Continuous Suture Technique Research Articles

The Effect of Fibrin Glue Application as a Sealant in Protecting Colon Anastomosis with Continues Suture Compared to Simple Interrupted Suture in Intraperitoneal Infection Condition Measured by Tissue Hydroxyproline Level (Wistar Rat Study)

Background: Anastomotic leakage is a serious complication in gastrointestinal surgery, especially inperitonitis condition. Simple interrupted suture is the gold standard for intestinal anastomosis; however, ithas a greater risk of contamination by peritoneal fluid. Fibrin glue has been used as a barrier to protect theintestinal anastomotic suture by increasing hydroxyproline levels. But its benefit in continuous suture is stilldebatable.Objective: To determine the effect of fibrin glue as a sealent in protecting colon anastomosis with continuoussuture compared to simple interrupted suture in intraperitoneal infection conditions.Method: In this experimental study, the rats were divided into two groups: control group (Groups 1 and 2)and experimental group (Groups 3 and 4). Group 1 and 3 were performed by simple interrupted, while theothers by continuous suture. Full-thickness incisions were made on the left colon and fibrin glue was appliedover the sutures in experimental groups. The samples were taken on day 10.Result: According to hydroxyproline levels (mcg/gr tissue), average values of the groups was 201.18 ±27.81 (Group 1), 208.73 ± 17.81 (Group 2), 245.83 ± 20.47 (Group 3), and 241.55 ± 16.85 (Group 4). Tissuehydroxyproline levels in experimental groups were significantly higher compared to control (P < 0.05). Inexperimental group, mean hydroxyproline levels in subject with continuous suture was lower than simpleinterrupted suture; however it was not significant statistically (p=0.796).Conclusion: As a result, the use of fibrin glue is beneficial to increase hydroxyproline level in colonanastomotic tissue especially in simple interrupted than continuous suture technique.

Simple Interrupted and Continuous Interlocking Suturing Techniques Comparison in Maxillofacial Trauma – A Randomized Controlled Trial

Aim: To compare the efficacy of simple interrupted and continuous interlocking suturing techniques using 3-0 vicryl (polyglactin) sutures. Method: The study sample included 20 patients (16 males and four females) with maxillofacial trauma requiring ORIF (Open Reduction and Internal Fixation) of maxilla or mandible fractures. They were randomly allocated to two groups (Group A and Group B). Patients in the age group of 20-50 years, requiring ORIF under local anesthesia or general anesthesia through an intraoral approach and incision measuring 4-6 cm were included in the study. Exclusion criteria included patients requiring extra-oral incisions, comminuted fractures with acute illness, infection, pregnancy, immune compromised conditions and patients not willing to participate in the study. Surgical site was closed in single layer using 3-0 vicryl sutures. Intraoperatively, time taken for suturing, wound dehiscence and wound healing were monitored on third, seventh and 30th day post-operatively. Results: In terms of time taken for suturing, dehiscence of wound and wound healing, continuous interlocking sutures showed superior results than that of simple interrupted sutures. Conclusion: Even though simple interrupted suturing is an easy technique, continuous interlocking suturing technique showed superior results. However, surgeons operating maxillofacial trauma may have their own point of view and selection of technique depends on individual preferences.

Economic evaluation of suture versus clip anastomosis in arteriovenous fistula creation

ObjectiveTechniques such as the use of nonpenetrating vascular clips for arteriovenous fistula (AVF) anastomotic creation have been developed in an effort to reduce fistula-related complications. However, the outcomes data for the use of clips have remained equivocal, and the cost evaluations to support their use have been largely theoretical. Therefore, the present study aimed to determine both the clinical and the cost outcomes of AVFs created with nonpenetrating vascular clips compared with the continuous suture technique during a 10-year period at a single institution. MethodsAll patients undergoing AVF creation in the upper extremity from 2009 through 2018 were retrospectively analyzed. The patient demographics and AVF outcomes were collected and compared stratified by the surgical technique used. A cost analysis was performed of a subgroup of patients from 2013 to 2018. ResultsDuring the 10-year study period, 916 AVFs were created (79% using the continuous suture technique and 21% using nonpenetrating vascular clips). Patient demographics and comorbid conditions did not differ between the two groups, and no differences were present in maturation, primary patency, assisted primary patency, or complication rates between the two groups at 1 year. The suture group had a shorter time to maturation (4.3 months vs 5.5 months; P < .01) and improved secondary patency compared with the clip group (77.13% vs 69.59%; P = .03) The cost analysis of the procedures revealed a significant difference in direct costs (suture, $1389.26 vs clip, $1716.51; P < .01) and contribution margin (suture, $1770.19 vs clip, $1128.36; P < .01) for the two groups. ConclusionsBoth suture and clip techniques in AVF creation demonstrated equivalent rates of maturation, primary patency, assisted primary patency, and complications at 1 year with higher expense associated with the use of clips. Thus, in an effort to reduce the economic burden of healthcare in the United States, the findings from the present study support the preferential use of the standard polypropylene suture technique when creating upper extremity AVFs.

