Closure Group Research Articles

Influence of closure technique on leakage pressures in an ex vivo canine typhlectomy model.

To determine the influence of three closure techniques on leakage pressures of canine typhlectomies. Experimental, ex vivo. Grossly normal cecal segments from 24 adult canine cadavers. Typhlectomies were assigned to one of three closure techniques: simple continuous closure with a Parker-Kerr pattern with 4-0 polydioxanone (group 1), closure with a 60-mm gastrointestinal stapler loaded with a 3.8-mm staple cartridge (group 2), and placement of a Cushing suture to augment the stapled closure (group 3). The median (range) of initial leakage pressure (ILP) and maximum leakage pressure (MLP) was compared between groups along with leakage location. Typhlectomies in group 3 leaked at higher ILP (310 mm Hg; 188-310) than those in groups 1 (43 mm Hg; 31-80) and 2 (109.5 mm Hg; 68-173; P < .0001). Maximum leakage pressure were greater in group 3 than in other groups (P < .0001). Leakage was detected in 20 of 24 (83%) typhlectomies, located at the incisional line in 13 of 24 (54%) specimens and from suture holes in seven of 24 (29%) specimens. Placement of a Cushing suture pattern to augment stapled incisions improved the ability of typhlectomies to sustain pressure compared with sutured or stapled cadaveric specimens alone. These results provide evidence to support placement of a Cushing suture pattern to augment the staple line for typhlectomies in dogs, although in vivo studies are required to determine the clinical significance of these findings.

Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis.

Device closure is the first-line treatment for most atrial septal defects (ASDs). Minimally invasive cardiac surgery (MICS) has been found safe and effective for ASD closure with comparable mortality/morbidity and superior cosmetic results compared to conventional median sternotomy. Our goal was to compare percutaneous versus MICS of ASDs. A systematic review was performed using PubMed and the Cochrane Library (end-of-search date on May 22, 2019). Meta-analyses were conducted using fixed and random effects models. In the present systematic review, we analyzed six studies including 1577 patients with ASDs who underwent either MICS (n = 642) or device closure (n = 935). Treatment efficacy was significantly higher in the MICS (99.8%; 95% CI 98.9-99.9) compared to the device closure group (97.3%; 95% CI 95.6-98.2), (OR 0.1; 95% CI 0.02-0.6). Surgical patients experienced significantly more complications (16.2%; 95% CI 13.0-19.9) compared to those that were treated with a percutaneous approach (7.1%; 95% CI 5.0-9.8), (OR 2.0; 95% CI 1.2-3.2). Surgery was associated with significantly longer length of hospital stay (5.6 ± 1.7days) compared to device closure (1.3 ± 1.4days), (OR 4.8; 95% CI 1.1-20.5). Residual shunts were more common with the transcatheter (3.9%; 95% CI 2.7-5.5) compared to the surgical approach (0.95%; 95% CI 0.3-2.4), (OR 0.1; 95% CI 0.06-0.5). There was no difference between the two techniques in terms of major bleeding, hematoma formation, transfusion requirements, cardiac tamponade, new-onset atrial fibrillation, permanent pacemaker placement, and reoperation rates. MICS for ASD is a safe procedure and compares favorably to transcatheter closure. Despite longer hospitalization requirements, the MICS approach is feasible irrespective of ASD anatomy and may lead to a more effective and durable repair.

Challenges and Outcome of Management of Gastroschisis at a Tertiary Institution in North-Eastern Nigeria.

