Search

OBJECTIVE: To compare the safety and feasibility of T-tube drainage and primary suture after laparoscopy combined with choledochoscopy in the treatment of secondary choledocholithiasis. METHODS: The clinical data of patients who underwent laparoscopic choledochoscopy combined with choledochoscopic common bile duct exploration (LCBDE) for secondary choledocholithiasis from June 2015 to June 2020 were analyzed retrospectively. According to the different treatment method of common bile duct (CBD) incision, the patients were divided into a T-tube drainage group and a primary suture group. The preoperative clinical characteristics, results of preoperative liver function tests (LFTs), LFTs on the first day after the operation and the fourth day after the operation, operation time, intraoperative bleeding, postoperative complications, and times of postoperative hospital stay were compared between the two groups. RESULTS: There was no significant difference in preoperative clinical data, preoperative LFTs, and postoperative complications between the two groups (P > .05). However, primary suture demonstrated significant advantages (P

Purpose The ideal method of central slip reconstruction is difficult to determine due to the multitude of techniques, nonstandardized outcome reporting, and small patient series in the literature. Although most boutonniere deformities may be treated with nonsurgical measures, chronic, subacute, or open injuries may require operative intervention. To aid surgeons in the choice of the ideal central slip reconstruction method, this biomechanical study compared the 3 most common methods performed at our institution: direct repair, lateral band centralization, and distally-based flexor digitorum superficialis (FDS) slip repair. Methods A boutonniere deformity was induced in 35 fresh-frozen cadaver digits. The central slip was repaired in 9 digits using a primary suture repair, in 9 digits using a lateral band centralization technique, and in 9 digits using a distally-based FDS slip reconstruction. A control group without injury was tested in 8 digits. Following repair or reconstruction, each digit was tested for load to failure, strain, and stiffness at the repair. Results The average load to failure after central slip reconstruction was significantly greater for a distally based FDS slip method at 82.1 ± 14.6 N (95% CI, 62.2–101.9 N) than all other repair types. Although the FDS slip reconstruction was not as strong as the intact state (82.1 N vs 156.2 N, respectively), it was 2.6 times stronger than the lateral band centralization (82.1 N vs 31.6 N, respectively) and 3 times stronger than a primary repair (82.1 N vs 27.6 N, respectively). Conclusions Reconstruction of the central slip using a distally-based FDS slip provided the greatest biomechanical strength compared with the direct repair or lateral band centralization. Clinical relevance The use of a distally based reconstruction using FDS may allow for safer early motion.

Objective Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol. Methods We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol. Results Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the Conclusion Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction. Resumo Objectivo Infecção e exposição da prótese são algumas das complicações mais comuns e preocupantes após reconstrução da mama com implantes. Atualmente, ainda não há consenso quanto ao manejo destas complicações. O objetivo deste estudo foi o de revisar os casos da nossa instituição e apresentar um protocolo clínico. Métodos Realizou-se uma revisão retrospectiva de todos os casos consecutivos submetidos a reconstrução mamária imediata com prótese entre 2014 e 2016. Todos os casos foram conduzidos de acordo com um protocolo específico e estruturado. Resultados A exposição do implante ocorreu em 33 de 227 reconstruções (11,9%). Dentre estas, duas pacientes tinham histórico de radioterapia, e foram submetidas a remoção da prótese e posterior reconstrução com retalho miocutâneo. Sinais de infecção local grave foram observados em 12 pacientes, e, em 5, necrose extensa de tecido, e todas foram submetidas a remoção dos implantes; destas, 8 foram recons truídas com expansor, e 2, com retalho miocutâneo. As 14 pacientes remanecentes não haviam sido submetidas previamente à radioterapia, não tinham sinais de infecção, nem necrose extensa; portanto, foram submetidas a sutura primária em uma tentativa de salvar a prótese. Dessas, 8 pacientes (57,1%) conseguiram manter os implantes originais. Conclusão Nosso protocolo clínico é baseado em três pontos principais: histórico de radioterapia, infecção grave, e necrose extensa de tecido. Ele constitui um método prático e potencialmente reprodutível de manejo de uma das complicações mais comuns da reconstrução mamária com implantes.

We report a case of aseptic abscess in the cavernous body at the base of the penis. In our clinical observation, the patient underwent puncture and drainage of the corpus cavernosum abscess, followed by surgical resection of the abscess wall, with the incisions closed layer by layer with primary suture. In addition, we paid attention to strengthening the postoperative management by using elastic bandages to wrap the penis intermittently to prevent edema; the incision would not be covered with dressings from the third day after the operation, so as to keep the incision site dry in an open way. During the period of indwelling of the catheter after the operation, we noticed the care of the external orifice of the urethra to reduce the occurrence of catheter-related infections. Finally, the patient was diagnosed with a penile aseptic abscess in the cavernous body at the base of the penis. The patient recovered well after surgery and was discharged 1 week later. At 1.5 years after the operation, the shape of the penis returned to normal, and the erectile function was normal. It was seen that good nursing concept is of great help for prognosis, which could avoid infection and edema, and is conducive to wound healing.

