Polyglycolic acid sheet fibrin glue filling method for esophageal fistula.
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ABSTRACT:
SUBMITTER: Kinoshita S
PROVIDER: S-EPMC6162968 | biostudies-literature | 2018 Oct
REPOSITORIES: biostudies-literature
Publications
Polyglycolic acid sheet fibrin glue filling method for esophageal fistula.
Kinoshita Satoshi S Nishihara Yuichi Y Mori Hideki H Nishizawa Toshihiro T
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20180906 10
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Project description:Background:Uniportal video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP) has demonstrated acceptable surgical outcomes while being less invasive than other surgical techniques. Fibrin glue-covered absorbable mesh has been applied to reinforce resected regions to prevent recurrence. We aimed to evaluate the outcomes of this technique without pleural abrasion in uniportal VATS for PSP. Methods:Between July 2012 and May 2017, 54 consecutive patients with PSP underwent uniportal VATS by a combination technique using a polyglycolic acid (PGA) sheet and fibrin glue without mechanical pleural abrasion. A bilateral approach was performed in five additional patients; thus, postoperative surgical outcomes of a total of 59 cases were analyzed. For subgroup analysis, we first divided the patients into a group of PGA sheet coverage, followed by additional fibrin glue application (n=36, Group A) and a group of fibrin glue injection prior to PGA sheet coverage (n=23, Group B). We reviewed the data and compared surgical outcomes to evaluate the efficacy of the application techniques. Results:There was a total 59 cases (43 males) with a median age of 18.0 years (range, 12-50 years). Demographic data revealed no differences between the two groups. There was no significant difference in operation time (41.8±10.1 vs. 41.3±8.8 minutes, P=0.821), length of hospital stay (4.1±1.3 vs. 3.8±1.1 days, P=0.411), or chest tube in-dwelling time (2.6±0.9 vs. 2.2±0.7 days, P=0.078) in the additional glue application and glue injection groups. Recurrence rates revealed no significant difference [2/36 (5.5%) vs. 1/23 (4.3%), P=0.837] between the two groups. There were neither conversions to multi-port VATS nor perioperative complications during a median follow-up period of 21.5 months. Conclusions:The combination method of the absorbable PGA sheet with fibrin glue established satisfactory outcomes without increasing morbidities, regardless of application technique. This simple technique is an effective procedure that does not require mechanical pleural abrasion or pleurodesis to prevent postoperative recurrences when conducting uniportal VATS for PSP.
| S-EPMC7139057 | biostudies-literature
Project description:Interventions: Covering ulcer bed made after colorectal ESD with Neoveil and Beriplast
Primary outcome(s): The extent of remaining Neoveil on the ulcer bed 8 to 14 days after ESD
Study Design: Single arm Non-randomized
| 2624255 | ecrin-mdr-crc
Project description:Meniscal repair is one of the most common procedures for meniscal tears; however, a previous systematic review showed meniscal repairs have a greater reoperation rate compared with partial meniscectomies. Therefore, an improvement of existing meniscal repair techniques is warranted. Clinical results of polyglycolic acid (PGA) sheets have been reported for rotator cuff repairs. In recent years, we have performed meniscal repairs using wrapped fibrin clots in PGA sheet. We considered the use of wrapped fibrin clots with a PGA sheet to treat meniscus tears. The purpose of this paper is to introduce a step-by-step guide to our new delivery technique using fibrin clots.