Introduction: Gastroschisis is a congenital anterior abdominal wall defect characterized by herniation of abdominal contents through a defect usually located to the right side of the umbilical cord. It occurs in about 1 in 2,000–4,000 live births and is slightly commoner in males. Management has remained challenging in the low and middle-income countries, with high mortality rates. This study highlights the clinical presentation, treatment, outcomes, and challenges in the management of gastroschisis at a tertiary healthcare center in a resource-limited setting.Methods: This was a retrospective review of the records of all patients with gastroschisis managed over a period of 30 months (January 2016–June 2018). Data on patients' demographics, age, birth weight, clinical presentation, method of gastroschisis reduction and closure, complications, and outcomes were collated. Statistical analysis was performed using SPSS version 20. A p < 0.05 was considered significant.Results: Twenty-four patients with gastroschisis were managed. Of these, 18 patients had data available for analysis. There were 14 males, with a male-female ratio of 3.5:1. The median age at presentation was 11.0 h (range 1–36 h). Ten patients (55.6%) were delivered in a medical facility. One patient had type II jejunal atresia and transverse colonic atresia as associated anomalies. Improvised silos were applied by the bedside in 15 (83.3%) patients, while two patients (11.1%) had primary closure under general anesthesia. One patient died before definitive treatment could be done. Sterile urobags and female condoms were used for constructing improvised silos in 9 (60%) and 6 (40%) patients, respectively. Eight patients who had initial silo application had complete bowel reduction over a median time of 8.0 days (mean 10.0 ± 6.5days, range 2–23 days). Total parenteral nutrition was not available. The average time to commencement of feeding was 8.0 days ± 6.6 (median 6.0 days, range 2–22 days). Full feeding was achieved in five patients (two patients in the primary closure group and three from the silo group) over a mean time of 16.8 days ± 10.4 (median 14.0 days). Sepsis was the commonest complication. Four patients (22.2%) survived.Conclusion: Management of gastroschisis remains challenging in resource-limited regions.

Comparative Study between Mass Closure and Hughes Repair in Emergency Laparotomy

Abstract Background Exploratory laparotomy remains one of the common operations across the surgical disciplines. As such, the systematic and safe closure of such a laparotomy wound is the key to reduce the postoperative morbidity like wound pain, wound infection and incisional hernia. Objective To compare mass closure &amp; Hughes repair in emergency laparotomy as regard intraoperative technique, operation time, incidence of complication as wound infection, dehiscence, burst abdomen and incisional hernia. Patients and Methods This is a prospective comparative study between two types of closure, mass closure and hughes repair in emergency laparotomies. This study was conducted at Ain-Shams University Emergency Hospitals. Patients who underwent emergency laprotomy from September 2017 to March 2018 and the patients were followed up postoperatively for six months. All patients who underwent emergency laparotomy at Ain-Shams University Emergency Hospitals from September 2017 to March 2018 were chosen according to inclusion and exclusion criteria. Results In this study we used the same suture and materials” Polydioxanone PDS loop 1”. The comparative study included several items to discuss starting from the time of the technique in our study it ranged from 12 -19 minutes in the conventional method “Mass closure” and it ranged from 24-31 minutes in the huge repair group. It was observed that the length of the laprotomy incision determine the time of the technique. The overall operative time of mass closure group was shorter than the hughe repair technique Conclusion It was observed that there were major factors that affected the results such as the reason for the laparotomy and the general condition of the patient especially the chest condition, diabetes mellitus, serum albumin, anemia and the body mass index.

Transcatheter closure vs totally endoscopic robotic surgery for atrial septal defect closure: A single-center experience.

Transcatheter closure is the preferred method for atrial septal defect (ASD) closure. Robotic surgery has become the least invasive technique for ASD closure. Therefore, we sought to evaluate the outcomes in patients who underwent ASD closure with transcatheter or robotic surgery techniques. A total of 462 patients underwent totally endoscopic robotic (n = 217) or transcatheter ASD closure (n = 245). Demographic data, perioperative data, and outcomes were compared. The mean age was lower in the robotic surgery group than the transcatheter group (31.4 ± 11.8 vs 39.4 ± 13.2 years; P = .001). Ventilation time, intensive care unit (ICU) stay, and hospital stay was significantly lower in the transcatheter group. The postoperative new-onset neurological event was seen in one (0.5%) patient in robotic surgery, and four (1.6%) patients in the transcatheter closure group. New-onset atrial fibrillation was found to be higher in transcatheter closure (two vs seven patients; P = .133) group. Surgical conversion to a larger incision occurred in two patients (1%) in robotic surgery, while two patients (0.5%) underwent emergency median sternotomy due to device embolization to the main pulmonary artery. There was no mortality in both groups. During follow-up, one patient (0.5%) who underwent robotic surgery was reoperated, and two patients (0.8%) who underwent transcatheter procedure required surgical intervention due to device migration and severe residual shunting (P = .635). Both transcatheter and robotic surgery approaches had excellent outcomes but transcatheter closure had shorter hospital and ICU stays. Robotic surgery provides a similar complication risk that can be comparable to the transcatheter approach as well as patient comfort and cosmetic advantage over the other surgical techniques.

