Closure Operator Research Articles

Outcome of surgical site infection following inguinal hernia closure

Objective: This study's goal is to look into how inguinal hernia surgery patients respond to surgical site infections (SSIs). The purpose of the study is to examine the association between the prevalence of SSIs and demographic factors such as age, body mass index (BMI), habitation type (urban/rural), presence of diabetes mellitus and hypertension, degree of education, length of hospital stay, and length of surgery. Methods: Patients who underwent inguinal hernia closure surgeries were included in this retrospective analysis, which was carried out in a medical facility. A patient's demographics, BMI, type of habitation, diabetes and hypertension status, education level, length of hospital stay, length of operation, and presence or absence of surgical site infections were all collected from their medical records. To evaluate the patient population's characteristics and the prevalence of SSIs, data analytic techniques included frequency distribution and percentage calculation. In order to identify correlations between factors and the occurrence of SSI, statistical tests were run. Results: The study involved all of the patients. The age distribution displayed 35.1% in the 20–30 age, 21.1% in the 40–50 age, and 43.9 % in the 40–50 age. BMI categories were revealed with BMIs of 20–23, 23–25, and 25–28. Participants who lived in cities made up 22(29.7%) of the group, whereas participants who lived in rural areas made up 35.1 %. Diabetes mellitus was more common than hypertension 23 (20.2%) vs. 17(14.9%). The distribution of education levels was as follows: 17(14.9 %) with no education, 46 (40.4%) with SSC-level education and 51(44.7%) with HSSC or higher education. Hospital stays lasting 1-3 days in 55 (48.2%) of cases and 3-6 days in 59 (51.8%) of cases, respectively. There were two categories for operation length: 1-3 months 59(51.8%) and 3-6 months 55 (48.2%). 22 (19.3%) of cases had surgical site infections, while 92 (80.7%) of cases had no infections at all. Conclusion: The results of surgical site infections after inguinal hernia closure are clarified by this investigation. The frequency of SSIs highlights the significance of strict infection control procedures. Further investigation is required to determine the association between demographic factors and the prevalence of SSI. These findings have implications for post-operative care plans and surgical protocols that aim to reduce the risk of SSIs and improve patient outcomes. To fully comprehend the multifactorial nature of SSIs in inguinal hernia closure surgeries, additional study is required.

Case Report: 3D imaging-assisted minimally-invasive hybrid closure surgery of a complex coronary artery fistulas

Case Report: 3D imaging-assisted minimally-invasive hybrid closure surgery of a complex coronary artery fistulas

Synthesis and Evaluation of the Extraction Efficiency of Pristine Zeolite Na-A to Remove ReO4- Ions (Surrogate of 99TcO4-) from a Simulated Low-Level Waste Solution.

Zeolite Na-A was synthesized through hydrothermal, alkali-fusion, and sonochemical methods, using kaolin as an economically viable precursor. The synthesized zeolite Na-A samples were characterized using XRD, FT-IR, SEM, and Raman spectroscopy. Specific surface area and pore size distribution analyses (by BJH and DFT models) were conducted using a BET surface area analyzer. Additionally, thermal degradation studies were performed by TG-DTA to check the thermal stability of zeolite Na-A at high temperatures. Furthermore, kaolin-derived zeolite Na-A was employed for the extraction of perrhenate ions (ReO4-), which are a nonradioactive surrogate for pertechnetate ions (99TcO4-) without any postsynthetic modifications (using toxic surfactants, etc.) utilizing in situ modification of the solution medium for the first time. The sonochemically synthesized zeolite Na-A demonstrated superior sorption performance for the solid-phase extraction of ReO4- ions from the simulated low-level waste solution. The adsorption process was found to follow pseudo-second-order kinetics. The Langmuir isotherm model fit perfectly with the experimental data (R2 = 0.997) and exhibited a maximum sorption capacity of 926.8 mg/g at pH ∼11, showing superior sorption capacities compared to those of the numerous materials reported earlier. XPS confirmed the speciation of extracted rhenium as NH4Re(VII)O4, providing critical insights into the adsorption mechanisms and validating the suitability of the sonochemically synthesized zeolites toward ReO4- sorption. Furthermore, Raman studies of ReO4- adsorbed zeolite Na-A reflect the absence of characteristic breathing bands, indicating the closure of the pore openings due to the occupancy of adsorbate moieties within the pores. This study not only highlights the utilization of sonochemically synthesized zeolite Na-A as an efficient, benign, and cost-effective adsorbent for 99TcO4- removal from nuclear waste but also emphasizes its potential sustainable applications in various other industrial processes such as wastewater treatment, catalysis, gas separation, pollution control, and resource recovery from industrial effluents and in the pharmaceutical industry for selective ion removal.