| S-EPMC8626662 | biostudies-literature
Project description:BackgroundPostoperative pancreatic fistula (POPF) continues to be the most common complication after distal pancreatectomy (DP). Recent advancements in surgical techniques have established minimally invasive distal pancreatectomy (MIDP) as the standard treatment for various conditions, including pancreatic cancer. However, MIDP has not demonstrated a clear advantage over open DP in terms of POPF rates, indicating the need for additional strategies to prevent POPF in MIDP. This trial (WRAP study) aims to evaluate the efficacy of wrapping the pancreatic stump with polyglycolic acid (PGA) mesh and fibrin glue in preventing clinically relevant (CR-) POPF following MIDP.MethodsThis multicenter, randomized controlled trial will include patients scheduled for laparoscopic or robotic DP for tumors in the pancreatic body and/or tail. Eligible participants will be centrally randomized into either the control group (Group A) or the intervention group (Group B), where the pancreatic stump will be reinforced by PGA mesh and fibrin glue. In both groups, pancreatic transection will be performed using a bioabsorbable reinforcement-attached stapler. A total of 172 patients will be enrolled across 14 high-volume centers in Japan. The primary endpoint is the incidence of CR-POPF (International Study Group of Pancreatic Surgery grade B/C).DiscussionThe WRAP study will determine whether the reinforcement of the pancreatic stump with PGA mesh and fibrin glue, a technique whose utility has been previously debated, could become the best practice in the era of MIDP, thereby enhancing its safety.Trial registrationThis trial was registered with the Japan Registry of Clinical Trials on June 15, 2024 (jRCTs032240120).
| S-EPMC11481437 | biostudies-literature
Project description:BACKGROUND AND STUDY AIMS: The safety and efficacy of the application of polyglycolic acid (PGA) sheets with fibrin glue to ulcers induced by endoscopic submucosal dissection (ESD) have not been established in the treatment of lesions of the gastrointestinal tract, in which the influence of digestive fluid and peristalsis may affect treatment, and there may also be a risk of infection. The aims of this study were to evaluate the healing process of ESD-induced ulcers in animals treated with the application of a PGA sheet with fibrin glue and to verify experimentally the safety of this treatment procedure. MATERIALS AND METHODS: Gastric ESD was performed in nine pigs under general anesthesia. Two ulcer sites were prepared in each pig; one ulcer was treated by applying a PGA sheet with fibrin glue (treated ulcer site), while the other ulcer was left untreated (control ulcer site). Three pigs were euthanized at week 1, three at week 4, and three at week 8 after ESD, and the ulcer sites were macroscopically and histopathologically evaluated. RESULTS: Of the nine treated ulcer sites, seven ulcer sites, to which a PGA sheet had been applied without exposure to the mucosal fluid, showed no peeling of the sheet despite the influence of peristalsis and gastric acid. Histopathologic examination revealed abundant, newly formed blood vessels in the treated ulcers and good granulation. In the treated ulcers, no excessive inflammation, necrosis, or infection was observed. CONCLUSIONS: Our animal study experimentally demonstrated that this treatment technique can be safely applied to ESD-induced ulcers.
| S-EPMC4477022 | biostudies-other
Project description:Esophageal leaks are a potentially life-threatening condition. One treatment option is injection therapy with commercially available fibrin glue. We describe herein a method to close esophageal leaks by injecting autologous fibrin glue prepared exclusively with the patient's own blood.
| S-EPMC4612238 | biostudies-other
Project description:BackgroundAlthough there have been several reports of treating large post-endoscopic submucosal dissection (ESD) ulcers by covering them with a polyglycolic acid sheet (PGAs), this approach presents problems regarding PGAs delivery. This study assessed the usefulness of a device delivery station system (DDSS) to evaluate the appropriate and rapid PGAs coating method with DDSS.MethodsThirty-nine of 41 patients who were diagnosed with early gastric cancer over 20 mm in diameter and pathologically diagnosed with well-differentiated adenocarcinoma were randomly allocated to the following two groups according to delivery method: the conventional PGAs delivery group (C group) (n = 19) and the new DDSS group (DDSS group) (n = 20). The primary outcome was the coating area per minute in the C group and DDSS group (cm2/min).ResultsThere were significant differences in the coating time (min), with values of 34.1 (15.0-60.7) vs. 16.85 (11.5-27.2) min for the C group and DDSS group, respectively (p = 0.001). There was also a significant difference in coating area per minute, with values of 0.261 (0.02-1.00) and 0.96 (0.173-2.06) cm2/min for the C group and DDSS group, respectively (p = 0.001). There were four cases of post-ESD bleeding (1-7 days after ESD) in the C group compared with 0 in the DDSS group, which represented a significant difference (p = 0.030).ConclusionsThe DDSS was very useful for rapidly delivering and tightly attaching a PGAs to control post-ESD bleeding.Trial registrationUniversity Hospital Medical Network (UMIN) 000026377.
