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Background. Medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) are associated with severe disability and continuous pain, both of which are very difficult to control. This study aims to evaluate the outcome of platelet-rich fibrin (PRF) treatment compared to iodoform gauze packing and the primary suture of oral mucosa in patients with both MRONJ and ORN. Methods. Patients suffering from MRONJ and ORN who were treated in the Oral and Maxillofacial Surgery Clinic of Cluj-Napoca in the last 10 years were selected for this study from the hospital database. Results. PRF treatment proved to be a reliable method to help heal the necrotic bone sites. High-ASA risk patients and immunosuppressed patients are more prone to recurrence and persistent signs and symptoms. Intravenous bisphosphonates produce more intense symptomatology compared to oral administration. The posterior mandible is more difficult to treat compared to other sites. Conclusions. The quality of life of MRONJ and ORN patients may be improved by a protocol that reduces pain and hospitalization. [ABSTRACT FROM AUTHOR]

Abstract Objective To investigate the efficacy and safety of laparoscopy combined with choledochoscopy in the treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis. Methods A retrospective analysis of 114 patients admitted to our hospital from January 2020 to January 2023 was conducted. These patients underwent laparoscopic cholecystectomy combined with choledocholithiasis and were divided into an elderly group (≥ 60 years old) of 63 cases and a young and middle-aged group ( 0 0.05). Conclusion Strict adherence to surgical standards and enhanced postoperative care resulted in similar efficacy and safety results for double endoscopy combined with the exploration of treatment for elderly and young patients with cholecystolithiasis and choledocholithiasis.

Objective: To investigate the efficacy and safety of laparoscopy combined with choledochoscopy in the treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis. Methods: A retrospective analysis of 114 patients admitted to our hospital from January 2020 to January 2023 was conducted. These patients underwent laparoscopic cholecystectomy combined with choledocholithiasis and were divided into an elderly group (≥ 60 years old) of 63 cases and a young and middle-aged group (< 60 years old) of 51 cases according to age. The efficacy and safety indicators of the two groups of patients were observed, and complications were followed up by telephone within 6 months after surgery. The follow-up deadline was June 2023. Results: Among the eligible patients (53 men, 61 women, average age 57 years), all were successfully operated, and 1 case was converted to laparotomy. The elderly and young and middle-aged groups were compared concerning hospitalisation time, bowel sound recovery time, and total postoperative complications, and the differences were statistically significant (P-values were 0.009, 0.006, and 0.039). However, there was no statistically significant difference between the two groups of patients in terms of hospitalisation costs, intraoperative blood loss, operation time, drainage tube removal time, conversion to laparotomy rate, and stone clearance rate (P-values > 0 0.05). Conclusion: Strict adherence to surgical standards and enhanced postoperative care resulted in similar efficacy and safety results for double endoscopy combined with the exploration of treatment for elderly and young patients with cholecystolithiasis and choledocholithiasis. [ABSTRACT FROM AUTHOR]