Closure of the fascial defect during laparoscopic umbilical hernia repair: a randomized clinical trial

The objective of the study was to analyse patient-reported outcome measures (PROMs), seroma formation, long-term recurrence and chronic pain after closure of the fascial defect in patients undergoing laparoscopic umbilical hernia mesh repair. This was a randomized double-blinded trial in patients undergoing elective laparoscopic umbilical hernia repair comparing sutured closure of the fascial defect before intraperitoneal onlay mesh (IPOM) repair with a no-closure IPOM repair. Postoperative pain, movement limitations, discomfort and fatigue were registered before surgery and on postoperative days 1-3, 7 and 30. Seroma formation, quality of life and cosmesis were assessed at day 30, and at 2 years of follow-up. Recurrence (clinical and reoperation) and chronic pain were assessed after 2 years. Eighty patients were randomized. Median defect sizes in closure and no-closure groups were 2·5 (range 1·5-4·0) and 2·5 (2·0-5·5)cm respectively (P=0·895). There were no significant differences in early and late postoperative pain or in any other early or late PROMs, except for early fatigue which was higher in the closure group (P=0·011). Seroma formation after 30 days was significantly reduced after closure (14 of 40; 35 (95 per cent c.i. 22 to 51) per cent) compared with no closure (22 of 38; 58 (42 to 72) per cent) (P=0·043). Cumulative recurrence after 2 years was lower in the closure group: 5 of 36 (7 (3 to 17) per cent) versus 12 of 37 (19 (10 to 33) per cent) for no closure (P=0·047). Closure of the fascial defect in laparoscopic umbilical hernia IPOM repair significantly reduced early seroma formation and long-term recurrence without inducing side-effects such as pain, or other early or late PROMs. Registration number: NCT01962480 ( https://www.clinicaltrials.gov).

Kam ir kada gali būti naudingas kairiojo prieširdžio ausytės uždarymas

Prieširdžių virpėjimas (PV) išlieka dažniausias ritmo sutrikimas su kuriuo susiduriame klinikinėje praktikoje. Pacientai, kurie turi šį ritmo sutrikimą, turi žymiai didesnę insulto tikimybę, todėl jiems įprasta skirti vitamino K antagonistus (varfariną) arba tiesioginius geriamuosius antikoaguliantus (NGAK). Dėl pacientų jau esamo polimorbidiškumo tinkamai palaikyti terapinę hipokoaguliaciją sudėtinga, todėl galima kraujavimo rizika. Iki šiol sunkios būklės pacientai, kurie dėl gretutinių patologijų arba jau buvusių kraujavimo įvykių, negalėjo vartoti varfarino ir dėl to turėjo vartoti redukuotas NGAK dozes, gydymo aspektu vis sunkiau būdavo išlaikyti pusiausvyrą tarp didžiausios naudos ir mažiausios naujų komplikacijų rizikos pacientui. JAV maisto ir vaistų administracija (angl. American Food &amp; Drug Administration, USFDA), reglamentuojanti ir aprobuojanti naujus gydymo metodus, 2015 m. kovo mėn. patvirtino kairiosios prieširdžio ausytės uždariklių (KPAU) naudojimą. Taigi, pacientams sergantiems nevožtuvinės kilmės prieširdžių virpėjimu ir negalintiems vartoti antikoaguliantų, oficialiai atsirado alternatyva – kairiosios prieširdžio ausytės uždarikliai. Deja, ilgą laiką klinikinės indikacijos implantuoti pacientui KPAU nebuvo aiškiai apibrėžtos ir nebuvo įvertintos intervencinės komplikacijos bei vėlyvieji rezultatai po uždariklio implantavimo. Neseniai atliktų didžiausių atsitiktinių imčių tyrimų (PREVAIL, PROTECT­AF) duomenimis, kairiosios prieširdžio ausytės uždariklio implantavimo procedūra yra efektyvi ir saugi. Tyrimai įrodė, jog sėkmingai atlikus uždariklio implantavimą, sumažėja insulto tikimybė, sumažėja kraujavimo ir mirties rizika lyginant su varfarinu. Esant pakankamam įrodymų kiekiui, 2019 m. gegužės mėn., Kauno klinikose pirmą kartą atlikta sėkminga kairiosios prieširdžio ausytės uždarymo procedūra. Išvada. Remiantis pasauline klinikine praktika ir pirmosiomis patirtimis Kauno klinikose, kairiosios prieširdžio ausytės uždariklio implantavimas yra saugi ir efektyvi procedūra.

Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection.

BACKGROUNDWe recently developed a new endoscopic closure technique using only conventional endo-clips for colorectal lesions. Little is known about the feasibility of the endoscopic mucosa-submucosa clip closure method for gastric lesions.AIMTo elucidate the efficacy of the endoscopic mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection (ESD).METHODSTwenty-two patients who underwent gastric ESD and mucosa-submucosa clip closure were included in this study. In this method, endo-clips are placed at the edges of a mucosal defect. Additional endo-clips are then applied in the same way to facilitate reduction of the defect size. Additional endo-clips are applied to both sides of the mucosal defect. Complete closure can be achieved. We have also developed a “location score” and “closure difficulty index” for assessment purposes.RESULTSComplete closure was achieved in 68.2% of the patients (15/22). The location score in the failure group was significantly larger than that in the complete closure group (P = 0.023). The closure difficulty index in the failure group was significantly higher than that in the complete closure group (P = 0.007). When the cutoff value of the closure difficulty index was set at 99, the high closure difficulty index predicted failure with a sensitivity of 57.1%, specificity of 100%, and accuracy of 86.3%.CONCLUSIONThe endoscopic mucosa-submucosa clip closure method was unreliable after gastric ESD, especially in cases with a high closure difficulty index.

Outcomes of Layered versus Mass Closure in Transverse Incision during Emergency Laparotomy in Children

Background: The value of laparotomy closure technique may be measured by the incidence of early and late wound complications. The best laparotomy closure technique should be less time consuming, easy and cost-effective, while preventing both early and late complications. Objective: To compare the outcomes of layered versus mass closure in transverse incision during emergency laparotomy in children. Methods: This prospective comparative study was conducted at Department of Pediatric Surgery, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from July 2016 to June 2018. A total of 60 pediatric age cases that underwent laparotomy were included in this study. Cases were randomly allocated into two groups; 30 patients were in Group A (Layered closure) and 30 patients were in Group B (Mass closure). The outcome variables were time required for wound closure, wound infection, wound dehiscence and incisional hernia. Data were analyzed and compared by statistical tests. Results: The mean age of Group A and Group B patients were 31.08 ± 30.25 months and 34.70 ± 42.73 months respectively (p = 0.706). The ratio between male and female subject was 1.1:1 in Group A and 3.3:1 in Group B. The common diseases of the study patients who underwent laparotomy were intussusceptions, intestinal obstruction due to bands and adhesion, perforated appendix and perforation of small intestine due to blunt trauma respectively. Mean wound closure time was significantly less in mass closure group [28.20 ± 2.17 minutes in layered closure group and 18.80 ± 1.67 minutes in mass closure group, (p ≤ 0.001)]. Wound infection rate, incidence of superficial wound dehiscence, and incisional hernia were relatively less in mass closure group, however, the differences were not statistically significant (p = 0.053, p = 0.095 and p = 0.301 respectively). There was no complete wound dehiscence in Group A, but that was in 1 (3.3%) patient in Group B (p = 0.313). Conclusion: Mass closure technique is comparatively better than layered closure technique.

