Layer Closure Research Articles

Modified gluteus maximus transfer for hip abductor deficiency

Transfer of the gluteus maximus with refixation at the greater trochanter for treatment of abductor deficiency. Symptomatic abductor deficiency with atrophy and fatty degeneration of the gluteal muscles > 50% (grade3 by quartile) with good strength of the gluteus maximus. Low atrophy or fatty degeneration of less than 50% of the gluteal muscles, limited strength of the gluteus maximus, infection. First, the fascia lata is incised dorsally to the tensor fascia latae muscle, with the incision extending approximately 1.5 cm proximal to the iliac crest. Asecond incision divides the gluteus maximus muscle longitudinally along the muscle fibers and continues towards the fascia lata distal to the greater trochanter. These incisions result in atriangular muscle flap, which is elevated and divided into anterior and posterior portions. The posterior flap is positioned ventrally over the femoral neck and fixed to the anterior capsule and the anterior edge of the greater trochanter. The anterior flap is placed directly on the proximal femur. For this purpose, agroove is prepared in the area of the proximal femur using aspherical burr to freshen up the future footprint. The anterior flap is positioned from the tip of the greater trochanter towards the insertion of the vastus lateralis muscle. Subsequently, the anterior flap is fixed to the created groove with transosseous sutures and positioned under the elevated vastus lateralis muscle in 15° abduction of the leg. To provide additional stabilization to the tendinous part of the anterior flap, ascrew is inserted distally to the greater trochanter. The vastus lateralis muscle is attached to the distal tip of the anterior flap, and the remaining gluteus maximus muscle is sutured to the fascia lata to cover the anterior flap. Additionally, aflap of the tensor fascia latae muscle can be mobilized and adapted to the reconstruction. Layered wound closure is performed. The technique of agluteus maximus transfer represents amethod for the treatment of chronic abductor deficiencies and improves abduction function as well as the gait pattern in short-term follow-ups. Fifteen patients (mean age at time of surgery 62years) had after amean follow-up of 2.5years. The modified Harris Hip Score (mHHS) improved from 48points preoperatively to 60points at follow-up. Preoperatively, 100% had apositive Trendelenburg sign; at follow-up, this was about 50%.

A Comparison of the Efficacy Between Mass Closure and Layer by Layer Closure of Midline Laparotomy and Its Influence on Wound Healing: A Prospective Study

Introduction: The midline laparotomy is the most common approach in surgery which gives access to viscera of the abdomen. Following surgery, the laparotomy wound is sutured by two techniques: mass closure and layer by layer closure. The primary objective of wound closure is to restore the function of the abdominal wall. However the method adopted for incision closure has an influence on the outcomes of wound healing. Our study wants to compare the two suture techniques in terms of efficacy and wound healing. Aims: To compare conventional layer by layer suture technique versus mass closure in terms of efficacy and wound healing in patients with midline laparotomy approach. Methods: A Prospective study with a population size of 94 was performed at the surgery department of Nepalgunj medical college teaching hospital, Nepalgunj, starting from September 2023 to May 2024. A pre-tested questionnaire containing structural, semi-structural, and open-ended questions in printed form was made as a data collection tool. All the people in this study were interviewed after receiving their consent. Patients were followed up for 3 months to rule out any post operative complications. Results: Total 94 patients were studied among which majority of patients were in 30-39 age group. Male outnumbered the females. Incidence of early complications like seroma, wound infection and wound dehiscence was more in layered closure group as compared to mass closure. Average time taken in layered vs. mass closure group is 15 vs 25 mins respectively. Overall wound healing was found more efficacious in mass closure group which is also cost effective than layered closure group. Conclusion: Mass closure technique is less time consuming, along fewer instances of surgical site infection and dehiscence with better overall compliance.

51741 Aesthetic outcome of layered closure versus layered closure followed by 2-octyl cyanoacrylate: a randomized evaluator-blinding split-wound comparative effectiveness trial

51741 Aesthetic outcome of layered closure versus layered closure followed by 2-octyl cyanoacrylate: a randomized evaluator-blinding split-wound comparative effectiveness trial

Double-Needle Bidirectional Barbed Wire Continuous Layered Suture Technique for Laparoscopic Stage I Common Bile Duct Surgery.