Comparison of suture technique (interrupted vs. continuous) with respect to wound dehiscence

Objectives: Post-operative complete wound dehiscence, being an unfortunate and also a very serious complication, is associated with a high morbidity and mortality rate despite the most sophisticated intensive care these patients receive today. The quest for the best closure technique for abdominal incisions continues. To achieve this goal, several modifications in opening the abdomen and closing the wound have been tried. There are many studies in the literature comparing various methods of wound closure, with conflicting results. The aim of the present study was to assess the proportion of wound infection and wound dehiscence in the post-midline laparotomy patients, using interrupted X suture versus continuous suture technique in sheath closure. Material and Methods: A total of 80 patients undergoing vertical midline emergency laparotomy at one of the gynecology units were recruited randomly after taking written informed consent and were equally divided into 40 cases each group (interrupted X suture) and (continuous suture) they were randomized into two groups depending on whether the patient registration number was odd or even. Results: The age of the patients varied from 16 years to 82 years. In Group A, the mean age was 36.75 ± 13.78 years, and in Group B, the mean age of the patients was 38.37 ± 12.56 years. In Group A, 8 (20%) patients had comorbidity, whereas, in Group B, 10 (25%) patients had comorbidity. In Group A, 12 patients had wound infection, while in Group B, ten patients had wound infection (P = 0.001 [statistically significant]). In Group A, two patients had wound dehiscence, while none of the patients in Group B had wound dehiscence (P = 0.001 [statistically significant]). There was no incisional hernia in both the groups. Conclusion: Emergency laparotomy is associated with a higher rate of burst abdomen as compared to elective laparotomy, but using interrupted X suture technique in sheath closure, wound dehiscence can be prevented up to some extent.

Outside-in Continuous Meniscal Suture Technique of the Knee

The meniscus is largely responsible for the health and longevity of the knee. It has diverse functions, being fundamental in load absorption and distribution and even in joint stability. To preserve meniscal functions and prevent the occurrence of osteoarthritis after meniscectomy, several meniscal repair techniques have been developed. To perform meniscal repair in anterior horn, the outside-in technique is the most used. There are few devices for performing them, with most of the surgical techniques described using needles. Our group uses a device capable of performing meniscal repair in different ways. Our objective is to describe a continuous outside-in meniscal repair technique, especially indicated for anterior horn and meniscus body tears, with the “Meniscus 4-All suture device.” The continuous outside-in meniscal suture technique using this device is easy to perform, inexpensive, fast, and reproducible, minimizing the risk of soft-tissue entrapment. In addition, it allows the surgeon to perform meniscal repair in the posterior horn in extensive injuries with the same repair device, just switching to inside-out technique.

A COMPARATIVE STUDY OF CONTINUOUS VERSUS INTERRUPTED EPISIOTOMY REPAIR AFTER VAGINAL BIRTH IN PRIMIGRAVIDAE

Background: The use of continuous sutures are associated with lower short-term pain intensity assessed compared to the interrupted sutures; 2 days after repair and 10 days after repair. Objective: To assess the effects of continuous versus interrupted suturing methods on short and long term postpartum maternal morbidity experienced by primiparous women following repair of episiotomy after vaginal birth. Patients and methods: This comparative study was conducted in the Emergency Unit of Obstetrics and Gynecology at Desouk general Hospital. The study involved 200 primigravid women prepared for vaginal delivery with episiotomy). Results: In the current study, episiotomy repair with continuous sutures was more economic; it required a significantly shorter time and lesser number of Vicryl sutures. Repair of episiotomy wound using continuous suturing technique of the vaginal mucosa and perineal muscles results in a better post-procedural pain recovery. Conclusions: Continuous suturing technique consumed significantly shorter procedure time and less cost owing to fewer vicryl sutures.

A COMPARATIVE STUDY OF CONTINUOUS VERSUS INTERRUPTED EPISIOTOMY REPAIR AFTER VAGINAL BIRTH IN PRIMIGRAVIDAE

Background: The use of continuous sutures are associated with lower short-term pain intensity assessed compared to the interrupted sutures; 2 days after repair and 10 days after repair. Objective: To assess the effects of continuous versus interrupted suturing methods on short and long term postpartum maternal morbidity experienced by primiparous women following repair of episiotomy after vaginal birth. Patients and methods: This comparative study was conducted in the Emergency Unit of Obstetrics and Gynecology at Desouk general Hospital. The study involved 200 primigravid women prepared for vaginal delivery with episiotomy). Results: In the current study, episiotomy repair with continuous sutures was more economic; it required a significantly shorter time and lesser number of Vicryl sutures. Repair of episiotomy wound using continuous suturing technique of the vaginal mucosa and perineal muscles results in a better post-procedural pain recovery. Conclusions: Continuous suturing technique consumed significantly shorter procedure time and less cost owing to fewer vicryl sutures.

