Chromic Catgut Sutures Research Articles

Comparison of Vicryl Rapide Versus Chromic Catgut for Episiotomy Repair

A significant proportion of women benefit from episiotomy, but it’s also associated with short and long-term postpartum morbidities like perineal pain due to lacerations and scar formation after repair. The current study was designed to rule out the variations regarding pain and analgesia requirement. Objective: To evaluate outcome of vicryl rapide sutures versus chromic catgut sutures for episiotomy repair in terms of pain and analgesia requirement. Methods: In this randomized control trial from March to September 2021, a total of 206 females (103 in each group) were enrolled and the data was collected after taking informed consent. Episiotomy in all females was done by a single senior consultant. Subjects were randomly assigned one of two sutures. In Group-A females were managed by vicryl rapide 2-0 (36mm, 1/2circle double reverse cutting and round bodied needle) females. in group-B were managed by chromic catgut 1.0 (30 mm, 0.5 circle round bodied needle). Both groups were compared in terms of pain and analgesic requirement. Results: Comparison of pain in vicryl rapide sutures versus chromic catgut after repair of episiotomy showed that 32.0% (n=33) in Group-A and 49.5% (n=51) in Group-B had pain after 48 hours (p value = 0.01). Analgesia requirement at day 7 was recorded in 20.4% (n=21) in Group-A and 66.0%(n=68) in Group-B (p = <0.000). Conclusions: We concluded that vicryl rapide has a better outcome as compared with chromic catgut in repair of episiotomy in terms of pain and analgesic requirements.

ABNORMAL MASS IN MICE

The case animal was a mice, female, Mus musculus race, ± 2 years old and 39.4 g body weight. Based on the results of the anamnesis, the mice experienced a lump in the form of an abnormal solid mass. At first this lump was small and then grew larger for more than one month. The purpose of this study was to determine the type of abnormal mass in case mice. Histopathological examination was performed to confirm the diagnosis. Based on anamnesis, physical examination, and supporting examinations by finding abnormal masses, it can be concluded that case mice were diagnosed with cystadenoma with a fausta prognosis. Treatment with excision (removal) in total on the abnormal tissue. The wound was closed with a simple continuous suture pattern with 3-0 absorbable chromic catgut suture in the peritoneal lining. The subcutaneous tissue and skin were closed with a running locked suture pattern using absorbable chromic catgut size 3-0. Postoperatively the suture wound was cleaned with Ringer's lactate solution and given antibiotics. Observations on wound healing showed that the wound was healing in an improved direction. The wound healed on the 7th day. It is recommended to pay attention to the proper use of sewing thread used in mice.

Assessment of the Impact of Commonly used Beverages on Durability of Suture Materials: An In Vitro Study.

The current study was conducted to evaluate the influence of frequently ingested beverages on the stability of suture materials. This research comprised of two kinds of chromic catgut, polyglactin 910 (4-0) absorbable suture materials. Every specimen was subjected to tying using a square surgeon's knot. Subsequent to pretensioning, 80 suture samples (40 of every material) were employed in this research. Every specimen was subjected to immersion in artificial saliva to replicate the oral atmosphere. Specimens were sunken in the acidic drink (Coca Cola) and tea for 10 min every day. Tensile strengths of the suture specimens were subjected to test at particular time periods: before immersion and 1, 7, and 14 days after immersion. Tensile strength evaluation of the suture specimens was performed employing the microtensile tester at a cross-head speed of 2.0 mm/60 s. When subjected to exposure to acidic beverages, the tensile strength of chromic catgut suture before immersing was 25.14 ± 0.16, 25.02 ± 0.08 on the first day, 16.34 ± 0.23 on the seventh day, and 9.18 ± 0.28 on the fourteenth day. When the suture substance made contact with tea, the tensile strength before immersing was 24.48 ± 0.02, 24.14 ± 0.16 on the first day, 18.26 ± 0.11 on the seventh day, and 12.39 ± 0.14 on the fourteenth day. When subjected to exposure to acidic beverages, the tensile strength of polyglactin 910 sutures before immersing was 25.21 ± 0.02, 25.08 ± 0.01 on the first day, 18.12 ± 0.06 on the seventh day, and 10.06 ± 0.32 on the fourteenth day. When the suture substance made contact with tea, the tensile strength before immersing was 25.02 ± 0.14, 24.96 ± 0.04 on the first day, 20.48 ± 0.18 on the seventh day, and 14.10 ± 0.08 on the fourteenth day. The differences between the groups were statistically significant. In conclusion, polyglactin 910 exhibited a maintained strength superior than chromic catgut sutures subsequent to 14 days.