Chunlong Zhao,1,2,&ast; Zipeng Xu,1,&ast; Weidong Hu,1,&ast; Chen Ge,1 Zhengwei Zhang,1 Zhengxing Dai,3 Shuo Zhang,4 Neng Tang,4 Weiguo Wang,3 Jiayu Gu,3 Chaobo Chen,1,4,5 Songbing He2 1Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, People’s Republic of China; 2Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China; 3Department of Interventional and Vascular Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, People’s Republic of China; 4Department of Hepatic-Biliary-Pancreatic Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China; 5Department of Immunology, Ophthalmology & ORL, Complutense University School of Medicine, Madrid, Spain&ast;These authors contributed equally to this workCorrespondence: Chaobo Chen; Songbing He, Email bobo19820106@gmail.com; hesongbing1979@suda.edu.cnBackground: Laparoscopic cholecystectomy (LC) with laparoscopic common bile duct exploration (LCBDE) is convenient in treating cholelithiasis and choledocholithiasis due to its advantage of accelerated recovery. This retrospective study aimed to summarize the experience of cholelithiasis and choledocholithiasis treatment via three-port approach of LCBDE in Eastern China.Methods: Patients diagnosed with cholelithiasis and choledocholithiasis between July 2019 and October 2021 were included. Patients who received LC+LCBDE+primary suturing of the common bile duct (CBD) via a three-port approach were assigned to the LCBDE-P group, and those who received LC+LCBDE+T-tube drainage of CBD comprised the LCBDE-T group. The measurement data were compared between the two groups. P-values < 0.05 indicated statistical significance.Results: A total of 88 patients were divided into two groups: LCBDE-P (n=50) and LCBDE-T (n=38). Multiple logistic regression analysis showed that LCBDE-P is associated with a shorter length of stay (OR=0.115, 95% CI: 0.040– 0.329, P< 0.001) and lower hospitalization costs (OR=0.120, 95% CI: 0.041– 0.357, P< 0.001). No significant differences between the two groups were detected in the operation time, intraoperative hemorrhage, clearance rate of CBD stones, postoperative liver function, and postoperative complications (P> 0.05).Conclusion: The three-port approach of LCBDE is a safe and feasible strategy for managing cholelithiasis and choledocholithiasis. Compared to LCBDE-T, LCBDE-P reduces the length of hospital stay and medical costs during hospitalization.Keywords: cholelithiasis, choledocholithiasis, laparoscopic cholecystectomy, laparoscopic common bile duct exploration, primary suture, T-tube drainage

Background. Medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) are associated with severe disability and continuous pain, both of which are very difficult to control. This study aims to evaluate the outcome of platelet-rich fibrin (PRF) treatment compared to iodoform gauze packing and the primary suture of oral mucosa in patients with both MRONJ and ORN. Methods. Patients suffering from MRONJ and ORN who were treated in the Oral and Maxillofacial Surgery Clinic of Cluj-Napoca in the last 10 years were selected for this study from the hospital database. Results. PRF treatment proved to be a reliable method to help heal the necrotic bone sites. High-ASA risk patients and immunosuppressed patients are more prone to recurrence and persistent signs and symptoms. Intravenous bisphosphonates produce more intense symptomatology compared to oral administration. The posterior mandible is more difficult to treat compared to other sites. Conclusions. The quality of life of MRONJ and ORN patients may be improved by a protocol that reduces pain and hospitalization.

Aim:We aimed to compare the primary suture and stapler techniques with the hair knotting technique in patients presenting to the emergency department with scalp lacerations and investigate their efficacy in emergency service practice.Materials and Methods:This was a single-center prospective observational study in which patients were divided into three groups according to the treatment technique of hair knotting, stapler, and primary suture. Patients with a hair length greater than 3 cm and a linear incision less than 10 cm were included in the study. The duration of the procedures and the patients’ post-treatment complications, cosmetic problems, pain scores, and satisfaction status were evaluated.Results:A total of 120 patients were included in the study. The median length of stay in the emergency department in the hair knotting group was 23 min, which was shorter compared to the remaining stapler and primary suture (p=0.003 and p=0.001). The complication rates evaluated on days 7 and 14 were lower in the hair knotting group than in the primary suture group (p=0.002 and p=0.012, respectively). The hair knotting group also had a lower rate of cosmetic problems on days 0, 7, and 14 compared with the primary suture group (p=0.014, p=0.003, and p=0.027, respectively).Conclusion:Hair knotting can be used as an alternative technique to the stapler and suture techniques in the emergency department due to its lower cost, less painful nature of the procedure, shorter stay of patients in the emergency department, and requirement of no sedation or local anesthesia.