Left Vertebral Artery to Common Carotid Artery Transposition in a Patient With Bilateral Vertebral Insufficiency: 3-Dimensional Operative Video

Extracranial vertebral artery (VA) atherosclerosis is responsible for 14% to 32% of posterior circulation infarctions.1 In the posterior circulation, narrowing of the VA>30% is significantly associated with strokes. Subclavian artery (SCA) atherosclerosis can produce subclavian steal. Retrograde VA flow around an occluded SCA decreases blood flow to the posterior circulation and causes vertebrobasilar insufficiency (VBI). Flow augmentation to the posterior circulation can be achieved by VA endarterectomy, arterial stenting, VA-common carotid artery (CCA) transposition, or bypass using an interposition graft.2,3 This video illustrates microsurgical revascularization of the proximal VA with VA-CCA transposition. A 58-yr-old man with a prior stroke and chronic right VA occlusion presented with dysarthria and gait instability. Angiographic evaluation confirmed complete midcervical right VA occlusion and left SCA occlusion proximal to VA origin, with subclavian steal. After obtaining patient consent and a failed attempt at endovascular recanalization of the left SCA, a left VA-CCA end-to-side transposition was performed. Neck dissection exposed the left CCA. The thyrocervical trunk served as a landmark to identify the SCA, which was traced proximally to the VA origin. After proximal occlusion, the VA was transected and "fish-mouthed" for end-to-side anastomosis to CCA. An intraluminal, continuous suture technique was used to sew the back walls of this anastomosis. Postoperative computed tomography angiography confirmed bypass patency. Collateral circulation through the thyrocervical and costocervical trunks likely supplied the left arm, and no cerebral, or limb, ischemic symptoms were noted on follow-up. VA-CCA transposition is an uncommon technique for safe and effective revascularization of symptomatic, medically refractory VBI caused by VA occlusion or, as in this case, SCA occlusion with secondary subclavian steal. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Vertical Continuous Meniscal Suture Technique

Meniscal injuries are common in the population, representing the major cause of functional impairment in the knee. Vertical longitudinal injuries of the meniscus can be stable or unstable. When extensive, they are commonly unstable and can lead to clinical signs of significant functional disability. Vertical longitudinal injuries have the best prognosis for repair, especially when occurring in the meniscal periphery, called the red-red zone. A recently developed type of meniscal suture device called Meniscus 4 A-II enables the surgeon to perform a meniscal suture from the inside-out continuously, reducing surgical time. Because it allows the surgeon to use a single and inexpensive device to repair the entire injury, costs are significantly reduced. Here, an approach to carry out continuous meniscal repair with vertical sutures is described. This technique warrants excellent stability to the meniscal repair, increasing the chances of a successful outcome. We believe that the popularization of the repair technique from the inside out using the Meniscus 4-All device will help many surgeons around the world save menisci that otherwise would have a great chance of being excised, since it is a cheap, reproducible, and easy-to-handle device.

Iatrogenic bronchial injury findings during video-assisted thoracoscopic surgery.

Iatrogenic tracheobronchial injury detected during cardiothoracic surgery should be repaired intraoperatively to ensure safe of postoperative management and stable respiratory conditions. We report herein a patient with lung cancer who underwent video-assisted thoracoscopic surgery right lower lobectomy. During surgery, pneumomediastinum and air leakage from mediastinal fatty tissue were detected. Furthermore, bronchial injury to the membranous part of the left main bronchus was incidentally detected. Hence, we switched from video-assisted thoracoscopic surgery to posterolateral thoracotomy and repaired this bronchial injury using a continuous suture technique under right femoral venoarterial extracorporeal membrane oxygenation support. The intraoperative findings could offer a clue for early detection and development of therapeutic strategy for iatrogenic tracheobronchial injury.

Variation in abdominal wall closure techniques in lower transverse incisions: a nationwide survey across specialties.