Background: Laparoscopic common bile duct exploration (LCBDE) proves a safe and effective treatment for choledochal stones. After LCBDE, preferred choledochal closure is favored for short- and long-term outcomes compared with t-tube drainage. However, there are no relevant studies on the technique of layered closure of the common bile duct with double-needle bidirectional barbed suture at home and abroad. Materials and Methods: A retrospective study of 37 patients who underwent laparoscopic choledochotomy from January 2021 to October 2023 in our hospital was performed. A continuous layered one-stage suture using two-needle bidirectional barb wire. The primary outcomes were stone clearance, operative time, blood loss, and complications. Secondary outcomes were complications, length of hospitalization, and time to drain removal. Results: During the study period, laparoscopic surgery was successful in all cases, and the initial stones were removed without complications. Conclusion: The treatment of choledocholithiasis with continuous layered one-stage suture with double-needle bidirectional barbed wire after LCBDE is a new convenient and effective treatment in selected patients.

Closure methods for large defects after gastrointestinal endoscopic submucosal dissection.

Nowadays, endoscopic submucosal dissection (ESD) is commonly performed for the removal of large gastrointestinal lesions. Endoscopic mucosal defect closure after ESD is vital to avoid adverse events. In recent years, many innovative instruments have emerged and proved to be beneficial. In this paper, we conducted a thorough literature review and summarized the closure methods for large-size post-ESD mucosal defects over decades. We separated these methods into five categories based on the operational principle: "side closure" method, "ring closure" method, "layered closure" method, "hand suturing closure" method, and "specially designed device closure" method. Side closure with clips assisted by instruments such as threads or loops is applicable for each segment of the gastrointestinal tract to prevent postoperative bleeding. If the defect tension is too large to close with the traditional side closure methods, zigzag closure and ring closure could be applied to gather the bilateral defect edges together and achieve continuous closure. In the stomach and rectum with a high risk of submucosal dead space between the submucosa and muscular layers, side closure methods with muscle layer grasping clip or layered closure methods could enable the involvement of the deep submucosa and muscle layers. The ring closure method and specially designed devices including over-the-scope clip, Overstitch, and X-tack could resolve perforation effectively. Individual closure method requires endoscope reinsertion or sophisticated operation, which may be limited by the deep location and the narrow lumen, respectively. Although specially designed devices are expected to offer promising prospectives, the cost-effectiveness remains to be a problem.

The changes in ultrasound parameters during treatment of chronic endometritis depending on the morphological type in women of reproductive age

Objective: to evaluate the dynamics of echographic parameters of structural changes in the endometrium depending on the morphological type of chronic endometritis (CE) before and after etiotropic therapy.Material and methods. A retrospective cohort based on the results of examination of 140 patients of reproductive age with a verified diagnosis of CE before and after complex etiotropic therapy. A pelvic ultrasound was performed in the 1st phase of the menstrual cycle with measurements of the endometrial and uterine volume, followed by a calculation of the percentage endometrial/uterine volume ratio (EV/UCV). The groups of hypoplastic, mixed, and hyperplastic morphotypes were formed according to the values of EV/UCV. The B-mode examination included the assessment of the structure and echogenicity of the uterine cavity mucosa; the line of closure or divergence of the endometrial layers; the external contour of M-echo; the presence of liquid in the uterine cavity, and acoustic artifacts, in particular reverberation, as a sign of gas bubbles.Results. An increase in the thickness and volume of the endometrium, and EV/UCV was obtained after therapy in the hypoplastic morphotype. There were no changes in the thickness or volume of the endometrium in the mixed morphotype. A significant decrease in the thickness and volume of the endometrium, and EV/UCV were found in the hyperplastic morphotype. In all morphotypes, the endometrium remained mostly hyperechoic and heterogeneous, with an abnormal midline.Conclusion. The hypoplastic and mixed morphotypes are characterized by more persistent endometrial changes that are difficult to treat. Pathological signs were eliminated much more often in the hyperplastic morphotype. The results of the study demonstrate the absence of a complete reduction in the analyzed ultrasound criteria of CE after end of treatment for all morphological types.

