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Wasay, Hafiz Ali, Muhammad Aamir Jameel, Muhammad Imran Anwar, HaroonJavaid Majid, and Sameen Tahir. "Comparative effects of suture and non-suture surgical techniques on platysma after Thyroid surgery." Pakistan Journal of Medical and Health Sciences 15, no. 7 (July 26, 2021): 1661–64. http://dx.doi.org/10.53350/pjmhs211571661.
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Background: Thyroidectomy is a routine general surgical procedure and pain after thyroidectomy is responsible for prolongation of hospital stay and increased risk of respiratory complications. Platysma is routinely sutured at the end of thyroidectomy before wound closure. This randomized controlled trial was conducted to compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Aim: To compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Place and duration of study: Dept. of Surgery at Sh. Zayed Hospital, Lahore from 26-12-2019 to 25-06-2020. Methodology: It is a randomized controlled trial study which consists of 92 patients, between 18 to 70 years of age in both gender and planned for thyroidectomy for nodular thyroid enlargement. Patients were randomly allocated into two treatment groups. After excision of thyroid, platysma was sutured as per conventional practice in one group while in the other group platysma was not sutured. For pain assessment Visual Analogue Scale (VAS) was used to 24 hours after surgery. Results: The mean age was 36.4±13.4 years. The mean VAS score for post-operative pain measured 24 hours after the surgery was significantly lower in patients undergoing thyroidectomy without platysmal suture as compared to those with conventional suturing of platysma during thyroidectomy (2.37±0.97 vs. 3.67±1.28; p <0.001). Similar significant difference was also noted between groups and subgroups which based on patient’s age, gender, BMI and educational status. Conclusion: Avoiding the suturing of platysma significantly reduced the post-operative pain which advocates a change in current practice and encourages non-suturing of platysma to decrease the morbidity of patients in post-operative period. Keywords: Thyroidectomy, Platysma, Suture, No Suture, Pain
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Bilgic, Elif, Madoka Takao, Pepa Kaneva, Satoshi Endo, Toshitatsu Takao, Yusuke Watanabe, Katherine M. McKendy, Liane S. Feldman, and Melina C. Vassiliou. "Development of a Model for the Acquisition and Assessment of Advanced Laparoscopic Suturing Skills Using an Automated Device." Surgical Innovation 25, no. 3 (March 20, 2018): 286–90. http://dx.doi.org/10.1177/1553350618764221.
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Background. Needs assessment identified a gap regarding laparoscopic suturing skills targeted in simulation. This study collected validity evidence for an advanced laparoscopic suturing task using an Endo StitchTM device. Methods. Experienced (ES) and novice surgeons (NS) performed continuous suturing after watching an instructional video. Scores were based on time and accuracy, and Global Operative Assessment of Laparoscopic Surgery. Data are shown as medians [25th-75th percentiles] (ES vs NS). Interrater reliability was calculated using intraclass correlation coefficients (confidence interval). Results. Seventeen participants were enrolled. Experienced surgeons had significantly greater task (980 [964-999] vs 666 [391-711], P = .0035) and Global Operative Assessment of Laparoscopic Surgery scores (25 [24-25] vs 14 [12-17], P = .0029). Interrater reliability for time and accuracy were 1.0 and 0.9 (0.74-0.96), respectively. All experienced surgeons agreed that the task was relevant to practice. Conclusion. This study provides validity evidence for the task as a measure of laparoscopic suturing skill using an automated suturing device. It could help trainees acquire the skills they need to better prepare for clinical learning.
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Limbo, B., and HC Jha. "Intraoperative Complications of High Volume Sutureless Cataract Surgery in Nepal: A Prospective Study." Kathmandu University Medical Journal 12, no. 3 (October 19, 2015): 194–97. http://dx.doi.org/10.3126/kumj.v12i3.13717.
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BackgroundWith high backlog of cataract blindness in the developing countries sutureless high volume cataract surgery is preferred surgical technique.ObjectiveTo report the intraoperative complications of high volume sutureless cataract surgery at secondary level eye care centre of Nepal.MethodThis prospective study consisting 1087 eyes that underwent manual small incision cataract surgery from 2nd to 28th December 2007 at Shree Janaki Eye Hospital, Janakpur, Nepal and operated by a single eye surgeon. Preoperative and postoperative ocular findings together with intraoperative complications were carefully noted in every individual case. At post operative day one each patient was examined including uncorrected visual acuity and post operative complications which were subsequently recorded in Performa. Data were analysed using SPSS 11.5.ResultSixty-three eyes (5.8%) of 1087 eyes developed intraoperative complications. Out of 63 eyes that had intra operative complications, posterior capsular rupture were seen in 42 (3.9%), sclera corneal tunnel suturing in 12 eyes (1.1%), iridodialysis 5 eyes (0.5%) and Descemet stripping in 4 eyes (0.4%). 62.1% of patients attained uncorrected visual acuity 6/18 or better and in 91.7% of eyes, there were no post operative complications.ConclusionHigh volume suture less cataract surgery is safe surgery and should be continue in developing countries to achieve the goal of vision 2020, where there is huge backlog of cataract blindness.Kathmandu University Medical Journal Vol.12(3) 2014; 194-197
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Pogorelić, Zenon, Dario Huskić, Tin Čohadžić, Miro Jukić, and Tomislav Šušnjar. "Learning Curve for Laparoscopic Repair of Pediatric Inguinal Hernia Using Percutaneous Internal Ring Suturing." Children 8, no. 4 (April 11, 2021): 294. http://dx.doi.org/10.3390/children8040294.
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Background: Percutaneous internal ring suturing (PIRS) is a simple and popular technique for the treatment of inguinal hernia in children. The aim of this study was to analyze the learning curves during implementation of PIRS in our department. Methods: A total of 318 pediatric patients underwent hernia repair using the PIRS technique by three pediatric surgeons with different levels of experience in laparoscopic surgery. These patients were enrolled in a prospective cohort study during the period October 2015–January 2021. Surgical times, intraoperative and postoperative complications, in addition to outcomes of treatment were compared among the pediatric surgeons. Results: Regarding operative time a significant difference among the surgeons was found. Operative time significantly decreased after 25–30 procedures per surgeon. The surgeon with advanced experience in laparoscopic surgery had significantly less operative times for both unilateral (12 (interquartile range, IQR 10.5, 16.5) min vs. 21 (IQR 16.5, 28) min and 25 (IQR 21.5, 30) min; p = 0.002) and bilateral (19 (IQR 14, 21) min vs. 28 (IQR 25, 33) min and 31 (IQR 24, 36) min; p = 0.0001) hernia repair, compared to the other two surgeons. Perioperative complications, conversion, and ipsilateral recurrence rates were higher at the beginning, reaching the benchmarks when each surgeon performed at least 30 PIRS procedures. The most experienced surgeon had the lowest number of complications (1.4%) and needed a fewer number of cases to reach the plateau. The other two surgeons with less experience in laparoscopic surgery had higher rates of complications (4.4% and 5.4%) and needed a higher number of cases to reach the plateau (p = 0.190). Conclusions: A PIRS learning curve for perioperative and postoperative complications, recurrences, and conversion rates reached the plateau after each surgeon had performed at least 30 cases. After that number of cases PIRS is a safe and effective approach for pediatric hernia repair. A surgeon with an advanced level of experience in pediatric laparoscopic surgery adopted the technique more easily and had a significantly faster learning curve.
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Lebret, Clément, Elsa Garot, Mélodie Amorim Pereira, Jean-Christophe Fricain, Sylvain Catros, and Mathilde Fénelon. "Perioperative outcomes of frenectomy using laser versus conventional surgery: a systematic review." Journal of Oral Medicine and Oral Surgery 27, no. 3 (2021): 36. http://dx.doi.org/10.1051/mbcb/2021010.
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Introduction: Frenectomy is an oral surgical procedure usually performed with a scalpel. Several authors recently reported the interest of laser, as a minimally invasive and efficient alternative tool to perform frenectomy. This study aimed to compare the perioperative management of patients requiring a frenectomy using scalpel versus laser. Materials and methods: A systematic review of the literature has been carried out from Pubmed and Scopus databases following PRISMA guidelines. PICO method was used to select the relevant articles. Clinical studies comparing the perioperative outcomes of patients requiring frenectomies using scalpel versus laser were included. Results: Ten articles involving 375 patients were included. Pre-operative parameter (anxiety before surgery) and per-operative data such as anesthesia, surgery duration, bleeding, suture and difficulty were assessed. The post-operative outcomes investigated were pain, analgesics use, functional discomfort, edema, healing and satisfaction of patients. Laser achieved satisfactory peri-operative outcomes such as shorter operative time, without suturing requirement, as well as less post-operative pain and functional discomfort. Discussion: The low number of eligible studies, the different type of lasers used and heterogeneity across the methodology of the selected studies were the limits of the study. Conclusion: Laser-assisted surgery became an attractive tool to perform oral soft tissue surgery.
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Potaris, Konstantinos, Emmanouil Kapetanakis, Konstantinos Papamichail, Elena Midvighi, Alexis Verveniotis, Fotios Parissis, Demetrios Apostolou, et al. "Major Lung Resections Using Manual Suturing Versus Staplers During Fiscal Crisis." International Surgery 102, no. 5-6 (May 1, 2017): 198–204. http://dx.doi.org/10.9738/intsurg-d-15-00116.1.
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During fiscal crisis there was a period of shortage of staplers in our hospital, which drove us to manual suturing of bronchi and pulmonary vessels during major lung resections. We present our experience during that period in comparison to a subsequent period when staplers became available again. A total of 256 lobectomies and 78 pneumonectomies using manual suturing (group A) were performed between September 2009 and September 2010, and were compared regarding surgical outcome with 248 lobectomies and 60 pneumonectomies using staplers (group B), performed between September 2011 and September 2012. Although we did not observe statistically significant differences but only a trend toward shorter operative time, for both lobectomies (P = 0.21) and pneumonectomies (P = 0.31) we actually noted savings of 41 and 47 minutes, respectively, in operative time using staplers (group B), in comparison with manual suturing (group A). We also observed a trend toward lower morbidity rates in group B patients who underwent lobectomy (10.48%) and pneumonectomy (20%) versus group A patients who underwent lobectomy (15.62%) and pneumonectomy (30.76%); we did not observe any substantial differences in the other surgical outcome variables, in patients' demographic, comorbidities, or in anatomic allocation of surgical procedures performed. The use of staplers offers safety with secure bronchial or vascular sealing, as well as reduction of operative time. Their unavailability at an interval during fiscal crisis, although it did not affect surgical outcome, revealed their usefulness and value.