Evaluation of Anterior and Posterior Pillar Suturing Following Adult Tonsillectomy in Terms of Hemorrhage, Pain, and Dysphagia Complications.

Tonsillectomy is one of the most common surgical procedures performed by otolaryngologists. Postoperative complications, although rare, can be observed in tonsillectomy. This study aimed to investigate the effect of anterior and posterior pillar suturing on dysphagia, hemorrhage, and pain complications following tonsillectomy in adult patients. The study included 80 patients (32 males, 48 females; > 18years) who underwent tonsillectomy. The patients were divided into two groups: Group 1, in which the tonsillar lodge was closed by anterior-posterior pillar suturing with a 3-0 chromic catgut suture after hemostatic compression and Group 2, in which the tonsillar lodge was exposed following hemostatic compression and bipolar cauterization. Post-surgical pain was assessed using the Numeric Rating Scale (NRS). Oropharyngeal dysphagia was evaluated using the Eating Assessment Tool (EAT)-10. None of the patients experienced postoperative primary hemorrhage. However, postoperative secondary hemorrhage was observed in seven patients, two from Group 1 and five from Group 2. There was no significant difference in postoperative hemorrhage between the two groups (p = 0.449). Furthermore, no statistically significant difference was observed between the two groups in terms of the NRS scores on postoperative day 1 and at postoperative week 2 (p = 0.130 and 0.142, respectively) or the EAT-10 scores at postoperative week 2 and postoperative month 6 (p = 0.925 and 0.090, respectively). Anterior-posterior pillar suturing, which is performed for hemorrhage control after tonsillectomy, is not superior to the conventional bipolar method in terms of postoperative dysphagia, hemorrhage, and pain.

COMPARATIVE STUDY OF EPISIOTOMY REPAIR: CHROMIC CATGUT AND VICRYL RAPIDE

Background: Prevalence of the episiotomy varies around the world depending on whether it is used as a routine or a restricted procedure. The rates are still higher in developing countries, like ours, since the use of restricted episiotomy is not being practiced widely in primigravidas.
 Methods: In our randomized comparative study of 222 women who were admitted to the Department of Obstetrics and Gynaecology, SMS Medical College Jaipur, the enrolled women were divided into 2 groups. In Group-A: Vicrylrapide (polygalactin-910) suture material was used in 111 patients and in Group-B chromic catgut suture material was used in another 111 patients, for repair of episiotomies.
 Results: In our present study in vicryl rapide group at 24-48 hrs pain was present in 49.55% of patients, redness was found in 8.10% of patients, swelling was found in 3.60% patients and analgesic used by 72.97% of patients. In chromic group at 24-48 hrs pain was present in 69.36% of patients, redness was found in 21.62%, swelling was found in 7.20% and analgesic was used by 89.18% of patients.
 Conclusion: Our study recommends use of vicryl rapide for episiotomy repair in the care of parturient women.
 Keywords: Complication, Chromic Catgut, Vicryl Rapide, Episiotomy