Background Right-sided Bochdalek hernias are uncommon congenital diaphragmatic hernias that can be challenging to manage because they can contain bowel, omentum, kidney or liver. Methods We describe our experience at a single centre and integrate this with all reported cases in the literature to evaluate how this rare problem has been managed and when a minimally invasive approach is appropriate. Results A total of 31 patients were identified, four patients from our institution and 27 case reports from the literature. A minimally invasive approach was utilized in 15 of 31 patients (including two of four at our institution) and was more common if the operation was performed in the elective setting (10/12 versus 4/19). If a bowel resection was required, an open approach was more common (9/17 versus 1/14). The commonest method of repair was a primary suture repair (18/31), and the mesh was used in 13 cases, particularly in the elective setting (9/12 versus 4/19). Conclusion Right-sided Bochdalek hernias are an uncommon and challenging problem. These hernias can contain bowel, kidney and even liver but can still be successfully repaired using minimally invasive techniques, especially in the elective setting and when an emergency bowel resection is not required.

Aim “Incisional hernia (IH) has an incidence of 10–23%, which can increase to 38% in specific risk groups. The objective of this study is to report the results at 3 years of follow-up of the use of the reinforced tension line (RTL) technique compared with primary suture only (PSO) closure in the prevention of IH in high-risk patients undergoing laparotomy.” Material and Methods “Open randomized controlled clinical trial. Included were patients older than 18 years who underwent midline laparotomy, emergency or scheduled, who were considered high risk, and who completed 3-year follow-up. The patients were randomized 1:1 to the RTL technique or to PSO. The objective was to report the incidence of IH and the complications associated with the closure method. Intention-to-treat analysis and Cox regression were performed.” Results “A total of 124 patients were randomized; 51 patients from the RTL group and 53 patients from the PSO group finished the 3-year follow-up. The incidence of IH was higher in the PSO group (15/53, 28.3%) than the RTL group (5/51, 9.8%) (p = 0.016, OR 0.35, 95% CI 0.14–0.88, number needed to treat 5.4, log-rank test p = 0.017). The groups were similar in the rates of surgical site infection, hematoma, seroma, and postoperative pain during follow-up.” Conclusions “The RTL technique is useful in the prevention of IH when compared with PSO in high-risk midline laparotomy patients, and it is not associated with a higher percentage of complications. Clinical trials NCT02136628, retrospectively registered”

Linea arcuate herniae (LAH) are rare and usually asymptomatic but can present with generalized abdominal pain in the absence of bulging and are impalpable. Diagnosis is dependent on cross-sectional imaging, and operative approach to their management is debatable. Here, we report the case of a 56-year-old female with abdominal pain diagnosed with a linea arcuate hernia by computed tomography (CT) scan. She went on to have laparoscopic primary suture closure of the hernial defect with reinforcing underlay mesh. LAH are effectively elucidated with CT. Although there are concerns regarding mesh-related complications, we advocate a laparoscopic approach and repair with prosthetic mesh reinforcement, fixated with sutures. Long-term follow-up of these patients is still required.

Objective: To compare the effectiveness and safety of continuous suture and interrupted suture in Laparoscopic Common Bile Duct Exploration (LCBDE) for choledocholithiasis. Materials and Methods: T...

Background Aesthetic surgical reconstruction of auricular keloids is still a conundrum. This study introduces our experiences in analyzing the anatomic morphological features of auricular keloids, and devising optimized surgical procedures accordingly. Methods A total of 129 ears with auricular keloids were classified and operated. All patients were followed up for at least 12 months. Results According to their anatomic positions, auricular keloids were divided into 3 Groups (A, B, and C). The morphological features of keloids were further interpreted according to Chang-Park classification of earlobe keloids. The authors optimized surgical procedures according to the anatomic morphological features from a range of surgical techniques. The recurrence rate of Group C was statistically higher than Group A and B. There was no significant difference in recurrence rate between keloids treated with "primary suture" and "filleted flaps." Conclusions According to the anatomic positions and morphological features of auricular keloids, we could conveniently devise optimized surgical strategies to obtain aesthetic reconstruction of auricular keloids.

Relevance. Baker's cyst is the formation in the popliteal region, resulting from the accumulation of synovial fluid in the semimembranous bursa due to anastomosis between the joint cavity and the synovial bursa of the popliteal region. Trauma and/or some inflammatory diseases of the joints are the main causes of these cysts. Despite the success of endoscopic methods of treatment of this category of patients, the frequency of postoperative complications is 3-10%. The aim is to conduct a comparative analysis of the Baker's cysts treatment results using intracavitary laser obliteration and traditional cyst excision. Materials and methods. The treatment results of 39 patients with Baker cysts, who entered the clinic for the period from 2012 to 2017, are analyzed. Patients were divided into 2 representative groups. Ultrasound-guided intracavitary laser obliteration of Baker's cyst was performed in 24 (62%) patients of the main group. Traditional radical excision of all cyst elements with application of the primary suture was performed for 15 (38%) patients of the control group. A russian single-wave programmable three-mode laser scalpel LSP - "IRE-Polyus" was used in the work. Results. The patients of the main group had almost no pain syndrome, the duration of hospital treatment and rehabilitation were 4 times shorter than in the group of traditional operations (p≤0,05). Satisfaction with the laser treatment results of the patients from this group was 83.3%, while in the traditional treatment group - only 66.6%. Conclusion. The minimum number of the disease recurrences after ultrasonic-controlled intracavitary laser obliteration of Baker's cysts, the simplicity and low-traumatism of manipulation, the low level of complications, coupled with the high patient satisfaction with the treatment results, set apart this technology from traditional one, which allows recommending this method for wide application.