| S-EPMC5988784 | biostudies-literature
Project description:The coverage technique using absorbable mesh was first described in a European guideline published in 2015 as a preventive method for the recurrence of spontaneous pneumothorax. We performed a meta-analysis based on a literature search of primary studies that compared the postoperative recurrence rate of primary spontaneous pneumothorax between the use and nonuse of polyglycolic acid sheet coverage. Two reviewers independently selected and evaluated the quality of the relevant studies. The risk ratio in each study was calculated in a random-effect meta-analysis. Statistical heterogeneity among the included studies was quantitatively evaluated using the I2 index, and publication bias was assessed using a funnel plot. A total of 19 retrospective cohort studies were analyzed: 1524 patients who underwent wedge resection alone (the control group) and 1579 who received additional sheet coverage. Polyglycolic acid sheet coverage was associated with a lower recurrence rate than that in the control group (risk ratio: 0.27, 95% confidence interval 0.20-0.37, P < 0.001; I2 0%). The funnel plot suggested possible publication bias. The covering technique reduced the recurrence rate of pneumothorax after thoracoscopic surgery to one-fourth.
| S-EPMC7873206 | biostudies-literature
Project description:BackgroundMiddle lobe torsion is a rare complication of right upper lobectomy. Middle lobe torsion can be critical; thus, various preventive measures are used.Case presentationA 77-year-old man underwent thoracoscopic right upper lobectomy with partial middle resection and S6 segmentectomy for right upper lobe lung cancer located at the confluence of the three lobes and lower lobe lung cancer. Inversion of the middle lobe was observed during lung expansion before chest closure. A bridging structure with an absorptive sheet and fibrin glue was placed in the basal section of the middle lobe under lung expansion to prevent torsion. On postoperative day 1, the patient was tachycardic and was found to have decreased lung field permeability. The patient underwent emergency surgery for suspected middle lobe torsion. Dislocation of the bridging structure between the basal segments of the middle lobe was confirmed, and the middle lobe was deviated cephalad. In addition, pulmonary congestion in S4 due to pressure stenosis of V4 caused by the deviation of the middle lobe was observed, and middle lobe resection was performed. The postoperative course was uneventful.ConclusionsThis case suggested that the reinforcement method with an absorptive sheet and fibrin glue lacked sufficient strength to prevent middle lobe torsion. Stronger fixation should be considered if the middle lobe rotation is thought to be sufficiently strong when the lung is reinflated before chest closure.
| S-EPMC9643308 | biostudies-literature
Project description:BackgroundPostoperative stricture and refractory stricture are severe adverse events which occur after expansive esophageal endoscopic submucosal dissection (ESD). The aim of this study was to assess the efficacy of steroid injection, polyglycolic acid (PGA) shielding, and of additional steroid injection thereafter for the prevention of refractory esophageal stricture.MethodsThis is a retrospective cohort study of 816 consecutive cases of esophageal ESD performed between 2002 and 2021 at the University of Tokyo Hospital. After 2013, all patients with a diagnosis of superficial esophageal carcinoma covering over 1/2 the esophageal circumference underwent preventive treatment immediately after ESD with either "PGA shielding", "steroid injection", or "steroid injection + PGA shielding". Additional steroid injection was performed for high-risk patients after 2019.ResultsThe risk of refractory stricture was especially high in the cervical esophagus (OR 24.77, p = 0.002) and after total circumferential resection (OR 894.04, p < 0.001). "Steroid injection + PGA shielding" was the only method significantly effective in preventing stricture occurrence (OR 0.36; 95% CI 0.15-0.83, p = 0.012). This method also decreased the risk of refractory stricture (OR 0.38; 95% CI 0.10-1.28, p = 0.096), but additional steroid injection was the only significantly effective method for prevention of refractory stricture (OR 0.42; 95% CI 0.14-0.98, p = 0.029).ConclusionCombining steroid injection and PGA shielding is effective for preventing post-ESD stricture and refractory stricture. Additional steroid injection is a viable option for patients at high-risk for refractory stricture.
| S-EPMC10338585 | biostudies-literature