By G. Herold, G. Preclik, E. F. Stange (auth.), Univ.-Prof. Dr. Günther Schlag, Univ.-Prof. Dr. Wolfgang Wayand (eds.)
The final quantity within the sequence Fibrin Sealing in Surgical andNonsurgical Fields discusses a variety of makes use of of fibrin glue in endoscopic surgical procedure. over the last years fibrin sealant has been verified within the therapy of gastrointestinal ulcers and esophageal fistulae.
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This regimen was successful in 20 patients (61 %) treated in the lower GIT; 11 of the 14 anastomotic defects (79 %) could be repaired _permanently. However, in only five of 13 patients with colorectal fistulas (38 %) and four of six patients with rectovaginal fistulas was fibrin glue treatment completely effective, usually being less successful in patients with long-term, chronic fistulas and those who had chronic infections. The duration of treatment was considerably longer (up to 16 weeks) and more frequent in the lower GIT than in the upper GIT.
The hook incises successively the serosal layer, the oblique, and then the circular superficial muscular layers. The two borders are then grasped and gently spread apart mechanically, thus breaking the remaining deep circular fibers. Electrocautery completes the division whenever necessary. Once the last muscular fibers have been divided, the mucosa can easily be identified by its typical blue color as it "pops" out of the incision. Because of the magnification, the surgeon can easily verify that no holes have been made inadvertently.
Mouiel et a1. Conclusion Laparoscopic surgical treatment of duodenal ulcer disease is as safe and efficient as in open surgery. In elective cases, posterior truncal vagotomy and seromyotomy according the Taylor's procedure is full of promise and can be proposed for the patients resistant to medical treatment or noncompliant to maintenance drugs. Nevertheless, this new laparoscopic technique needs to be evaluated by multicenter control trial to evaluate not only the results of laparoscopic surgery but to compare them with medical treatment as to their efficacy and their cost effectiveness.
Endoscopy by G. Herold, G. Preclik, E. F. Stange (auth.), Univ.-Prof. Dr. Günther Schlag, Univ.-Prof. Dr. Wolfgang Wayand (eds.)