Revision of the Retracted Posttracheostomy Scar by Anatomical Restoration; Four Layer Closure

AbstractMost tracheostomy scars are depressive and adherent to the underlying trachea, which causes up and down movement when swallowing. This tracheocutaneous tethering causes discomfort, pain, dysphagia, and bad appearance. A tracheocutaneous fistula may be accompanied. Here, we present a new method for reconstructing a tracheostomy scar deformity with tracheocutaneous tethering: layer-by-layer restoration of the anatomical structure with a subcutaneous fat tissue blanket. The scar tissue was fully excised, with the associated skin and subcutaneous tissue. The bilateral strap muscles around the scar were dissected proximally and distally and approximated to the midline, secured without tension. Bilateral platysma muscle flaps cover them firmly. The subcutaneous tissue around the incision margin, which included the superficial cervical fascia was elevated to form a fat blanket, closed transversely. The skin was closed after confirming the absence of retraction upon swallowing. From 2010 to 2018, 10 patients with tracheocutaneous tethering and one patient with tracheocutaneous fistula underwent surgery. All patients were functionally and aesthetically satisfied with the results. The only complication was a hypertrophic scar in one patient, which was managed with a triamcinolone injection. An anatomical layer-by-layer restoration with a fat blanket provided consistent, satisfying results for correcting tracheostomy scar deformities without using additional tissue. This simple method was effective for reconstructing tracheocutaneous tethering.

The Novel Parallel Closure Technique Compared to Single-Layer Closure of the Uterus After Primary Cesarean Section Decreases the Incidence of Isthmocele Formation and Increases Residual Myometrial Thickness.

Background Isthmocele or a scar defect is a relatively common consequence of cesarean section resulting in menstrual disturbances and infertility and may compromise the myometrial integrity of the uterus in women contemplating subsequent vaginal birth. Several preventive measures have been suggested, including the modification of surgical techniques used for the closure of the uterine incision. The current study aimed to compare the incidence of isthmocele and assess residual myometrial thickness in women who underwent single versus parallel layered closure to approximate the endo-myometrial layer during cesarean section. Methodology This retrospective study evaluated data of women undergoing their first cesarean section under elective conditions (n = 497) where the uterine incision was closed using a single (n = 295) or a parallel layer (n = 202) technique. Patients were evaluated twice, at 3-6 months and 18 months postpartum, with a transvaginal ultrasound noting the presence or absence of an isthmocele and measurement of the residual myometrial thickness. Results Regardless of the closure technique, 64 (12.9%) women had an ultrasound-diagnosed isthmocele. Significantly fewer patients in the parallel-layer closure group presented with an isthmocele both at 3-6 (13.6 vs. 6.9%; p = 0.019) and 18 months (16.3 vs. 7.8%; p = 0.009) postpartum. Residual myometrium was significantly thicker in the parallel-layer closure group (8.0 vs. 13.2 mm at 3-6 months postpartum; p = 0.000 and 7.2 vs. 12.3 mm at 18 months postpartum; p = 0.004). For all patients, a retroverted position of the uterus at 3-6 months follow-up examination significantly increased the frequency of isthmocele (36/395 (9.1%) with an anteverted uterus and 18/102 (17.6%) with a retroverted uterus; p = 0.002). In patients with a single-layer closure, a retroverted uterus at the 3-6-month follow-up was associated with an isthmocele in 29.5% (18/61) of patients, while no isthmocele was recorded when the uterus was retroverted in the parallel-layer closure group (0/41) (p = 0.001). At 18 months postpartum, of the 64 patients with an isthmocele, 26 (40.6%) presented with abnormal uterine bleeding mainly in the form of postmenstrual spotting. Of the 26 patients with abnormal bleeding, 23 were in the single-layer and three were in the parallel-layer closure group. Conclusions The parallel-layer closure when compared to a single-layer closure of the uterine incision in patients undergoing primary cesarean section decreased the incidence of isthmocele formation and increased residual myometrial thickness. More patients in the single-layer closure group had menstrual cycle disturbances at 18 months postpartum.

Surgical Closure of Equine Abdomen, Prevention, and Management of Incisional Complications.

