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Background Ventricular septal defect (VSD) is the most common congenital heart defect in children and adults. Until recently, open-heart surgical closure has traditionally been considered the mainstay of intervention for the majority of VSDs. The development of a trans-catheter occlusion technique with the advancement of the newer percutaneous occluding VSD closure devices that can safely and effectively close these defects was welcomed by cardiologists, patients, and their families making trans-catheter device closure an attractive and feasible alternative. Objective We aim to evaluate the intermediate and long-term follow-up outcome of patients who underwent percutaneous trans-catheter closure of isolated ventricular septal defects. Patients and Methods This study is an exploratory pilot single-tertiary center study. The study included 25 patients who have successfully undergone percutaneous ventricular septal closure in the cardiac catheterization unit of the cardiology department at Ain Shams university Hospitals in the period from June 2015 till June 2018. The follow up protocol includes detailed history taking, clinical examination, and full 2D echocardiography with additional circumferential and radial strain imaging by speckle tracking technique (STE), resting and Holter electrocardiograms. Results A significant increase in growth parameters were noticed during 6.3 month mean follow up time, with an overall mean weight increase by 10% and an overall mean height increase by 6.2%. Sequential echocardiographic follow-up showed highly significant decrease in LV dimensions and volumes, circumferential LV strain values, pulmonary to systemic circulation (Qp:Qs) ratio, RVSP and mPAP. Significant complications occurred in (12%) of patients: symptomatic/significant Brady-arrhythmia (Complete heart block) that required permanent pacemaker implantation (4%), significant residual shunt causing hemolytic anemia requiring re-intervention (4%) and significant valvular regurgitation (Severe Tricuspid Regurgitation) (4%) Conclusion The development of a VSD trans-catheter occlusion technique with the advancement of the newer percutaneous occluding VSD closure devices is an attractive and feasible procedure with high success rates

Background: Given appropriate case selection and capability, many acute lacerations can be managed in the primary care setting. An understanding of the basic pathophysiology, assessment and management principles is essential. Objective: The aim of this article is to provide a basic framework for assessing and managing simple acute lacerations. Discussion: The aim of assessment is initially to decide whether the laceration is suitable for office-based treatment, and then whether it requires formal surgical closure with sutures or staples. Two non-surgical techniques for skin closure in amenable wounds are described. A companion article in this issue provides details of surgical closure techniques and wound aftercare.

Introduction. Few randomized controlled studies have been conducted comparing a small to large fascial bite technique, yet recommendations have been made to standardize small bite closures. However, large scale randomized controlled trials require considerable effort and may benefit from a pilot study. Methods. This multi-center randomized controlled pilot study of adult patients undergoing median laparotomy incision investigated the feasibility of studying the outcomes between small and large surgical closure techniques. Results. Fifty of 100 planned patients consented, 32 patients completed surgery and 19 patients completed the one-year ultrasound. Enrollment was 2.7 versus 8 patients per month pre/post addition of study coordinator. Clinical results are summarized for feasibility demonstration purposes, but not analyzed for hypothesis testing. The total cost of the pilot study was $19,152.50 and took 22 months from first surgery to final one-year ultrasound. Conclusions. This feasibility assessment demonstrates the complexity of planning a large scale randomized trial evaluating small and large bite surgical closure technique. To expand this pilot study to a full scaled sample size study would require dedicated personnel and large grant funding.

Enterocutaneous fistulas are a rare occurrence after placement of a PEG tube. The key risk factor for their development is the time the PEG tube is in situ, giving time for the fistula tract to mature. Enterocutaneous fistulae are traditionally treated with parenteral nutrition or surgical management. We present a case of a 69-year-old woman who underwent surgical closure of an enterocutaneous fistula with a fibrin plug. The fistula recurred on post-operative Day 5, and the patient was placed on thickened fluids to increase the viscosity of the fluid exiting the fistula tract. This approach decreased the output and lead to subsequent closure of the fistula by outpatient follow up at 4 weeks. This case demonstrates an application of Poiseuille’s law to closure of fistula tracts.

Introduction: Stoma construction is a life saver method for emergent and elective operations in colorectal surgery. However, they are associated with high rates of morbidity and mortality. Aim: To compare the operative findings, early postoperative complications, and costs of stapled and hand-sewn closures in loop ileostomies that are constructed in emergent and elective colorectal surgery. Material and methods: The data of 68 patients requiring loop ileostomies during colorectal surgery were retrospectively evaluated. SPSS (version 20) was used for data analysis. Results: The study group consisted of 44 men and 24 women with a mean age of 55.5 years. The ileostomy closures were performed with hand-sewn method in 36 patients (group 1) and stapled method in 32 patients (group 2). The mean operation time was 75.4 min in group 1 and 46.7 min in group 2 (p < 0.001). Early postoperative complications were wound infection (8.8%), small bowel obstruction (6.06%), and anastomotic leakage (2.9%). Total costs, flatulence and faeces outlet time, oral feeding starting time, time of hospital stay, and early postoperative complications were lower in the stapled group. Conclusions: Morbidity and mortality rates of stoma construction and its closure are still considerable. Lower anastomotic leakage rate, complication rate, and costs and shorter operative times in the stapled group make this method preferable.