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Samartsev, Vladimir, Alex Kuchumov, and Vasiliy Gavrilov. "Sutures in abdominal surgery: biomechanical study and clinical application." Open Medicine 9, no. 6 (December 1, 2014): 849–59. http://dx.doi.org/10.2478/s11536-013-0334-7.
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AbstractThe aim of this study is to improve treatment results and SSI prevention by differential usage of the contemporary suture materials and choice of proper suturing technique. To simulate suturing process and compared two suturing techniques, two FE models were developed. Finite-element analysis (FEA) was based on experimental data of contemporary commercial sutures and soft tissue properties. We applied obtained results for abdominal wall closure in rats and compared non-absorbable suture (capron) with absorbable suture (PDS Plus) for chosen technique. Cross-sections were examined by lighting electron microscope. Afterwards, the results of patients’ treatment are also presented. It was shown that running sew was more appropriate for aponeurosis suturing compared to interrupted sew. The optimal parameters of suturing techniques were computed. Single-row running sew by PDS Plus was proved to hold wound edges for 90 days with less inflammatory response compared to other suture in the result of histological analysis. Application of contemporary synthetic absorbable suture materials with antibacterial coating for laparotomic wounds closure and anastomosis decreases local inflammatory reaction and provides the successful tissue regeneration. Application of advanced SSI prophylactics algorithm was shown to decrease risk of post-operative suppurative complications from 14.2 to 1.6 %.
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S, Prakash N., Shreyas K, Puneeth P. J, Nishtha Sharma, and Veena Prabhakaran. "A Comparative Study of the Effects of Anterior Nasal Packing versus Trans-Septal Suturing in Post-Septoplasty Patients." Bengal Journal of Otolaryngology and Head Neck Surgery 28, no. 2 (August 31, 2020): 103–11. http://dx.doi.org/10.47210/bjohns.2020.v28i2.323.
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Introduction
Following septoplasty, the usual norm is to pack the nose using polyvinyl alcohol or white petroleum jelly impregnated gauze. But due to side effects like pain, respiratory problems, headache or pain during pack removal, trans-septal suturing is recommended as it provides stability and prevents septal hematoma formation without causing the above mentioned complaints. This study aims to conduct an in-depth comparison of the outcomes of the two aforementioned methods in an Indian population.Materials and Methods
A prospective randomized comparative study was done for 30 patients between 18-50 years undergoing septoplasty, while excluding those requiring additional surgical interventions. Trans-septal suturing was done for 15 patients and polyvinyl alcohol nasal packing for the rest. Visual Analogue Scale was used to record discomfort levels 1 day post-operatively. A vast multitude of symptoms were assessed during regular visits for 3 months after surgery.
Results
Post-operatively, nasal pain, headache, dyspnoea, sleep disturbance, post-nasal drip, crusting, and epiphora were found to be reduced in patients who underwent trans-septal suturing when compared with packing, deeming it to be a superior choice of method. However, nasal bleeding was comparable in both groups.
Conclusion
Trans-septal suturing reduces pack related problems and post-operative complications, without significantly increasing the duration of surgery. Hence, we recommend the practice of placing sutures to positively improve patients’ quality of life post-surgery.
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Waldron, DR, and J. Robertson. "Partial splenectomy in the dog: a comparison of stapling and ligation techniques." Journal of the American Animal Hospital Association 31, no. 4 (July 1, 1995): 343–48. http://dx.doi.org/10.5326/15473317-31-4-343.
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Partial splenectomy was performed in 17 adult dogs by using either surgical stapling instrumentation or conventional suturing techniques. Blood loss was minimal as determined by clinical observation and comparison of packed cell volumes and total protein levels before and after surgery. Surgical stapling instrumentation or suturing techniques may be used safely for partial splenectomy in the dog; however, the stapling technique significantly decreases operative time.
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Wali, Fariha S., Muhammad Jawed, Rafeen Talpur, Naeemullah Shaikh, Shehnilla Shujaat, and Khalid I. Talpur. "Pterygium excision with suture-less and glue-free conjunctival autograft." Asian Journal of Ophthalmology 17, no. 2 (April 30, 2020): 227–32. http://dx.doi.org/10.35119/asjoo.v17i2.579.
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Introduction: Pterygium excision is a commonly encountered surgery with different methods being used. These procedures range from simple excision to use of grafts. Limbal conjunctival autograft is currently the most popular surgical procedure. The most common method of autograft fixation is suturing. But it has its own drawbacks like increased operating time, post-operative discomfort, inflammation, buttonholes, necrosis, giant papillary conjunctivitis, scarring, and granuloma formation. Glue is widely used due to many advantages like easy fixation of the graft, shorter operation time, and reduction in complications and post-operative discomfort but at the same time has some disadvantages also like high cost, the risk of transmission of infectionsand inactivation by iodine preparations.
Purpose: In the following study, we describe a simple method of accomplishing conjunctival autograft adherence during pterygium surgery avoiding possible complications associated with the use of fibrin glue or sutures.
Design: Prospective study.
Method: We used conjunctival autograft, which was not sutured or glued to the scleral bed. The fibrin formed from the oozing blood was used to get the graft adhesion to the scleral bed. This study was approved by institutional review board, and written consent form was taken from each participant.
Results: The suture-less and glue-free conjunctival autograft was found to have excellent results in terms of surgical outcome as well as post-operative recovery. In addition, risk of side effects related to sutures and glue was eliminated.
Conclusion: Suture-less and glue-free conjunctival autograft is a new, easy, and cheaper technique for the management of pterygium.
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Usenko, Oleksandr, Andrii Sydiuk, Andriy Mazur, Andrii Klimas, and Olena Sydiuk. "PS01.150: NEW METHOD OF ESOPHAGO-GASTRO ANASTOMOSIS AFTER ESOPHAGECTOMY." Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 92. http://dx.doi.org/10.1093/dote/doy089.ps01.150.
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Abstract Background Medical science has introduced a lot of innovations and advanced equipment since the first esophagectomy was performed, nevertheless surgeons still continue to discuss benefits of certain methods and suggest changes to them because mortality and post-operative complications after esophagus resection remain high. The choice of the surgical approach, anastomosis location and its variety, conduit location and its variety, the volume of lymph node dissection and the use of minimally invasive present the most important and complex issues for surgeons. Methods The research included 40 patients who were given Lewis surgery for malignant tumors of esophagus in Shalimov's National Institute of Surgery and Transplantation: Control group comprised 20 patients who were given Lewis surgery involving end-to-side classical mechanical EGA through a circular suturing tool.; Research group comprised 20 patients who were given Lewis surgery involving invaginated mechanical EGA. (image 1). The objects for estimation included post-operative mortality as well as the number of post-operative anastomosis complications: the number of EGA leakages in the early post-operative period and the number of post operative strictures in the EGA area three months after the surgery. Data processing was done by means of Statistic—licensed application programs for Windows. Differences were considered valid if р < 0,05. Results Research group did not register a single case of EGA leakage while one patient in control group (р < 0,05). had the leakage which was stopped by means of ‘Endovac’ system. There were 2 cases of esophagus post-operative strictures which developed 3 months after the surgery in the research group which was less than in the control group which saw 6 cases of strictures of EGA (р < 0,05). Neither of the groups had any cases of post-operative mortality. Conclusion Our results allows us to conclude that invaginated mechanical EGA within Lewis surgery reduces post-operative complications of anastomosis in patients with esophagectomy. Disclosure All authors have declared no conflicts of interest.
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Wang, Po-Fang, Dax Carlo Pascasio, Soo Ha Kwon, Shih-Hsien Chen, Pang-Yun Chou, Chuan-Fong Yao, Ying-An Chen, Cheng-Hui Lin, and Yu-Ray Chen. "The Effect of Absorbable and Non-Absorbable Sutures on Nasal Width Following Cinch Sutures in Orthognathic Surgery." Symmetry 13, no. 8 (August 15, 2021): 1495. http://dx.doi.org/10.3390/sym13081495.
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Background: Non-absorbable materials (nylon) are always used in cinch sutures to maintain nasal width and to improve harmonious facial symmetry in orthognathic surgery. However, a few drawbacks of nylon materials have been clinically reported following orthognathic surgery, such as nasal irritation and exposure of the sutures. An absorbable material (PDS) has been proposed in cinch sutures, not only to avoid the complications of nylon but also to stabilize the nasal width for a long-term follow-up. Methods: Fifty-seven patients with Angle’s malocclusion classification III receiving orthognathic surgery were enrolled in this study. A non-absorbable material (nylon) and an absorbable material (PDS) were utilized for the cinch sutures. Pre-operative (T1) and post-operative six-month (T2) craniofacial 3D images were collected for all patients to measure the alar curvature (Ac) width and the alar base (Al) width. A significance level of p < 0.05 was applied in the statistical analysis. Results: With the approval of IRB, cinch suturing was performed with nylon in 29 patients and with PDS in 28 patients. Pre-operative Ac and Al distances showed no significant difference between these two groups. There were also no significant differences between the suture materials in the peri-operative change in nasal width, including Ac (nylon: 1.999 ± 1.40; PDS: 1.484 ± 0.97; p = 0.112) and Al (nylon: 1.861 ± 1.66; PDS: 1.115 ± 0.92; p = 0.056). Conclusions: For cinch sutures in orthognathic surgery, PDS can maintain the peri-operative nasal width similarly to nylon; additionally, it can be absorbed in a timely manner without the drawbacks of non-absorbable materials.
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N, Dr Abhilash, Dr Venugopal KJ, and Dr Srikanth K. Aithal. "A prospective study of outcome of resection anastomosis in elective GI surgeries." Surgical update: International Journal of Surgery and Orthopedics 7, no. 3 (June 1, 2021): 67–72. http://dx.doi.org/10.17511/ijoso.2021.i03.05.