Although rarely fatal, complications of ventral midline laparotomy incision in equine patients increase hospitalization cost and duration and may jeopardize return to athletic function. Therefore, many techniques have been developed to reduce their occurrence and expedite their resolution when they occur. Our technique of celiotomy incision closure includes the use of tension sutures (vertical U mattress) of polyglactin 910 on the linea alba, which is then apposed by polyglactin 910 interrupted sutures or a simple continuous pattern suture with a stop midway before routine closure of the superficial layers. The celiotomy incision is protected by an elastic bandage during the immediate postoperative period. This technique has been associated with favorable results: 5.3% confirmed incisional infections after a single celiotomy and 26.7% after repeat celiotomy. The overall incisional complication (serous/sanguineous discharge, hematoma, infection, hernia formation, and complete wound breakdown) occurrence was 9.5% and 33.3% after single and repeat laparotomy, respectively. In cases considered more susceptible to infection (early relaparotomy or laparotomy incisions longer than 30 cm), negative pressure therapy was found easy to apply on closed incisions. No detrimental effects were observed. However, the potential prophylactic benefit of this therapy needs to be confirmed in a larger group. In infected laparotomy wounds requiring drainage, the use of negative pressure therapy seemed to have a positive effect on the formation of granulation tissue. However, there was no control group to allow statistical confirmation. Finally, one case of complete breakdown of the laparotomy incision was managed by stainless steel retention sutures, the application of negative pressure therapy, and a hernia belt. At re-evaluation 15 months post-surgery, several small hernias were detected, but the horse had returned to his previous level of sports performance and had not shown any episode of colic.

D104. Long-term Outcomes Of A Modified Straight-line Palate Repair Technique: Low Fistula and Speech Correcting Surgery Rates with Single Layer Closure at the Hard-soft Junction

D104. Long-term Outcomes Of A Modified Straight-line Palate Repair Technique: Low Fistula and Speech Correcting Surgery Rates with Single Layer Closure at the Hard-soft Junction

The utility of Martius fat pad in the repair of urogenital fistulae: review of current evidence.

To present the contemporary evidence on transvaginal urogenital fistulae (UGF) repair withMartius fat pad (MFP), compared to direct graftless fistula repair. We reviewed all available studies reporting lower UGF repair via the transvaginal approach in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). The primary outcome of interest was the fistula closure rates. When available, patients' baseline characteristics, indications for surgery, and early and late postoperative complications with focus on MFP-related complications are reported. In obstetric fistulae, tissue interposition has been almost completely abandoned, with contemporary large series reporting closure rates of >90% with graftless repair, even for complex fistulae. Similarly, most simple, non-irradiated iatrogenic fistulae can be closed safely without or with tissue interposition with success rates ranging between 86% and 100%. However, MFP is valuable in fistulae with difficulty achieving tension-free and layered closure, with significant tissue loss, urethral involvement and with poorly vascularised tissues after radiotherapy, with reported success rates between 80% and 97% in those challenging situations. A UGF repair should be individualised after considering the specific characteristics and complexity of the procedure. MFP interposition is probably unnecessary for the majority of low (obstetric) fistulae within otherwise healthy tissues. However, MFP may still have a place to maximise outcomes in low-income settings, in select cases with higher (iatrogenic) fistulae, and in most cases with radiotherapy.

Enhancing dielectric passivation on monolayer WS2 via a sacrificial graphene oxide seeding layer

The full utilization of two-dimensional transition metal dichalcogenides (2D TMDCs) faces several challenges, among which is realizing uniform material deposition on the 2D surface. Typical strategies to enable material growth lead to a poor interface quality, degrading the 2D TMDC’s properties. In this work, a sacrificial, graphene oxide-based seeding layer is used (1) as passivation layer, protecting the underlying 2D TMDC and (2) as nucleation layer, enabling uniform material growth. Graphene is transferred on monolayer WS2, establishing a high-quality van der Waals interface. After transfer, the polymeric residues on graphene are cleaned via a combination of wet- and dry treatments and functionalized via dry UV/O3 oxidation. The rate of graphene oxidation is shown to be substrate dependent, which is explained by UV light-induced ultrafast charge transfer between the graphene and WS2 monolayer. The carbon-oxygen functionalities serve as nucleation sites in a subsequent HfO2 ALD process, achieving more uniform dielectric growth and faster layer closure compared to direct deposition. The graphene-based nucleation- / passivation approach offers adaptability, allowing for tailored surface chemistry to enable any alternative material growth, while maintaining a prefect van der Waals interface.