Background: At present, T-tube drainage or primary suture for common bile duct stones is common management. Methods: The clinical data of 100 patients who underwent laparoscopic common bile duct exploration and T-tube drainage or primary suture for common bile duct stones from 2019 to 2021 were analyzed retrospectively, including 50 cases of primary suture and 50 cases of T-tube drainage. Results: The operation time and postoperative hospital stay of patients with primary suture were lower than those in T-tube drainage group (P < .05). There was no significant difference in the incidence of postoperative complications and hospitalization expenses between the two groups (P > .05). Conclusions: It has been suggested that the therapeutic effect of laparoscopic primary suture is better than that of T-tube drainage; although they have different indications, they should be selected according to the specific individual situation of patients. [ABSTRACT FROM AUTHOR]

There are still many physicians who are reluctant to use primary biliary suture in Laparoscopic common bile duct exploration (LCBDE) for fear of more complications. We compare and analyze the clinical effectiveness of bile duct primary suture with three laparoscopic ports and indwelling T-tube drainage (with four laparoscopic ports) in patients with choledocholithiasis after LCBDE. Clinical data of 135 patients with common bile duct (CBD) stone were compared, including general conditions, postoperative hospital stay, postoperative complications, hospitalization costs, postoperative follow-up and other indicators. Forty-eight patients underwent primary suture of bile duct (group A) and 87 were treated with external T-tube drainage (group B). There were no significant differences between the two groups neither relating to the age, gender, BMI, diameter of CBD, number of stones, preoperative bilirubin value, number of previous surgeries in preoperative, nor the operation time, residual stones, the number of cases converted from laparoscopic conversion to laparotomy. The postoperative complications like fever, bleeding, incision infection, bile duct stricture has no differences between two group. The incidence of bile leakage (p = 0.008) and postoperative electrolyte disturbance (p = 0.001) were slightly lower in group A. There were fewer postoperative complications in group A vs group B (p = 0.04). Patients in group A experienced shorter postoperative hospital stay (p < 0.001), earlier postoperative extubation (p < 0.001), lower total hospitalization costs (p = 0.03), and earlier postoperative recovery (p = 0.000). Primary suture of CBD is a safe and effective method for some patients after LCBDE. [ABSTRACT FROM AUTHOR]

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Objective To explore the value of triple mirror combination technique in patients with dilated choledocholithiasis. Methods A retrospective analysis of 81 patients with dilated common bile duct stones （common bile duct diameter 0.8cm） were admitted to the Second Affiliated Hospital of Kunming Medical University from December 2019 to October 2021.Depending on the surgical method, patients were divided into three-mirror group group A （n = 40）, sequential laparoscopic cholecystectomy LC + laparoscopic-choledotoscopy combined exploration lithotomy LCBDE + endoscopic nasal bile duct drainage ENBD + primary common biliary suture PS.Double-mirror Group B （n = 41）, sequential rows of LC + LCBDE + PS. The observation indexes included preoperative indexes （stone size, total bile duct diameter）, intraoperative indexes （bleeding amount, operation time） and postoperative indexes （near-term complication rate, residual stone rate） and statistical treatment. Results Both groups of preoperative indicators, and the intraoperative indicators had no statistically significant differences. Operation time and bleeding volume were better in group B than in group A. Postoperative residual rate had no significant difference between the two groups. In terms of recent complications, the incidence of bile leakage in group A was lower than that in group B, and the long-term complications were relatively insignificant. Conclusions Application of triple oscopy combined primary suture in patients with cholangiogenic cholelithiasis can reduce the incidence of bile leakage in the first-phase bile duct suture technique, reduce the pain of patients, improve the patient compliance, and does not increase the incidence of complications and tube wearing time. It is worthy of clinical promotion and use. [ABSTRACT FROM AUTHOR]

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 < .05) in terms of the operation time, intraoperative blood loss, postoperative hospital stay, and other related factors. Bilirubin levels on the first day after the operation and the fourth day after the operation between the two groups suggested that T-tube drainage reduces bilirubin in the short term, but that long-term bilirubin draining is similar between the two strategies. Univariate and multivariate analyses showed that choledochal diameter less than 8 mm was an independent risk factor for bile leakage. Conclusions: Laparoscopy combined with intraoperative choledochoscopic CBD exploration is superior to T-tube drainage in terms of the operation time, intraoperative blood loss, and postoperative hospital stay. The ability of reducing bilirubin by traditional T-tube drainage is indeed better than that of primary suture in the early stage after operation, but there is no difference in long-term outcome between the two groups. Choledochal diameter ≤8 mm was an independent risk factor for bile leakage. To summarize, LCBDEs primary suture for secondary choledocholithiasis is safe and feasible. [ABSTRACT FROM AUTHOR]

