Two techniques of duodenum-preserving resections of the head of the pancreas have been described by Beger and Frey for treatment of chronic pancreatitis. These techniques were compared in a prospective randomized trial following a pilot study. The course of 31 patients with chronic pancreatitis was prospectively documented with 25 patients having undergone Beger’s and 6 Frey’s procedure. Thereafter 38 patients were randomly allocated to either Beger’s or Frey’s group. The mean interval between symptoms and surgery was 5.4 years in the pilot study and 5.6 years in the randomized study. 17 adjacent organs (13 common bile duct stenoses, 4 duodenal stenoses) were affected in 13 patients in the pilot study, and 35 adjacent organs (28 common bile duct stenoses, 6 duodenal stenoses, 1 pancreatopleural fistula) in 28 patients in the randomized study. The mean follow-up was 4.8 years in the pilot study and 1.5 years in the randomized study (minimum 6 months). In both series there was no mortality. Morbidity was 26% in the pilot study (28% Beger, 17% Frey) and 16% in the randomized study (21 % Beger, 11 % Frey). In the pilot study complete pain relief was achieved in 92 and 83% of patients after Beger’s and Frey’s procedure, and in the randomized trial in 95 and 89% of patients after Beger’s and Frey’s procedure. Associated affection of adjacent organs was definitively resolved in 94% (16 of 17) in the pilot study (92% Beger, 100% Frey) and in 94% (33 of 35) in the randomized study (90% Beger, 100% Frey). Both techniques of duodenum-preserving pancreatic head resection are equally safe and effective with regard to pain relief and definitive control of complications affecting adjacent organs.
An alternative microsurgical method for achieving vessel union without applying sutures is presented. The basic principles of the technique involve the creation of an extraluminal cuff that permits exact adaptation of both endothelial layers, without intraluminal damage or application of foreign material. When used for microsurgical procedures, the method can be further simplified by using a Teflon cuff secured by means of a mini-clip. The anastomosis can be accomplished quickly, in an uncomplicated and precise fashion. On the basis of preliminary experiments, this method appears to offer a wide range of applications, particularly if absorbable material is used.
The effect of fibrin sealant on breaking strength of colonic anastomosis was evaluated in peritonitis and ischemia. (1) Under normal conditions, breaking strength of sutureless anastomosis (SLA) increased up to the 24th postoperative hour, while breaking strength of fibrin-glued anastomosis (FGA) remained on continuously low levels. (2) In peritonitis, breaking strength of FGA was significantly higher than that of SLA after 6 and 24 h. (3) In ischemia, SLA failed completely, even after temporary adaptation for more than 3 h. Breaking strength of FGA of ischemic bowel was as high as SLA under normal conditions.
In the present study the effects of local bowel perfusion on anastomotic healing of experimental colonic anastomoses were evaluated in 54 female chinchilla rabbits. Local ischemia was induced by devascularization of the sigmoid colon. Animals were randomly allocated to 4 operative groups. In the animals of group 1 a colo-colonic anastomosis was performed in an area graded as ischemia grade A (intact perfusion). Animals of group 2 received a colo-colonic anastomosis in the sigmoid colon segment, graded as ischemia grade B (marginal perfusion). Group 3 received pretreatment with neomycin and was otherwise treated like group 2. Animals of group 4 a colo-colonic anastomosis was performed in the ischemia grade-C region (total ischemia). The rate of anastomotic leakage was monitored by periodic double contrast enemas. The experiment was terminated on the 8th postoperative day, and microangiography to assess revascularization was performed followed by assessment of perianastomotic adhesions. The rate of anastomotic failure as well as the occurrence of anastomotic failure over time highly depended on the severity of ischemia. Bowel sterilization by neomycin significantly reduced the rate of anastomotic leakage. The development of perianastomotic adhesions correlated with the severity of ischemia. Microangiography suggested that revascularization originated in the perianastomotic adhesions.
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