International Endometrial Tumor Analysis (IETA) descriptors in the diagnosis of chronic endometritis

Objective: to compare the terms, definitions and measurement methods developed by the IETA group with the ultrasound criteria of chronic endometritis (CE) used in Russia.Material and methods. A retrospective cohort study of 158 reproductive age women with clinical and laboratory diagnosis of CE was carried out. Sonographic examination was performed in the early or middle proliferative phase (cycle day 4–10 days) with the use of Affiniti70 ultrasound system (Philips, the Netherlands) with a multifrequency 3D endocavitary probe. Uterine corpus volume, endometrial thickness and volume were measured, followed by percentage endometrial/uterine volume ratio calculation, the so-called adjusted endometrial volume. Qualitative analysis of grayscale imaging included assessment of endometrial structure and echogenicity; closure or separation of the endometrial layers; contour of endometrial midline; the presence of acoustic artifacts, such as reverberation in the presence of gas or liquid in the uterine cavity, described by a number of authors. Relevant IETA descriptions were searched when assessing all qualitative CE features. In parallel, a qualitative score analysis proposed by the IETA group was carried out.Timely preoperative diagnosis of endometrioic cyst (endometrioma), as well as deep endometriosis remains relevant. The aim of the study was to assess the diagnostic value of ultrasound in patients with endometriomas and assess the combination of them with other foci of external genital endometriosis. The study based on retrospective analysis of a date of 95 patients with ultrasound signs of ovarian endometriomas, who underwent examination in MedicoProfi LLC – Borisov Medical and Diagnostic Clinic (Krasnoyarsk) during the period from January 2019 to October 2023. All of patients underwent surgery , followed by morphological evaluation. In the vast majority of cases, it was possible to detect a combination of endometriomas with one or more foci of deep endometriosis. Superficial peritoneal endometriosis and adhesions were found on surgery in all cases when endometriomas appeared isolated on ultrasound. The results of the study showed: endometriomas combined with deep endometriosis in 96.8% of cases. Thus, ultrasound detection of endometrioma is a very reliable sign of deep endometriosis presence. The “kissing ovaries” symptom in bilateral endometriomas can be considered as an absolutely reliable sign of the uterosacral ligaments endometriosis with specificity of 100% and positive predictive value of 100%. The presence of the “kissing ovaries” sign should be depicted in the conclusion of the ultrasound protocol, since it highly suggestive to obliteration of the pouch of Douglas and involvement of adjacent organs (fallopian tubes, intestines, ureters, etc.) in the endometrioid infiltrates, which is extremely important for the surgery planning, as well as in patients with infertility. There is an obvious need to introduce the extended pelvic ultrasound protocol to the diagnostic algorithm for patients with suspected endometriosis, which will more accurately describe the disease extension.Results. The comparative analysis of endometrium description in CE indicates a similar measurement technique for endometrial and intrauterine lesions thickness, both proposed by the IETA group and used in our country. Most of the IETA descriptors for qualitative ultrasound findings may be used in CE diagnosis. However, there are no some significant ultrasound features for identifying the inflammation, such as marked and partially or completely thickened midline, as well as gas focuses within the endometrium or in the uterine cavity, in IETA description.Conclusion. Terminology standardization allows compare the results and perform multicenter studies followed by meta-analysis for the diagnosis of chronic endometritis, if researchers use the similar descriptors.

The Impact of Platysma Closure on Post-Thyroidectomy Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This systematic review and meta-analysis of randomized controlled trials (RCTs) compare the impact of platysma muscle layer closure technique among patients undergoing thyroidectomy in terms of postoperative outcomes, specifically pain. Five electronic databases (PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Central Register of Controlled Trials) were searched from inception until July 22, 2023. The Cochrane risk of bias tool 2 was employed for risk of bias (ROB) assessment. Data were pooled as mean difference (MD), standardized MD (SMD), or risk ratio (RR) based on data type (continuous or dichotomous) using RevMan software. This meta-analysis included four RCTs with a total of 426 patients. Three RCTs had a low risk of bias, while one had some concern regarding bias. The overall MD of the postoperative pain score favored the non-closure group over the closure group (MD = 0.63; 95% CI: [0.09, 1.18]; P = 0.02). However, no significant differences were observed between the two groups in terms of patient scar assessment scale (MD= -0.61; 95% CI: [-3.39, 2.17]; P = 0.67), observer scar assessment scale (SMD = 0.26; 95% CI: [-0.30, 0.81]; P = 0.37), length of the scar (MD = 0.27; 95% CI: [-0.12, 0.67]; P = 0.17), wound infection (RR = 0.63; 95% CI: [0.13, 3.16]; P = 0.57), and seroma or hematoma (RR = 3.00; 95% CI: [0.49, 18.55]; P = 0.24). Our findings suggest that the platysma muscle layer closure during thyroidectomy might lead to increased postoperative pain but does not significantly impact scar outcomes or postoperative complications. The online version contains supplementary material available at 10.1007/s12070-024-04503-3.