Typhoid fever is an infectious disease produced by the bacterium Salmonella typhi; it is more frequent in children, adolescents and young adults. Due to its high incidence in rural regions of Angola, we intend to describe the evolution of a case of typhoid fever in a schoolchild in the province of Bie. The bibliography related to the subject was consulted, where there were points of coincidence such as the time of evolution of the disease that in the majority come late to the health area; as for the most frequent signs and symptoms, the abdominal pain being the most reported. Regarding the number of intestinal perforations, it is highlighted that more than a single perforation prevails; the most used surgical technique is the primary suture with edge resection and the postoperative complication that presented itself due to infection of the surgical wound. [ABSTRACT FROM AUTHOR]

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.

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: The data of 125 patients with choledocholithiasis treated with LCBDE in our department from January 2017 to January 2019 were retrospectively collected and divided into two subgroups: the continuous suture group (n = 56) and the interrupted suture group (n = 69). The operation duration, time to suture, intraoperative blood loss, extubation time, hospital stay, total hospitalization expenses, preoperative and postoperative diameters of the common bile duct (CBD), and the occurrence rate of postoperative complications were all compared between the two groups. Results: The operative duration, time to suture, and intraoperative blood loss in the continuous suture group were less compared with those in the interrupted suture group (P < .05). There was no statistical significance between the 2 groups considering extubation time, hospital stay, total hospitalization expenses, and the occurrence rate of postoperative complications (P > .05). The postoperative CBD diameters in both groups were significantly larger than the preoperative CBD diameters (P < .05). Conclusions: The continuous suture technique shortened the operative duration, time to suture, and reduced intraoperative blood loss. It proves to be an effective and safe method in patients diagnosed with CBD stones. [ABSTRACT FROM AUTHOR]

Introduction: Abdominal wall complications are common after kidney transplantation, and although they have a minor impact on patient and graft survival, they increase the patient's morbidity and may have an impact on quality of life. Abdominal wall complications have an overall incidence of 7.7–21%. Methods: This review will explore the natural history of abdominal wall complications in the kidney transplant setting, with a special focus on wound dehiscence and incisional herni, with a particular emphasis on risk factors, clinical characteristics, and treatment. Results: Many patient‐related risk factors have been suggested, including older age, obesity, and smoking, but kidney transplant recipients have an additional risk related to the use of immunosuppression. Wound dehiscence usually does not require surgical intervention. However, for deep dehiscence involving the fascial layer with concomitant infection, surgical treatment and/or negative pressure wound therapy may be required. Conclusions: Incisional hernia (IH) may affect 1.1–18% of kidney transplant recipients. Most patients require surgical treatment, either open or laparoscopic. Mesh repair is considered the gold standard for the treatment of IH, since it is associated with a low rate of postoperative complications and an acceptable rate of recurrence. Biologic mesh could be an attractive alternative in patients with graft exposition or infection. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of laparoscopic choledocholithotomy with either an indwelling T-tube or primary suture in treating cholecystolithiasis complicated by choledocholithiasis., Methods: We conducted a retrospective analysis of 133 patients with cholecystolithiasis complicated by choledocholithiasis treated at Inner Mongolia Aerospace Medical Baogang Hospital from March 2020 to March 2023. Patients were divided into a control group (laparoscopic choledocholithotomy with T-tube placement) and an observation group (laparoscopic choledocholithotomy with primary suture). We compared general and surgery-related data between groups. Factors correlated with favorable postoperative outcomes were identified using univariate and multivariate logistic regression analyses., Results: The observation group exhibited significantly shorter surgical times, faster intestinal function recovery, reduced postoperative hospital stays, and lower total hospitalization costs compared to the control group (all P < 0.05). No significant differences were observed in postoperative total bilirubin (TBIL), aspartate aminotransferase (AST), or alanine aminotransferase (ALT) levels between the groups (all P > 0.05). Both primary suture technique and the absence of postoperative complications were independent predictors of favorable outcomes., Conclusion: Laparoscopic choledocholithotomy with primary suture is associated with shorter operation times, reduced medical costs, decreased hospitalization duration, and quicker gastrointestinal recovery compared to the traditional T-tube approach. This method is safe and feasible, provided clinicians are well-versed in its indications., Competing Interests: None., (AJTR Copyright © 2024.)