The circuit of cognition: Operational closure and the interpenetration of views. Comment on “The affective grounds of the mind. The affective pertinentization (APER) model” by Salvatore et al.

The circuit of cognition: Operational closure and the interpenetration of views. Comment on “The affective grounds of the mind. The affective pertinentization (APER) model” by Salvatore et al.

Correlation between forceps grasp count and skill proficiency in single-incision laparoscopic percutaneous extraperitoneal closure: A retrospective single-center study.

This study aimed to investigate the correlation between forceps grasp count and procedure time in single-incision laparoscopic percutaneous extraperitoneal closure surgeries and the evolution of these metrics with accumulated experience. We retrospectively reviewed 741 procedures performed by surgeons between 2015 and 2023. Surgical videos were analyzed to calculate the procedure time, defined as the time required for suturing around the hernial orifice, and the forceps grasp count. Correlations were evaluated using Spearman's rank correlation coefficients. Changes in experience were assessed using linear regression. Surgeons demonstrated a significantly longer procedure time (585 s vs. 437 s, p < .001) and higher grasp counts (22 times vs. 17 times, p < .001) for surgeries performed on male patients than on female patients. Grasp count was strongly correlated with procedure time (male patients: r = .800; female patients: r = .758, p < .001). With accumulated experience, both procedure time and grasp count decreased, although novice surgeons showed delayed improvement in forceps manipulation compared with improvement in procedure time. Grasp count was strongly correlated with procedure time in single-incision laparoscopic percutaneous extraperitoneal closure. Accumulated experience improved both metrics, with novice surgeons possibly requiring more time to acquire efficient forceps manipulation skills. Efficient forceps manipulation is a valuable metric for evaluating surgical skills.

Operation on Generalized Semi Open Sets in Bitopological Spaces

The aim of this paper is to more contribute the study of operations on bitopological spaces. The concept of operation on generalized semi open sets in bitopological spaces is introduced and studied. Two closure operators related to this concept are introduced and some of their properties and the relation between them are discussed.

On two types of closure operators associated with networks

Binary relation plays a prominent role in the study of network structures. Since network structures are discrete system, topological techniques cannot be utilized to study the system. Rather, the concept of closed sets defined in closure spaces involving a closure operator is used in such types of studies. Recently, Šlapal and Pfaltz studied network structures by using foresets as defined in the Closure spaces via relation. In this paper, two types of closure operators via relations are taken into consideration to verify some results associated with networks. In one case, the relation is binary whereas in the other case the relation is reflexive and symmetric. The situation when a network structure is discrete/indiscrete is investigated. Further, a situation in which a set is closed in a tree-like network structure is obtained and examples in support are provided.

Cloacal Exstrophy Closure Without Osteotomy and Immobilization: A Recipe for Failure

BackgroundCloacal exstrophy (CE) remains one of the most severe birth defects compatible with life with a constellation of anomalies involving the bladder, genitalia, hindgut, and spinal cord. Pelvic osteotomy and immobilization have been utilized to facilitate bladder closure, yet their role as adjuncts remains a topic of debate. The authors sought to evaluate the outcomes of CE closure without the use of osteotomy or lower extremity (LE)/pelvic immobilization. MethodsAn institutional database of 173 CE patients was reviewed for patients closed without osteotomy and/or limb immobilization. Patient records were reviewed for continence procedures, reclosure operations, and continence outcomes. ResultsA total of 59 closure surgeries that met inclusion criteria were identified in 56 unique patients. Thirty-seven closure procedures developed eventual failure (63%) with secondary closure events also resulting in failure. Most closures did not use an osteotomy, 93.2%. LE immobilization-only was used in most closures (43/59), of which only 37% were successful. Failures were attributed to dehiscence (14/37), bladder prolapse (19/37), or both dehiscence and prolapse (4/37). The median age at closure was 3 days old (1–18.5 IQR) with the majority of closure events (47) closure events taking place in the newborn period. Median diastasis prior to primary closure was 6 cm (4.8–8 cm IQR). The median number of closure attempts needed to close the bladder was 2 (1–2 IQR). Of the 56 patients, 31 have >3 h of daytime continence, with the entirety of these patients catheterizing a stoma or below. ConclusionThese results highlight the critical role of osteotomy and lower limb immobilization in successful closure of the bladder and abdominal wall in CE. Type of StudyTreatment Study. Level of EvidenceLevel III.

