Experimental model for treatment of splenic injury with surgical adhesives, through laparoscopy, in heparinized pigs

Objetivo. Estudar o efeito hemostático do adesivo biológico em ferimento esplênico de suíno heparinizado, aplicado por laparoscopia. Métodos. Foram utilizados 18 animais machos distribuídos em três grupos de seis, I (adesivo biológico + heparina), II (heparina) e III (controle). O Grupo I foi heparinizado e teve a aplicação de 0,5 mL de adesivo no ferimento esplênico, por via laparoscópica; o Grupo II foi heparinizado e não teve o ferimento tratado com adesivo e o Grupo III não foi heparinizado nem teve o ferimento tratado com adesivo. No Tempo 0, 10 e 20 minutos da lesão, foram anotados dados clínicos e hemodinâmicos e colhidas amostras sanguíneas para exames laboratoriais. Em seguida ao Tempo 20m os animais foram sacrificados e laparotomizados. A perda sanguínea intra-abdominal foi mensurada, a lesão do baço foi analisada macroscopicamente e foram colhidas amostras para estudo microscópico das lesões tratadas com adesivo cirúrgico. Na análise estatística aplicaram-se os testes de Kruskal-Wallis, de Mann-Whitney, de Friedman, de Wilcoxon e de Fisher. Resultados. O adesivo biológico aplicado por laparoscopia foi efetivo e eficaz em coibir o sangramento da lesão em todos os animais do Grupo I, mostrando significância estatística em relação ao Grupo II, no qual o sangramento persistiu até a eutanásia. Conclusão. O adesivo biológico aplicado por laparoscopia é eficaz para a hemostasia de ferimento esplênico em suínos heparinizados.Objective: To study the hemostatic effects of biological adhesive in splenic injury of heparinized pig, applied by laparoscopy. Methods: We have used 18 males distributed in three groups of six, group I (biological adhesive + heparin), group II (heparin) and group III (control). Group I was heparinized and received the application of 0.5 mL of adhesive in splenic injury by laparoscopic; Group II was heparinized and the wound was not treated with adhesive; Group III was not heparinized and received no adhesive treatment at wound. At time 0, 10 and 20 minutes of the injury, hemodynamic and clinical data were recorded as also blood samples for laboratory tests were collected. At 20 minutes animals were sacrificed and laparotomized. The intra-abdominal blood loss was measured, the splenic lesion was macroscopically examined and samples were collected for microscopic examination of the lesions treated with surgical adhesive. Statistical analyses were applied using Kruskal-Wallis, Mann-Whitney, Friedman, Wilcoxon and Fisher tests. Results: The biological adhesive applied by laparoscopy was effective and efficient to curb bleeding of lesion in all animals in Group I, showing statistical significance in relation to Group II in which bleeding persisted until euthanasia. Conclusion: The biological adhesive applied by laparoscopy is effective for hemostasis of splenic injury in heparinized pigs.TEDEBV UNIFESP: Teses e dissertaçõe

Prótese intracava provisória no tratamento de lesão da veia cava retro-hepática

One of the most difficult challenges to surgeons is the treatment of wounds on the retro hepatic vena cava. The anatomic particularities of this venous segment make its approach and treatment difficult, contributing to a high morbidity and mortality. Several techniques have been described for the treatment of these types of lesions. In this particular case, authors have chosen the introduction of a fastened provisory intra caval prothesis, without primary suturing of the wounds. The provisory intra caval prothesis can be an option for the treatment of retro hepatic vena cava lesions

Estudo comparativo das anastomoses manuais em plano único do intestino delgado de cães