Delayed primary suture closure of gastric perforation is prone to dehiscence hence the repaired area should be buttressed to avoid re-operation. We aimed to investigate whether DuraSeal®(DS) has a potent adjunctive effect on delayed closure of gastric perforation comparing with 2-octly-cyanoacrylate(CYN) in an experimental model.Sixty rats were randomly divided into 6 groups. All subjected to gastric perforation, subsequently perforation areas were repaired by primary suturing, delayed repair was performed 12 h after surgery. According to DS or CYN application on anastomosis, the groups were classified as control(C), delayed control(CD), closure with CYN(CYN), delayed closure with CYN(D-CYN), closure with DS(DS), delayed closure with DS(D-DS).After euthanization on POD 7,anastomotic bursting pressure(ABP) were measured. Tissue samples were taken for histopathological examination and hydroxyproline(TH) assessment.Delayed condition significantly reduced ABP and TH levels in CD group comparing with all groups(p 0.01).Either CYN or DS application on delayed repaired area significantly raised the measure of ABP and TH up to the levels of C group(p 0.05,comparing with CD).Microscopically,either CYN or DS application significantly improved tissue necrosis, submucosal bridging and collagen formation comparing with CD group(p 0.012).There were no difference regarding ABP, TH and tissue healing between each CYN and DS groups.DuraSeal® application on sutured gastric perforation area yielded a significant adjunctive effect both in normal and delayed conditions. However, DuraSeal® revealed no superior effect to CYN in both condition.Our results demonstrated that the clinical use of DuraSeal® can be considered for reinforcing the sutured line in patients undergoing delayed surgery for gastric perforation.

BACKGROUND: Mesh augmentation has proved efficacious for the prevention of incisional hernia (IH). A recent network meta-analysis (NMA) identified onlay and retrorectus mesh (OM and RM) as the most effective therapeutic options, but the risk of surgical site infection (SSI) and other complications require additional consideration.METHODS: The NMA generated pooled risk differences (RD) for the benefits of reducing IH and the risk of SSI and composite seroma/hematoma (CSH) for use in Monte-Carlo data simulations with 1000 replications. Mean incremental risk-benefit ratios (IRBR), i.e., the ratio of incremental risk (or RD) and incremental benefit, and 95% confidence intervals (95% CI) were estimated with a probability of risk-benefits (PRB) across risk-benefit acceptability thresholds from the acceptability curves generated.RESULTS: The RDs of IH were 0.237 and 0.201 lower in OM and RM than primary suture closure, compared to 0.027 and -0.001 for SSI. IRBRs (95% CI) for SSI risk were -0.118 (-0.124, -0.112) and 0.006 (-0.002, 0.013) for OM and RM, respectively. PRBs were much higher in RM than OM, especially at low acceptability thresholds of 0.05 and 0.1. IRBRs (95% CI) for CSH were -0.388 (-0.395, -0.381) and -0.105 (-0.111, -0.100) for OM and RM, respectively. RM yielded a PRB of 0.87 at an acceptability threshold of 0.2, in contrast to OM, which did not.CONCLUSION: Overall, RM offered improved benefit in IH prophylaxis over the risk of complications relative to OM and appeared to be the preferred treatment option for this indication.

Objective: To explore the non-placement of “T�?tube after laparoscopic choledochotomy. feasibility and complication analysis of primary suture bile duct. Methods: Retrospective analysis of January 2013~ December 2016, Laparoscopic choledocholithotomy for primary bile duct suture in 87 cases, Combined with literature, the indications, methods and complications of the operation were summarized and analyzed. Results: There was no operative death in the whole group, Postoperative complications occurred in 5 cases (5.7%), 1 case with jaundice, gradually subsided after 4 days of conservative treatment. Two cases had postoperative bile leakage, to prolong the drainage time of the peritoneal drainage tube and stop by itself. In 1 case, bile duct stenosis occurred. 1 case of residual common bile duct stones. The average postoperative hospitalization was 9 days. Conclusion: Select the right case strictly, Patient and delicate operation, Laparoscopic choledochotomy is safe and feasible.

