A Comparative study on Outcome of Stapler Versus Hand Sewn Anastamosis in Elective Gastro Intestinal Surgeries

INTRODUCTION: In gastro intestinal surgery after rection of bowel loops, anastomosis of the bowel loops is the central part of the gastroentrology. Sero muscular suture technique is the main stay of the Gastro intestinal surgery which is described lembert in 1826. Single layer extra mucosal anastomosis is the more commonly used now a days which is described by Matheson of Aberdeen because of which has the capacity to produced least tissue necrosing or luminal narrowing. Which has to replaced to catgut and silk now a days The stapler devices recently introduced and this helps anastomosis of bowel loops with less tissue injury and ased time duration of procedure. It also decreases the anastamotic leak complication. For the past years stapler technique commonly used many of the surgeons, its more useful than the hand sewn anastomosis for safety, easily accessibility, duration of procedure, efficiency. This study compares the hand sewn anastomosis with stapler anastomosis and it conducted in our Govt. Stanley Hospital. So stapler technique is commonly used in many surgical deparment and widely accepted. Many surgeon having doubt regarding the stapler, how its used in critical sites, regarding 100% water with air anastomosis. Hand sewn statics made over stapled anastomosis it will protect the anastomotic site. AIM OF THE STUDY: The purpose of the presentation is to compare the feasibility safety and efficacy of the outcome of stapler and hand sewn anastomosis in elective gastro intestinal surgeries. MATERIALS AND METHODS: This study was conducted in the department of surgery & Department of gastroenterology at Govt. Stanley medical college, started from December 2011 to November 2012 between the groups of hand sewn and stapler anastomosis in elective gastro intestinal surgeries. • Control group- hand sewn anastomosis, • Study group-stapler anastomosis. This study included 100 patients; 56 of them underwent hand sewn anastomosis. Its consists of 37 male patients, 19 female patient (mean age group 51 years). 44 of them underwent stapler technique. Out of 44 patient 27 male patient,17female patient(mean age group 49 years). Hand sewn anastomosis done by single layer or double layer is under control group, but the study group has stapler anastomosis. Which was done by side to side or end to end anastomoses, it depends upon accessibility, the need of surgery, anastomotic site, using which type of stapler instruments. RESULTS: The mean age of this procedure 52 in hand sewn, 50 in stapler total number of patient was19 where 10 underwent hand sewn anastomosis, 9 underwent stapler anastomosis. In my study the average time of operation in hand sewn anastomoses is 2.400 hrs but in case stapler anastomoses it was 2.167 hrs. The return of bowel sound is 2.80 days in suture anastomosis, it was 2.22 in mechanical devices. The mean time of starting oral feeding is 3.20 days in hand sewn anastomoses but in case of stapler anastomoses it was 2.56 days .hospitalization is 8.10 days in hand sewn anastomoses, but it was 6.44 days stapler anastomoses. Average return to work in hand sewn technique is 5.60 month in contrast 4.22 month in stapler technique the p value of this 0..002. CONCLUSION: Comparison study of hand sewn versus stapler was conducted previously had not shown any different between these two anastomotic technique. In my study i found a significant difference in reduction of time duration of surgical procedure using well trained surgeons in both type ofanastomotic technique. Seven variability compare the six group gastro intestinal surgeries.The variability are following: • Duration of procedure, • Return of bowel sound, • Oral feeding, • Return to work, • Hospitalization, • Complication, • Mortality. So after conducting in my study the following results showing stapler anastomoses is superior to the hand sewn anastomoses: • Less tissue injury, • Less operating time, • Early recovery of bowel sound, • Oral feeding started as early as possible, • Early mobilization from the bed, • Decreased hospitalization, • Early return to normal day to day activity, Recent advanced mechanical are more costly than the suture materials, cost benefit not included in my study because the study done in Govt. hospital. The stapling techniques are quicker to perform, particularly in situations where inaccessibleeg pelvic surgeries like low colorectal anastomosis or in various oesophageal anastomosis. Thus, the staplinganastomosis can be used safely and effectively as part of the surgical department and one should be equally adept with a stapler gun as with needle-holder and suture