COMPARISON OF WOUND REPAIR OUTCOMES OF CHROMIC CATGUT VERSUS VICRYL SUTURES FOR EPISIOTOMY REPAIR: A CLINICAL TRIAL

AbstractBackground and Aim:A large number of postpartum women suffer from short and long-term complications of episiotomy.The aim of this study was to compare Chromic Catgut and Vicryl Sutures wound healing inpostpartum women.Materials and Methods:This study was a randomized clinical trial. The sample was 102 pregnant women who wererandomly divided into two groups. The episiotomy wound repaired by Chromic Catgut and Vicrylrespectively. 4-6 weeks after delivery both groups were evaluated for wound healing. Woundhealing was evaluated using the scale (REEDA). The reeda scale consisted of 5 items includingredness, edema, ecchymosis, discharge, approximation. The data was analyzed by t-test and Mann-WhitneyEu test.Results:The results showed that the two groups had no significant difference in terms of age, gestationalage, parity, duration of the second stage of delivery, the time between the delivery and repair ofepisiotomy, length of episiotomy repair and education. Reeda scale average score was lower invicryl sutured wounds (p<0.05). The mean scores of redness, edema, ecchymosis and dischargewere also significantly lower in vicryl group. The approximation scores had not significantdifference between the two groups.Conclusions:According to the results of this study it seems that vicry sutures had better outcomes in healing ofepisiotomy wounds.Keywords:Episiotomy; Vicryl; Catgut; Wound Healing

Serum cortisol of Sahel goats following rumenotomy with assorted anaesthetics and sutures

The utmost need for pragmatic combination of surgical sutures and local anaesthetic that would evoke minimal post-surgical stress response and allow uncomplicated healing is essential for successful surgeries. Fifteen Sahel goats were randomly allocated into three groups A, B and C to quantitatively assay (ELISA) serum cortisol profiles following rumenotomy, as markers of surgical stress. Diazepam at 0.2mg/kg was administered intravenously to groups A and B with subsequent lidocaine HCl and bupivacaine inverted-L block respectively. Group C did not receive any treatment. Chromic catgut (CCG) and polyglycolic acid (PGA) sutures were used for rumen and abdominal muscles closure for groups A and B respectively and nylon for skin closure. Blood samples were taken at post anaesthetic induction (PAI) and post-surgery at 0, 5, 8, 24, 48 and 72h. The Group A goats expressed serum cortisol that was significantly high 52.76±6.12ng/mL at 5h post-surgery. At 8h post-surgery serum cortisol for both groups A (72.53±3.79ng/mL) and B (61.59±3.90ng/mL) were at their peak. Serum cortisol levels compared to the baseline data were significantly different (P<0.05) at 5, 24, and 48h for the CCG goats. The serum cortisol levels at 72h drastically decreased to 20.53±8.74ng/mL for groups A and 17.59±2.45ng/mL for group B and were not significantly different (p>0.05). Cortisol responses unambiguously indicate that diazepam-bupivacaine induce less stress than Diazepam-lidocaine, hence a preferred anesthesia. Moreover, polyglycolic acid sutures are associated with less inflammatory reaction than chromic catgut.

Caesarean section surgical techniques: 3 year follow-up of the CORONIS fractional, factorial, unmasked, randomised controlled trial

SummaryBackgroundThe CORONIS trial reported differences in short-term maternal morbidity when comparing five pairs of alternative surgical techniques for caesarean section. Here we report outcomes at 3 years follow-up.MethodsThe CORONIS trial was a pragmatic international 2 × 2 × 2 × 2× 2 non-regular fractional, factorial, unmasked, randomised controlled trial done at 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan. Pregnant women were eligible if they were to undergo their first or second caesarean section through a planned transverse abdominal incision. Women were randomly assigned by a secure web-based allocation system to one intervention from each of the three assigned pairs. All investigators, surgeons, and participants were unmasked to treatment allocation. In this follow-up study, we compared outcomes at 3 years following blunt versus sharp abdominal entry, exteriorisation of the uterus for repair versus intra-abdominal repair, single versus double layer closure of the uterus, closure versus non-closure of the peritoneum, and chromic catgut versus polyglactin-910 for uterine repair. Outcomes included pelvic pain; deep dyspareunia; hysterectomy and outcomes of subsequent pregnancies. Outcomes were assessed masked to the original trial allocation. This trial is registered with the Current Controlled Trials registry, number ISRCTN31089967.FindingsBetween Sept 1, 2011, and Sept 30, 2014, 13 153 (84%) women were followed-up for a mean duration of 3·8 years (SD 0·86). For blunt versus sharp abdominal entry there was no evidence of a difference in risk of abdominal hernias (adjusted RR 0·66; 95% CI 0·39–1·11). We also recorded no evidence of a difference in risk of death or serious morbidity of the children born at the time of trial entry (0·99, 0·83–1·17). For exteriorisation of the uterus versus intra-abdominal repair there was no evidence of a difference in risk of infertility (0·91, 0·71–1·18) or of ectopic pregnancy (0·50, 0·15–1·66). For single versus double layer closure of the uterus there was no evidence of a difference in maternal death (0·78, 0·46–1·32) or a composite of pregnancy complications (1·20, 0·75–1·90). For closure versus non-closure of the peritoneum there was no evidence of a difference in any outcomes relating to symptoms associated with pelvic adhesions such as infertility (0·80, 0·61–1·06). For chromic catgut versus polyglactin-910 sutures there was no evidence of a difference in the main comparisons for adverse pregnancy outcomes in a subsequent pregnancy, such as uterine rupture (3·05, 0·32–29·29). Overall, severe adverse outcomes were uncommon in these settings.InterpretationAlthough our study was not powered to detect modest differences in rare but serious events, there was no evidence to favour one technique over another. Other considerations will probably affect clinical practice, such as the time and cost saving of different approaches.FundingUK Medical Research Council and the Department for International Development.