Gastrointestinal: Leveraging intestinal ultrasound to guide endoscopic closure of the internal opening of a vesico-sigmoid fistula in ileo-colonic Crohn's disease.

Gastrointestinal: Leveraging intestinal ultrasound to guide endoscopic closure of the internal opening of a vesico-sigmoid fistula in ileo-colonic Crohn's disease.

Laparoscopic Versus Open Closure of Duodenal Perforations: A Retrospective Comparative Study in a Rural Hospital, Andhra Pradesh, India

Abstract Introduction: Evidence on the outcomes of laparoscopic surgeries, especially in emergency conditions such as peptic ulcer, remains unknown. A retrospective study was conducted in a rural surgical unit in Andhra Pradesh to compare morbidity, mortality, and duration of hospital admission in patients undergoing laparoscopic (Group L) and open (Group O) closure of duodenal perforations. Methods: Retrospective data of adult patients with peptic ulcer perforation treated by surgical approach during January 2012 and December 2017 were scrutinized. Pre- and postoperative records were abstracted for clinical conditions. Mortality was compared between the two groups with appropriate statistical tests. Results: A total of 120 patients, 60 in each group, were recruited for the study. The preoperative clinical characteristics of the two groups were similar. The mean duration of surgery was significantly higher in Group L (212.8 ± 29 min) compared to Group O (107 ± 16 min) (P &lt; 0.001). Wound discharge (n = 3, 5%) and postoperative leak (n = 2, 3.3%) were the only complications noted in the L group. Several complications were noted in the O group including wound discharge (n = 51, 85%), wound dehiscence (n = 12, 20.0%), postoperative leak (n = 8, 13.3%), pneumonia (n = 1, 1.7%), and need for ventilation (n = 6, 10.0%). Three (5%) patients died in the hospital in Group O while none died in Group L. The average duration of hospital admission was 7.1 days (standard deviation [SD] =1.0 days) for Group L and 11.7 days (SD = 2.2 days) for Group O (mean difference: 4.6 days; 95% confidence interval: 4.6–5.2 days). Conclusion: Laparoscopic correction of duodenal ulcer perforation is both feasible and effective in reducing morbidity and mortality and overall treatment duration at peripheral centers.

A rare spatial relation of the great arteries in patients with transposition of the great arteries: Posterior aorta and its effect on outcomes

Background: This study aimed to evaluate patients diagnosed with posterior transposition of the great arteries (TGA) in detail. Methods: This retrospective study included 192 patients (155 males, 37 females; mean age: 0.4±0.9 month; range, 0.1 to 6 month) with TGA who were followed between August 1, 2016, and August 1, 2022. Patients with ventriculoarterial discordance, normal vessel relationship, and mitral-aortic continuity were considered posterior TGA. Demographic features, clinical findings, echocardiographic data, and surgical results of each patient were recorded. Results: Posterior TGA was present in 11 (5.7%) of the patients. The median age of patients with posterior TGA at the time of surgery was two months (interquartile range [IQR], 1-3 months), and their median body weight was 6.2 kg (IQR, 5-7.2 kg). The median oxygen saturation of the patients was 85% (IQR, 80-90%). A ventricular septal defect was present in all patients on echocardiography. There was also nonrestrictive atrial septal defect and patent ductus arteriosus in four patients, and one patient had arcus aorta hypoplasia. A coronary anomaly was determined in eight of the patients during surgery. These were 1LRCA2Cx in three cases, 1LRCx in three cases, 1R2LCx in one case, and 1L2RCx in one case. Arterial switch operation and ventricular septal defect closure was performed in 10 patients initially and in one patient after a pulmonary banding operation. The median cardiopulmonary bypass time was 190 min (IQR, 170-210 min). The Lecompte maneuver was not performed in any of the patients. The median stay in the intensive care unit and the hospital was 7 days (IQR, 5-10 days) and 16 days (IQR, 14-18 days), respectively. Two patients died in the early postoperative period. Conclusion: In patients with suspected congenital heart disease, a segmental echocardiographic evaluation should be performed, and it should be kept in mind that the aorta may be located posteriorly as a rare spatial relationship in patients with TGA.