To investigate the feasibility and clinical effect of laparoscopic choledochotomy for primary suture of bile duct. Methods: There were 190 cases of cholecystolithiasis with choledocholithiasis. They were randomly divided into endoscopic group and open group. In the endoscopic group ,87 patients underwent laparoscopic choledocholithotomy and primary bile duct suture. A total of 103 patients in open group were treated with open bile duct incision and T tube drainage. The operative time, intraoperative blood loss, postoperative ventilation time, hospital stay and postoperative complications were compared between the two groups. Results: The length of hospital stay, the amount of bleeding during operation and the time of postoperative ventilation were less than those in open group. The operation time was longer than that in open group, P

Introduction. This pilot study evaluates if an electronic nose (eNose) can distinguish patients at risk for recurrent hernia formation and aortic aneurysm patients from healthy controls based on volatile organic compound analysis in exhaled air. Both hernia recurrence and aortic aneurysm are linked to impaired collagen metabolism. If patients at risk for hernia recurrence and aortic aneurysms can be identified in a reliable, low-cost, noninvasive manner, it would greatly enhance preventive options such as prophylactic mesh placement after abdominal surgery. Methods. From February to July 2017, a 3-armed proof-of-concept study was conducted at 3 hospitals including 3 groups of patients (recurrent ventral hernia, aortic aneurysm, and healthy controls). Patients were measured once at the outpatient clinic using an eNose with 3 metal-oxide sensors. A total of 64 patients (hernia, n = 29; aneurysm, n = 35) and 37 controls were included. Data were analyzed by an automated neural network, a type of self-learning software to distinguish patients from controls. Results. Receiver operating curves showed that the automated neural network was able to differentiate between recurrent hernia patients and controls (area under the curve 0.74, sensitivity 0.79, and specificity 0.65) as well as between aortic aneurysm patients and healthy controls (area under the curve 0.84, sensitivity 0.83, and specificity of 0.81). Conclusion. This pilot study shows that the eNose can distinguish patients at risk for recurrent hernia and aortic aneurysm formation from healthy controls.

A novel technique for the damage control of big diaphragmatic injuriesPurpose: To evaluate and describe a novel technique for the temporary closure ofmajor diaphragmatic defects not suitable for primary suture in damage control setting.Background: It is an acceptable opinion that all left sided diaphragmatic injuriesshould be repaired, as opposed to right sided where the liver may safely protect thedefect. In most cases the repair of the diaphragm is simple, using non-absorbablesutures. Closure of defects not suitable for primary suture, remains a reallychallenging problem. Up today, there is no adequate solution for prevention of re-protrusion of abdominal contents in a damage control setting.Methods: We report a novel technique suitable for treating diaphragmatic injuries indamage control setting. This method allows a rapid temporary closure of, non-suitablefor primary closure, large diaphragmatic defects and part of the damage controlconcept.Results: Two anesthetized pigs were used in an animal trial to evaluate the feasibilityof the technique. Same size defects were created in both subjects. In the first subject,the defect was closed with a plastic (Bogota) bag. In the second subject, thediaphragmatic defect was covered using a large abdominal pad. In both cases, nochest protrusion was observed after completion of the experiment.Conclusion: We describe a simple new technique for temporary diaphragmatic closurethat might be done as part of damage control. Further investigation will help toinclude it to routine surgical arsenal.

Traumatic left ventricular pseudoaneurysms are rare and surgical correction is the treatment of choice. In this article, it is reported a case of a myocardial stab injury with primary suture and development of a giant pseudoaneurysm, five years later, that underwent surgical repair.

Parastomal hernia repair remains a significant surgical challenge. Recurrence after standard “keyhole” or primary suture repair is common. We adopted and modified a new technique using a construct shaped like an inverted top hat. We review our experience over the last six years in the first 30 patients (31 consecutive procedures). Of these 31 procedures, six (19%) resulted in a parastomal hernia recurrence with a median follow-up of 31 months (range 0.5–80). Four of the recurrences occurred in our initial experience, when we constructed the top hat of xenograft alone. When the technique was modified, using a synthetic composite mesh for the underlay portion of the hat, there were only two subsequent recurrences in 16 patients (13%) with a median follow-up of 22 months. One of these “recurrences” was secondary to infection of the top hat construct, which had to be removed. This initial success in preventing recurrence of parastomal hernia is probably due to the design of the construct, for it occludes the vulnerable stoma/fascial angle, through which most parastomal hernia recurrences occur.

To compare adhesion scores, repair strength and histological findings among sublay, onlay and primary repair incisional hernioplasty techniques. Surgical repairs were employed directly on healthy animals, without previous hernia induction, to avoid confounding factors related to hernia development. Forty Wistar rats were divided into four groups, control, simulation, onlay and sublay. After 42 days, adhesion intensity, tensile strength of the abdominal wall and anatomopathological histological substrate were compared. SL group presented greater adhesion scores (p

There are three choledochotomy closure methods available following laparoscopic common bile duct exploration: T-tube insertion, antegrade stenting, and primary choledochorrhaphy. We reviewed the experience of 12 years at our center searching for the optimal closure technique.We analyzed retrospectively 146 patients that underwent one of the three closure methods from February 2004 to March 2016. Hospital stay, need for readmission, incidence of early and long-term complications, and biliary leakage development and their clinical impact were determined for each technique.Hospital stay was more prolonged, and need for readmission was higher in the T-tube group. Nine patients of the T-tube group (17.3%), 5 patients (8.6%) of the antegrade stenting group, and 1 patient of the primary suture group (2.8%) developed Dindo-Clavien ≥3 complications (P = .076). The incidence of biliary leakage was 3.8%, 8.6%, and 16.7% for the T-tube group, antegrade stenting group, and primary suture group, respectively. There was no grade C biliary fistula in the primary suture group, and all grade B leaks in these patients were only due to prolonged duration. The T-tube removal caused adverse events in 21.1% of the patients, and complications directly related with stents occurred in 9.6%.Antegrade stents or T-tube insertion do not provide any added value for choledochotomy closure but are charged with specific morbidity. On the contrary, despite biliary leaks being more frequent after primary suture, they are of little clinical consequence and may be managed on an outpatient basis.

