New microsurgical vascular anastomosis technique for the treatment of intestinal failure
Posted by: admin | July 30, 2009 | 0 Comments
with intestinal failure who are not good candidates for total parenteral nutrition
(TPN) treatment or for patients who have had previous reactions to TPN are left with only one option, small-intestine transplantation (SIT). This option comes with a risk of infection, acute and chronic rejection, and graft-versus-host disease. Therefore, a significant effort has been put forth in order to solve this challenge. The rat has played an important role in the development of surgical protocols and in the understanding of the immunological consequences of these procedures. This year Xue et al have summarized previous transplantation protocols and introduced a new microsurgical vascular anastomosis technique using porto-portal cuff anastomosis without a microscope or traditional suture for vascular construction and they reported a decreased rate of complication and an increased survival rate with this technique. Please see the abstract below.
BACKGROUND: Establishment of an instant, reproducible, and reliable rat model of a refined 3-cuff technique for performing orthotopic intestinal transplantation is reported, and the surgical skills required to perform modified surgical procedure are discussed.
METHODS: A retrospective analysis was used to study 270 rat cases subject to orthotopic intestinal transplantation (OIT) performed in our transplantation center from March 2006 to March 2008. After establishing the portal vein cuff method, a conventional hand-sewn anastomosis method combination, with porto-to-portal re-establishment by cuffed anastomosis technique, was used in group 1 (n _ 140), and the modified 3-cuff anastomosis method was applied in group 2 (n _ 130). Statistical comparison was made between the 2 groups.
RESULTS: In group 1, 97 of 140 (69.3%) recipients survived _7 days, and 69 (49.3%) survived 30 days, whereas in group 2, respective survival was 110 of 130 (84.6%) and 86 of 130 (66.2%). Average cold ischemic times in the 2 groups were 48.5 _ 5.1 minutes and 31 _ 3.0 minutes,respectively. There was a significant difference between the 2 groups (P _.05). In most cases, the average volume of bleeding during recipient surgery was _1 mL using the simplified 3-cuff anastomosis technique. There was shorter graft revascularization time with the new model of sutureless microanastomosis using cuff apparatus for OIT in rats compared with the control group. The method adopted in group 2 was much easier, more stable, and more feasible than that in group 1. Sixty-three rats died in 7 days, and autopsy verified the causative factors leading to death, which are summarized in the text. The results obtained were acceptable and satisfactory. Overall, there was a comparative lower incidence of complications
associated with the procedure used in group 2.
CONCLUSIONS: The modified 3-cuff anastomosis technique for rat OIT models has several obvious advantages, which can be summarized as follows: vascular anastomosis is stable and simplified, and blood loss is significantly decreased; natural anatomic physiologic portal graft drainage is maintained; and intraoperative mortality and postsurgical morbidity are minimized. Furthermore, technical refinement of rat OIT models established by our research team can be carried out without a microscope and can be easily implemented in the laboratory by 1 trainee with acceptable success after a short period of training. We regard it as one of the best available orthotopic small-bowel transplantation methods in rat.