Objective To summarize experience treating dog bites in the oral and maxillofacial regions of children and provide a reference for clinical practice. Methods Nineteen children with dog bite wounds in the maxillofacial region were treated from July 2011 to June 2018 with primary debridement and suturing. A rabies vaccine, tetanus vaccine and human immunoglobulin as a passive immune agent were given via intramuscular injection. Anti-inflammatory therapy with amoxicillin and clavulanate potassium or other antibiotics. Follow-up observation and a retrospective analysis of the treatment effect were carried out. Results After treatment, among the 19 pediatric patients, 18 cases showed primary healing and 1 case showed secondary healing. The follow-up period ranged from six months to seven and a half years. No cases of rabies occurred. Conclusion For the treatment of patients with maxillofacial dog bite wounds, the first stage debridement and suture can reduce the scar after operation and is beneficial to the recovery of face.

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.

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. [ABSTRACT FROM AUTHOR]

Abstract 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

Background: Incisional hernia occurs approximately in 40% of high-risk patients after midline laparotomy. Prophylactic mesh placement has shown promising results, but long-term outcomes are needed. The present study aimed to assess the long-term incisional hernia rates of the previously conducted PRIMA trial with radiological follow-up., Methods: In the PRIMA trial, patients with increased risk of incisional hernia formation (AAA or BMI ≥27 kg/m 2 ) were randomised in a 1:2:2 ratio to primary suture, onlay mesh or sublay mesh closure in three different countries in eleven institutions. Incisional hernia during follow-up was diagnosed by any of: CT, ultrasound and physical examination, or during surgery. Assessors and patients were blinded until 2-year follow-up. Time-to-event analysis according to intention-to-treat principle was performed with the Kaplan-Meier method and Cox proportional hazard models. Trial registration: NCT00761475 (ClinicalTrials.gov)., Findings: Between 2009 and 2012, 480 patients were randomized: 107 primary suture, 188 onlay mesh and 185 sublay mesh. Five-year incisional hernia rates were 53.4% (95% CI: 40.4-64.8), 24.7% (95% CI: 12.7-38.8), 29.8% (95% CI: 17.9-42.6), respectively. Compared to primary suture, onlay mesh (HR: 0.390, 95% CI: 0.248-0.614, p < 0.001) and sublay mesh (HR: 0.485, 95% CI: 0.309-0.761, p = 0.002) were associated with a significantly lower risk of incisional hernia development., Interpretation: Prophylactic mesh placement remained effective in reducing incisional hernia occurrence after midline laparotomy in high-risk patients during long-term follow-up. Hernia rates in the primary suture group were higher than previously anticipated., Funding: B. Braun., Competing Interests: None of the authors declare conflict of interest., (© 2023 The Author(s).)