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Background: Bowel anastomosis is successful when there is accurate union with no tension.Previous literature has compared between hand suturing and stapling devices in retrospective andprospective designs with varying outcomes. In this study a comparison between hand suturing andsurgical stapling in patients undergoing bowel surgery is done. Methods: A prospective study designover a period of 12 months was conducted in 40 patients undergoing elective resection andanastomosis. Different time parameters for anastomisis procedure, time taken for bowel sounds toreturn, resumption of oral feeds, postoperative hospital stay were collected. Follow up for 30 dayspost-operative was done. Results: In total forty patients were studied out of which twenty patientsunderwent hand sewn and twenty patients underwent stapler anastomosis. Main group analysis inmean time durations between hand sewn and stapler anastomosis were respectively; 35.25 minutesand 12 minutes for anastomosis, 3.4 days and 3.35 days for return of bowel sounds, 4.08 days and4 days for resumotion of oral feeds, 9.35 days and 8.50 days for post-operative hospital stay. A sub-group analysis was also done.Conclusion: Stapler anastomosis had shorter anastomosis time andtotal duration of operation compared to hand sewn anastomosis. However no difference was seen inreturn of bowel activity, resumption of oral feeds and duration of hospital stay.
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Murali, Biju, Sundeep Vijayaraghavan, P. Kishore, Subramania Iyer, Mathew Jimmy, Mohit Sharma, George Paul, and Sachin Chavare. "Cross-chest liposuction in gynaecomastia." Indian Journal of Plastic Surgery 44, no. 01 (January 2011): 081–86. http://dx.doi.org/10.1055/s-0039-1699484.
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ABSTRACT Background: Gynaecomastia is usually treated with liposuction or liposuction with excision of the glandular tissue. The type of surgery chosen depends on the grade of the condition. Objective: Because gynaecomastia is treated primarily as a cosmetic procedure, we aimed at reducing the invasiveness of the surgery. Materials and Methods: The technique complies with all recommended protocols for different grades of gynaecomastia. It uses liposuction, gland excision, or both, leaving only minimal post-operative scars. The use of cross-chest liposuction through incisions on the edge of the areola helps to get rid of all the fat under the areola without an additional scar as in the conventional method. Results: This is a short series of 20 patients, all with bilateral gynaecomastia (i.e., 40 breasts), belonging to Simon's Stage 1 and 2, studied over a period of 2 years. The average period of follow-up was 15 months. Post-operative complications were reported in only two cases, with none showing long-term complications or issues specifically due to the procedure. Conclusions : Cross-chest liposuction for gynaecomastia is a simple yet effective surgical tool in bilateral gynaecomastia treatment to decrease the post-operative scars. The use of techniques like incision line drain placement and post-drain removal suturing of wounds aid in decreasing the scar.
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Pradhan, Ameena. "Management of Ankyloglossia: Comparison of Pre-Suturing Scalpel Technique, Electrosurgery and Dlode Laser Methods." Nepalese Journal of ENT Head and Neck Surgery 5, no. 2 (March 20, 2018): 11–14. http://dx.doi.org/10.3126/njenthns.v5i2.19409.
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Objective: To compare various novel surgical techniques for management of Kotlow’s Class III and IV ankyloglossia,in terms of intra-operative bleeding, postoperative pain and satisfaction of the patients.Material and Methods: Patients older than the age of 15 years, with ankyloglossia ready for the surgical procedure were enrolled in the study. All Ankyloglossia was managed by a frenectomy procedure using a pre-suturing scalpel method (group A); frenectomy procedure using electrocautry (groupB) or frenectomy with Diode laser without suture (group C) from January 2012 to June 2014. These three techniques were compared in order to assess intra-operative bleeding, postoperative pain and satisfaction of the patients towards these techniques.Results: Total of 16 patients with ankyloglossia was operated during the study period. Out of sixteen, seven patients were in group A, five in group B and four in group C. There was no significant bleeding during surgery in all the cases. Post- operative visual analog scale (VAS) was highest in group B at 24 and 48 hours during speaking. (Mean VAS= 6.4 with S.D.0.82 and 6.0 with S.D 0.7). Patients’ satisfaction was higher towards laser.Conclusion: For management of ankyloglossia,a frenectomy procedure using a pre-suturing scalpel method; frenectomy procedure using electrocautry or frenectomy with Diode laser without suture can be performed safely without significant bleeding with minimal pain and greater patients’ satisfaction.Nepalese Journal of ENT Head and Neck Surgery, Vol. 5, No. 2, 2014, page: 11-14
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Manigrasso, Michele, Nunzio Velotti, Federica Calculli, Giovanni Aprea, Katia Di Lauro, Enrico Araimo, Ugo Elmore, et al. "Barbed suture and gastrointestinal surgery. A retrospective analysis." Open Medicine 14, no. 1 (August 9, 2019): 503–8. http://dx.doi.org/10.1515/med-2019-0055.
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AbstractAlthough minimally invasive surgery is recognized as the gold standard of many surgical procedures, laparoscopic suturing is still considered as the most difficult skill in laparoscopic surgery.The introduction of barbed sutures facilitates laparoscopic suturing because it is not necessary to tie a knot. The efficacy of this method has been evaluated in different types of surgery; however, less is known about general surgery.We retrospectively analysed data from 378 patients who had undergone bariatric or surgical treatment for colic or gastric malignancy requiring a closure of gastroentero, entero-entero or enterocolotomy from January 2014 to January 2019, admitted to the General Surgery Unit and Operative Unit of Surgical Endoscopy of the University Federico II (Naples, Italy).We registered 12 anastomotic leaks (3.1%), 16 anastomotic intraluminal bleedings (4.2%) and 7 extraluminal bleedings. Other complications included 23 cases of postoperative nausea and vomit (6%), 14 cases of postoperative ileus (3.7%) and 3 cases of intra-abdominal abscess (0.8%). Overall complications rate was 19.8% (75/378). No postoperative death was registered.Thus, by pooling together 378 patients, we can assess that barbed suture could be considered safe and effective for closure of holes used for the introduction of a branch of mechanical stapler to perform intracorporeal anastomosis.
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Wolak, Przemyslaw Karol, Agnieszka Strzelecka, Aneta Piotrowska, Katarzyna Dąbrowska, Piotr Przemysław Wolak, Ilona Piotrowska, and Grażyna Nowak-Starz. "The Operative Time for Unilateral Inguinal Hernia Repair in Children Performed with Percutaneous Internal Ring Suturing (PIRS) or Open Approach Method." Journal of Clinical Medicine 10, no. 6 (March 21, 2021): 1293. http://dx.doi.org/10.3390/jcm10061293.
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In this study, we compared the operative time for unilateral inguinal hernia repair in children performed with either an open approach (OA) or the Percutaneous Internal Ring Suturing (PIRS) method. It was a retrospective chart review of all patients ages 0 to 18 who underwent unilateral inguinal hernia repair in the Department of Pediatric Surgery, Urology and Traumatology of the Regional Hospital in Kielce between January 2011 and December 2018. Patients with bilateral hernias or additional problems were excluded. Of 878 patients qualified for the study, 701 were in the OA group and 177 in the PIRS group. Overall, the time needed to complete the procedure was significantly longer for the OA method. The operative time was longer if the hernia was left-sided (p = 0.024). Analysis by gender showed that operative time was generally longer in males. For both genders, surgery was shorter if the PIRS method was used. For males in the PIRS group the operative time was affected by the location of the hernia, and it was longer for a left-sided hernia. The take-home message is that the PIRS procedure is faster than the OA for inguinal hernia repair in children and it might be considered as a preferred method, especially in females.
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MacCormack, BJ, and JPH Lam. "Laparoscopic repair of congenital duodenal obstruction is feasible even in small-volume centres." Annals of The Royal College of Surgeons of England 98, no. 8 (November 2016): 578–80. http://dx.doi.org/10.1308/rcsann.2016.0218.
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INTRODUCTION It has been suggested that laparoscopic repair of congenital duodenal obstruction (CDO) should be restricted to a limited number of designated centres of expertise. After gaining extensive experience with intracorporeal suturing in other procedures, we evaluated the feasibility of this approach at the Royal Hospital for Sick Children (RHFSC; Edinburgh, UK). METHODS We conducted a retrospective review of all cases of CDO presenting to the RHFSC from 2012 to 2014. Cases were identified from our electronic database using standardised codes. Data comprised: gestation; birth weight; associated anomalies; patient age and weight at surgery; operative time; complications; postoperative course. RESULTS Five consecutive non-selected cases of isolated CDO were repaired laparoscopically, and all were carried out by the senior surgeon. The male:female ratio was 4:1. Corrected gestational age at surgery was 35–38 weeks, and the weight at surgery was 1.7–3.1 kg. None of our patients had significant associated anomalies. CONCLUSIONS The present study demonstrates the feasibility of laparoscopic repair of CDO in small-volume centres, and is the first report of laparoscopically managed congenital duodenal atresia in twins.
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Zwagerman, Nathan T., Mathew N. Geltzeiler, Eric W. Wang, Juan C. Fernandez-Miranda, Carl H. Snyderman, and Paul A. Gardner. "Endonasal Suturing of Nasoseptal Flap to Nasopharyngeal Fascia Using the V-Loc™ Wound Closure Device: 2-Dimensional Operative Video." Operative Neurosurgery 16, no. 2 (May 30, 2018): E40—E41. http://dx.doi.org/10.1093/ons/opy146.
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Abstract We present a case of cerebrospinal fluid (CSF) leak after endoscopic endonasal resection of a large clival chordoma in an obese patient. The leak was at the lower reconstruction at the craniocervical junction and had failed repositioning. Using the V-Loc™ wound closure device (Covidien, New Haven, Connecticut) to suture the nasoseptal flap to the nasopharyngeal fascia, a water-tight seal was created and, along with a lumbar drain, the patient healed successfully. CSF leak after an endoscopic endonasal approach (EEA) to intradural pathologies remains one of the more common complications.1-4 Various closure techniques have been developed5-8 with success in mitigating this risk, but all have their limitations and rely on multiple layers including vascularized flaps like the nasoseptal flap.9-11 Endonasal suturing of graft materials offers the advantage of creating a water-tight seal. We present the use of the V-Loc™ wound closure device (Covidien) to successfully seal a postoperative CSF leak. The absorbable V-Loc™ wound closure device does not require the surgeon to tie knots, which is the most challenging step in a deep, 2-dimensional corridor. The suture is barbed and is anchored by threading the needle through a prefabricated loop at the end of the suture which locks in place. Each throw of the suture through tissue maintains the suture line as the barbs catch the tissue and prevent retraction. After successful closure, the needle can simply be cut off. The V-Loc™ wound closure device (Covidien) is a safe and effective adjunct to reconstruction after endoscopic endonasal skull base surgery as it provides an option for graft/flap suturing. A written release from the patient whose name or likeness is submitted as part of this Work is on file.