Topologies related to (I)-envelopes

We investigate the question whether the (I)-envelope of any subset of a dual to a Banach space X may be described as the closed convex hull in a suitable topology. If X contains no copy of ℓ1 then the weak topology generated by functionals of the first Baire class in the weak⁎ topology works. On the other hand, if X contains a complemented copy of ℓ1 or X=C([0,1]) no locally convex topology works. If we do not require the topology to be locally convex, the problem is still open. We further introduce and compare several natural intermediate closure operators on a dual Banach space. Finally, we collect several intriguing open problems related to (I)-envelopes.

Myringoplasty: A comparison of inlay and underlay techniques

PurposeMyringoplasty aims to improve hearing and prevent otorrhea, making graft uptake rates and hearing crucial considerations. This study analyzed the factors associated with unsuccessful graft uptake and hearing improvement to guide the selection of optimal surgical approaches for myringoplasty. MethodsWe retrospectively reviewed 56 ears with chronic otitis media. All patients were followed up for >6 months after tympanic membrane closure surgery. We compared the underlay method using the transcanal approach with the inlay method using the retroauricular approach for myringoplasty in patients with chronic otitis media. The underlay and inlay methods were used for 23 and 33 ears, respectively. The primary outcomes were graft uptake rate and hearing improvement. Additionally, factors such as the location of tympanic membrane perforation, patient age, and the degree of mastoid development were evaluated. ResultsThe perforation rate was high when the transcanal underlay method was employed to repair perforations in the anterior inferior quadrant. Both the underlay and inlay methods significantly improved hearing. However, the success rate of the inlay method was lower. Within the cases performed using the inlay method, outcomes tended to be poorer in older age groups. There were no significant differences in surgical success rates related to mastoid development. ConclusionThe inlay method using the retroauricular approach is a favorable option for repairing perforations involving the anterior inferior quadrant. However, older patients presented lower rates of hearing improvement when the inlay method was used.

A population-based study of incidence, aetiology, treatment and outcome of enterocutaneous fistula.

The aim of this work was to investigate the incidence of enterocutaneous fistula (ECF), including both small bowel and colonic fistulas, in a defined population of 1.04 million during a 10-year period and to describe aetiology, treatments, care consumption and outcome. A comprehensive search algorithm including diagnostic and procedural codes, enterostomal therapy nurse notes and in-hospital care for >60 days yielded 1970 search hits. After reviewing medical records, 187 patients with ECF were identified. The annual incidence of ECF was 2.3 per 100 000, the incidence of ECF with intestinal failure type II was 0.9 per 100 000. Spontaneous closure of the fistula occurred in 16.0% of patients, while closure was seen in 97.3% of patients who underwent reconstructive surgery with recurrences in 6.7% and 8.3%, respectively. Cumulative ECF-related in-hospital care until closure or end of follow-up was 4 (range 0-61) weeks. Eighty-eight patients (47%) received home-based healthcare including parenteral feeding and/or fistula wound care. The estimated overall mortality at 1, 3 and 5 years was 33.7%, 42.1% and 47.6% respectively. Mortality was mainly in patients without spontaneous closure or reconstructive surgery, and the risk of ECF-related death was 30.2%. This study defines the population-based incidence of ECF and reports a high overall mortality rate. Initial survivors were characterized by either spontaneous closure or eligibility for later reconstructive surgery, but with an eventual mortality rate of approximately 20%. ECF patients are high consumers of care: 55.1% needed ≥4 weeks in hospital and many received home-based healthcare.