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. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect, adaptability, and advantages/disadvantages of primary suture versus T-tube drainage in laparoscopic common bile duct exploration (LCBDE), and to provide reliable evidence for clinical treatment. Methods PubMed, OVID, WOS, EMBASE, Chinese Scientific Journal Full-Text Database, Wanfang Data, and VIP were searched for articles published from January 1, 2005 to December 31, 2016. The articles were screened according to inclusion and exclusion criteria, and RevMan 53 software was used for meta-analysis. Results A total of 12 articles were included, with 1222 patients in total, among whom 616 were given primary suture (observation group) and 606 were given T-tube drainage (control group). There were significant differences between primary suture and T-tube drainage in time of operation (weighted mean difference ［WMD］ =-10.79, 95% confidence interval ［CI］: -13.55 to -8.03, P＜0.001), length of postoperative hospital stay (WMD=-4.16, 95% CI: -4.84 to -3.48, P＜0.001), time to first flatus (WMD=-8.39, 95% CI: -12.50 to -4.27, P＜0.001), biliary drainage time (WMD=-27.06, 95% CI: -51.08 to -3.04, P=0.03), and incidence rate of bile leakage (odds ratio = 0.47, 95% CI: 0.27-0.82, P=0.008). Conclusion Primary suture in LCBDE is safe and effective and has significant advantages over T-tube drainage. Therefore, it holds promise for clinical application. [ABSTRACT FROM AUTHOR]

Background: 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.Methods: 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.Results: 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%.Conclusion: 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. [ABSTRACT FROM AUTHOR]

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 <9 as independent risk factors associated with increased mortality. Treatment within the first 24 h was found to be protective (OR 0.284; 95% CI, 0.148--0.546; p < 0.001). Injury to the thoracic esophagus was also an independent risk factor for overall complications (OR 1.637; 95% CI, 1.06--2.53; p = 0.026). Conclusions: Despite improvements in surgical technique and critical care support, the overall mortality for traumatic esophageal injury remains high. The presence of a thoracic esophageal injury and extensive esophageal damage are the major independent risk factors for mortality. Early surgical treatment, within the first 24 h of admission, is associated with improved survival. Trial registration: iStar, HS-16-00883 [ABSTRACT FROM AUTHOR]

Introducción: existe una controversia sobre la alternativa quirúrgica para la solución de las urgencias quirúrgicas en el colon izquierdo. Objetivo: comparar la sutura primaria e ileostomía transcecal con una sonda de colostomía convencional en los pacientes operados del colon izquierdo. Métodos: se realizó un estudio analítico, observacional, prospectivo y longitudinal. Universo: se diagnosticaron 70 pacientes con enfermedades quirúrgicas urgentes del colon izquierdo. Muestra: 34 pacientes del Hospital General Docente Abel Santamaría Cuadrado y Hospital Clínico Quirúrgico León Cuervo Rubio, operados entre enero de 2006 y 2010. Se formaron aleatoriamente dos grupos: grupo A (muestra), 34 pacientes con sutura o resección intestinal y anastomosis primaria e ileostomía transcecal con sonda; grupo B (control) 36 pacientes con resección intestinal y colostomía convencional. Se aplicó la prueba Ji cuadrado con un nivel de significación de 0,05 y porcientos. Resultado: predominaron las perforaciones sigmoideas traumáticas 37,1% y el vólvulo del sigmoide con un compromiso vascular 31,4% en ambos grupos, prevalencia en el género masculino y la edad de 51-60 años. En el grupo A el 11,7% de los pacientes presentaron complicaciones no relacionadas con dehiscencia de la anastomosis; en el grupo B alcanzaron el 55,5% predominando la infección de la herida y las generales. La mortalidad global de la sutura primaria con ileostomía transcecal fue de 2,9% y 11,1% en la colostomía convencional. La sonda de ileostomía se retiró como promedio a los 7 días, y la calidad de vida de estos pacientes es satisfactoria en la actualidad. Conclusiones: La sutura primaria e ileostomía transcecal tiene menos complicaciones y mortalidad, minimiza la injuria psicológica, y es la alternativa quirúrgica más fisiológica.Introduction: a controversy about surgical alternative to the solution of surgical emergencies of left colon gives rise. Objective: to compare primary suture and transcecal ileostomy with a conventional colostomy probe in patients operated on left colon. Methods: an analytical, observational, prospective and longitudinal study. Target group: 70 patients having the diagnosis of surgical emergencies due to left colon conditions. Sample: 34 patients who underwent left colon surgeries from January 2006 and 2010 at "Abel Santamaria Cuadrado" and "Leon Cuervo Rubio" Provincial General University Hospitals. Two groups chosen at random were included: group-A (sample), 34 patients with suture or intestinal resection plus primary anastomosis and transcecal ileostomy with probe; group-B (control) 36 patients with intestinal resection and conventional colostomy. Chi square test with a significance level of 0,05 and percentages were applied. Results: traumatic sigmoid perforations prevailed (37,1%) and sigmoid volvulus with vascular compromise (31,4%) in both groups, male sex and ages from 51 to 60 predominated. In group-A the 11,7% of patients presented complications that were not related to dehiscence of anastomosis; in group-B the complications reached 55,5% prevailing the infection of surgical wound and the general ones. Global mortality of the primary suture with transcecal ileostomy was 2,9% and 11,1% with conventional colostomy. The probe of the ileostomy was removed at 7 days on average; currently the quality of life of these patients is satisfactory. Conclusion: primary suture and transcecal ileostomy present much less complications as well as mortality, it minimizes psychological damage, and this is the most physiologic surgical alternative.