Layered closure by endoscopic hand suturing involving the muscle layer for large defect after gastric endoscopic submucosal dissection.

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Chronic Achilles Tendon Avulsion Repair: Central Third Fascia Slide Technique with Flexor Hallucis Longus Transfer.

Chronic Achilles Tendon Avulsion Repair: Central Third Fascia Slide Technique with Flexor Hallucis Longus Transfer.

Long-term outcomes of foreskin reconstruction in distal hypospadias; a cohort study spanning twenty years

Surgical correction of hypospadias aims to achieve normal functionality and appearance. This entails foreskin reconstruction (FR) in countries where the uncircumcised penis constitutes the norm. Long-term data are however scarce. To investigate the long-term outcome of FR in cohort of patients operated for distal hypospadias combined with approximately 20 years after surgery. The hospital management system was searched for patients operated for distal hypospadias in conjunction with FR between 1997 and 2004. Prospective participants were invited to participate in an online questionnaire. Signed consent allowed for extended medical chart review, with regards to hypospadias grade, surgical procedure and complications. Response rate of 44.6%. For 113 participants, median age at primary surgery was 5.2 (1.0-15.5) years. Two-thirds had a distal meatus while the remaining, meatus was mid to distal shaft. Urethroplasties performed were mainly glanular approximation procedures and meatal based flap procedures in 85%. Foreskin fistula developed in 15% of cases. There was no significant relationship between urethroplasty procedure or meatal position and risk of foreskin complications. Three layer closure of foreskin resulted in significantly less complications than two layer closure. Twenty years on 95% of the men still had an intact foreskin, of whom 16.8% had received treatment for phimosis. Foreskin was retractable in 92.5% and 74.7% in the flaccid and erect states respectively. Ninety intact men had had their sexual debut and in those 23.3% reported foreskin related issues with intercourse. Evolution of foreskin retractability can be seen in the figure. Current results show that three layer FR in conjunction with hypospadias surgery is feasible and that short-term complication rates were comparable with what has previously been published in the literature. Long-term results indicate that FR is durable with regards to anatomical reconstruction however foreskin function especially in relation to sexual function was compromised in about 25%. Foreskin retractability after surgery predicted retractability in adulthood for the flaccid but not erect penis. Limitations of this study include the retrospective nature of data collection, and that the questionnaire used was not validated. We however achieved a decent response rate and were able to capture important long-term data. FR has an acceptable complication rate. Long-term results two decades on are remarkably durable with regards to the anatomical preservation of the prepuce, however functionality was compromised with regards to retractability and sexual function in approximately 25%.

HPB P50 A comparison of layered vs mass closure in development of incisional hernia following Kocher’s incision for open cholecystectomy, a retrospective analysis

Abstract Background Incisional hernias are a common complication of abdominal surgery. Open cholecystectomy procedures predispose to development of incisional hernias. Studies have shown rates of incisional hernias in visceral abdominal surgery to be 12.6% at one year and 22.4% at 3 years [1]. Several techniques have been developed to reduce rates of incisional hernia, namely abdominal wall closure in layers rather than mass closure. The purpose of our study is to evaluate whether layered closure is superior in preventing incisional hernias compared to mass closure. Methods The study reviewed retrospective data on 694 cholecystectomies at Southport or Ormskirk NHS Trust between 2018-23. Of these cases, 104 underwent open procedures. Operation notes and follow up were accessed electronically and analysed. Patients were also contacted by telephone to further establish whether they have developed incisional hernias and discuss other complications following surgery. The primary objective was to compare hernia rates between mass and layered closure. Secondary objectives were to establish hernia incidence in relation to gender, age, BMI, and elective vs emergency surgery. Results Of the data analysed, there was an equal proportion of male and female patients. Median age of patients was 62. Median BMI of all patients was 29 and median BMI of those developing hernias was 37. 80.8% of open cholecystectomies were elective procedures and 19.2% were emergency procedures. Infection rate was found to be 3.8%, and 30-day mortality was 1.9%. The mean rate of incisional hernia was 7.7% with mean rates of mass and layered closure at 2.7% and 11.1%, respectively. Fisher’s exact test showed that there was no statistical significance in closure method on hernia development. Conclusions We found no statistical significance in incisional hernia development between mass and layered closure in open cholecystectomies. No statistical significance was seen in hernia development with relation to age, gender and elective vs emergency surgery, however greater BMI was found to be statistically significant in increasing risk of hernia development. Larger, prospective multi-centre data are needed to further evaluate these results and aid surgeons in choosing an optimal closure technique in the future.

