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A study comparing the outcomes of a surgical procedure by name feeding jejunostomy(a procedure wherein a tube is placed into the small intestine for feeding purposes, in patients who have a block in food passage due to cancer), when done via laproscopy vs open techniques.

ABSTRACT: Intervention1: laparoscopic feeding jejunostomy: The patient will be placed in supine position. Pneumoperitoneum will be achieved using open technique with 10 mm umbilical port. Diagnostic laparosco-py will be performed to confirm the stage of the cancer. Two 5 mm working ports will be put one in right hypochondriac and other in the left lumbar region. Duo-deno-jejunal flexure will be identified and the loop of the jejunum 30cm distal to it will be selected. The loop will be anchored to the anterior abdominal wall at the proposed site of jejunostomy i.e. left hypochondrium using two intracorporeal sutures. A purse-string suture will be taken around the site of enterotomy. A 12F Ryles tube will be inserted transcutaneously with the help of 5mm trocar and will be inserted into the lumen of the jejunum by performing the enterotomy within the purse-string suture. The tube will be fixed externally to the skin, and purse-string suture will be tied. The jejunostomy site will be secured to the anterior ab-dominal wall using intracorporeal sutures. Further two parietal anchoring sutures will be applied to efferent loop of the jejunum 5cm distal to the jejunostomy site to prevent the volvulus. The patency of the tube will be checked by confirming the free flow of the Normal saline through tube. The port sites will be closed. Sterile dressing will be applied. The patients shall be followed up for 30 days. Control Intervention1: open feeding jejunostomy: abdomen will be opened via 5-6 cm supra umbilical midline vertical incision. The abdominal cavity will be inspected to confirm the stage of the cancer. Duo-deno-jejunal flexure will be identified and the loop of the jejunum 30cm distal to it will be selected. The loop will be anchored to the anterior abdominal wall at the proposed Primary outcome(s): To assess and compare the incidence of jejunostomy-associated early major complications (Clavien Dindo score ï?³ 3) of the laparoscopic and conventional open feeding jejunostomy in patients with obstructive upper alimentary tract malignancies.Timepoint: 30 days Study Design: Randomized, Parallel Group Trial Method of generating randomization sequence:Permuted block randomization, fixed Method of allocation concealment:Sequentially numbered, sealed, opaque envelopes Blinding and masking:Open Label

DISEASE(S): Malignant Neoplasm Of Overlappingsites Of Esophagus,Malignant Neoplasm Of Overlappingsites Of Hypopharynx,Malignant Neoplasm Of Pylorus,Medical And Surgical

PROVIDER: 2722793 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Many surgical tendon repairs fail despite advances in surgical materials and techniques. Tendon repair failure can be partially attributed to the tendon’s poor intrinsic healing capacity and the repurposing of sutures from use in other tissues. Electrospun materials show promise as a biological scaffold to support endogenous tendon repair, but their relatively low tensile strength has limited their clinical translation. It is hypothesized that combining electrospun fibres with a stronger material may improve the suture’s mechanical properties while retaining biophysical cues necessary to encourage cell-mediated repair. This paper describes the production of a hybrid electrospun-extruded suture with a sheath of submicron electrospun fibres and a core of melt-extruded fibres. The porosity and tensile strength of this hybrid suture is compared to an electrospun-only braided suture and clinically used sutures Vicryl and PDS. Bioactivity is assessed by measuring the adsorbed serum proteins on electrospun and melt-extruded filaments using mass spectrometry. Human hamstring tendon fibroblast attachment and proliferation was quantified and compared between the hybrid and control sutures. Combining an electrospun sheath with melt-extruded cores created a hybrid braid with increased tensile strength (70.1±0.3N) compared to an electrospun only suture (12.9±1N, p<0.0001). The hybrid suture had a similar force at break to clinical sutures, but lower stiffness and stress. The Young’s modulus was 772.6±32Mpa for the hybrid suture, 1693.0±69Mpa for PDS, and 3838.0±132MPa for Vicryl, p<0.0001. Hybrid sutures had lower overall porosity than electrospun-only sutures (40±4% and 60±7%, respectively, p=0.0018) but had a significantly larger overall porosity and average pore diameter compared to surgical sutures. There were similar clusters of adsorbed proteins on electrospun and melt-extruded filaments, which were distinct from PDS. Tendon fibroblast attachment on hybrid and electrospun sutures was significantly higher than on clinical sutures (hybrid 28±7%; electrospun 24±7%; Vicryl 10±5%; PDS 2±0.1%, p<0.0001). Cell proliferation was significantly higher on hybrid and electrospun sutures compared to on clinical sutures. Overall, this study demonstrated that a bioactive suture with increased tensile strength and lower stiffness could be produced by adding a core of 10um melt-extruded fibres to a sheath of electrospun fibres. In contrast to currently used sutures, the hybrid sutures promoted a bioactive response: serum proteins adsorbed, and fibroblasts attached, survived, grew along the sutures, and adopted appropriate morphologies.

Dataset Information

A study comparing the outcomes of a surgical procedure by name feeding jejunostomy(a procedure wherein a tube is placed into the small intestine for feeding purposes, in patients who have a block in food passage due to cancer), when done via laproscopy vs open techniques.

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