INTRODUCCIÓN. La mortalidad por heridas de colon debidas a traumatismos penetrantes del abdomen ha disminuido, pero en algunos centros sanitarios se mantiene una controversia en relación con efectuar o no la sutura primaria de dichas heridas. En este trabajo se buscó presentar los resultados del uso de la sutura primaria de colon en heridas penetrantes de abdomen en pacientes atendidos por un grupo básico de trabajo de cirugía del Hospital Clinicoquirúrgico «Joaquín Albarrán Domínguez» (La Habana). MÉTODOS. Se realizó un estudio prospectivo de todos los pacientes con heridas penetrantes de abdomen y lesión de colon a los cuales se les realizó sutura primaria de colon, que fueron atendidos por nuestro grupo básico de trabajo entre enero de 2005 y mayo de 2008. Los criterios de exclusión comprendieron solamente el estado de choque hipovolémico, la demora de más de 6 h entre el momento de la lesión y la cirugía, y la contaminación fecal grave. RESULTADOS. En el período citado fueron intervenidos quirúrgicamente de urgencia 17 pacientes: 94 % de ellos del sexo masculino, rango de edad de entre 16 y 43 años, el 76,4 % de ellos con lesiones intraabdominales asociadas. El agente causal de la herida fue un arma blanca en el 100 % de los casos. El colon izquierdo fue el sitio más afectado (53 %). El 100 % de los pacientes recibieron antibióticos, y los más empleados fueron las cefalosporinas de tercera generación asociadas siempre con metronidazol. Hubo 3 reintervenciones, ninguna por dehiscencia de suturas. No hubo muertes y la estadía promedio fue de 6,9 días. CONCLUSIONES. La sutura primaria de las heridas de colon producidas por arma blanca es segura, aun cuando éstas se localicen en el colon izquierdo y existan lesiones asociadas en otros órganos.INTRODUCTION. Mortality due to colon due to penetrating abdominal traumata has decreased but in some health centers there is a controversy related to primary stitch or not such wounds. In present paper authors showed the results of colonic primary suture in penetrating abdominal wounds in patients seen by a surgery working basic team from the "Joaquín Albarrán Domínguez" Clinical Surgical Hospital (La Habana). METHODS. A prospective study was performed in all patients presenting with abdominal penetrating wounds and colonic lesions who underwent colon primary suture seen by our working basic team between January, 2005 and May, 2008. The exclusion criteria included only the hypovolemic shock status, delay for more than 6 hours from the moment of lesion and surgery as well as the severe fecal contamination. RESULTS. During the above period 17 male patients aged 16 and 43 were operated on the 76,4% with associated intra-abdominal lesions. The causal agent of wound was a steel in the 100% of cases. Left colon was the more involved site (53%). The 100% of patients received antibiotics and the more used were third-generation cephalosporins associated always with the Metrodinazole. There were re-surgical interventions without dehiscence suture. No death occurred and man stay was of 6,9 days. CONCLUSIONS. The suture of colonic wounds produced by steel safe even though these be located in the left colon and there are lesions associated with other organs.