Serum Haptoglobin Responses following Rumenotomy in the Sahel Goat

Fifteen Sahel goats were randomly allocated into three groups A, B and C to evaluate Serum Haptoglobin (Hp) profiles following rumenotomy as markers of surgical stress using Quantitative ELISA. Diazepam at 0.2mg/kg was administered intravenously to sedate goats in groups A and B with subsequent lidocaine HCl and bupivacaine inverted-L block for groups A and B respectively. Group C did not receive any treatment. Chromic catgut (CCG) and Polyglycolic Acid (PGA) sutures were used for rumen closure and apposition of abdominal muscles for groups A and B respectively while nylon for skin closure. Blood samples were collected via jugular venipuncture before induction of anaesthesia to establish baseline data. Further blood sampling were at five minutes post anaesthetic induction (PAI) and immediately after surgery 0 hour (38±6.0 minutes post surgery), then subsequently at 5, 8, 24, 48 and 72 hours post surgery. Values in groups A and B differs significantly (P<0.05). Group A peak Hp values was 6.23±1.82 mg/mL at 72hrs post surgery. The goats in group B had a peak of 4.26±1.55 mg/mL Hp at 72hrs post surgery. Hp in the Sahel goat showed no significant stress at five minutes post induction of local anaesthesia with lidocaine and bupivacaine post diazepam sedation. The sutures in the experiment CCG and PGA, produced significant stress but was earlier in onset and highest in concentration among goats that had sutured rumen and abdominal muscles with CCG (group A).

Combined use of CO2 laser and tissue glue versus conventional surgical techniques for circumcision – A prospective study

AbstractUse of a COThirty boys were divided into two groups. Group 1 (n=17) underwent circumcision using a scalpel with approximation of the wound edges using chromic catgut sutures. Group 2 (n=13) underwent circumcision using a COGroup 1 (scalpel+sutures) had a significantly longer operation time (The combined use of a CO

Comparison of a CO2 (Carbon Dioxide) Laser and Tissue Glue with Conventional Surgical Techniques in Circumcision.

CO2 (Carbon Dioxide) laser application in circumcision, for cutting and coagulation, has been reported to have excellent results. Also, tissue glue has been reported to have advantages over sutures for approximation of wound edges. Most previous studies focused on comparisons between CO2 laser and scalpel, or between tissue glue and sutures. This study prospectively compared the results and complications CO2 laser and tissue glue, with standard surgical techniques in circumcision. Thirty boys were prospectively divided into two groups. Group 1 (n = 17) underwent circumcision by scalpel with approximation of the wound edges using chromic catgut sutures. Group 2 (n = 13) underwent circumcision with CO2 laser and approximation of the wound edges using tissue glue. Patient age, indications for surgery, operative time, wound swelling, bleeding, wound infection, local irritation, pain score, and cosmetic appearance were recorded. Group 1 had a significantly longer operative time (P= 0.011), higher rate of local irritation (P= 0.016), and poorer cosmetic appearance (P< 0.001) than group 2. Bleeding only occurred in one patient in group 1. There were no significant differences in pain score, wound infection rate, or cost of surgery between the two groups. CO2 laser and tissue glue have advantages over standard surgical techniques in circumcision, with a significantly shorter operative time, lower rate of local irritation, and better cosmetic appearance. The cost of surgery is similar between the two groups.