Risk of port site hernia after laparoscopic sleeve gastrectomy

Aim: Recently, one of the most preferred options in the surgical treatment of obesity is laparoscopic sleeve gastrectomy The purpose of this study is to investigate the incidence of port site hernia formation and the factors affecting the fascia defect in the group with and without closure after LSG.Material and Methods: The data of patients who were operated due to morbid obesity in a single center between March 2014 and June 2018 was reviewed and analyzed retrospectively. The patients were divided into two groups, being those in whom the fascial defect at the 12-mm trocar insertion site from which the gastric remnant was removed during surgery was closed, and those in whom the fascial defect was not closed. The incidence of port site hernia and the factors affecting the development of port site hernia were evaluated with physical and ultrasound examinations 1year after surgery.Results: The study was completed with a total of 207 patients, of which 112 fascias was not closed and 95 fascia was closed. The rate of hernia formation was significantly lower in the fascial closure group than in the non-fascial closure group (p:0,036). Aside from this parameter, no significant difference was identified in the other parameters of the two groups. Age was significantly higher in patients that developed hernias following surgery than in those who did not develop hernias.Conclusion: This study determined that the closure of the fascial defect is a protective factor against the development of port site hernia when compared to non-fascial closure.

Complete closure versus simple closure for perforations during colorectal endoscopic submucosal dissection.

Background and study aims The efficacy of complete closure versus simple closure for perforations during endoscopic submucosal dissection (ESD) has never been evaluated. We evaluated the efficacy of complete closure and simple closure for perforations and muscular layer injuries incurred during ESD. Patients and methods Thirty-four consecutive patients who underwent “complete closure” or “simple closure” for correction of perforations and muscular layer injuries during colorectal ESD were enrolled in this study. Complete closure was performed by the mucosa-submucosa clip closure method using only conventional endo-clips. For simple closure, endo-clips are placed just for perforation or muscular layer injury, while leaving any mucosal defects open. Results Among the 15 patients in the complete closure group, eight developed perforations and seven developed muscular layer injuries. Among the 19 patients in the simple closure group, six developed perforations and 13 developed muscular layer injuries during the ESD procedure. There were no statistically significant differences between the two groups in inflammatory reactions, adverse events, or length of the hospital stay. Conclusion Complete closure and simple closure for perforations and muscular layer injuries during ESD seem to have similar efficacy. While simple closure for a perforation during ESD seems sufficient, further study will be required to confirm our results.

Use of institutional criteria for transcatheter device closure of Fontan fenestration - Midterm outcomes.

Background:There are no established criteria to decide suitability for Fontan fenestration closure. Our institution has the following criteria: an unobstructed Fontan pathway with no significant decompressing venovenous collaterals, baseline Fontan pressure ≤15 mmHg, baseline cardiac index ≥2 L/min/m2, and a decrease in cardiac index ≤20% with test occlusion of the fenestration.Objective:The objective of the study was to review midterm outcomes following device closure of Fontan fenestration using institutional criteria.Materials and Methods:A retrospective review was performed of patients who underwent catheterization with prior fenestrated Fontan procedure between May 2005 and January 2015. Patients were classified as those who underwent successful closure (A), had closure deferred due to failure to meet criteria (B), or were not referred for closure (C).Results:There were 42 patients in Group A, 10 in Group B, and 150 in Group C. The mean Fontan pressure increased from 13.1 ± 2.1 to 14.5 ± 2.1mmHg in Group A and 14.6 ± 1.5 to 15.7 ± 2.2 mmHg in Group B (P = not significant). With test occlusion, cardiac index fell by 18.12% ± 15.68% in Group A and 33.75% ± 14.98% in Group B (P = 0.019). At a median of 46 month follow-up, oxygen saturation increased significantly from 85.15% ± 6.29% at baseline to 94.6% ± 4.43% (P < 0.001) in Group A but with no statistically significant difference in the rates of plastic bronchitis, protein-losing enteropathy, stroke, or heart transplantation between the three groups.Conclusions:Using institutional criteria, transcatheter device closure of Fontan fenestration was followed by significant increase in oxygen saturations and no statistically significant difference in morbidity or mortality between closure and nonclosure groups.

