In the early 1920´s, de Petz developed a relatively simple automatic suturing clamp after experimenting with large and more cumbersome devices. But at that time, the suture line was reinforced with an inverting nonabsorbable sutures.
Recently the Auto-Suture Staplers developed by the U.S. Surgical Corporation have been used widely in the United States and European countries and these staplers have the improved qualities over the other stapling instruments in the past. These devices have been modified and designed to accept disposable cartridges.
There are several kinds of stapling instruments which are: TA go, TA 55, TA 30 and GIA for the division and suturing of the gastrointestinal tract, EEA for the luminal anasto-mosis of the gastrointestinal tract. There are also LDS and SFS for the ligation and division of the vessels and suturing of the fascia and skin.
121 cases of the gastrointestinal surgery with the Auto-Suture Staplers have been studied during the period of Dec. 1980, to Oct. 1982 at the Department of Surgery, Keimyung Unive-rsity, Dong San Hospital and the clinical analysis and review of literatures were carried out on theses cases.
The results were as follows;
1) In 121 cases, 92 were males and 29 were females and the most common age distribution was in the 5th decade.
2) Specific surgery of the 121 cases was as follows;
Total gastrectomy with esophagojejunostomy in 30 cases, partial gastrectomy with gastroje-junostomy (B-II) in 37 cases, partial gastrectomy with gastroduodenostomy (B-I) in 11 cases, pyloroplasty in 11 cases, proximal gastrectomy with esophagogastrostomy in 3 cases, esopha-geal transection with esophagogastric devascularization for the bleeding esophageal varices in 14 cases, lower anterior resection in 8 cases and Duhamel´s procedure for congenital megaco-Ion in 6 cases.
3) Postoperative specific complications developed in 5 cases; anastomotic leakage in 3 cases (2.32%), bleeding in 2 cases (1. 55%) and there was no mortality in these series.
4) The advantages of the Auto-Suture Staplers are
a) reduction of operating time
b) reduction of blood loss
c) lesser tissue manipulation
d) technical simplicity
e) relatively lower operative mortality
f) more secure and cosmetic closure.
Of course, the Auto-Suture stapling technique cannot completely substitute the conventional suturing method, but with the above mentioned many advantages the use of stapling instrum-ent is well recommended and will contribute more for the development of surgical science.
|