Real-life effectiveness of allogeneic expanded adipose-derived mesenchymal stem cell therapy for perianal fistulizing refractory Crohn's disease

BackgroundReal life data about the long-term efficacy of darvadstrocel for treating perianal fistulas in Crohn's disease (CD) remain scarce. Aim: To report the effectiveness and safety of darvadstrocel therapy to close perianal fistula in a real-life cohort of CD patients. MethodsAll patients with CD suffering complex draining perianal fistulas who consecutively underwent administration of a single local injection of darvadstrocel at two centres were followed up and evaluated. The primary endpoint was clinical remission (closure of all external openings with no discharge at pressure) at week 24. Combined remission (defined as clinically plus MRI-assessed fistula closure) were also assessed at week 24 and 52. ResultsA total of 36 CD patients (19 Male, mean age 38.5 years) were included with a median follow up of 16 months. Clinical remission was achieved in 17 out of 36 patients (47.2 %) and combined remission in 15 out of 36 patients (41.6 %) at week 24. At week 52, clinical and combined remission was achieved in 17 out of 36 patients (47.2 %) and in 15 out of 33 evaluable patients (45.4 %), respectively. ConclusionIn this real-world setting, a successful response to darvadstrocel therapy based on clinical remission was reported in around half of the patients and combined remission including radiological assessment in more than 4 out of 10 patients.

Atrial Septal Defect

Background: Atrial Septal Defect (ASD) is one of the most common congenital heart diseases, occurring in about 25% of children and accounting for 6-10% of all congenital heart conditions. ASD is more frequently observed in females with a ratio of 2:1 and often does not show symptoms in infants, unless there is an increase in right ventricular volume. Case Report: A 7-year-old girl was referred with complaints of shortness of breath and cyanosis at the fingertips, accompanied by palpitations. Initial diagnosis was established through physical examination and echocardiography, which revealed a secundum ASD measuring 1.9 cm. The ASD closure surgery was performed but had to be halted due to intraoperative bradycardia. The patient then underwent subsequent therapy with Lisinopril and Spironolactone and was in good condition at the last follow-up. Discussion: Management of ASD, whether through surgical or catheter-based intervention, is recommended to prevent further complications such as paradoxical embolism and pulmonary hypertension. This case underscores the importance of timely diagnosis and treatment to prevent long-term health impacts in patients with ASD.

Pycnogenol® + Centellicum® supplementation improves skin elasticity and microperfusion. Implication for surgical patients: a conceptual registry study.

The aim of this registry study was to evaluate the effects of Pycnogenol® and Centellicum® (PYCE) on skin perfusion and skin elasticity in healthy women over a period of 4 weeks. The supplemented women used 150 mg of Pycnogenol® and 450 mg of Centellicum® daily. The supplemented group used the combination PYCE daily for 4 weeks and followed the standard management (SM) in addition. A control group used only the SM. SM for all subjects included a healthy diet (low levels of NaCl, low sugar, low calories), vitamin supplementation (C, E, B), daily mild outdoors exercise, regular washing with neutral soap; the same non-clinical, non-specific hydrating cream (Nivea) was used once daily. Sixty-three women completed the registry study. Thirty women using the PYCE combination and 33 women in the control group. The groups were comparable at baseline. No clinical condition was observed during the registry; no drug was used. There were no side effects or tolerability problems with the supplements. After 4 weeks, ultrasound elastosonography showed that skin elasticity significantly improved with the PYCE combination (P<0.05) without significant changes in the control group. In parallel, transcutaneous skin PO<inf>2</inf> increased significantly with PYCE compared to controls and transcutaneous skin PCO<inf>2</inf> decreased significantly compared to controls (P<0.05). This showed that skin oxygenation and nutrition improved with PYCE. Skin hydration also significantly improved with PYCE (P<0.05) in comparison with controls. Skin flow, indicating skin blood perfusion (thermoregulatory flow), assessed by laser Doppler flowmetry significantly improved over 4 weeks compared to controls (P<0.05). More specifically, the most superficial part of the flow, in the most superficial layer of the skin, corresponding to the nutritional blood flow, significantly improved with the combination PYCE compared to controls (P<0.05). Skin and tissue elasticity are crucial in surgery for healing, scarring, and wound closure. Reduced elasticity can lead to irregular or delayed healing. This preliminary concept study suggests that PYCE supplementation enhances skin elasticity, perfusion, and nutrition, with visible effects seen in just 4 weeks. This preliminary, concept study indicates that skin elasticity, skin perfusion, and skin nutrition improved with the supplementation of PYCE and the effects of PYCE were visible after only 4 weeks. A longer observation period should be considered in future studies. In conclusion, this pilot concept study shows a significant activity of the combination Pycnogenol® and Centellicum® on skin elasticity over a short period of supplementation.