BACKGROUND: Two-layer intestinal anastomosis increases the inflammatory response while single-layer anastomosis results in a better wound healing. However the four main kinds of stitches which may be chosen in performing single layer intestinal sutures never before had been comparatively studied. AIM: To compare the four more commonly used types of single layer surgical anastomosis sutures of the digestive tract. METHODS: Six mongrel dogs were operated, each one receiving two anastomosis: one at 30 cm from de Treitz angle - sero-submucosal technique, and the other at 60 cm - total technique. This placement was alternatively inverted. The four more commonly used types of single layer surgical anastomosis sutures of the digestive tract, namely: sero-submucosal stitches tied in the lumen, over the submucosa; sero-submucosal stitches tied in the exterior of the organ, over the serosa; total stitches tied in the lumen, over the mucosa; and total sutures tied in the exterior, over the serosa (Gambee's stitches) were tested. After euthanasia (7th post-operative day) macro and microscopic features were evaluated. Friedman's test was applied for morphometry and for evaluation of the peritoneal adhesions. RESULTS: Statistical significance was demonstrated through major residual acute inflammation and proliferation in total sutures and more profuse adhesions with the sero-submucosal stitches tied in the lumen. The sero-submucosal stitches tied in the exterior over the serosa, had excellent realignment and regeneration of the layers. CONCLUSION: The sero-submucosal stitches tied in the exterior, over the serosa, were the best ones.RACIONAL: As anastomoses intestinais em dois planos aumentam a resposta inflamatória tecidual, enquanto que a anastomose em plano único resulta em um lúmen maior com menos danos às bordas teciduais. Entretanto, os quatro tipos de suturas mais comumente utilizados em suturas intestinais nunca foram antes estudados comparativamente. OBJETIVO: Comparar os quatro tipos de sutura do tubo digestivo em plano único mais freqüentemente utilizados para anastomoses manuais do tubo digestivo. MÉTODOS: Seis cães de raça indefinida foram operados, cada um recebendo duas anastomoses: uma a 30 cm do ângulo de Treitz - técnica sero-submucosa, e a outra a 60 cm - técnica total. Esta localização foi aleatoriamente invertida. Os quatro tipos de sutura em plano único mais freqüentemente utilizados para anastomoses manuais do tubo digestivo, denominados: pontos extramucoso atados no lúmen da víscera, sobre a submucosa, pontos extramucosos atados no exterior, sobre a serosa, pontos totais atados no lúmen, sobre a mucosa, e pontos totais especiais de Gambee atados no exterior sobre a serosa, foram testados. Eutanásia e necropsia parcial no 7º dia pós-operatório permitiu avaliação de aspectos macro e microscópicos. O teste de Friedman's foi aplicado para a morfometria e avaliação das aderências peritoniais. RESULTADOS: Foi demonstrada diferença estatisticamente significante para a inflamação residual aguda e maior proliferação nas suturas totais, bem como na maior ocorrência de aderências com pontos extramucosos atados no lúmen da víscera, sobre a submucosa. A sutura extramucosa com nós atados na serosa teve regeneração das bordas e alinhamento excelentes. CONCLUSÃO: A sutura extramucosa com nós atados na serosa mostrou-se a melhor.Universidade Federal de São Paulo (UNIFESP) Department of Surgery Division of Operative Techniques and Experimental SurgeryUNIFESP, Department of Surgery Division of Operative Techniques and Experimental SurgerySciEL

The laparoscopy splenic injury repair: the use of fibrin glue in a heparinized porcine model O reparo de lesão esplênica por laparoscopia: o uso da cola de fibrina em porcos heparinizados

PURPOSE: To investigate the effectiveness of fibrin glue (laparoscopic via) into promote the hemostasis of a spleen injury on a heparinized porcine model. METHODS: Eighteen Landrace porcine were submitted to laparoscopic spleen injury and randomly distributed: GHA (heparin plus adhesive), GH (heparin without adhesive) and GS (Sham - without heparin or adhesive). Ten minutes before the surgical procedures a single IV dose (200UI/kg) of heparin sodium was administrated only to groups GHA and GH. In the GHA, adhesive was applied after the mechanical injury and recorded the time until the polymerization and clot formation. RESULTS: No significant differences occurred among the groups (Fisher test) considering the weight and surgery time. The blood amount in the abdominal cavity on GH was significantly higher in comparison to the sham group and especially with the GHA (p<0.004). No significant differences were observed in the body temperature, heart rate, cardiac output, means arterial pressure, pulmonary artery pressure during the experiment. The activated partial thromboplastin time (APTT) was lower in the GHA in comparison to GH (p<0.003). CONCLUSION: The fibrin biological adhesive applied by laparoscopy is effective for hemostasis of minor spleen injury in a porcine model under the effect of anticoagulant drug.<br>OBJETIVO: Investigar a eficácia da cola de fibrina (via laparoscópica) na hemostasia de uma lesão no baço de porco heparinizado. MÉTODOS: Dezoito suínos Landrace foram submetidos a lesão do baço e distribuídos aleatoriamente: GHA (heparina adesivo), GH (heparina sem adesivo) e GS (Sham - sem heparina ou adesivo). Dez minutos antes dos procedimentos uma dose única (200UI/kg) de heparina sódica (EV) foi administrada nos grupos GHA e GH. A fibrina (GHA) foi aplicada após a lesão e registrado o tempo até a polimerização e formação do coágulo. RESULTADOS: Não houve diferenças significativas entre os grupos (teste de Fisher), considerando o peso e o tempo de cirurgia. A quantidade de sangue na cavidade abdominal de GH foi significativamente maior em comparação ao GS e, especialmente, com o GHA (p<0,004). Não foram observadas diferenças significativas na temperatura corporal, frequência cardíaca, débito cardíaco, pressão arterial ou pressão da artéria pulmonar durante o experimento (20 minutos). O tempo de tromboplastina parcial ativada (TTPA) foi menor no GHA em relação ao GH (p<0,003). CONCLUSÃO: A cola de fibrina biológica aplicada por laparoscopia é eficaz para a hemostasia de lesões no baço menor em um modelo suíno sob o efeito de drogas anticoagulantes

Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review

Background the aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress needle described in the literature.Methods Iatrogenic injuries caused by Veress needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. the following words were combined: Veress'' or insufflation needle'' or pneumoperitoneum needle,'' and complications'' or injuries'' or lesions.'' the bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress needle insertion in the studies that reported Veress needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution).Results Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed).Conclusion the insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.Universidade Federal de São Paulo, Div Operat Tech & Expt Surg, Dept Surg, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Div Operat Tech & Expt Surg, Dept Surg, BR-04023900 São Paulo, BrazilWeb of Scienc