Introduction: Spontaneous iliac vein rupture is a rare but lethal disease. Most patients suffer from shock status in the emergency department. Until now, open laparotomy combined with primary suture is the most common treatment of iliac vein rupture. However, there is high mortality and morbidity in the patients who underwent open laparotomy. Case Presentation: A 71-year-old woman denied trauma history and sustained hypovolemic shock. The abdominal computed tomography showed one huge retroperitoneal hematoma. The emergency angiography revealed one obvious rupture point on the left external iliac vein. We repaired the lesion with endovascular stent and open laparotomy for abdominal decompression. The patient progressed well and was discharged. Conclusion: Endovascular repair is an effective and safe treatment. Compared with open laparotomy and primary suture, stent leads to fewer complications and a lower mortality rate.

Background: Eyelids reconstruction after tumor resection has be one of the most challenging procedures in reconstructive plastic surgery. Small defects may be closed by primary suture or covered by small local flaps or skin graft. But in large eyelids defects, we need to find a bigger source of color and texture matching tissue that will ensure functional and aesthetical outcomes. Many techniques have been described, but in this case, the author suggest a split lateral forehead flap designed to cover upper and lower eyelids. Patient and Operation Techniques: A Male 51 years-old-patient, presented himself in our clinic with a basal cell carcinoma involving the right upper and lower eyelids. The tumor had a history of 7 years, without any pain or vision disorders involved. Tumor was widely excised, leaving a full thickness on upper and lower eyelids. The inner lining palpebral was replaced by composite auricular graft following by lateral cantophexy. A lateral forehead flap raised with a right temporal pedicle, and the distal part of flap was split in half, and inset into the upper and lower eyelids defect. The donor region was closed with an STSG from Femur Dextra. After 14 days the flap was divided, the functional result was excellent. Discussion: At first, surgeons were worried of raising forehead flaps beyond the midline, fearing that by splitting the distal flap would cause its compropmise. However, rich anastomostic plexus exists between the major forehead angiosomes lined by the smaller calibre “choke” vessels. Conclusions: Periorbital Basal cell carcinoma resection may leave great defect to the underlying tissue. The need to provide adequate support to this structure requires complex techniques with minimum two flaps. In our case, we performed a split lateral forehead flap with a good functional and cosmetic outcome.

Background Spontaneous colonic perforations are scarce, and cecal perforations even more so. Preoperative diagnosis of the latter in a pregnant woman is particularly difficult because of physiologic changes and restrictions on some diagnostic imaging techniques, such as X-rays. Furthermore, management of these patients is a big challenge. Case presentation We present a case of a spontaneous cecal perforation in a 40-year-old pregnant black woman in the Regional Hospital of Bafoussam in Cameroon. The results of clinical examination and ultrasonography on admission were in line with acute generalized peritonitis in a woman at 20 weeks of a viable pregnancy, indicating an urgent laparotomy. Operative findings were a 1 × 1-cm perforation on a distended cecum with minimal fecal contamination. The treatment consisted of excision of the edges, primary suture of the perforation, and omentoplasty. The recovery of the patient was uneventful. Conclusions The management of spontaneous cecal perforation in a pregnant woman was a big challenge. The perforation was repaired by primary suture and omentoplasty. Further studies comparing this approach with right hemicolectomy are recommended.

Background Traditionally, Surgical treatment strategies for elderly patients diagnosed with choledocholithiasis combined with cholecystolithiasis include laparoscopic choledocholithotomy, cholecystectomy, and T-tube drainage. However, T-tube drainage in the biliary tract can still cause pain and other complications. This study was designed to compare the primary closure of choledochotomy and the use of T-tube after laparoscopic choledochotomy to determine whether primary suture can be as feasible and safe as suture with T-tube drainage in elderly patients. Methods From January 2017 to January 2018, 85 patients were selected to undergo laparoscopic surgery. They were divided into two groups: primary suture group (n=56) and T tube group (n=29). Preoperative data, intraoperative index, postoperative complications were recorded. Results There were no differences in preoperative data in both groups. Compared with the T-tube group, the postoperative total drainage volume on the first day and patients of residual stones were fewer, and all drainage tube extubation time was shorter in the primary suture group. And there were statistically significant differences in postoperative TBIL between the two groups. There were no pressure sores, hypostatic pneumonia, deep vein thrombosis, serious complications of heart, lung and brain and even death in both groups. Conclusion Only if accurate preoperative risk assessment and strict treatment of basic diseases in elderly patients, intraoperative fine suture of the common bile duct, primary suture in elderly patients are feasible, safe, and valid after laparoscopic choledochotomy for verification of ductal clearance.

