We have located links that may give you full text access.
Modeling suture patterns for endoscopic gastrojejunostomy revision: Analyzing a technique to address weight regain after gastric bypass.
BACKGROUND: Weight regain after Roux-en-Y gastric bypass affects up to 30% of individuals. A dilated gastrojejunostomy contributes to regain through decreased restriction. Endoscopic gastrojejunostomy revision is a safe alternative to revisional surgery. There is evidence that technique affects outcome, but the mechanical properties of various sutured repairs have not been evaluated.
OBJECTIVE: To compare different suture patterns for endoscopic gastrojejunostomy revision using an ex vivo porcine model.
SETTING: University hospital, United States; surgical laboratory.
METHODS: Gastrojejunostomoies were created between porcine stomach and a small intestine with a circular stapler. The gastrojejunostomy was revised with 1 of 5 suture patterns: simple-interrupted, vest-over-pants, figure-of-eight, purse-string, or hairpin. After revision, the stomachs were pressurized with water under continuous manometric monitoring. Failure pressure was recorded when either the hardware or the tissue became compromised.
RESULTS: Procedure time, failure type, and pressure were recorded for 8 trials per pattern. Average failure pressures from lowest to highest were simple interrupted, vest-over-pants, figure-of-eight, purse-string, and hairpin. By analysis of variance, the failure pressures were different (P<.01). The suture-anchor connection failed 16 times, the tissue tore 24 times, and failure pressure of the former was lower (P<.01). Failure pressure was moderately correlated with number of bites-per-suture. The purse-string pattern was the fastest to perform (P<.05).
CONCLUSION: This study successfully used an ex vivo porcine model to compare performance of suture patterns used for endoscopic gastrojejunostomy revision. More bites-per-suture seems to improve durability by reducing tension on the suture-anchor. For this reason, the interrupted technique is inferior and should likely be abandoned in favor of patterns with more bites-per-suture.
OBJECTIVE: To compare different suture patterns for endoscopic gastrojejunostomy revision using an ex vivo porcine model.
SETTING: University hospital, United States; surgical laboratory.
METHODS: Gastrojejunostomoies were created between porcine stomach and a small intestine with a circular stapler. The gastrojejunostomy was revised with 1 of 5 suture patterns: simple-interrupted, vest-over-pants, figure-of-eight, purse-string, or hairpin. After revision, the stomachs were pressurized with water under continuous manometric monitoring. Failure pressure was recorded when either the hardware or the tissue became compromised.
RESULTS: Procedure time, failure type, and pressure were recorded for 8 trials per pattern. Average failure pressures from lowest to highest were simple interrupted, vest-over-pants, figure-of-eight, purse-string, and hairpin. By analysis of variance, the failure pressures were different (P<.01). The suture-anchor connection failed 16 times, the tissue tore 24 times, and failure pressure of the former was lower (P<.01). Failure pressure was moderately correlated with number of bites-per-suture. The purse-string pattern was the fastest to perform (P<.05).
CONCLUSION: This study successfully used an ex vivo porcine model to compare performance of suture patterns used for endoscopic gastrojejunostomy revision. More bites-per-suture seems to improve durability by reducing tension on the suture-anchor. For this reason, the interrupted technique is inferior and should likely be abandoned in favor of patterns with more bites-per-suture.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association.Circulation 2024 April 19
Essential thrombocythaemia: A contemporary approach with new drugs on the horizon.British Journal of Haematology 2024 April 9
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app