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PURPOSE

Staple line leak (SLL) is a serious complication after sleeve gastrectomy (SG). Common endoscopic treatment options include self-expandable metallic stent (SEMS), endoscopic internal drainage (EID), and endoscopic closure. The endoscopic negative pressure therapy (ENPT) is a promising treatment option combining temporary sealing of the defect with drainage of the inflammatory bed. In this study, we compare the outcome of ENPT and SEMS for the treatment of SLL following SG.

MATERIALS AND METHODS

A retrospective cohort of 27 patients (21 females) treated at a single center for SLL after SG was included. ENPT was primary therapy for 14 patients and compared with 13 patients treated primarily using SEMS.

RESULTS

ENPT was associated with a significant reduction of hospital stay (19 ± 15.1 vs. 56.69 ± 47.21 days, p = 0.027), reduced duration of endoscopic treatment (9.8 ± 8.6 vs. 44.92 ± 60.98 days, p = 0.009), and shorter transabdominal drain dwell time (15 (5-96) vs. 45 (12-162) days, p = 0.014) when compared to SEMS. Whereas endoscopic management was successful in 12/14 (85.7%) of patients from the ENPT group, SEMS was successful in only 5/13 (38.5%) of patients (p = 0.015). Furthermore, ENPT was associated with a significant reduction of endoscopic adverse events compared with SEMS (14.3% vs. 76.92% p = 0.001).

CONCLUSION

Compared with SEMS, ENPT is effective and safe in treating SLL after SG providing higher success rates, shorter treatment duration, and lower adverse events rates.

Endoscopic negative pressure therapy (ENPT) represents a modern and effective treatment strategy for gastrointestinal tract wall defects. The intracavitary treatment strategy is based on placing a sponge within the defect cavity (Fig. 1), whereas the intraluminal treatment approach is based on placing a drainage device within the visceral lumen overlapping the defect area (Fig. 2). These strategies complement each other and are successful treatments for gastrointestinal perforation and postoperative adverse events in the upper or lower GI tract.

An open-pore film drainage (OFD) device was first described in 2015 by Loske et al3 and has been used for several indications in the upper GI tract, urinary tract, and other sites. OFD may offer several advantages in terms of easier placement, adhesiveness to the wound base, less frequent reintervention, and better fluid mobilization. In this video (Video 1, available online at www.giejournal.org), we present the assembly and placement procedure of a fashioned OFD device that allows simultaneous enteral feeding.

Since the introduction of negative pressure therapy of the abdomen, care has been taken to protect the intestine from the effects of negative pressure in order to avoid impairments of abdominal organs. As an alternative to the widespread AB-Thera^R system (KCI, San Antonio, Texas, USA), the different concept of Suprasorb CNP^R (Lohmann & Rauscher, Austria-Germany) was introduced by the producer with the premise of achieving a better therapeutic effect. Due to numerous pores of the film, the effects of the negative pressure are brought to the surface of the intestinal organs and these effects were tested on seven experimental animals. Particular attention was paid to the small intestine, colon, liver, and pancreas. Over 8 h continuously, three animals were tested with −80 mmHg, 4 with −60 mmHg. The results showed no macroscopic pathological changes. The histological results showed borderline changes in the small intestine and colon with −80 mmHg application, minimal or none with −60 mmHg. The liver and pancreas were found free of pathological changes. For use on human organs, the intra-abdominal application of −60 mmHg for the Suprasorb CNP system is proposed as the standard.

A monofilament fibre debridement pad has been found to be a rapid and effective mechanical method of removing dry skin, biofilm and debris from acute and chronic wounds with minimal patient discomfort. Evidence of its impact on prescribing and wound healing, however, has been more limited. The aim of this audit was to show evidence of the monofilament fibre debridement pad's impact on wound treatment costs through an analysis of NHS wound-care prescribing data in England. A dataset for 486 uniquely identified patients who had been newly prescribed the monofilament fibre debridement pad was obtained from the NHS Business Services Authority. All data were anonymised. Costs were identified for the six months before and six months after the month of first prescription of the monofilament fibre debridement pad. The total cost of wound-care prescribing fell by 14% or £101,723 in the six months after the intervention compared with the six months before. The average monthly expenditure per patient fell from £244 before the intervention to £209 (n=486) after. These results indicate that use of the monofilament fibre debridement pad could reduce prescribing costs and the use of antimicrobial and negative pressure therapies. Further research is warranted to investigate the clinical role of the monofilament fibre debridement pad in wound healing.

OBJECTIVE

The aim of this study was to evaluate the effect of an iodine tampon on postoperative discomfort after surgical removal of a mandibular third molar.

