diabetes y calidad de vida después de someterse a bypass gástrico.More from Congreso Internacional Cirugía Bariátrica y Metabólica (20)
Factores que comprometen la esterilidad d eproductos médicos
Factores que comprometen la esterilidad d eproductos médicos
Mendoza 2011 tips para un correcto bypass gástrico
Mendoza 2011 tips para un correcto bypass gástrico
Outcomes of conversions in bariatric surgery mendoza 2011
Outcomes of conversions in bariatric surgery mendoza 2011
Importancia del soporte nutricional post by pass gastrico
Importancia del soporte nutricional post by pass gastrico
Evaluacion y preparacion psicologica en cirugia metabolica
Evaluacion y preparacion psicologica en cirugia metabolica
Staple line reinforcement
- 1. Staple Line Reinforcement. Options and Does it Make Sense? Samer G. Mattar, MD, FRCS, FACS Associate Professor of Surgery Indiana University
- 2. Outline Why use SLR? Options of SLR. Case for its use. Case against it. Conclusions
- 3. Why use SLR? Mechanical staplers are now standard devices and are widely used in all areas of the GI Tract. Even most experienced surgeons will over or under- estimate the thickness of tissue. The majority of staplers are reliable, but very rarely, some will fail.
- 4. Why use SLR? Staple line leaks, especially in Sleeve gastrectomy, can be devastating. There is concern for postoperative bleeding that may result in blood transfusions or return to the
- 5. Hand-sewn vs. Stapled anastomoses Cochrane review of stapled versus hand-sewn anastomoses: 1233 patients, 9 trials Lustosa SA, et al. Cochrane Database Syst Rev 2001:; CD003144
- 6. Hemostasis? 20 patients undergoing BPD-DS A: 10 patients had SLR (Seamguard) B: 10 patients no SLR Consten et al. ObesSurg 2004;14:1360-6
- 7. Hemostasis? Blood Loss Group A: 120mls. Blood Loss Group B: 210 mls. LOS: 3.8 days (A) vs. 4.6 das (B). Consten et al. ObesSurg 2004;14:1360-6
- 8. Fibrin glue Used successfully in animal studies.* Used to reinforce anastomoses. Used to reinforce long staple lines. Used to control non-surgical bleeding. *Nguyen et al. J Surg Res 2004;122(2):218-24
- 9. Types of SLR Gore – Seamguard (synthetic bioabsorbable) Cook SIS (biologic) Synovis Veritas (collagen matrix derived from bovine pericardium) Covidien Duet (absorbable synthetic polyester)
- 10. Comparison in Hemostasis Animal study Swine capsular stripping model. Veritas and Duet were compared. Veritas and Syvek were more successful (<10 min). Collagen buttresses are superior to synthetic. Specter et al. SurgEndosc 2011;25(4):1148-52
- 11. Comparison of Tissue Handling and Slippage Ex-vivo canine gastric tissue model. SULU alone vs. Seamguard vs. Duet. Volckmann et al. Poster presented at SAGES 2010
- 12. Comparison of Tissue Handling and Slippage Volckmann et al. Poster presented at SAGES 2010
- 13. Comparison of Burst Pressures Small intestine stapled swine model. Gastric staple line in rabbit model. Arnold & Shikora. ObesSurg 2005;16:164-71
- 14. Comparison of Burst Pressures P = 0.0137 Arnold & Shikora. ObesSurg 2005;16:164-71
- 15. Prospective Randomized Trial Group 1: No SLR Group 2: Seamguard Group 3: Suture reinforcement Dapri, Cadiere, Himpens. ObesSurg 2010(20) 462-7
- 16. Prospective Randomized Trial Group 1 (no SLR) was associated with shortest OP duration. Seamguard reduced blood loss. No difference among all groups in incidence of postoperative leaks. Dapri, Cadiere, Himpens. ObesSurg 2010(20) 462-7
- 17. Fibrin sealant and Strictures? 529 LRYGB patients. 104 with no fibrin. 425 with fibrin reinforcement Stricture rate: 5.8% vs. 11.3%. Ibele et al. Presented at SAGES 2011
- 18. Conclusion Tissue stapler technology is in evolution. There is no perfect tissue stapler. There are a variety of SLR products; absorbable versus permanent, synthetic versus biologic, and solid versus liquid. Generally, SLRs provide additional security from bleeding and maybe leaks.
- 19. Conclusions Complications may include increased adhesions and strictures. More research is needed to assess cost-effectiveness of these products.
- 20. Thank you!