Purpose Morgagni−Larrey congenital diaphragmatic hernia (MLH) is rare in adult patients and surgery is performed infrequently. The evidence regarding the most beneficial treatment modality is low. Nevertheless, with increasing experience in minimally-invasive surgery, the literature proves the laparoscopic approach as being safely feasible. However, knowledge on the disease as well as treatment options are based on single surgeon’s experiences and small case series in the literature. Methods Retrospective single-center analysis on adult patients (≥ 18 years) with MLH from 01/2003 to 06/2019 regarding symptoms, hernia sac contents, surgical technique and perioperative outcome. Results 4.0% of diaphragmatic hernia repair procedures were performed for MLH (n = 11 patients). 27.3% of these patients were asymptomatic. Dyspnea or gastrointestinal symptoms were frequently observed (both in 45.5% of the patients). Colon transversum (63.6%), omentum majus (45.5%) and/or stomach (27.3%) were the most common hernia sac contents. Correct diagnosis was achieved preoperatively in 10/11 patients by cross-sectional imaging. All procedures were performed by trans-abdominal surgery (laparotomy in four and laparoscopy in seven patients). All hernias were reinforced by mesh after primary closure. No differences were observed in the perioperative outcome between patients who underwent hernia repair by laparotomy versus laparoscopy. Pleural complications requiring drainage were the most common postoperative complications. Conclusion MLH repair seems to be safely feasible by laparoscopic surgery. The benefit of mesh augmentation in MLH repair is not clear yet. In contrast to the current literature, all patients in this study received mesh augmentation after primary closure of the hernia. This should be evaluated in larger patient cohorts with long-term follow-up.

Purpose: Surgical excision is the preferred treatment modality for sacrococcygeal pilonidal sinus (PS). Notably, the desirable features of an ideal surgical intervention are excision with minimal tissue loss, closure without tension, and a lateral suture line. The present study aimed to investigate early outcomes of surgical excision through the inverse D (?) incision based on tissue loss, wound tension, and suture line location. Methods: This prospective study was comprised of 80 patients with PS in whom excision of PS was performed through the '?' incision to minimize tissue loss with a tensionless primary surgical wound closure. The suture line was located laterally in all patients. Early and late postoperative complications, duration of hospital stay, return to work, and recurrence rates were investigated. The mean duration of the follow-up period was 36 months. Results: Sixty-three patients (78.8%) were male. PS in all patients was surgically removed by subcutaneous excision through a '?' incision. Laterally placed surgical wounds were closed primarily with interrupted vertical mattress sutures. No general complications were encountered. Five patients (6.3%) experienced early postoperative surgical site complications. On average, the duration of hospital stay and return to work were 2.4 days and 3.8 days, respectively. Recurrence was seen in 1 case (1.3%) during the follow-up period. Satisfaction score was high in 83.8% of patients. Conclusion: The method of sinus excision using the '?' incision with a primary suture facilitates excision with minimal tissue loss and closure without tension with an off-midline suture. It is both a simple and effective surgical technique for the treatment of sacrococcygeal PS. Copyright © 2019, the Korean Surgical Society 2-s2.0-85077220819

Following after the report of the first successful definitive surgery for Hirschsprung’s disease described by Swenson and Bill in 1948 [1], modification and novel development of the surgical procedures were described one after another in the 1950s and 1960s. The three satisfactory procedures were finally established: Swenson’s abdominal prolapse technique, Duhamel’s retrorectal transanal pull-through, and Soave’s submucosal endorectal pull-through technique. The latter two procedures were furthermore modified later. In the present chapter, Soave-Denda-Boley procedure, a modified technique of Soave’s procedure with a primary suture of the colon to the anal site and its clinical results are presented.

Subxiphoid and suprapubic hernias represent uncommon hernias, most of which develop following incisions for cardiac or intra-abdominal surgery. Primary suture repair is associated with unacceptably high recurrence rates. This chapter discusses the details of these very different hernias. Additionally, the operative technique for robotic repair is reviewed. Postoperative management is also discussed.

The effective repair of ventral and incisional hernias is a challenging and dynamic field that continues to advance with research and innovation. Primary suture repair of ventral hernias has now largely been abandoned due to high recurrence rates. Prosthetic mesh placement is now the standard of care for all but the smallest ventral hernias. Mesh placement has been described above, below, and within each layer of the abdomen. Intraperitoneal onlay mesh (IPOM) technique places a mesh within the peritoneal cavity and below the peritoneum. Once implanted, the mesh forms an inflammatory reaction with the peritoneum, creating a durable and tensile prosthesis. Literature has shown IPOM to be an efficacious repair with reduced complications. Here we discuss the origins of the IPOM as well our experience and technique using the IPOM repair.

Analyzed the results of treatment of 584 patients operated on for soft tissue tumors of the head and neck with the elimination of the defect formed by directly comparing the edges of wounds by primary suture. Taking into account the level of the wound by M.I. Kuzin et al. (1977), the dynamics of clinical and laboratory results, morphological, biological research, local thermometry and vulnotenziometry. Statistical significance was estimated using the Student's t-test, Mann–Whitney U-test, and criteria χ2 and Fisher with certainty changes in p < 0.05. Found that in the majority of patients kept the wound heals biologically programmed tissue reactions. At the same time, high bacterial contamination of integumentary tissues in the area of operations, especially against the background of the malignant tumor was a risk factor for the development of wound complications in 18 % of patients. The observed the oncological impact was characterized by the five-year survival at 90.6 ± 1.9 %. The 4.5 ± 1.9 % of patients had a direct link to death from malignant tumor.