Objective: Aim of surgical treatment is the primary stabilization of the unstable elbow following a ligamentous elbow dislocation., Indications: Ligamentous elbow dislocations are typically accompanied by injuries to the surrounding musculature and collateral ligaments of the elbow joint. Surgical treatment is indicated in case of failure of nonoperative therapy, i.e., when a dislocation can only be prevented in immobilization > 90° and pronation of the elbow or an active muscular centering of the elbow fails after 5-7 days., Contraindications: Contraindications for a solely "internal bracing" augmented primary suture are generally in the case of accompanying bony injuries in elbow dislocations, extensive soft-tissue injuries, and septic arthritis of the elbow., Surgical Technique: The augmented primary suture of the elbow is performed using both a lateral (Kocher or Kaplan) and medial (FCU split) approach to the elbow. After reduction of the elbow, the collateral ligaments are first augmented with high-strength polyethylene suture and fixed in the distal humerus together with another high-strength polyethylene augmentation suture. The extensors and flexors are then fixed to the medial and lateral epicondyle, respectively, using suture anchors., Postoperative Management: The aim of the postoperative management is early functional exercise of the elbow. The elbow is placed in an elbow brace to avoid varus and valgus load., Results: Between August 2018 and January 2020, a total of 12 patients were treated with an augmented primary suture following unstable ligamentous elbow dislocation. After a mean follow-up of 14 ± 12.7 months, the mean Mayo Elbow Performance Score was 98.5 points with a mean functional arc of 115°. None of the patients reported a recurrent dislocation or persistent instability of the elbow., (© 2022. The Author(s).)

Incidence of bile duct injuries (BDI) is low but remains a dramatic complication after laparoscopic cholecystectomy (LC). This study aimed to assess BDI incidence and management strategies. All patients treated in our institution for BDI after LC between 2000 and 2011 were retrospectively analyzed. Patients referred from others centers were excluded. Strasberg classification was used to determine the type of lesion. Thirteen patients presented iatrogenic BDI among 2,840 consecutive cholecystectomies performed (0.46%). Four cases were classified Strasberg type A, 4 type D, and 5 type E. Injury was recognized intraoperatively in 6 cases (46%). Three of these 6 required conversions to open surgery and all but one were primary sutured on a drain; the remaining patient required immediate biliodigestive anastomosis. In 7 patients, the injury was discovered postoperatively (54%). Among them, one was treated by direct closure of a cystic leak through immediate relaparoscopy. Six underwent initially main bile duct stenting, but 4 required delayed secondary surgery (mean time 115 days), 2 to improve bile duct drainage and 2 for biliodigestive derivation. BDI incidence remains low but management depends on the time of diagnosis. BDI are complex and require tailored treatment usually in a tertiary center for a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Background: Incisional hernia (IH) remains one of the most frequent postoperative complications after abdominal surgery. As a consequence, primary mesh augmentation (PMA), a technique to strengthen the abdominal wall, has been gaining popularity. This meta-analysis was conducted to evaluate the prophylactic effect of PMA on the incidence of IH compared to primary suture (PS). Methods: A meta-analysis was conducted according to the PRISMA guidelines. Randomized controlled trials (RCTs) comparing PMA and PS for closing the abdominal wall after surgery were included. Results: Out of 576 papers, 5 RCTs were selected comprising 346 patients. IH occurred significantly less in the PMA group (RR 0.25, 95% CI 0.12-0.52, I20%; p < 0.001). No difference could be observed with regard to wound infection (RR 0.86, 95% CI 0.39-1.91, I2 0%; p = 0.71) or seroma (RR 1.22, 95% CI 0.64-2.33, I2 0%; p = 0.55). A trend was observed for chronic pain in favor of the PS group (RR 5.95, 95% CI 0.74-48.03, I20%; p = 0.09). Conclusion: The use of PMA for abdominal wall closure is associated with significantly lower incidence of IH compared to PS. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]