Long-term impact of fistula status on growth and anemia in infants with congenital anorectal malformations.

To evaluate the impacts of fistula status over 12 months on growth and development and anemia in infants with anorectal malformation (ARM) and to analyze the effects of comorbidities. The ARM group included infants who suffered from ARM and underwent three operations including colostomy, anoplasty (group A) and fistula closure (group B). The normal group included infants aged approximately 6 months and 12 months who were classified as groups C and D. A 24-h dietary recall questionnaire was completed by the guardians of all the participants. Data on height, weight, hemoglobin (Hb) level and comorbidities were extracted from electronic medical records. Then, we compared the impacts of the 12-month fistula status on growth and development and anemia among the infants. In total, 47 patients in the ARM group and 100 infants in the normal group were included. The height-for-age z-score (HAZ) was lower in group A than in group B. Compared with those in group D, weight, height, the HAZ and the weight-forage z-score (WAZ) were lower in group B. The incidence of anemia was higher in the ARM group than in the normal group. Patients with ARM are at risk for growth problems and anemia. The long-term impacts of fistula status on infant length presented earlier than those associated with other physical indicators. Compared to infants with urogenital comorbidities, those with congenital heart disease (CHD) seemed to be more prone to growth disorders and anemia.

Evaluation of postoperative outcomes following primary suction closure for breast abscess

Background: Breast abscess is a common inflammatory condition among lactating women. Although initial stages of breast abscess can be managed through antibiotics, surgery may be required in the presence of advanced stages in the form of incision and drainage with or without placement of surgical drain. This study was carried out to evaluate the outcomes between open and closed incision and drainage. Methods: This randomized control trial was carried out among 60 cases clinically diagnosed breast abscess. The participants were randomly allocated to experiment group (30 patients) consisting of closed primary suction closure and control group (30 patients) open incision and drainage. Postoperative outcomes in terms of recurrence, pain, secondary infection and duration of hospital stay were recorded. Results: Postoperative pain was present among six participants in the experimental group as compared to 18 participants in the control group, none of the participants in the experimental group experienced residual abscess, scar formation or secondary infections. Moreover, the mean duration of hospital stay among experimental group was 9.1 days as against 11.6 days in the control group. Conclusion: Considering the potent clinical, surgical and financial advantages associated with closed primary suction closure, this method may be routinely used for effective management of acute breast abscess, especially in lactating women.

Evaluating the role of topical tranexamic acid in cancers of the head-and-neck: A single-center randomized controlled trial

Background: Closed suction drains can reduce the complications associated with neck dissection (ND) by facilitating the removal of bodily fluids from the operated site. A lower drain output helps in faster wound healing, thereby leading to early drain removal and better recovery. Topical application of tranexamic acid (TXA) to the raw area created by surgery has been shown to be beneficial in reducing the bleeding in cardiac, orthopedic, and endoscopic nasal surgeries.Objectives: This study aimed at assessing whether the topical application of TXA after ND reduced the drain output, time to drain removal, and postoperative complications in patients undergoing surgery for head and neck cancers.Materials and Methods: The present study was performed in a tertiary care teaching hospital in north India between August 2014 and December 2017. One hundred patients with head and neck cancer who underwent ND were randomized into two groups. Group 1 received 20 ml of 25 mg/ml topical TXA per neck after hemostasis, and Group 2 underwent routine neck closure. Primary end points included the daily drain output until postoperative day 5 and the day of drain removal. Age, lymph node yield, operative time, type of reconstruction, and postoperative complications till 30 days postoperatively were also recorded.Results: The demographic and clinicopathological profiles were comparable between the two groups. Output from the neck drains was significantly lower in the TXA group compared to the standard closure group (208.29 ± 84.18 ml vs. 344.56 ± 110.93 ml; respectively, P < 0.0001). In addition, drain removal in the tranexamic acid group was done earlier than in the standard closure group (6.11 ± 1.20 days vs. 7.56 ± 1.42 days, respectively,P < 0.0001). Postoperative complications and requirement of secondary procedures were comparable between the two groups.Conclusions: Topical TXA effectively reduces the postoperative drain output after ND in patients with head and neck cancer. It facilitates the early removal of the drain and helps in better recovery without any significant difference in the rate of postoperative complications.