Background: The aim of this study is to explore the application value of layered suture technique in two-port laparoscopic choledocholithotomy with primary suture. Materials and Methods: A prospective study of 267 patients received laparoscopic common bile duct choledocholithotomy with primary suture in our hospital from January 2014 to July 2017. Of these cases, layered suture technique was utilised in 110 patients, and single-suture technique was used in 157 patients. The operation time, post-operative hospital stay and post-operative complications were compared between the two groups. Results: Two groups of patients were operated smoothly, with no conversations to laparotomy. Post-operative recovery was symptom free. The operative time was not significantly different between the two groups of patients (t = −0.587, P = 0.086). The post-operative hospital stay and incidence of post-operative bile leakage were significantly lower in layered suture group than those in single-layer suture group ([7.6 ± 1.8] days vs. [5.8 ± 1.7] days, t = 2.776, P = 0.000; 4.5% [5/110] vs. 20.4% [32/157], χ2 = 9.885, P = 0.002). In the single-layer suture group, the incidence of post-operative bile leakage was significantly higher in patients complicated with acute cholangitis (44.4% [12/27] vs. 15.4% [20/130], χ2 = 11.634, P = 0.001), whereas in the layered suture group, the incidence of post-operative bile leakage was insignificantly different among patients with and without acute cholangitis (11.8% [2/17] vs. 3.2% [3/93], χ2 = 0.848, P = 0.357). Conclusion: Application of layered suture technique in laparoscopic choledocholithotomy with primary suture is feasible and safe, with advantages of less bile leakage and shorter hospital stay.

INTRODUCTION The advantages of laparoscopic surgery for ventral hernia repairs are well documented, but its application for small paraumbilical hernias has been less studied. There is no consensus regarding the best technique. METHODS All patients who had open (suture or mesh) and laparoscopic repair of primary paraumbilical hernia between September 2007 and September 2017 in a single center were identified. Hernial defects of 2 cm or less were included; recurrent hernias were excluded. Primary outcomes included operative time, length of hospital stay, and surgical complications. RESULTS Seventy-seven patients were recruited: 54 (70.1%) had open repair and 23 (29.9%) had laparoscopic repair. Forty-six patients (85%) in the open group had primary suture repair. The mean operative time was significantly shorter in the open group than in the laparoscopic group (27.2 vs 56.1 min, P

An analysis of the treatment results was made in 447 patients with closed abdominal injury combined with liver damage. An individualized treatment-and-diagnostic program considering the data of field surgery- MT scale was applied in victims with closed abdominal trauma with liver damage. At the same time the classification E. Moore et.all (1990) for liver injuries was used for assistance. The indications for endovideosurgical homeostasis, a primary suture of liver wound and the hepatic resection were determined. The indications for packing the liver wound were specialized using strategy of «Damage control». An application of given individualized surgical strategy allowed reduction of the lethality level from 32,3% to 17,1% in the case of closed abdominal trauma with liver damage.

Background The treatment of postpneumonectomic empyema is challenging. The aim of this study was to test the efficacy of vacuum-assisted closure (VAC) in the treatment of patients with open window thoracostomy (OWT). Methods Between January 2010 and April 2014, eight patients developed empyema following pneumonectomy for malignant diseases in our department and then underwent an OWT with subsequent VAC therapy; their cases were retrospectively studied. Each session of VAC therapy lasted 72 hours, and therapy was completed after approximately 6 sessions. Results OWT in six patients resulted in either decreased size or complete closure after VAC treatment. Five patients had a bronchopleural fistula (BPF), which was closed either with a tracheal stent (three patients), primary suture, or omentoplasty. The BPF in one of these patients closed during VAC therapy. The treatment failed in two patients due to the microfistula becoming obvious in one and persistence of the fistula in the other. Conclusion We believe that the use of VAC in the treatment of postpneumonectomy empyema is effective, except for patients with BPF.

Relevance The treatment of suppurative lactation mastitis remains urgent surgical problem. Despite significant advances of modern medicine in the treatment and prevention of surgical infections, mastitis is one of the first places in the structure of postpartum purulent-inflammatory complications, making towards them to 26-67% of cases. Until recently, it remained the most common traditional method of surgery at a mastitis, comprising the wide opening purulent focus one or more radial slits without a radical excision of nonviable tissue. Application of active surgical treatment purulent diseases has improved the results of treatment in this complex surgical pathology. However, its implementation in practical surgery is complicated because absence or imperfection of special technical means for active drainage, which leads to poor-quality sanitation purulent cavity and lengthens treatment time. The purpose of the study Analysis of immediate and long-term results treatment of suppurative lactation mastitis using a device AMP-01. Results and their discussion The use of active surgical method for the treatment of patients with GLM (main group, the comparison group 2) have led to a significant reduction in the duration of treatment and get good functional and cosmetic results compared to the comparison group 1 (the traditional method). A comparative study of treatment results in the study group research using the method of rehabilitation program using the device AMP-01 in the comparison group 2 with flow-suction method there are some differences. The use of primary suture in combination with active aspiration of wound and in the creation of a permanent purulent cavity vacuum of 80-100 mm of water. Art. It provides better sanitation of purulent focus and leads to the blocking of its walls and speed up recovery. Therefore, the results of treatment in the study group were slightly better for all the assessment criteria immediate and long-term results compared with a comparison group 2. Conclusion Application of the rehabilitation program using the device AMP-01 in treatment patients with GLM allows significantly accelerate clearance of the wounds from necrotic tissues, microbial bodies, stimulates regeneration processes, all of which helps to reduce the treatment durstion and getting good immediate and long-term clinical results. Method rehabilitation program using the device AMP-01 had advantages over other methods of active surgical treatment for all the assessment criteria of immediate and late treatment results.