Objective To assess the frequency of surgical techniques at cesarean delivery (CD) among U.S. obstetricians. Methods Members of the American College of Obstetrician Gynecologists were randomly selected and e-mailed an online survey that assessed surgical closure techniques, demographics, and reasons. Data were analyzed using SPSS (IBM Corp., Armonk, New York, United States), descriptive statistics, and analysis of variance. Results Our response rate was 53%, and 247 surveys were analyzed. A similar number of respondents either “always or usually” versus “rarely or never” reapproximate the rectus muscles (38.4% versus 43.3%, p = 0.39), and close parietal peritoneum (42.5% versus 46.9%, p = 0.46). The most frequently used techniques were double-layer hysterotomy closure among women planning future children (73.3%) and suturing versus stapling skin (67.6%); the least frequent technique was closure of visceral peritoneum (12.2%). Surgeons who perform double-layer hysterotomy closure had fewer years in practice (15.0 versus 18.7 years, p = 0.021); surgeons who close visceral peritoneum were older (55.5 versus 46.4 years old, p Conclusion Similar numbers of obstetricians either reapproximate or leave open the rectus muscles and parietal peritoneum at CD, suggesting that wide variation in practice exists. Surgeon demographics and safety concerns play a role in some techniques.

BACKGROUND The hemodynamic perturbation related to patent ductus arteriosus (PDA) is associated with a higher risk of necrotizing enterocolitis (NEC). OBJECTIVE To determine whether primary surgical closure, as compared with treatment with indomethacin or exposure to prophylactic indomethacin, reduces the incidence of NEC in preterm infants

Endoscopic management of nonmalignant leaks, perforations, and ruptures becomes increasingly important with the growing availability of endoscopic therapy. In general, treatment strategies depend on the time of intervention (immediate complication management vs therapy of chronic fistulas and leaks). The approach used to close an acute perforation is adopted from surgical closure techniques, although a serosa-to-serosa adaptation is difficult to achieve, even with new devices. Nonacute leaks—if not treated by stents—are more complex and treatment is based on secondary wound closure after implantation of certain materials and devices. Nevertheless, apart from these general considerations it is important to know that therapy is not standardized and is therefore often based on a patient's individual factors, availability of respective devices, and knowledge in handling them.

Transcatheter closure of congenital and acquired septal defects has been performed for over 40 years. In several circumstances, it is now considered first in-line therapy over surgical closure. In this review, we summarize the indications to close congenital and acquired septal defects and briefly review the technique and devices used to repair such defects.

Exposure to a chronic persistent patent ductus arteriosus (PDA) is associated with several neonatal morbidities, but whether such outcomes are as a result of a persistent left-to-right shunt across the PDA or as a consequence of prematurity remains in question. Animal studies have shown significant benefit to early PDA closure, but such findings have not been replicated in any human trial. Both pharmacologic and surgical treatment options exist for closing a PDA, both of which have their own morbidities. Although the incidence of PDA is high in preterm infants, there also is a high rate of spontaneous PDA closure. Treatment of a PDA is not benign and has not been shown to prevent any morbidities associated with prematurity. For this reason, there has been much debate in recent years as to when a PDA is pathologic and when closure is indicated. This discussion focuses on the debate, treatment options for PDA, and outcomes associated with PDA and its treatment.

The rotator interval is a triangular space located between the subscapularis and supraspinatus tendons in the anterosuperior region of the shoulder. Within its borders lie the superior glenohumeral and coracohumeral ligaments, the long head of biceps tendon, and capsule. From a biomechanical standpoint, the rotator interval contributes to shoulder stability and maintains normal glenohumeral translation, and helps maintain stability of the long head of the biceps. Multiple studies have described various surgical closure techniques and the associated outcomes on overall function; still the optimal surgical technique is a source of debate. The primary objectives of this chapter are to review the anatomy and biomechanics of the rotator interval, its components and their function, and surgical treatment of the rotator interval as related to stiffness.

We present a 77-year-old female with recent myocardial infarction complicated by antero-apical ventricular septal defect (VSD) and quick development of low cardiac output. Using interrupted horizontal mattress sutures VSD closure was successfully performed on the beating heart. Transthoracic echocardiography at the four-month follow-up did not reveal residual VSD.

Continuous percutaneous and dermal suture closures have an important role in the approximation of long, linear lacerations in the emergency department. This report documents the scientific basis for these continuous closure techniques. In addition, a detailed description of these surgical closure techniques is presented.

