Felicien M. Steichen

A stapling instrument for end-to-end inverting anastomoses in the gastrointestinal tract.

A stapling instrument is described for end-to-end inverting anastomoses applicable principally to low rectal anastomosis or esophagogastric or esophagojejunal anastomosis. The instrument creates an inverting anastomosis held by a double staggered row of stainless steel wire staples creating an anastomosis 21.2 mm internal diameter with no significant inverted flange. The early experience is encouraging.

Mechanical sutures in esophageal surgery.

Precise, safe and expeditious suturing of the esophagus to the stomach or the small or large bowel is required in procedures designed to re-establish continuity following esophagogastrectomy, partial or total esophagectomy and total gastrectomy, and to control exsanguinating hemorrhage from ruptured esophageal varices. In the anastomosis of the esophagus to the stomach, small or large bowel, and in the control of hemorrhage from bleeding esophageal varices by a modified Tanncr-Boerema procedure, the EEA, the GIA (loaded with SGIA cartridges) and the TA-55 stapling instruments significantly facilitate and simplify these operations.

Hepatic Trauma in Adults

Some 15 to 20 per cent of all blunt abdominal injuries involve the liver, which is also the intra-abdominal organ most frequently injured with penetrating trauma. The type and extent of liver injuries are described, and the operative procedure is presented.

Autosuture ileal conduit construction: experience in 110 cases.

Our experience with 110 cases of ileal conduit construction with autosuture stapling devices is discussed. The technique is described briefly and the results are compared to results with ileal conduits constructed with the conventional suture technique. Analysis of our data revealed a significant reduction in operating time and postoperative morbidity.

Current Concepts in Operative Surgery Using Videoendoscopically Assisted Mechanical-Suture Techniques

As surgeons have gained experience with state-of-the-art stapling instruments and techniques, it has become obvious that mechanical sutures did not simply replace manual sutures. They elevated operative surgery to a higher level of sophistication and reduced the need for physically wearing prolonged or repetitive maneuvers, allowing the surgeon to concentrate on the design and execution of standard and complex reconstructive procedures. What appeared at first to be a simple conversion from manual to mechanical sutures evolved into a system of new techniques made possible by the staples.

111. Darmplastiken nach Oesophagus-, Magenund Dickdarm-Resektion mittels mechanischer Nahtgeräte

SummaryFor replacement of the esophagus, the author has used the right or left colon and, more recently, the reversed gastric tube as described by Gavriliu and Heimlich. Following total gastrectomy, a jejunal pouch (Hunt-Lawrence or Paulino) has proved superior to all other methods of reconstruction. Since the description by Kock of his continent ileostomy, the author has been very pleased with the results obtained with this technique after total colectomy. Excision of the esophagus, stomach, or colon and creation of the appropriate substitute are performed in one stage. Extensive procedures such as these are greatly facilitated by the use of stapling instruments, especially in the creation of the various substitute organs.ZusammenfassungFür die Ersetzung des Osophagus haben wir eine rechte oder linke Coloplastik und neuerdings die Magentube nach Gavriliu benutzt. Nach totaler Gastrektomie hat sich der Dünndarmbeutel nach Hunt-Lawrence oder nach Paulinogutbewährt. Die Darmplastiknach Kockhatgute Resultate ergeben nach totaler Colektomie. Oesophagus-, Magen- und Dickdarm-Resektion sowie die respektive Magen- oder Darm-Plastik nehmen wir immer in derselben Operationszeit vor, in primären, elektiven Fällen. Der chirurgische Eingriff, besonders die Plastik, wird sehr erleichtert durch den Gebrauch mechanischer Nahtgeräte.