OGC O05 Linear stapled technique for robotic assisted minimally invasive oesophagectomy and gastrectomy: technique, stepwise introduction, reproducibility and outcomes

Abstract Background Robotic-assisted surgery (RAS) for oesophagectomy and gastrectomy is gaining in popularity. Compared to open oesophagectomy and conventional minimally invasive techniques, RAS is associated with decreased rates of complications, increased harvested lymph nodes and shorter length-of-stay. However, high anastomotic leak rates (20-27%) have been seen within randomised trials and case series, with up to 50% early in some published series. We present our technique for a linear anastomosis and the results of its staged introduction. Methods Initially developed by a single surgeon at open surgery, it was adapted to thoracoscopic procedures and then reproduced during RAS by several surgeons across two centres. Using a prospectively maintained database we reviewed the first sixty-three cases utilising a modified linear anastomosis technique for oesophageal anastomosis. Outcomes, with particular focus on the anastomosis were reviewed. We also describe in detail the technical steps involved in our technique for a side-to-side linear semi-mechanical stapled anastomosis using a tri-stapler with a 2-layer V-lock closure of the common enterotomy, during robotic surgery (video). Results Sixty-one patients had a two-stage oesophagectomy (one for benign disease), one with colonic reconstruction and two total gastrectomy. Median age was 63 (range 47-85). 89% (55/62) were adenocarcinomas, the remainder squamous cell carcinomas. The anastomosis was performed via an open approach initially in 11, thoracoscopically in 4, then robotically in 48 (including the gastrectomies). The first 20 anastomoses were performed by one surgeon, who then proctored four others. Two Type I anastomotic leaks (3.2%) and two Type I conduit necrosis occurred. There was no in hospital mortality. Non-anastomotic complications occurred in 28/63 (44.4%) of patients, most commonly respiratory (15/63, 23.8%). Conclusions We report a reproducible technique for semi-mechanical linear stapled anastomosis and its safe introduction into oesophageal and gastric resections including RAS, with anastomotic leak rates below the internationally reported rates, even in the early phase of its introduction in open, thoracoscopic and RAS. This technique, combined with training and mentorship may help more centres safely introduce a RAS oesophago-gastric programme, and improve patient outcomes.

Cesarean delivery surgical techniques in Africa: A survey study from Ethiopia.

To describe the surgical techniques of Caesarean delivery (CD) practiced by Ethiopian Obstetricians and Gynecologists. A descriptive survey study was conducted in Ethiopia from March 1, 2021 to April 30, 2021. Members of the Ethiopian Society of Obstetrician and Gynecologists were randomly selected and their Cesarean delivery surgical techniques were explored. Data were analyzed using IBM SPSS statistics 22. Simple descriptive analysis were employed and frequencies and percentage were calculated to present the data. A total of 258 obstetricians and Gynecologists practicing in Ethiopia were approached with a response rate of 97.3% (251/258). Double layer closure of uterine incision (98.4%) and subcuticular closure of skin wound (96.4%) are practiced by most of the participants. There was a large difference in practice of blunt versus sharp fascia extension (43.3 vs 55.8%), cephalo-caudad versus lateral uterine incision extension (58 vs.39%), and closure versus non-closure of pelvic and parietal peritoneum (57.4 vs 42.6, and 39.8 versus 60.2%). Blunt and sharp fascia extension, cephalo-caudad and lateral uterine incision extension, closure and non-closure of the pelvic and parietal peritoneum are practiced by similar numbers of Ethiopian Obstetricians and Gynecologists. This demonstrates a wide variation exists in the techniques of Cesarean Delivery across Ethiopia.