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Deshpande, Sumeet, and Rashmi R. Anwekar. "Clinical Outcome of Fibrin Glue versus Sutures in Conjunctival Autografts in Patients Undergoing Pterygium Excision - A Prospective Study from Kalaburagi, Karnataka." Journal of Evidence Based Medicine and Healthcare 8, no. 26 (June 28, 2021): 2316–21. http://dx.doi.org/10.18410/jebmh/2021/432.
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BACKGROUND Pterygium removal is prone for recurrence. Use of conjunctival autografting is considered the most suitable approach that can lower the recurrence. Traditionally, the conjunctival autograft (CAG) is attached to the sclera by suturing. Recently fibrin glue has been used as an alternative to suturing. Advantages being shortened operating time, improved postoperative comfort and absence of suture related complications. Fibrin glue (Baxter TISSEEL kit) is a biological tissue which has a fibrinogen component and a thrombin component prepared by processing plasma. On activation of human fibrinogen by thrombin it imitates the final stage of the coagulation cascade and acts as a tissue adhesive. Fibrin glue is absorbable, relatively easy to use and can be kept at room temperature or in a refrigerator. We wanted to compare the postoperative outcomes in patients undergoing pterygium surgery with conjunctival autografting using fibrin glue (fibrin glue group) in comparison to suturing with 10 - 0 nylon (suture group). METHODS This was a prospective study carried out at M.R. Medical College, Kalaburgi, in the Department of Ophthalmology. Patients with pterygium were enrolled into the study after taking informed and written consent. Clinical grading of pterygium was done as Grade 1 - < 2 mm onto cornea, Grade 2 – 2 to 4 mm onto the cornea, Grade 3 - > 4 mm onto the cornea. 100 subjects were randomly divided into 2 groups of 50 patients each undergoing pterygium surgery between Nov 2018 and Oct 2019. Group 1: Conjunctival autograft with 10 0 nylon suture. Group 2: Conjunctival autograft with fibrin glue. A post-operative comfort scale was used to assess pain, foreign body sensation and lacrimation. These patients were followed up on postoperative day 1, one week, 1 month for postoperative signs and symptoms and 6 months for any recurrence of pterygium. RESULTS Patients in the fibrin glue group experienced significantly less pain, foreign body sensation and lacrimation on day-one, 1 week and at 1 month after surgery, compared to those in the suture group. Other complications like graft oedema, graft retraction, corneal scarring, sub graft haemorrhage were noted in both the groups. At the end of 6 months follow up, no recurrence was noticed in both the groups. CONCLUSIONS The use of fibrin glue for attaching autografts in pterygium surgery is an effective method with global autograft success, less post-operative discomfort like pain, foreign body sensation, lacrimation and less chance of recurrence. KEYWORDS Pterygium, Conjunctival Autograft, Suture, Fibrin Glue
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Hendricks, Benjamin K., and Robert F. Spetzler. "Moyamoya Disease Superficial Temporal Artery-to-Middle Cerebral Artery Onlay: 2-Dimensional Operative Video." Operative Neurosurgery 18, no. 6 (March 6, 2020): E229. http://dx.doi.org/10.1093/ons/opaa039.
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Abstract The most frequently performed low-flow bypass procedure is the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass. If available, a suitable M2 or M3 cortical branch is anastomosed to the donor vessel. This patient had severe moyamoya disease with an ipsilateral perfusion deficit and transient ischemic attacks. Given the need for revascularization, an STA-to-MCA bypass was performed. There was no suitable recipient M3 branch for direct anastomosis, and therefore an indirect bypass was performed by onlaying the STA onto the cortical surface and suturing the adventitia of the STA to the arachnoid of the underlying cortex. The dural leaflets were then inverted to potentiate further revascularization of the underlying cortex. The patient remained at their neurological baseline and demonstrated an enhanced perfusion of the ipsilateral MCA territory on follow-up evaluation. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
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Hossain, Gazi Mohammad Zakir, Mofizur Rahman, and Rashedul Hasan. "Laparoscopic Pyeloplasty - Our Early Experience." Journal of Paediatric Surgeons of Bangladesh 1, no. 1 (July 8, 2014): 10–14. http://dx.doi.org/10.3329/jpsb.v1i1.19448.
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Objectives: To present our initial experience with laparoscopic pyeloplasty and to evaluate the safety and short-term outcome of this technique.Methods: Five patients underwent laparoscopic dismembered pyeloplasty for the management of ureteropelvic junction obstruction (UPJO) at Chittagong between July2007 to Mach2009. Patient age at surgery was 822 years. There were two boys and three girls. All had unilateral UPJO with a normal contralateral kidney. We used 5 mm instruments for grasping, blunt dissection, incising and suturing to facilitate safe and precise surgery. The outcome was measured by the operative time, perioperative complications and resolution of obstruction and symptoms.Results: Mean operative time was 195 minutes (range 175220 min). No major perioperative complications occurred in any cases. Overall, successful resolution of UPJO was observed in all the five cases evident by renogram.Conclusions: Laparoscopic pyeloplasty represents a safe and effective option in the surgical treatment of UPJO.DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19448
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Puca, Alfredo, Alessio Albanese, Giuseppe Esposito, Giulio Maira, Barbora Tirpakova, Giacomo Rossi, Alice Mannocci, and Roberto Pini. "DIODE LASER-ASSISTED CAROTID BYPASS SURGERY." Neurosurgery 59, no. 6 (December 1, 2006): 1286–95. http://dx.doi.org/10.1227/01.neu.0000249217.27214.ec.
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Abstract OBJECTIVE Conventional suturing methods of microvascular anastomosis are associated with various degrees of vascular wall damage that can lead to thrombosis and bypass occlusion. An experimental model of double end-to-side venous graft anastomosis on the common carotid artery was set up to compare conventional suturing methods with a low-power diode laser vascular welding technique. METHODS The experiments were performed on 40 rabbits that underwent implantation of a 15-mm segment of jugular vein on the common carotid artery. The proximal end-to-side suture was performed by eight interrupted stitches; the distal suture, which was done using a laser welding technique, was supported by four stay sutures. The animals were evaluated after 2 days (n = 15), 9 days (n = 15), and 30 days (n = 10). The vascular segments were excised and subjected to histological, immunohistochemical, and ultrastructural evaluation. RESULTS The average clamping time to perform both anastomoses was 35 minutes. At the end of the follow-up period, one case of complete occlusion was observed after 9 days and one case was observed after 30 days. Surgical observations and pathological evaluation indicated that adoption of the laser welding technique reduced operative time and bleeding. Histologically, a reduction of thrombosis, inflammation, myointimal hyperplasia, and dystrophic calcification was observed in laser-assisted anastomoses. A better preservation of the endothelium was also evident in laser-treated anastomoses. The observed differences were deemed statistically significant (P< 0.05). CONCLUSION Our study demonstrated the efficacy of diode laser welding in improving surgical techniques of high-flow bypass and in reducing the vascular wall damage observed with conventional methods.
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Elvira, Brătilă V., P. C. Brătilă, and Andra-Teodora Negroiu. "Vaginally-Assisted Laparoscopic Hysterosacropexy for Advanced Utero-Vaginal Prolapse: A Series of 32 Cases." ARS Medica Tomitana 20, no. 2 (May 1, 2014): 63–70. http://dx.doi.org/10.2478/arsm-2014-0012.
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Abstract Advanced utero-vaginal prolapse is a frequent condition in the aging female population and several strategies aimed at its treatment have been developed. In order to demonstrate the importance of using the vaginal route in assistance to laparoscopic hysterosacropexy, a retrospective case series was designed, comparing thirty-two patients diagnosed with stage III-IV uterovaginal prolapse according to the POP-Q system. The patients were treated between 2006-2011 using one of two methods of hysterosacropexy: vaginally assisted laparoscopic hysterosacropexy (VALHS) in 18 cases and total laparoscopic hysterosacropexy (LHS) in 14 cases. The choice of method was based on the primary mechanism of central compartment prolapse. The total operative time, the time required for mesh fixation at the cervix and sacrum, the cure rate of prolapse and the rate of re-operation for prolapse were statistically analyzed for both LHS and VALHS and compared between these two procedures by Student T-Test. The main outcome parameters were related to the operative method. The total operative time proved to be equal for both procedures, although the time necessary to attach the mesh to the cervical ring was shorter in VALHS. Therefore, the combination of the vaginal and laparoscopic routes yields a minimally invasive variant of sacropexy with as short an operative time as possible. The vaginal route offers a safe alternative for suturing the mesh and treating concurrent vaginal wall prolapse, while laparoscopy reduces the inherent risks of open abdominal surgery.
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Bilkhu, Rajdeep, Michael A. Borger, Norman Paul Briffa, and Marjan Jahangiri. "Sutureless aortic valve prostheses." Heart 105, Suppl 2 (March 2019): s16—s20. http://dx.doi.org/10.1136/heartjnl-2018-313513.
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Conventional surgical aortic valve replacement (AVR) is the ‘gold standard’ for treatment of severe or symptomatic aortic valve stenosis. The increasing age of patients and increasing comorbidities has led to the development of procedures to minimise operative time and reduce risks of surgery. One method of reducing operative times is the use of sutureless aortic valves (SU-AVR). We examine the current literature surrounding the use of SU-AVR. Alternatives to AVR are SU-AVR, sometimes referred to as rapid deployment valves, or transcatheter aortic valve implantation (TAVI). TAVI has been demonstrated to be superior over medical therapy in patients deemed inoperable and non-inferior in high and intermediate-risk patients compared with surgical AVR. However, the lack of excision of the calcified aortic valve and annulus raises concerns regarding long-term durability and possibly thromboembolic complications. TAVI patients have increased rates of paravalvular leaks, major vascular complications and pacemaker implantation when compared with conventional AVR. SU-AVR minimises the need for suturing, leading to reduced operative times, while enabling complete removal of the calcified valve. The increase in use of SU-AVR has been mostly driven by minimally invasive surgery. Other indications include patients with a small and/or calcified aortic root, as well as patients requiring AVR and concomitant surgery. SU-AVR is associated with decreased operative times and possibly improved haemodynamics when compared with conventional AVR. However, this has to be weighed against the increased risk of paravalvular leak and pacemaker implantation when deciding which prosthesis to use for AVR.