Thermo-Mechanical Modeling of Carbon Nanotube Thermal Interfaces

In the last decade, much research has attempted to develop a highly conducting and mechanically reliable thermal interface material. Vertically aligned carbon nanotube arrays (CNTs) is a promising thermal interface material due to the high thermal conductivity of each CNT and the mechanical compliance of CNT arrays [1]. The computational modeling of CNTs is usually at an atomistic scale; however, atomistic simulations are computationally expensive for modeling macroscopic CNT arrays used in experiments. Coarse grain simulation techniques [2] have been developed to reduce the number of degrees of freedom and hence making large scale simulations computationally tractable. The purpose of this project is to build a nanoHUB tool for performing coarse grain simulations of vertically aligned CNT arrays. The tool simplifies the simulation process and allows for parametric studies that would help in the design optimization of CNT thermal interface materials. Geometric parameters such as CNT array height, spacing, and CNT diameter can be input from the GUI and results such as stress-strain curve and Young’s modulus of the array can be downloaded. The pressure dependence of thermal contact resistance can also be obtained from the tool. This tool is expected to be useful to experimental researchers working in the field of CNT-based thermal interfaces

Formative Evaluation to Determine Facilitators and Barriers to Nurse-driven Implementation: Designing an Inpatient mHealth Intervention to Support Smoking Cessation

The inpatient setting is often a missed opportunity for the introduction of technology to promote health using behavioral techniques. Nurses are stakeholders in the implementation of technology for patients in the inpatient setting and are essential for the determination of feasibility and relevance. The objective of this study was to identify facilitators and barriers for introduction of health-related patient technology, and specifically the appropriateness of mobile health (mHealth) technology in the hospital setting as identified by nurse leaders and staff. Methods of formative evaluation included nurse leader and staff semi-structured interviews and qualitative analysis. Nurses are comfortable with patients using mHealth technology in the inpatient setting. Facilitators for the introduction of technology to hospitalized patients were identified. Based on the formative evaluation findings, we developed an Implementation Program for mHealth technology introduction in the inpatient setting

A test-bed for the Correlation Center of Digital Services

For an e-business to be successful, companies need to formulate a business strategy, have informative strategic alliances, develop an international system, build a proactive infrastructure, internationalize their model, capture the residual value, exploit the international telecommunications liberalization, homogenize the data structure and globalize human resources. To achieve their objective, businesses need a more integrated automation system to speed up the process of establishing and conducting Internet-based services. In this paper, a component-based prototyping approach is used in developing a generic model and framework for a correlation center that provides entrepreneurs with a tool to quickly build and automate e-commerce linkages, thus enabling companies to establish their businesses over the Internet using a proven methodology

A Web-based interactive Student Advising system using Java frameworks

The use of open source frameworks and tools has become popular in Java development. These frameworks and tools have core strengths and weaknesses and are selected accordingly for development. Consequently, one of the key issues that developers face is to integrate and configure these tools together. This paper demonstrates the use of popular Java frameworks and tools to develop a Web-based interactive Student Registration and Advising system

Recommender Systems For Computer Tailored Health Communications

Presentation on the development of a recommender system for a computer-tailored health communications tool that assists with helping tobacco users to quit smoking. This presentation was part of the retreat mini-symposium entitled: Smartphones, Sensors, and Social Networks: The New Tools of Health Behavior Change

Process Personalization Framework for Service-Driven Enterprises

Service functions and service activities are integral part of enterprises. Although technologies have improved for developing service functions, errors persist in service activities. Noted computer scientist Ramamoorthy describes personalization, customization, and humanization of service functions as an effective approach for reducing error in service activities. This paper argues that current personalization approaches does not effectively address the entire spectrum of service functions. The proposed personalization framework can advance current state of personalization through enabling tools as services and services as tools. We discuss the framework utilizing biological research as a service-driven enterprise example. The proposed framework is based on our enterprise process personalization patent