A 41-year-old man experienced a swollen scrotum three days after a motorcycle accident and presented to our hospital. He had had a primary suture repair for anoperineal trauma in an outside hospital at the time of the injury. He presented to us with general fatigue, low grade fevers, and perineal pain. Abdominal computed tomography showed subcutaneous emphysema from the scrotum to the left chest. The sutured wound had foul-smelling discharge and white exudate. We made the diagnosis of necrotizing fasciitis and immediately opened the sutured wound and performed initial debridement and lavage with copious irrigation. We continued antibiotics and lavage of the wound until the infection was controlled. Fortunately, the necrotizing fasciitis did not worsen and he was discharged after 15 days. Our experience indicates that anoperineal injuries should not be closed without careful and intensive follow-up due to the potential of developing necrotizing fasciitis.

Objective: To investigate the feasibility, safety and the clinical value of primary suture following 3-port laparoscopic common bile duct exploration (LCBDE). Methods: From January 2012 to September 2014, 176 patients suffered from choledocholithiasis were treated with primary suture following 3-port LCBDE and the clinical data were retrospectively analyzed. Results: All cases were operated successfully and none was converted to open surgery. The duration of operation was 92.2 ± 18.8 min and the length of postoperative hospital stay was 4.4 ± 3.7 d. Postoperative bile leakage occurred in 2 cases and these patients recovered by simple drainage for 3 to 7 days without re-operation. All patients recovered smoothly without any serious complications. Conclusions: Primary suture following 3-port LCBDE is safe, effective and mini-invasive, which is worthy of further clinical application.

In our case study, the left ear of a 57-year-old male patient was subtotally amputated due to an iron-plate cutting accident. Only a 5-mm inferior skin pedicle connected the amputated ear to the lobule. The ear was reattached with primary suture without microsurgery. The reattached ear healed uneventfully.

BACKGROUND The skin on the lower leg has abundant perforators and, thus, is an excellent donor site for transplant tissue flaps. However, due to vascular variations and body positions, tissue flaps at the posterolateral proximal portion of the lower leg are rarely used for transplantation. This study reports our experience with the use of superficial lateral sural artery perforator (SLSAP) flaps in the repair of moderate-sized hand wounds. METHODS From March 2012 to April 2015, the hand wounds of 15 patients were planned for repair using a superficial sural artery perforator flap. In total, 6 patients had a defect in the palm of the hand, 5 in the dorsum of the hand, and 3 in the finger; 1 patient sustained a contracture of the first web space. RESULTS In 12 of the 15 cases, an SLSAP flap was successfully harvested. In the remaining 3 cases, the planned harvest of an SLSAP flap was converted to the harvest of a superficial medial sural artery perforator flap during the operation. The flaps ranged in area from 1.8 × 3.8 cm to 5.5 × 6.5 cm. Primary suture of the donor site was performed in all cases. Dissection of the muscular tissue was avoided. After the operation, venous crisis occurred in 1 case, and a partial area of necrosis developed at the distal end in 1 case. The flap survived in all other cases. CONCLUSIONS Our experience showed that the SLSAP flap is suitable for reconstruction of moderate-sized hand defects.

Background Traumatic, non-iatrogenic esophageal injuries, despite their rarity, are associated with significant morbidity and mortality. The optimal management of these esophageal perforations remains largely debated. To date, only a few small case series are available with contrasting results. The purpose of this study was to examine a large contemporary experience with traumatic esophageal injury management and to analyze risk factors associated with mortality. Methods This National Trauma Data Bank (NTDB) database study included patients with non-iatrogenic esophageal injuries. Variables abstracted were demographics, comorbidities, mechanism of injury, Abbreviated Injury Scale (AIS), esophageal Organ Injury Scale (OIS), Injury Severity Score (ISS), level of injury, vital signs, and treatment. Multivariate analysis was used to identify independent predictors for mortality and overall complications. Results A total of 944 patients with non-iatrogenic esophageal injury were included in the final analysis. The cervical segment of the esophagus was injured in 331 (35%) patients. The unadjusted 24-h mortality (8.2 vs. 14%, p = 0.008), 30-day mortality (4.2 vs. 9.3%, p = 0.005), and overall mortality (7.9 vs. 13.5%, p = 0.009) were significantly lower in the group of patients with a cervical injury. The overall complication rate was also lower in the cervical group (19.8 vs. 27.1%, p = 0.024). Multilogistic regression analysis identified age >50, thoracic injury, high-grade esophageal injury (OIS IV–V), hypotension on admission, and GCS