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Chou, Ping-Ruey, Sheng-Hua Wu, Meng-Chien Hsieh, and Shu-Hung Huang. "Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-Based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation." Medicina 55, no. 12 (December 12, 2019): 781. http://dx.doi.org/10.3390/medicina55120781.
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Background and Objectives: The tie-over bolster technique has been conventionally used for skin graft fixation; however, long operative times and postoperative pain are the main disadvantages of this method. In this study, we introduce a new method using vacuum-assisted closure (VAC) with a silicon-based dressing as an alternative for skin graft fixation. This retrospective study aimed to evaluate the clinical effect of the VAC plus silicon-based dressing method and the conventional tie-over bolster technique for skin graft fixation in terms of pain, operative time, and skin graft take rate. Materials and Methods: Sixty patients who underwent skin graft surgery performed by a single surgeon from January 2017 to October 2018 were included in this clinical study. They were divided into two groups based on the type of treatment: tie-over bolster technique and vacuum-assisted closure (VAC), or silicon-based dressing groups. The operative times were recorded twice (during suturing or stapling of the graft and during removal of the dressing) in the two groups; similarly, pain was assessed using a numeric rating scale (NRS) after surgery and during dressing removal. Skin graft take rate was evaluated two weeks after dressing removal. Results: Twenty-six patients who met the eligibility criteria were enrolled into the study and assigned to one of the two groups (n = 13 each). No significant differences in age, gender, and graft area were noted between the two groups of patients. The VAC plus silicon-based dressing group demonstrated higher skin graft take rates (p < 0.05), shorter operation times (p < 0.05), and lower levels of pain (postoperative pain and pain during dressing removal) compared with the tie-over bolster technique group (p < 0.05). Conclusions: These findings indicate that VAC with silicon-based dressing can be used for skin graft fixation due to its superior properties when compared with the conventional method, and can improve the quality of life of patients undergoing skin graft fixation.
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Chan, Chying-Chyuan, and Ching-Yu Lee. "Feasibility and Safety of Absorbable Knotless Wound Closure Device in Laparoscopic Myomectomy." BioMed Research International 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/2849476.
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Purpose.Myomectomy has been performed through laparoscopy. Suturing is known as rate-limiting step in laparoscopic myomectomy. The present study was aimed at comparing the clinical outcomes of absorbable knotless wound closure device with the results of conventional suturing.Methods. This prospective study included 62 women who underwent laparoscopic myomectomy at Taipei City Hospital, Zhongxiao Branch, from January 2010 through to August 2012. The patients were randomized into two groups according to suturing materials, the knotless group and the 2-0 Vicryl suture group. Patient demographics, overall operative time, and intraoperative blood loss were compared between two groups.Results. Demographic characteristics and laboratory variables before surgery were comparable. Operative time was significantly shorter in knotless group compared with that in 2-0 Vicryl suture group (112±47versus147±63minutes;p<0.05). The results revealed a significant difference in intraoperative blood loss between two groups (knotless versus 2-0 Vicryl:112.8±54.2versus143.6±64.9). Use of absorbable knotless wound closure device was associated with greater hemostasis compared with that of 2-0 Vicryl. During a 2-year follow-up period, 12 patients (46.2%) from the group with absorbable knotless wound closure device and 14 patients (38.9%) from 2-0 Vicryl suture group became pregnant.Conclusion.Closure of myometrium using absorbable knotless wound closure device after laparoscopic myomectomy resulted in a shorter operative time and less blood loss.
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Jaiswal, N. K., and Sandeep Shekhar. "Study of burst abdomen: it’s causes and management." International Surgery Journal 5, no. 3 (February 26, 2018): 1035. http://dx.doi.org/10.18203/2349-2902.isj20180826.
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Background: Burst abdomen (abdominal wound dehiscence) is a severe post-operative complication. Burst abdomen is defined as post-operative separation of abdominal musculo-aponeurotic layers. The study aims to find etiological factors of burst abdomen in hospitalised patients ,evaluate current management methods and to compare conservative and operative approach with respect to complication and outcomes.Methods: All cases presenting with abdominal wound dehiscence after surgery were included. An elaborate clinical history was taken in view of the significant risk factors, the types of surgery performed , type of disease involved and management methods and their outcome. A total of 82 cases were included in this prospective study. Data was analysed using appropriate software.Results: The results concluded that male patients have a higher incidence of laparotomy wound dehiscence and in 5th decade. Patients presenting with peritonitis secondary to gastro-duodenal perforation are more prone to burst abdomen.Conclusions: Burst abdomen is a serious sequel of impaired wound healing. Presence of anaemia, hypoproteinemia favours high incidence of burst abdomen. Delayed suturing, of burst abdomen has a lower frequency of complications . Adherence to proper technique and sincere efforts to minimize the impact of the predisposing factors play a much larger role in both treatment and prevention of this condition.
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Bhandari, Shilpa, Pallavi Agrawal, and Aparna Singh. "Body Mass Index and Its Role in Total Laparoscopic Hysterectomy." International Scholarly Research Notices 2014 (October 28, 2014): 1–5. http://dx.doi.org/10.1155/2014/787604.
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Objective. To evaluate operative and perioperative outcomes in patients undergoing total laparoscopic hysterectomy according to their body mass index. Method. A retrospective study was performed for patients undergoing total laparoscopic hysterectomy at a tertiary care center for a period of 4 years. Patients were divided into two groups: obese (BMI > 30 Kg/m2) and nonobese (BMI < 30 Kg/m2). Duration of surgery, intraoperative blood loss, successful laparoscopic completion, and intraoperative complications were compared in two groups. Result. A total of 253 patients underwent total laparoscopic hysterectomy from January 2010 to December 2013. Out of them, 105 women (41.5%) had a BMI of more than 30 kg/m2. Overall, the mean blood loss was 85.79 ± 54.17 mL; the operative time was 54.17 ± 19.83 min. The surgery was completed laparoscopically in 244 (96.4%) women while laparotomy was done in 4 cases and vaginal suturing and closure of vault were done in 5 cases. Risk of vaginal assistance was higher in obese patients whereas out of the 4 conversions to laparotomy 3 had BMI < 30 kg/m2. The operative time was increased as the BMI of patient increased. Conclusions. Total laparoscopic hysterectomy is a safe and effective procedure for obese patients and can be performed with an efficacy similar to that in nonobese patients.
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Ye, Jianfei, Shudong Zhang, Xiaojun Tian, Guoliang Wang, Lei Zhao, and Lulin Ma. "Knotless retroperitoneoscopic nephron-sparing surgery for small renal masses: Comparison of bipolar sutureless technique and barbed suture technique." Journal of International Medical Research 46, no. 4 (March 8, 2018): 1649–56. http://dx.doi.org/10.1177/0300060518760737.
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Objective Laparoscopic knot-tying and suturing are the most difficult steps in shortening the warm ischemia time and learning curve of laparoscopic nephron-sparing surgery. This study was performed to demonstrate the safety, oncological efficacy, and technical tips of sutureless retroperitoneal laparoscopic nephron-sparing surgery (RPNSS). Methods This retrospective study included 78 cases of RPNSS using a sutureless technique and 126 cases of RPNSS using a single-layer barbed self-retaining suture technique performed from December 2012 to December 2016. Results The mean warm ischemia time was significantly shorter in the sutureless technique group than in the barbed self-retaining suture technique group (6.8 vs. 21.1 minutes, respectively). There was no significant difference in the mean age, body mass index, R.E.N.A.L. Nephrometry score, operative time, maximal tumor diameter, intraparenchymal depth, blood loss, operative time, transfusion rate, complication rate, or postoperative hospital stay between the two groups. No open conversion was needed. No positive margins or local recurrence were observed during follow-up. Conclusions The sutureless technique was proven to be safe and oncologically effective and may allow novice laparoscopic surgeons to easily and quickly master RPNSS, a technically difficult procedure.
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Margolick, Joseph, David Kanters, and Brian Cameron. "Procedural skills training for Canadian medical students participating in international electives." Canadian Medical Education Journal 6, no. 1 (April 20, 2015): e23-e33. http://dx.doi.org/10.36834/cmej.36695.
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Background: International medical electives (IMEs) are unique learning opportunities; however, trainees can risk patient safety. Returning medical students often express concern about doing procedures beyond their level of training. The Canadian Federation of Medical Students has developed guidelines for pre-departure training (PDT), which do not address procedural skills. The purpose of this research is to determine which procedural skills to include in future PDT.Methods: Twenty-six medical students who returned from IMEs completed surveys to assess PDT. Using a Likert scale, we compared procedures performed by students before departing on IME to those performed while abroad. We used a similar scale to assess which procedures students feel ought to be included in future PDT.Results: There was no significant increase in number of procedures performed while on IME. Skills deemed most important to include in future PDT were intravenous line insertion, suturing of lacerations, surgical assisting and post-operative wound care.Conclusions: Pre-departure training is new and lacks instruction in procedural skills. Over half the students rated several procedural skills such as IV line insertion, suturing, assisting in surgery, post operative wound management and foley catheterization as important assets for future PDT.
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Madhusudhan, Napa, and R. Prabhakar. "Loose knots and surgical site infections in abdominal surgeries (clean-contaminated and contaminated wounds)." International Surgery Journal 8, no. 7 (June 28, 2021): 2050. http://dx.doi.org/10.18203/2349-2902.isj20212705.