Comparison of impact of polyglactin 910 (Vicryl rapide) and chromic catgut sutures on perineal pain following episiotomy wound repair in eastern Indian patients

Objective: To compare the impact of polyglactin 910 (1-0) (Vicryl rapide) (VR) and Chromic Catgut (1-0) (CC) sutures on perineal pain in walking, sitting, and lying posture at 24 h, 48 h, and 6 weeks after episiotomy wound repair. Materials and Methods: Patients were divided randomly into two groups: VR group and CC group. Each group consisted of 50 patients. Severity of the pain was assessed by the visual analogue scale and by the requirement of analgesics. Ordinal data were analyzed by Mann-Whitney U-test. Categorical data were analyzed by Chi-square test. Results: Compared to CC, VR produced significantly less pain (P < 0.001) among patients following episiotomy wound repair in walking, sitting, and lying posture at 24 h, 48 h, and 6 weeks postpartum. Conclusion: Perineal repair with VR suture is associated with less pain perception compared to CC suture.

Treatment of Obesity by Catgut Embedding: An Evidence-Based Systematic Analysis

Catgut embedding therapy has been used for thousands of years in traditional Chinese medicine for the treatment of many conditions, such as perimenopausal syndrome, chronic urticaria, depressive neurosis, refractory insomnia, obesity, sciatica, etc. Treating obesity with catgut embedding is commonly believed to be effective and better than Western medical practice. It involves weekly infixing 10 to 15 surgical chromic catgut sutures into the subcutaneous tissue of the extremities and abdomen with a specialised needle under aseptic precautions. Even though this traditional treatment is considered safe, a complication has recently been reported in this journal.1 There is still no evidence-based consensus on the contribution of catgut embedding to the …

Tensile Strength of a Surgeon's or a Square Knot

To test the integrity of surgeon's knots and flat square knots using 4 different suture materials. Chromic catgut, polyglactin 910, silk, and polydioxanone sutures were tied in the 2 types of knot configurations. For all sutures, a 0-gauge United States Pharmacopeia suture was used. Knots were tied by a single investigator (J.B.). The suture was soaked in 0.9% sodium chloride for 60 s and subsequently transferred to a tensiometer where the tails were cut to 3-mm length. We compared the knots, measuring knot strength with a tensiometer until the sutures broke or untied. A total of 119 throws were tied. We found no difference in mean tension at failure between a surgeon's knot (79.7 N) and a flat square knot (82.9 N). Using a chi(2) test, we did not find a statistically significant difference in the likelihood of knots coming untied between surgeon's knots (29%) and flat square knots (38%). Under laboratory conditions, surgeon's knots and flat square knots did not differ in tension at failure or in likelihood of untying.

Testicular tissue histology in rabbit testes after transparenchymal suturing with six different types of suture material

Our aim was to investigate the changes in testicular tissue histology associated with six different types of commonly used suture material. Twenty-one adult male New Zealand White rabbits were randomly assigned to seven groups of three animals each: sham-operated controls; polyglyconate suture; chromic catgut suture; polypropylene suture; polyglactin-910 suture; silk suture; and poliglecaprone-25 suture. All the materials tested were 6-0 caliber. In each suture-group rabbit, bilateral vertical paramedian incisions were made in the scrotal skin. Three interrupted transparenchymal sutures were then passed through the upper pole, middle, and lower pole of each testis and then fixed to the tunica albuginea using small tapered atraumatic needles. The control group underwent the same procedures but the needle was passed without suture attached. Bilateral orchiectomies were performed 30 days after suture placement, and the tissues were histologically scored. The parameters evaluated were the numbers of foreign-body giant cells and the proportion of the area that histiocytes infiltrated nearby the suture material; severity of fibrosis in the surrounding tissue; the proportion of tubules affected by the material; and spermatogenetic activity in the seminiferous tubules surrounding the suture material. The control tissues showed no inflammatory reaction and no changes in spermatogenesis. All tissue samples from all suture groups showed foreign-body reaction. In addition, all the suture-group specimens exhibited reduced spermatogenesis. Polypropylene suture had highest numbers of tubules with normal spermatogenesis and lowest numbers of maturation arrest. All the suture materials had a negative impact on spermatogenesis. Polypropylene suture caused less reaction and damage than the other five materials tested.