Crystallized phenol treatment is less effective in patients with recurrent pilonidal disease after surgery compared to patients with primary pilonidal disease

Aim: Primary pilonidal disease can be treated with crystallized phenol with an overall cure rate of 80%. However, the effect of crystallized phenol in patients who had recurrence after pilonidal disease surgery has not been analyzed in the English medical literature in detail yet. The purpose of this study was to investigate the effect of crystallized phenol in recurrent pilonidal disease. Material and Methods: 28 male and 10 female patients who had recurrence after surgical intervention to treat pilonidal disease were evaluated. Twenty male and 8 female patients underwent excision and primary closure surgery, whereas 8 male patients and 2 female patients underwent modified Limberg flap surgery. All of these 38 patients were treated with one-time application of crystallized phenol.Results: The mean period for recurrence of patients treated with single application of crystallized phenol after primary excision and primary closure surgery was 45.85±11.82 days (range: 35-90 days) and it was 66.5±25.31 days (range: 40-120 days) after modified Limberg flap surgery. The follow-up period was 6 months. The cure rate in recurrent excision and primary closure group was 57.14%, whereas the cure rate in the recurrent modified Limberg flap group was 40%. Overall cure rate was 52.63%.Conclusion: As a result, crystallized phenol treatment was less effective in patients who had recurrence after pilonidal disease surgery in comparison to patients who were only treated with crystallized phenol without prior surgical intervention.

Assessment of local wound healing complications after groin surgery: a comparative study between two wound closure techniques

Background: Scars are inevitable sequelae of any surgical procedure. Wound closure method has been shown to affect the post-operative scar outcome. This study compared the post-operative scar of two wound closure techniques in paediatric groin surgeries. Methods: This was a prospective comparative analytical study involving 60 paediatric surgical patients randomized into two groups. After a groin procedure in patients who met the inclusion criteria, patients in Group A had only the skin layer closed whereas both skin and subcutaneous tissue were closed in Group B. Scar assessment was done using the Patient and Observer Scar Assessment Scale (POSAS) at 1 week, 3 weeks and 6 weeks after surgery. Results: The mean POSAS score was 108.44 ± 20.32 and 113.91 ± 26.18 for groups A & B respectively (P = 0.379) while the overall opinion score for groups A & B were 19 (IQR = 4) and 21(IQR = 10) (P = 0.392) respectively. The average duration of surgery was 35 minutes in each group. There was equal distribution of seroma formation among the two wound closure groups. Among the patients that developed wound dehiscence, 25% were in group A, while 75% were in group B. Ninety-five percent of the wounds healed with fine linear scar. Conclusion: Majority of paediatric groin wounds heal with fine linear scars. Although no statistically significant association exists between wound closure technique and scar assessment scores, patients who had two-layer wound closure recorded worse scar assessment scores compared to those who had one-layer closure.

1078: Barbed versus conventional suture for uterine closure during cesarean section: An integrated retrospective study