MATERIAL AND METHODS

Patients were randomly assigned to two groups: one group received an alveolar iodine-containing tampon in the extraction socket (N = 44), and the other group used a disposable syringe (Monoject®) to rinse the wound (N = 43). Postoperative discomfort was assessed with the Oral Health Impact Profile-14 (OHIP-14) questionnaire, Pain Intensity Numerical Rating Scale (PI-NRS), and questions about self-care and discomfort.

RESULTS

This study included 87 patients (52 women and 35 men) with an average age of 26.47 years (SD, 6.36). The mean OHIP-14 sum scores were significantly lower in the iodine tampon group compared with the Monoject® syringe group. Mean PI-NRS scores significantly differed between the iodine tampon group (3.33; SE, 0.27) and Monoject® syringe group (4.46; SE, 0.27) (F (1, 85) = 8.16, p < 0.01), with no interaction effect between time and PI-NRS (F (6, 510) = 1.26, p = 0.28). Patients in the iodine tampon group reported less postoperative discomfort.

CONCLUSIONS

Insertion of an iodine-containing tampon in the postoperative socket reduced the pain and impact on oral health-related quality of life during the first postoperative week and positively influenced postoperative sequelae.

Aim: Foam dressings are thought to aid in the establishment of a beneficial moist wound environment as they exhibit excellent fluid management capacity by absorbing as well as donating fluid. Therefore, a scratch wound healing model using human fibroblasts and keratinocytes was developed depending on the donation of fluid by the applied dressings. The effect on cell proliferation and migration of NFD* and cotton gauze was investigated.

Methods: Human dermal fibroblasts (DF) and human epidermal keratinocytes (HaCaT) were seeded into 6-well-plates and cultivated for 48h before scratching. NFD and gauze were cut aseptically (d=3.5cm), soaked in medium and applied directly on the cell scratches without further medium addition. Cells were stained with hematoxylin/eosin after 1, 6, 24, and 48h. Scratches were photographed using a digital microscope and evaluated using the Image J program.

Results: It was found that NFD supported the scratch healing in vitro by promoting fibroblast and keratinocyte proliferation and migration through establishing a moist wound environment. Results were almost comparable to the medium control. In contrast, scratches covered with gauze remained open, probably due to the loss of moisture by drying of the wound dressing.

Conclusions: It could be shown that NFD is able to promote wound healing by effectively creating humid conditions favouring wound closure while gauze was not able to maintain the moist environment resulting in non-healing cell scratch wounds in vitro.

*NFD - Suprasorb® P sensitive (Lohmann&Rauscher)

Background and Aims

In the management of leg ulcers and hyperkeratosis of the surrounding skin, it is not uncommon for them to affect very large areas of the leg. The large size also leads to an increase in the level of exudate and the amount of devitalised tissue. As a result, a larger amount of material is needed to loosen and remove the devitalised tissue than is the case with smaller wounds. To evaluate the performance of this debridement pad optimised for larger wounds and the surrounding skin, a small case series was performed.

Methods

For the case series leg ulcers of various origins that needed debridement were treated once or over a longer period of time with the larger pad when indicated. The treatment was documented both photographically and in writing.

Results

Five patients between the ages of 64 and 83 were treated. All of them suffered from chronic ulcers covering a big area on their legs. At least some of the wounds were colonised with bacteria/biofilm. Two patients were suffering from hyperkeratosis, too. The debridement with the debridement pad was well tolerated by the patients. Biofilm as well as devitalised tissue were removed effectively. All wounds were healed or becoming better.

Conclusions

Most of the time one pad was sufficient, even for ulcers spreading to cover the entire gaiter area. A much larger area could be treated efficiently and quicker than it would have been possible with a smaller device. In addition, the enlargement of the device is accompanied by an increase in the absorption capacity for exudate, slough and debris.

Background and Aims

In the management of leg ulcers and hyperkeratosis of the surrounding skin, it is not uncommon for them to affect very large areas of the leg. The large size also leads to an increase in the level of exudate and the amount of devitalised tissue. As a result, a larger amount of material is needed to loosen and remove the devitalised tissue than is the case with smaller wounds. To evaluate the performance of this debridement pad optimised for larger wounds and the surrounding skin, a small case series was performed.

Methods

For the case series leg ulcers of various origins that needed debridement were treated once or over a longer period of time with the larger pad when indicated. The treatment was documented both photographically and in writing.

Results

Five patients between the ages of 64 and 83 were treated. All of them suffered from chronic ulcers covering a big area on their legs. At least some of the wounds were colonised with bacteria/biofilm. Two patients were suffering from hyperkeratosis, too. The debridement with the debridement pad was well tolerated by the patients. Biofilm as well as devitalised tissue were removed effectively. All wounds were healed or becoming better.

Conclusions

Most of the time one pad was sufficient, even for ulcers spreading to cover the entire gaiter area. A much larger area could be treated efficiently and quicker than it would have been possible with a smaller device. In addition, the enlargement of the device is accompanied by an increase in the absorption capacity for exudate, slough and debris.