A Literature Review Case Study Of Pt Xyz Strategy Implementation Seen From The Business Feasibility Study Aspect

PT XYZ is an e-commerce startup company in the clothing sector that was successful in its time. In carrying out its business, PT However, all these efforts were hit by the COVID-19 pandemic which ultimately resulted in PT XYZ experiencing the closure of operations and liquidation. The research tries to analyze the PT XYZ case study from business feasibility study aspects such as financial, marketing, technical and legal aspects using the literature study method. By carrying out this research, it is hoped that it will help business people make smarter and more measurable decisions in developing their business. From the research results, it shows that overall, PT XYZ has taken strategic steps in financial, marketing, technical and legal aspects to increase its business viability. However, the impact of the COVID-19 pandemic shows the importance of careful financial planning and flexibility in dealing with crises

WP1.14 - Evaluation of mesh closure of laparotomy and extraction incisions in open and laparoscopic colorectal surgery: A systematic review and meta-analysis

Abstract Background In colorectal surgery, postoperative evisceration and incisional hernia (IH) were not only noted after open procedures, but also at extraction incision (EI) sites used in laparoscopic resections. Few techniques, including using different sutures, closure techniques, and surgical meshes, have been evaluated in the literature to prevent the occurrence of IH and postoperative wound failure. This systematic review investigates the efficacy and safety of using prophylactic mesh on closure of midline laparotomy or extraction incision (EI) in colorectal oncological and non-oncological resections. Method Literature databases, including PubMed, Cochrane, Science Direct and Google Scholar, were searched for studies comparing the use of prophylactic mesh to conventional suture closure in colorectal operations, either in laparotomy closure in open surgery or EI closure in laparoscopic procedures, regardless of the indication; oncological and non-oncological. Primary endpoints were identified as incisional hernia (IH), and postoperative evisceration. Other outcomes included surgical site infection (SSI), seroma formation and length of hospital stay (LOS). Results Six studies fulfilled the inclusion criteria and studied 1,398 patients. Occurrence of IH was significantly reduced on using mesh closure compared to suture closure (OR 0.23, P=0.00001), while there was no statistically significant difference in evisceration rate (OR 0.51, P=0.25). Additionally, no notable difference was identified between both groups in terms of SSI (OR 1.20, P=0.54), postoperative seroma (OR 1.80, P=0.13), and LOS (MD -0.54, P=0.63). Conclusion The use of prophylactic mesh on closing laparotomy incision or EI for open and laparoscopic colorectal resections reduces the risk of developing IH. There were no significant safety concerns; however, further randomised trials may provide more creditable results.

Closing the internal opening with a rectal advancement flap increases the efficacy of mesenchymal stem cell injection for complex Crohn's disease anal fistulas.

The efficacy of injections of mesenchymal stem cells (MSC) for anal fistula treatment may be impaired by the persistence of stools passing into the fistula, causing bacterial contamination and a local inflammatory reaction. We aimed to compare remission rates between patients treated by MSC injection with simple sutures and those treated with a rectal advancement flap. This single-center prospective study compared the first patients who underwent internal opening closure with sutures with the subsequent patients treated with a flap. Complete clinical remission was defined as complete closure of the external opening(s) without pain or discharge, and complete radiological remission was defined as a Magnifi-CD score of 0. We compared the first 42 patients who had sutures with the 20 subsequent patients who had an advancement flap. The median follow-up was 15.5 [8.8-24.9]months. The cumulative incidence of complete clinical response at M12 was 53.8% [38.1-69.6%] in the suture group versus 93.3% [77.4-100.0] in the flap group (p < 0.001). The Magnifi-CD score was 0 for 41.7% [25.5-59.2%]) of patients treated with sutures versus 72.7% [39.0-63.9%]) of patients treated with a flap (p=0.093). Anal incontinence score did not differ between the two groups. Practicing an advancement flap was the only significant factor associated with complete clinical remission over time (adjusted HR [95% CI] of 2.6 [1.4-4.9], p = 0.003). Complete clinical remission rates following MSC injection are significantly higher after closure of the internal opening with a rectal flap than after closure with sutures, without consequences on anal continence.