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Background: Surgical site infections (SSIs) are associated with high healthcare costs and worsen the post-operative course of a considerable proportion of general abdominal surgical patients. SSIs raise the risk of post-operative morbidity and mortality, necessitating hospitalization, intravenous antibiotics, and potentially surgical reintervention. The aim of the study was to compare the outcome of intermittent loose knots and the conventional vertical mattress suturing in patients undergoing abdominal surgeries.Methods: This prospective comparative study was done in patients undergoing emergency abdominal surgeries for any cause. Patients were divided into 2 groups- (a) group 1 (45 patients): intermittent loose knots between conventional vertical mattress sutures; (b) group 2 (45 patients): conventional vertical mattress suturing.Results: In this study, 31% of patients were in the 41-50 years age group, 53.3% of patients were male. Among various abdominal surgery opted, laparotomy was the most commonly performed procedure (47%). In this study, group 1 patients shown a decrease in wound gap, secondary wound closure and delayed wound approximation than group 2 patients.Conclusions: Loose knots in between conventional vertical mattress sutures are better than conventional vertical mattress suturing in terms of wound gap, secondary wound closure and delayed wound approximation.
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Demiroglu, Melek, Canan Ün, Dilsen Hatice Ornek, Oya Kıcı, Ali Erdem Yıldırım, Eyup Horasanlı, Semih Başkan, Emel Fikir, Mehmet Gamli, and Bayazit Dikmen. "The Effect of Systemic and Regional Use of Magnesium Sulfate on Postoperative Tramadol Consumption in Lumbar Disc Surgery." BioMed Research International 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/3216246.
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Aim.To investigate the effect of magnesium administered to the operative region muscle and administered systemically on postoperative analgesia consumption after lumbar disc surgery.Material and Method.The study included a total of 75 ASA I-II patients aged 18–65 years. The patients were randomly allocated into 1 of 3 groups of 25: the Intravenous (IV) Group, the Intramuscular (IM) Group, and the Control (C) Group. At the stage of suturing the surgical incision site, the IV Group received 50 mg/kg MgSO4intravenously in 150 mL saline within 30 mins. In the IM Group, 50 mg/kg MgSO4in 30 mL saline was injected intramuscularly into the paraspinal muscles. In Group C, 30 mL saline was injected intramuscularly into the paraspinal muscles. After operation patients in all 3 groups were given 100 mg tramadol and 10 mg metoclopramide and tramadol solution was started intravenously through a patient-controlled analgesia device. Hemodynamic changes, demographic data, duration of anesthesia and surgery, pain scores (NRS), the Ramsay sedation score (RSS), the amount of analgesia consumed, nausea- vomiting, and potential side effects were recorded.Results.No difference was observed between the groups. Nausea and vomiting side effects occurred at a rate of 36% in Group C, which was a significantly higher rate compared to the other groups (p<0.05). Tramadol consumption in the IM Group was found to be significantly lower than in the other groups (p<0.05).Conclusion.Magnesium applied to the operative region was found to be more effective on postoperative analgesia than systemically administered magnesium.
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Marwah, V., S. Dutta, S. Kedia, and P. Mittal. "Total laparoscopic hysterectomy (TLH) with endosuturing compared with conventional technique using energy sources." Facts, Views and Vision in ObGyn 13, no. 2 (June 30, 2021): 149–58. http://dx.doi.org/10.52054/fvvo.13.2.018.
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Background: The aim of the study was to demonstrate the technique of total laparoscopic hysterectomy (TLH) with intra-corporeal endosuturing using simple sutures and basic surgical instruments and compare with TLH using electric coagulation equipment i.e. energy sources with regard to operative time, blood loss, postoperative stay and pain scores. Methods: A retrospective study was undertaken, in Max Super Specialty Hospital Saket, from June 2015 to May 2018, which included 586 cases of TLH (for benign gynecological conditions), of which 287 were performed using intra-corporeal endosuturing (Group 1) and 299 were performed using energy sources (Group 2). To avoid bias, baseline matching was done for body mass index (BMI), indications for surgery, size of uterus, previous abdominal surgeries and comorbidities like diabetes and hypertension after which there were 172 patients in each group. Results: The mean age of patients was 48.24 ± 6.76 years. All operative outcomes including operative time (104.1 ± 22.6 vs 107.6 ± 32.6 mins, p=0.25), blood loss (78.9 ± 101.6 vs 99.7 ± 177.6 ml, p=0.19), pain score (2.5 ± 1.3 vs 2.7 ± 1.2, p=0.13) and post-operative stay (2.05 ± 0.2 vs 2.07 ± 0.3 days, p=0.36) were similar between the two groups. Uterine size was the major determinant of operative time and operative blood loss. Conclusion: TLH with intracorporeal endosuturing can be performed safely and gives results comparable with TLH performed using energy sources. Advancement in suturing devices can decrease operative time further and potentially make it easier and more acceptable.
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Khan, K., IA Hunter, and T. Manzoor. "Should the rectal defect be sutured following TEMS/TAMIS carried out for neoplastic rectal lesions? A meta-analysis." Annals of The Royal College of Surgeons of England 102, no. 9 (November 2020): 647–53. http://dx.doi.org/10.1308/rcsann.2020.0135.
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Introduction Management of the rectal defect following transanal endoscopic microsurgery (TEMS) or minimally invasive surgery (TAMIS) carried out for excision of neoplasm in the lower rectum is controversial. We aimed to extract evidence by carrying out a meta-analysis to compare the peri- and postoperative outcomes following rectal neoplasm excision carried out by TEMS and/or TAMIS, whereby the defect is either sutured or left open. Methods A literature search of Ovid MEDLINE and EMBASE was performed. Full-text comparative studies published until November 2019, in English and of adult patients, whereby TEMS or TAMIS was undertaken for rectal neoplasms were included. The main outcome measures were postoperative bleeding, infection, operative time and hospital stay. Findings Three studies (one randomised controlled trial and two comparative case series) yielded 555 cases (283 in the sutured group and 272 in the open group). The incidence of postoperative bleeding was higher and statistically significant (p = 0.006) where the rectal defect was left open following excision of the neoplasm (19/272, 6.99% vs 6/283, 2.12%). There was no statistical difference between the sutured and open groups regarding infection (p = 0.27; (10/283, 3.53% vs 5/272, 1.84%, respectively), operative time (p = 0.15) or length of stay (p = 0.67). Conclusion Suturing the rectal defect following excision of rectal neoplasm by TEMS/TAMIS reduces the incidence of postoperative bleeding in comparison to leaving the defect open. However, suturing makes the procedure slightly longer but there was no statistical difference between both groups when postoperative infection and length of hospital stay were compared.
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Mondal, Samiron Kumar, and Sharmistha Roy. "Laparoscopic Cholecystectomy- A Safe treatment option for Gangrenous Cholecystitis 48 and Empyema Gallbladder in experienced hands." Journal of Surgical Sciences 19, no. 2 (November 13, 2019): 48–51. http://dx.doi.org/10.3329/jss.v19i2.43981.
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Background: Laparoscopic cholecystectomy has become the gold standard of treatment for gall stone disease and in acute cholecystitis. But controversy persists regarding laparoscopic approach to gangrenous gallbladder and empyema gallbladder due to the risk of life threatening complications. We share our experience in a tertiary care multidisciplinary diabetic hospital where we encounter significant number of patients with empyema Gallbladder and gangrenous gallbladder because most of our patients are diabetic and hence immunocompromised. Purpose of this study was to evaluate the safety of laparoscopic procedure for the treatment of empyema of gallbladder and gangrenous gallbladder in an experienced hand.
Methods & Materials: Between January 2013 and January 2015 we performed 1191 cases of laparoscopic cholecystectomy. Empyema gallbladder and gangrenous gallbladder were found per operatively in 345 and 53 cases respectively.All were managed by laparoscopic procedure except two cases, where conversion to open cholecystectomy was needed.
Result: The mean operating time was 72 minutes(45-100 minutes) in empyema gallbladder. In gangrenous cholecystitismean operating time was 80 minutes(60-100 minutes). Total number of patients (including empyema gallbladder 345 and gangrenous cholecystitis 53) were 398. Among them 52 patients (13%) had excessive bleeding(>100ml) from calot’s triangle or gallbladder bed in liver. Spillage of stones occurred in 28 patients (7%). 1 patient had common bile duct injury (.25%). Gallbladder retrieval was difficult in 71 patients (18%). In the post operative period 21 patient (5%) developed minor port infection in the umbilical port. 9 patients (2%) developed chest infection, and 1 patient (.25%) developed MI. 356 patients (89%) were discharged within 72 hours of surgery.
Conclusions: Innovative technique, appropriate instruments, knowledge about the possible risks and way to manage them, with expertise in intracorporeal suturing and knotting are an essential pre requisites to attempt these cases. Operating time is more but post operative recovery is prompt. Hospital stay is significantly less than open cholecystectomy. Laparoscopic cholecystectomy is a safe procedure in cases of Empyema and gangrenous gallbladder, provided the surgeon is experienced enough and has a low threshold to convert to open cholecystectomy at anypoint of time.
Journal of Surgical Sciences (2015) Vol. 19 (2) : 48-51
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McLeod, Ian K., Eric A. Mair, and Patrick C. Melder. "Potential Applications of the da Vinci Minimally Invasive Surgical Robotic System in Otolaryngology." Ear, Nose & Throat Journal 84, no. 8 (August 2005): 483–87. http://dx.doi.org/10.1177/014556130508400810.
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Anatomic constraints and instrumentation design characteristics have limited the exploitation of endoscopic surgery in otolaryngology. The move toward less invasive and less morbid procedures has paved the way for the development and application of robotic and computer-assisted systems in surgery. Surgical robotics allows for the use of new instrumentation in our field. We review the operative advantages, limitations, and possible surgical applications of the da Vinci Surgical System in otolaryngology. In the laboratory setting, we explored the setup and use of the da Vinci system in porcine and cadaveric head and neck airway models; the setup was configured for optimal airway surgery. Endoscopic cautery, manipulation, and suturing of supraglottic tissues were performed in both the porcine and cadaveric models. We found that the da Vinci system provided the advantages of the lower morbidity associated with endoscopic surgery, more freedom of movement, and three-dimensional open surgical viewing. We also observed that the system has several limitations to use in otolaryngology.
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Johnson, Carl A., Juan A. Siordia, Katherine L. Wood, Davida A. Robinson, and Peter A. Knight. "Right Mini-thoracotomy Bentall Procedure." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 13, no. 5 (September 2018): 328–31. http://dx.doi.org/10.1097/imi.0000000000000555.