Although a variety of options exist for uterine incision repair during cesarean section (CS) in regards to suture type and repair technique, there is limited evidence on the best approach. The objective of this study was to compare knotless barbed and conventional synthetic suture use for uterine closure in different settings of CS. A retrospective cohort study was conducted using 217 CS cases at a community teaching hospital between January 2016 and May 2019, in which the hysterotomy incision was closed with knotless barbed (n=99, 45.6%) or conventional synthetic suture (n=118, 54.4%). Aggregate cases were further categorized into one or two-layer hysterotomy closure and primary or repeat CS. Parameters of operating room (OR) time, estimated blood loss (EBL), and complication rate were designated for comparison. Patient body mass index (BMI) and assistant post-graduate year (PGY) were correlated with OR time. Statistical analysis was performed to assess whether differences between groups were significant using a p-value of ≤0.05. Mean OR times, mean EBL, and complication rates were lower for knotless barbed compared to conventional synthetic suture across all uterine closure scenarios (Figure 1 and 2). Statistically significant differences were observed for EBL in aggregate (752.9 vs. 820.9 mL; p=0.03), two-layer closure (643.6 vs. 850.4 mL; p=0.002), and repeat CS (712.2 vs. 824 mL; p=0.03) groups. BMI positively correlated with OR time (r=0.205; p=0.002). There was no significant correlation between assistant PGY and OR time (r=-0.067; p=0.325). Using knotless barbed suture compared with conventional synthetic suture for uterine closure during CS is associated with significantly lower EBL, particularly for two-layer closure and repeat CS groups. Consideration of other factors is imperative during such comparison. When selecting suture material for uterine closure, knotless barbed suture may be a favorable option to conventional synthetic suture from a patient care and healthcare cost perspective.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Comparative Analysis of Suture versus Linear Stapler Pharyngeal Closure in Total Laryngectomy: A Prospective Randomized Study.

The aim of this study was to prospectively evaluate and compare the outcomes in patients undergoing pharyngeal closure with the linear stapler and suture techniques after total laryngectomy. Forty-one patients who needed total laryngectomy for laryngeal cancer were enrolled in the study. Patients were randomized into two groups according to the pharyngeal closure technique: the linear stapler group (Group A) and the suture closure group (Group B). Rate of pharyngocutaneous fistula (PCF), nasogastric tube (NGT) removal time and pharyngeal closure time were analyzed and compared between the two groups. PCF developed in three patients in Group A (14.3%) and in seven patients in Group B (35%). Although the rate of PCF was lower in Group A, this did not represent a statistical difference (p:0.129). Median NGT removal time was 12 days (IQR=3) and 19.5 days (IQR=1) in Groups A and B, respectively. Median NGT removal time was not statistically different between the two groups (p:0.642). All patients were able to swallow liquids and solids without difficulty. Median pharyngeal closure time was 3 minutes (IQR=1) and 37.5 minutes (IQR=9) in Groups A and B, respectively. Median pharyngeal closure time was significantly lower in Group A (p:0.00). The linear stapler technique in total laryngectomy is a reliable, safe, easy-to-apply and time-saving method. Closure with linear stapler significantly reduces pharyngeal closure time without adverse effect on NGT removal times and PCF rates.

Skin closure after ileostomy reversal: comparative study between conventional linear versus purse-string suturing

Background: Wound infection and scarring are relatively common complication after stoma reversal. Immediate skin closing by conventional linear closure technique is associated with varying percentage of wound infection ranging from 2 to 41%. Delayed skin closure is associated with prolonged healing time and poor scar cosmesis. In order to overcome these problems, an alternative method of skin closure during stoma reversal has been suggested. It involves taking purse-string subcuticular absorbable sutures to close the skin during Ileostomy reversal. Our study is a comparative study between conventional linear skin closure and this alternative form skin closure in stoma closure procedures for the assessment of surgical site infection and scar cosmesis.Methods: 40 patients were enrolled for the study, divided in two groups, one undergoing purse-string skin closing (n=20) and the other undergoing linear skin closure (n=20) during stoma reversal. All the data was analysed using IBM SPSS version 21.0 taking p value less than 0.05 was taken as level of significance.Results: Surgical site infections were seen in 3 out of 20 patients in whom purse-string skin closure was done, while it was 9 out of 20 patients in primary linear closure during stoma reversal group. Post-operative pain was found significantly lesser in purse-string group compared to linear closure group on same and first post-operative day. Scar cosmesis was assessed using patient and observer scar assessment scale and was observed better in purse-string group of patients.Conclusions: Purse-string skin closure is a better alternative surgical option to consider during stoma reversal surgeries as compared to conventional linear closure.