SUMMARY The aim of this research was to evaluate the effect of the Delaire surgical technique on the midfacial morphology in a group of subjects with a congenital unilateral cleft of lip and palate (UCLP), prior to orthodontic treatment. Thirty-fi ve UCLP (15 left and 20 right) patients (16 males and 19 females, mean age 7.03 ± 0.9 years; age range 8.7 – 5.0 years), treated for the correction of congenital malformation, were retrospectively selected. Analysis of midfacial growth was undertaken on lateral cephalograms, and the data were compared with reference values (Ricketts analysis). A Mann – Whitney ranked sum test was used to detect signifi cant differences between the fi ndings and reference values. P ≤ 0.05 was considered as signifi cant. The results demonstrated a retropositioning of both the maxilla and mandible (SNA and SNB P < 0.01) and increased mandibular development (Go – Me distance). Vertically, there was a trend to a posterior rotation of the mandible ( P < 0.01), resulting in a hyperdivergent profi le. This trend was confi rmed by the increase in SpA – SpP/Go – Me ( P < 0.05). In agreement with previous studies, the effects of surgical closure of a cleft lip might be responsible for excessive maxillary retropositioning with a downward rotation.

Transcatheter closure of atrial septal defects has evolved significantly over the last 20 years. Transcatheter closure has replaced surgical closure for the treatment of most secundum atrial septal defectsat the current time. A major reason for this is the lower morbidity of transcatheter closure procedures. Several closure devices have come into clinical use. The Amplatzer septal occluder (AGA Medical Co.) currently has the largest reported experience and subsequently the best-established safety and efficacy features. Clinically challenging situations, such as larger atrial septal defects, atrial septal defects with deficient rims and multiple atrial septal defects, are increasingly being addressed using the transcatheter approach, with improved results. The incidence of most complications has significantly reduced over time, and serious side effects are relatively uncommon. In this review, the literature is summarized regarding the current role of transcatheter closure, the evolution of the different available devices for clinical use and the complications that occur with their use. A comparison is also made with surgical closure techniques.

The surgical closure of septal perforations remains a distinctive challenge to the otorhinolaryngologist. This is demonstrated by the modest success in most techniques. An alternative method, involving surgical enlargement of the perforation with posterior edge repair, is described and the outcome is investigated. Thirteen patients with perforations of up to 50 mm in size underwent this technique. A questionnaire interview was conducted and symptom scores were obtained. The length of hospitalization, follow-up period and post-operative complications were evaluated as were measures of morbidity. The results showed a significant improvement in the symptom scores for nasal crusting, epistaxis and overall discomfort. This technique is straightforward and is especially suitable for larger perforations. The successful improvement in symptoms and an associated low morbidity makes it a complement to alternative surgical closure techniques.

We sought to examine the efficacy of vacuum-assisted closure (VAC) therapy for the reconstruction of full-thickness forehead defects and to determine the appropriate therapeutic strategies for its use. Medical records and photographs were reviewed for 3 patients with full-thickness tissue loss of the forehead region treated with a VAC system. All 3 patients had complete formation of healthy granulation tissue with VAC therapy alone. One patient was treated to full reepithelization of her wound; the other 2 patients underwent successful surgical closure after VAC reduction of the defect. The treatment was well tolerated, with no complications. Although this represents an initial study, it seems that the protocol for VAC therapy presented herein is a reliable technique for the repair of forehead defects that provides excellent functional and aesthetic outcomes.

Summary. Case reports are presented of two patients who had early surgical closure of cleft lip and palate and of one patient where palatal closure was delayed till about 6 years of age. The dental occlusion of these patients is compared with that of ten patients with cleft lip and palate who had no surgical treatment. It is suggested that too early surgical treatment may lead to maxillary collapse and to anteroposterior discrepancies of the maxilla. In unrepaired cleft lip and palate there is no interference with growth sites and there appears to be natural dentoalvolar compensation of the original aberration.

Intensive nutritional treatment is now recognized as the single most important factor in achieving closure of enterocutaneous fistulas, replacing attempts at early surgical closure. Operation in the early stages of management should be confined to the drainage of abscesses, the defunctioning of diseased or disrupted bowel and the formation of feeding enterostomies. In those few cases where spontaneous closure of the fistula does not occur, definitive surgical operation can be carried out when malnutrition has been corrected. The combination of nutritional treatment, skin protection and judicious surgery can reduce the mortality to below 10 per cent.

The function of the ductus arteriosus before birth is explained, and the reasons for its remaining patent after birth are given. Symptoms and diagnostic points are discussed, and the operative technique and results of the ligation of a patent ductus arteriosus are described. Statistics of the cause of death of untreated cases are presented together with numerous abnormalities and complications which may be encountered during the ligation of a patent duct.

Patent ductus arteriosus (PDA) has become very common in modern nurseries in recent years. The favorite methods of managing it are either doing nothing, giving indomethacin, or surgical closure. The initial enthusiasm for the use of indomethacin to induce closure is now being tempered as a result of experience. Early surgical ligation of PDA, especially that complicating respiratory distress syndrome, is considered too aggressive for extremely small preterm infants, and for the management of infants having congestive heart failure.

Twenty-five consecutive patients with atrial septal defects have been carefully evaluated clinically and by cardiac catheterization both before and after surgical repair of the defect. Critical review of the data indicates that successful closure of an atrial septal defect results in prompt and significant improvement in symptoms, physical findings, objective laboratory tests, and cardiovascular dynamics. It appears that physiologic abnormalities return to normal or near normal promptly after the defect is closed. Thus, atrial septal defect appears to be a readily curable lesion.