Bladder neck contracture after retropubic radical prostatectomy: incidence and risk factors from a large single‐surgeon experience

To examine a large, single-surgeon series of patients with prostate cancer who underwent retropubic radical prostatectomy (RRP) for men with postoperative bladder neck contractures (BNCs). From 1983 to 2007, 4132 men underwent RRP for prostate cancer by one surgeon. All patients had BN reconstruction with mucosal eversion. The bladder to membranous urethral anastomosis was made using six 2/0 chromic catgut sutures over an 18 F Foley catheter. The catheter was left in place for 10 days. Data from these men is stored in a prospective database, which was reviewed in this study for men with BNCs after RRP. Men with BNCs were compared with all other men in the series to determine risk factors for BNC development. Overall, BNCs developed in 110 patients (2.5%). Examining our last 500 patients there was a contemporary BNC rate of <1%. The median (range) follow-up was 44 (12-233) months. Tumour characteristics were similar in the men with BNCs and those with no BNCs, and the rates of organ-confined disease were also similar (65% vs 70%, P = 0.27). Men with BNCs had higher median preoperative prostate-specific antigen (PSA) levels (6.7 vs 5.7 mg/dL; P = 0.009) and were more likely to have PSA failure after RRP (30% vs 16%, P < 0.001). On multivariate analysis, non-nerve sparing (P = 0.003) and a surgical date before 1992 (P < 0.001) were significant predictors of BNC. Patients with BNCs had lower potency rates (49% vs 63%, P < 0.003) and continence rates (88% vs 94%, P = 0.07) at the 18-month follow-up. BNCs are rare, occurring in <1% in our modern series. The important surgical factors in preventing BNCs are to avoid closing the BN too tightly and attaining good apposition of the BN with the urethral stump with a watertight closure. BNCs are more common with non-nerve-sparing surgery and early in a surgeon's experience.

COMPARISON BETWEEN TONSILLECTOMY WITH THERMAL WELDING AND THE CONVENTIONAL ‘COLD’ TONSILLECTOMY TECHNIQUE

The aim of this study was the evaluation of length of the procedure, anaesthesia, the amount of the intraoperative fluid required, total blood loss and postoperative pain of the 'thermal welding system tonsillectomy (TWS)' compared with the conventional 'cold dissection tonsillectomy'. Fifty patients aged between 3 and 28 years were included in this prospective controlled study. Extracapsular tonsillectomy with TWS was carried out on 25 patients and conventional 'cold' extracapsular dissection complete tonsillectomy was carried out on the other 25 patients. Haemostasis was achieved with packing and 3/0 chromic catgut suture is used to treat the persistently bleeding sites in the 'cold' tonsillectomy group. Intraoperatively, the duration of the procedure, anaesthesia, the amount of the required intraoperative fluid, the total blood loss and the number of sutures were documented for each patient. In the hospital, the postoperative amount of intravenous fluids, oral intake (timing of onset and amount), the duration and the total dose of analgesics were recorded. Daily assessment included the type of diet, the level of appetite, the total number of analgesics, the presence of fever, the time required to return to normal activity and the pain score (twice daily). Pain was measured by means of Faces Pain Scale and Visual Analogue Scale. There was a statistically and clinically significant difference in the operating time in the intraoperative blood loss in favour of the conventional tonsillectomy group (P > 0.05). Although there was no statistically significant difference between the two groups for the postoperative evening pain scores (P > 0.05), there was a statistically significant difference for the morning pain scores (P < 0.05) in the first 2 days postoperatively (P > 0.05) and in the level of appetite in the first postoperative day (P > 0.05). The other outcome measures did not show any statistically significant difference. When we compared TWS with the conventional 'cold' dissection tonsillectomy, we found that TWS tonsillectomy offered an innovative new tonsillectomy method with significantly reduced blood loss and reduced surgical time and without any increase in the postoperative pain. It was a useful method for tonsillectomy.