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Objective Bentall procedures are traditionally performed through a median sternotomy. The right mini-thoracotomy approach is increasingly used in aortic valve replacement. This approach has been shown to have decreased blood loss and hospital length of stay compared with sternotomy. A right mini-thoracotomy approach may also be beneficial in selected patients requiring aortic root surgery. We present our initial clinical experience of patients who have undergone a right mini-thoracotomy Bentall. Methods This is a single-center retrospective review of seven patients who underwent a primary elective right anterior mini-thoracotomy Bentall. A thoracoscope was used in each case. Automated suturing technology was used for annular suturing in three of the seven patients. Clinical outcomes evaluated include 30-day mortality, intensive care and hospital length of stay, time to extubation, operative times, as well as postoperative sequelae including stroke, infection, and bleeding. Results Median cardiopulmonary bypass, cross-clamp, and circulatory arrest time were 217, 153, and 28 minutes, respectively. Median time to extubation was 10 hours and median intensive care unit and hospital stay was 1 and 4 days, respectively. One patient had a wound infection and one returned to the operating room for bleeding. There were no in-hospital or 30-day mortalities. Conclusions The Bentall procedure can be performed through a right anterior mini-thoracotomy in selected patients with excellent clinical results.
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Galli, Suzanne K. Doud, Fredrick Valauri, and Arnold Komisar. "Facial Reanimation by Cross-facial Nerve Grafting: Report of Five Cases." Ear, Nose & Throat Journal 81, no. 1 (January 2002): 25–29. http://dx.doi.org/10.1177/014556130208100109.
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Facial nerve repair is a dynamic reanimation technique. Direct nerve repair by suturing or grafting can provide good results within a specific time frame. Immediate nerve repair has been successful in cases of laceration injuries, but nerve grafting techniques are typically delayed when it is clear that direct suturing to the nerve trunk cannot be achieved without tension. Delayed nerve grafting is also employed following ablative procedures and in cases of trauma that cause segmental nerve deficits. Cross-facial nerve grafting is particularly useful when the peripheral branches are intact and the main trunk of the facial nerve is inaccessible. This method is also typically performed in a delayed fashion. Rehabilitation of the facial nerve and subsequent reinnervation of the mimetic motor endplates are achieved through axonal growth. In this article, we describe a consecutive series of five patients who developed facial paralysis following cranial surgery for acoustic neuroma. Each underwent successful cross-facial nerve grafting during the first week following their initial surgery. Each received a sural nerve graft to at least two main divisions of the VIIth cranial nerve. We discuss our operative technique and the degree of restored nerve function.
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Chiao, Jonathan, Jayme R. Dowdall, and Samuel K. Pate. "Resource Utilization and Billing in a Resident-Managed Inpatient Consult Service." Otolaryngology–Head and Neck Surgery 163, no. 2 (May 19, 2020): 244–49. http://dx.doi.org/10.1177/0194599820923620.
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Objective Patient care delivered by residents is an educational opportunity to foster autonomy. These services, however, may not be billed without direct faculty supervision. This quality improvement project analyzes descriptive data, procedures, and billing from an academic otolaryngology–head and neck surgery department’s inpatient consult service. Methods This prospective cohort study collected descriptive and billing data on all consults over 30 consecutive days. Data collected described bedside procedures and operative interventions. Encounters were Current Procedural Terminology coded and equivalent work relative value unit (wRVU) calculated. Codes submitted for billing were reviewed to identify opportunities for inpatient billing improvement. Results Ninety-eight new consults were included, and 105 bedside procedures were performed. Flexible laryngoscopy (n = 27), I&D (incision and drainage; n = 11), and suturing (n = 11) were the most performed bedside procedures. Operative intervention was required in 15 encounters. The inpatient consult team provided the equivalent of 391.39 wRVU. Seventy-three percent of operative compared to 3% of bedside procedures were submitted for billing. Discussion The productivity of our team approximated 61.8% of a full-time general otolaryngologist but with decreased billing submissions. Balance between resident autonomy, education, quality patient care, and the ability to capture service revenue is complex. Strategies other institutions have used to capture missed billing opportunities have included a hospitalist model, mid-level providers, and resident billing. Implications for Practice This study characterizes an academic inpatient consult service. Results describe a case for improving the structure of the inpatient consult service, caution that studies collecting data via department billing may underrepresent services, and suggest alternative service structures to overcome identified billing limitations.
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Al-Otaibi, Lubna M., and Maha A. Al-Mohaya. "Successful Excision of Oral Irritational Fibroma Using 940 nm Diode Laser: Case Series." Journal of Clinical Case Studies Reviews & Reports 2, no. 2 (April 30, 2020): 1–6. http://dx.doi.org/10.47363/jccsr/2020(2)113.
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Background: Irritational fibroma is a frequently observed benign exophytic and reactive oral lesion that develops as a result of trauma. The usual sites of irritational fibroma are buccal mucosa, tongue, and lower labial mucosa. These lesions are excised using conventional surgery, electrosurgery, or more recently by laser. Methods: A total of 36 patients underwent surgical excision of superficial proliferative lesions under local anesthesia using a 940 nm diode laser. Bleeding was stopped using laser dry bandage setting, and no suturing was needed. All specimens were sent for histopathological examination. Patients were examined for intra-operative and post-operative complications. Results: The procedure was simple to perform with minimum bleeding and excellent precision. It was well accepted by the patients, who also reported mild post-operative pain. Optimum healing was achieved with no residual ulceration or scarring. The excised specimens were adequate for histopathological examination and all diagnosed as oral fibromas. Conclusion: The 940 nm diode laser can be utilized in excisional biopsy of irritational fibromas with minimum bleeding, discomfort, scarring, and postoperative pain and should be considered as a practical alternative to the traditional surgical technique. PSMMC REC clinical study registration number: 1203, series of 2019
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Gosse, Emily, Richard Newsom, Peter Hall, and Jonathan Lochhead. "Changes in Day 1 Post-Operative Intraocular Pressure Following Sutureless 23-Gauge and Conventional 20-Gauge Pars Plana Vitrectomy." Open Ophthalmology Journal 7, no. 1 (August 21, 2013): 42–47. http://dx.doi.org/10.2174/1874364101307010042.
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Background/Aims: The benefits associated with transconjunctival sutureless vitrectomy techniques are continuing to be defined. The purpose of this study was to compare the incidence of extreme changes in day 1 intraocular pressure (IOP) following 23-gauge sutureless vitrectomy compared with conventional 20-gauge vitrectomy. Methods: Fifty consecutive 23-gauge and 50 consecutive 20-gauge cases were included; eyes with a history of previous vitreoretinal surgery were excluded. 23-gauge surgery was completed with passive fluid air exchange where no long acting tamponade was indicated. The surgery remained sutureless unless a leak was visible at the end of the procedure. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher’s exact and chi-square tests. Results: Twenty-two percent (11/50) of 23-gauge vitrectomies required suturing of one or more ports. On the first post-operative day hypotony (IOP<5mmHg) occurred in 1/50 eyes in the 20- and 23-gauge groups. Raised pressure (IOP>21mmHg) occurred in 30% (15/50) of eyes in the 20-gauge group and 8% (4/50) of eyes in the 23-gauge group; IOP>30mmHg only occurred in the 20-gauge group (3/50). Conclusion: Fluid air exchange following 23-gauge vitrectomy is associated with very low risk of day 1 hypotony. This predominantly sutureless technique appears to reduce the incidence and magnitude of early post-operative IOP elevation compared with conventional 20-gauge vitrectomy.
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Kawashima, Osamu, Toshikazu Hirai, Mitsuhiro Kamiyoshihara, Susumu Ishikawa, and Yasuo Morishita. "Use of a Pericardial Fat Pad for Alveolar Air Leaks after Pulmonary Resections." Asian Cardiovascular and Thoracic Annals 6, no. 2 (June 1998): 115–17. http://dx.doi.org/10.1177/021849239800600209.
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To investigate the effectiveness of using a free pericardial fat pad to control air leaks from residual raw parenchymal surfaces after pulmonary resections, 30 consecutive patients were studied. There were 23 males and 7 females with a median age of 69 years. The indication for this technique was any alveolar air leak from a residual raw parenchymal surface which could not been controlled by suturing. There were 25 lobectomies with incomplete fissure and 5 cases of segmentectomy. None of the patients exhibited air leaks beyond 2 days, post-operative space problems, or infections. All patients had chest drains removed within 2 days after the operation. The application of a free pericardial fat pad is a promising new method of treating air leaks from residual raw parenchymal surfaces after pulmonary resections.
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Moral, Sarah D., Ann Kathleen C. Barlin, and Jose M. Acuin. "Clinical Profile of Post-Tonsillectomy Bleeding: A 30-Month Institutional Review." Philippine Journal of Otolaryngology-Head and Neck Surgery 25, no. 2 (December 3, 2010): 14–17. http://dx.doi.org/10.32412/pjohns.v25i2.621.
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Objective: To determine the prevalence of post-tonsillectomy bleeding in our institution and to describe the clinical characteristics, tonsillectomy techniques and post-tonsillectomy bleeding intervention in these patients.
Methods:
Study Design: Observational descriptive study
Setting: Tertiary private hospital
Population: All patients who were treated for post-tonsillectomy bleeding were retrospectively reviewed from medical records of all patients who had undergone tonsillectomy between January 1, 2007 and June 30, 2009. Age and sex, indication for surgery, tonsil grade, Body Mass Index (BMI), surgical technique, post-operative medications, length of hospital stay, interval between tonsillectomy and onset of bleeding and interventions to address post-operative bleeding were noted.
Results: Of the 662 patients who underwent tonsillectomy, 37 (5.6%) were managed for post-operative hemorrhage. Most had grade 2 or 3 tonsils (18 or 48.6% and 16 or 43.2% respectively) and were obese (25 or 67.5%). The highest proportion of post-operative bleeding was 9.2% for bipolar cauterization technique (18 of 196 patients) followed by 7.4% with cold knife, monopolar cauterization and suturing (11 of 148 patients); 6.9% with harmonic scalpel (2 of 29 patients); 6.5% with monopolar and bipolar cauterization (3 of 46 patients), and 2.8% for cold knife or Fischer knife (3 of 109 patients). Seven patients (18.9%) required blood transfusion. Onset of bleeding occurred between 4-12 days following surgery (mean: 8 days). Possible causes of bleeding included heavy physical activity and cough but most had no identifiable cause. Majority of the patients (29 out of 37) required surgical exploration under general anesthesia.
Conclusion: Post tonsillectomy bleeding is still a clinically significant complication despite advances in surgical techniques. Surgeons must always consider trade-offs between benefits and risks of the procedure and be continually vigilant of this potentially serious complication.
Key Words: Post-tonsillectomy bleeding, tonsillectomy techniques
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Reyes, Niel Khangel. "Post-Operative Bleeding in Tonsillectomy versus Tonsillectomy with Fossa Closure in a Tertiary Military Hospital: A Cohort Study." Philippine Journal of Otolaryngology Head and Neck Surgery 35, no. 1 (May 17, 2020): 36–38. http://dx.doi.org/10.32412/pjohns.v35i1.1277.
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ABSTRACT
Objective: To determine the incidence of post-operative bleeding among patients who underwent tonsillectomy alone versus tonsillectomy with fossa closure at the Victoriano Luna Medical Center from January 2015 to December 2017.
Methods:
Design: Retrospective Cohort Study
Setting: Tertiary Military Hospital
Patients: Medical records of 83 patients that underwent tonsillectomy under the Department of Otorhinolaryngology – Head and Neck Surgery between January 2015 to December 2017 were retrospectively reviewed for data regarding sex, age, tonsillectomy with or without fossa closure and post-operative bleeding. Cases of tonsillectomy alone versus tonsillectomy with fossa closure were compared (particularly with respect to post-operative bleeding), tabulated and statistically analyzed using risk ratio and t-test.
Results: There were 57 cases of tonsillectomy alone versus 26 cases of tonsillectomy with fossa closure. The incidence of bleeding in all cases of tonsillectomy whether tonsillectomy alone or with fossa closure was 4.8%. The incidence of bleeding was higher in cases of tonsillectomy with fossa closure at 11.5% (versus 1.8% in tonsillectomy alone). Post-operative bleeding was 0.1 times more likely to occur in patients who underwent tonsillectomy alone than those who underwent tonsillectomy with fossa closure but there was no statistically significant difference in the risk of post-operative bleeding between the two.
Conclusion: Although the incidence of bleeding was higher in cases of tonsillectomy with fossa closure, our results suggest that there is no statistically significant difference in risk for postoperative bleeding between tonsillectomy alone or tonsillectomy with fossa closure.
Keywords: tonsillectomy; postoperative bleeding; tonsil pillars; suturing
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Kavitha, CV. "Outcome of conjunctival autograft sutured with polyamide black sutures in pterygium surgery." Nepalese Journal of Ophthalmology 5, no. 1 (March 26, 2013): 94–99. http://dx.doi.org/10.3126/nepjoph.v5i1.7833.
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Introduction: Pterygium excision with conjunctival autografting is the most effective way of treating pterygium with the least recurrence rate. The sutures which can be used to suture the conjunctival autograft are absorbable polyglactin 10-0 sutures or nonabsorbable polyamide 10-0 sutures. The polyamide sutures are inert, elicit minimal acute inflammatory reaction, do not support infection and allow easy removal without tissue adherence. They are very cost-effective compared to polyglactin sutures. Objective: This study was aimed to assess the efficacy of the cost-effective polyamide sutures in terms of patient comfort, graft stability, need for suture removal and recurrence. Materials and methods: In this prospective, non-comparative study, 56 eyes of 56 patients with primary pterygium underwent pterygium excision with conjunctival autograft transplantation sutured with 10-0 polyamide black sutures. The patients’ comfort, graft stability, need for suture removal and recurrence were assessed within a mean follow- up period of 28.75 months (range 47 - 14 months). Results: Mild discomfort was found in 14 (25 %) patients for up to 3 weeks, moderate discomfort in 8 (14.2 %) for up to 1 week, no patients had severe discomfort beyond the first day, and all patients were comfortable at the end of the sixth post-operative week. The graft was stable in all patients. Nine sutures in 5 patients out of 392 sutures in 56 patients, that is, 2.29 % of the sutures, needed to be removed at the end of the sixth post-operative week. Two patients, or 3.57 %, had a recurrence. Conclusion: In pterygium surgery, suturing the conjunctival autograft with cost-effective polyamide black sutures is efficient and safe. Nepal J Ophthalmol 2013; 5(9):94-99 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7833
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Rajper, Wajid Ali, Kashif Ali Channar, Munawar Din Larik, Sajid Ali Majeedano, Aftab Ahmed Soomro, and Asfar Hussain. "Comparison of postoperative complications after impacted mandibular third molar extraction with conventional suturing versus tube drainage." Professional Medical Journal 27, no. 07 (July 10, 2020): 1408–13. http://dx.doi.org/10.29309/tpmj/2020.27.07.4011.
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Objectives: To determine the effectiveness of tube drain compared with conventional suturing on postoperative complications after extraction of impacted mandibular third molars. Study Design: Cross Sectional study (Comparative). Setting: Department of Oral & Maxillofacial Surgery, Institute of Dentistry, LUMHS Jamshoro/Hyderabad. Period: Six months duration from 12-11-2015 to 13-05-2016. Material & Methods: All the patient age from 18 to 45 years irrespective of gender, having mesioangular impacted mandibular third molar were included in the study. Patients were divided into two groups, Group-A and group-B. The severity of pain was recorded by using Visual Analog Scale from 0 no pain to 10 worst pain, degree of swelling was measured by facial size through Amin and Laskin criteria and mouth opening was measured by interincisal distance through ruler. All data was recorded on the 3rd and 7th day by the clinician. Results: Mean age of group A was 31.22+7.21 years, and mean age of group B was 28.34+5.33 years. Male were found slightly more as compared to female. On 3rd day the post-operative pain assessment was almost equal in both groups p-value 0.06 and assessment of post-operative swelling on 3rd day was found with insignificant difference p-value 0.22. Assessment of pain on 7th post-operative day was that the severe pain was found significantly reduced in group B as compared to group A p-value 0.01, swelling was significantly reduced in group B p-value 0.04. While mouth opening was also found significantly more in group B as compared to group A p-value 0.022. Conclusion: After removal of impacted mandibular third molars, incorporating tube drain is very effective as compared to conventional suturing in reducing the facial swelling, trismus and postoperative pain.
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Watanabe, Tomoyuki, Tamaki Gekka, Akira Watanabe, and Tadashi Nakano. "Analysis of Changes in Corneal Topography after 27-Gauge Transconjunctival Microincision Vitrectomy Combined with Cataract Surgery." Journal of Ophthalmology 2019 (July 10, 2019): 1–5. http://dx.doi.org/10.1155/2019/9658204.
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Purpose. To investigate changes in the corneal shape before and after vitrectomy, over a period of time, using a 27-gauge system. Methods. Forty-five eyes underwent a combination of cataract surgery and vitrectomy. The surgeries were performed using a 27-gauge transconjunctival vitrectomy system, in which the corneal topography could be performed up to three months after the surgery. The surgeries were performed for an epiretinal membrane in 11 eyes, a macular hole in 14 eyes, and rhegmatogenous retinal detachment in 20 eyes. All of the surgeries were performed by the same surgeon, and in all cases, a 4-port 27-gauge vitrectomy device was used. Cataract surgery in all patients was performed with a 2.4 mm corneoscleral incision at 11 o’clock. The surgeries were performed without suturing the operative wound in all cases. Corneal topography was performed using a TMS-4 topographer (Tomey Corporation, Tokyo, Japan). The examinations were performed the day before and 1 day, 1 week, 1 month, and 3 months after the surgery. The results of corneal topography for the spherical, regular astigmatic, asymmetric, and high-order irregular astigmatic components were compared before and after surgery. Results. No significant differences were seen in any of the components in the epiretinal membrane group, but significant differences were seen in the asymmetric components and the high-order irregular astigmatic components between the macular hole and rhegmatogenous retinal detachment groups (p<0.05). There were no significant changes in intraocular pressure on any measurement time in the postoperative period compared to preoperative intraocular pressure. Conclusion. Irregular astigmatism was seen after surgery when 27-gauge vitrectomy with a 4-port system was performed together with cataract surgery with a 2.4 mm incision.
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Ersen, Burak, Yucel Sarialtin, Bulent Cihantimur, and Mustafa Ozyurtlu. "A new otoplasty procedure: combination of perichondrio-adipo-dermal flap, posterior auricular muscle transpositioning and cartilage suturing to decrease the post-operative complication rates." European Journal of Plastic Surgery 41, no. 5 (March 7, 2018): 557–62. http://dx.doi.org/10.1007/s00238-018-1407-2.
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B. L., Dharmendra, and Vijaykumar N. "A comparative study of on-lay and sub-lay mesh repair of ventral wall hernias in a tertiary health care centre." International Surgery Journal 5, no. 10 (September 25, 2018): 3386. http://dx.doi.org/10.18203/2349-2902.isj20184094.
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Background: Ventral hernia is a common occurrence in abdominal surgeries and an important source of morbidity. A wide spectrum of surgical techniques have been developed, ranging from suturing techniques to various types of prosthetic mesh repair. Use of mesh repair technique showed a reduced number of postoperative complications and recurrence compared with other techniques. The exact technique of mesh repair is still debated. The purpose of this study was to compare the traditional on‑lay mesh and sublay mesh placement in ventral hernia repairs in terms of time taken for surgery, duration of drainage after surgery, early complication and delayed complications.Methods: This is a prospective study which was conducted in the surgical department of our hospital. A total of 50 cases were included in this study. Of these cases, 25 cases were operated by the on‑lay mesh method and 25 by sublay mesh placement.Results: The operative time for sublay mesh placement was significantly higher than that of on‑lay mesh repair, whereas, the duration of post-operative suction drainage was significantly lower in case of the sublay group. Occurrence of complications like superficial surgical site infection and seroma formation were statistically insignificant in both the study groups, although frequency of complications was lesser in the sublay group. The recurrence rate was found to be 12% in on‑lay mesh repair and 8%in sublay(retro‑rectus) mesh repair.Conclusions: Sublay mesh repair is a better method than onlay repair with respect to the duration of the post-operative suction drainage. A lower rate of complications and a lower rate of recurrence was seen in the sublay mesh repair group.