Tubularized Incised Plate for Mid Shaft and Proximal Hypospadias Repair

We report outcomes from tubularized incised plate repair of mid shaft and proximal hypospadias by a single surgeon. Chart review of all patients undergoing mid shaft and proximal hypospadias was performed. Those with tubularized incised plate were divided into 2 groups for mid shaft and proximal repairs. Group 1 underwent single layer urethroplasty using chromic catgut suture, while group 2 underwent 2-layer polyglactin subepithelial closure. All patients had a dartos barrier flap, while spongioplasty was also done in group 2 when possible. A total of 30 patients underwent mid shaft repairs, while 35 had more proximal defects. Complication rates for mid shaft repairs did not differ between the 2 groups, and averaged 13%. However, complications in mid shaft vs proximal repairs (37%) were significantly different (p = 0.04). Overall complications (53% vs 25%) and incidence of fistulas (33% vs 10%) decreased in proximal repairs from group 1 to 2. Tubularized incised plate repair was applicable for all mid shaft hypospadias cases and for those more proximal cases when ventral curvature could be straightened without plate transection and the incised plate was grossly supple. Outcomes were improved using 2-layer subepithelial tubularization of the neourethra. Results of mid shaft vs proximal hypospadias repairs are significantly different and should be reported separately.

Non-formation of bladder flap at cesarean section

Efforts at improving cesarean section techniques have continued over time. The only study on omission of bladder flap formation at cesarean section did not evaluate long-term effects like adhesion formation. A 3-year prospective non-randomized study of 142 primary cesarean sections with omission of bladder flap formation comprising 23 (16.2%) elective and 119 (83.8%) emergency cases was done to assess the short and long term effects. Participants in the study that had subsequent repeat cesarean sections were examined intraoperatively for adhesion formation and scored. Sub-umbilical midline incisions were used uterine wounds were closed in two layers with chromic catgut 2 the first layer with interlocking sutures. Both peritoneums were repaired with chromic catgut sutures. Rectus sheath was repaired with Nylon 1 non-interlocking sutures. Subcutaneous layers were repaired with chromic catgut 2/0 sutures. (excerpt)

Fibrin Glue for the Suture-Less Correction of Penile Chordee: A Pilot Study in a Rabbit Model

OBJECTIVE To evaluate the use of fibrin glue as a scaffold for patching defects in the tunica albuginea in a rabbit model for a future application in correcting chordee. MATERIALS AND METHODS Nine New Zealand white male rabbits were utilized. All had a 15 × 5-mm defect created in the ventral tunica albuginea. Fibrin glue (1 mL) was applied to cover the defect in tunica albuginea and the penile skin closed with a continuous 5/0 chromic catgut suture. Animals were killed in groups of three at 2, 6 and 12 weeks afterward. The evaluation included an artificial erection test with intracavernosal injection of prostaglandin E1 (5 µg), cavernosography and histopathological examination of sections of the penis stained with haematoxylin and eosin or Masson trichrome. RESULTS None of the rabbits died during the procedure or developed bleeding or haematoma afterward. All animals had straight erections on testing with prostaglandin (5 µg). There was no evidence of corporal narrowing or venous leakage on cavernosography. Histopathological evaluation showed evidence of the fibrin sealant layer, with angiogenesis and a cell infiltrate at 2 weeks. At 6 and 12 weeks there was completely normal regeneration of the tunica albuginea. CONCLUSIONS In this pilot study in a rabbit model the haemostatic effect of fibrin glue was confirmed on covering a defect in the tunica albuginea. Moreover, there was regeneration of normal tunica albuginea with no scarring at 6 weeks and maintained at 12 weeks. Further well-controlled studies are required before using fibrin glue for corporal body grafting to treat chordee.