Lower transverse abdominal incisions are typically used by obstetricians/gynecologists and colorectal surgeons. The suture technique and choice of material when closing the abdomen is an essential factor to decrease the risk of incisional hernia. We conducted a nationwide survey among obstetricians/gynecologists and colorectal surgeons investigating the surgical handling of the fascia, rectus muscle, subcutis, peritoneum, and skin, in lower transverse incisions. All departments of obstetrics/gynecology and departments of surgery performing colorectal surgery in Denmark were invited to participate. An online questionnaire was sent to consultant obstetricians/gynecologists and colorectal surgeons. The survey consisted of demographic information together with questions on surgical details. The study was reported according to STROBE guidelines. A total of 252 (64.5%) consultants provided a complete response to the survey. We found that 98.0% of the colorectal surgeons and 65.8% of the obstetricians/gynecologists used monofilament suture when closing the fascia. The majority of the colorectal surgeons used continuous suture and small bites technique. This was only the case for half of the obstetricians/gynecologists. Approximately two thirds of the colorectal surgeons and one third of the OB/GYN used the suture length to wound length ratio > 4:1. Furthermore, we found significant differences between the groups in the handling of subcutis, peritoneum, and skin. We found significant variation in abdominal wall closure techniques in lower transverse incisions. Disagreement between the current guidelines within the specialties together with insufficient evidence on the closure of lower transverse incisions emphasizes the need for education as well as further studies.

Effect of bivalirudin on neointimal hyperplasia and endothelial proliferation in rabbit.

The aim of this study was to investigate the effects of bivalirudin on endothelial cell proliferation and neointimal hyperplasia in a rabbit carotid artery model. "New Zealand rabbits (n = 12)" weighing 2-3kg were randomly divided into two groups. Arteriotomy was performed to the rabbit carotid artery and closed with continuous suture technique. Group B (n = 6) as a control group received 150U/kg heparin sodium; however, group A (n = 6) was given 0.75mg/kg bivalirudin i.v. bolus and infusion 1.75mg/kg/hour (B01AE06-Bivalirudin 250mg) during perioperation period. At the end of the 28th day, the carotid artery segment was excised and evaluated histologically. All histological and immune staining analyzes were performed by two blind researchers in the treatment of rabbits. In the control group rabbit carotid artery sections, tunica intima was observed to thicken. In the bivalirudin group, intimal hyperplasia was less observed compared to the control group. No significant difference was observed between groups in tunica media thickness. Lumen diameter and lumen area were found to be wider in the experimental group. P value was found to be less than 0.05. Our study demonstrates that bivalirudin significantly affects and prevents neointimal hyperplasia and endothelial cell proliferation.

Natural Adhesion Blepharoplasty Technique.

Nonincisional blepharoplasty is widely practiced to make natural double eyelids. However, this method has the disadvantage of the double fold loosening compared to incisional blepharoplasty. Many researchers have proposed a method of nonincisional blepharoplasty with lower risk of loosening. The authors innovated the method to induce spontaneous adhesion in a nonincisional blepharoplasty with induction of partial linear adhesions, and, therefore, lowering the risk of suture loosening. While performing this procedure, the orbicularis oculi muscle and the levator palpebrae muscle were partially incised through eight tiny incisions to induce adhesion, and the double eyelid was made with the nonincisional continuous suture technique. This study included 99 patients who underwent natural adhesion blepharoplasty technique between January and December 2018. After 1 year of follow-up, no double eyelid loosening was observed. Natural adhesion blepharoplasty is simple technique to create natural-looking results and a durable double fold with satisfactory aesthetic results.

The Initial Experience on Thoracoscopic Sleeve Lobectomy: Continuous Suturing Technique of the Bronchial Anastomosis in 12 Cases.

Sleeve resection is a widely performed type of operation in the surgical treatment of non-small cell lung cancer. Video-assisted thoracoscopic surgery (VATS) is now used even in central tumor surgeries of the lung with the increasing technology and experience. Sleeve resection cases performed through VATS in our clinic in recent years were presented with demographic, surgical, pathologic, and survey characteristics. Twelve patients who underwent sleeve resection with VATS in our clinic between November 2015 and August 2019 were included in the study. Operative, pathologic, and postoperative characteristics of the patients were examined. A total of 12 patients, 3 female and 9 male individuals, were included in the study. The mean age of the patients was 61.7±12.9 years. According to the localization of the tumors, left upper lobectomy was performed in 4 patients and 8 patients underwent right upper lobectomy. During the sleeve anastomosis of the patients, 3/0 prolene sutures were used in 5 patients (36%) and 4/0 prolene sutures in 4 patients (36%), whereas 3/0 polydioxanone suture (PDS) was used in 3 patients (28%). The mean operation time was 288.2±77.1 (205 to 460) minutes and the mean anastomosis time was 70±18.5 (55 to 110) minutes. In the postoperative period, 1 patient who had acute myocardial infarction died on the fourth postoperative day. The mean postoperative drainage duration of the patients was 5.5±1.9 (3 to 10) days and the mean length of hospital stay was 6.4±1.9 (4 to 11) days. When the pathologic features were examined, the mean tumor diameter was found to be 2.5±1.2 (1 to 5.5) cm. The mean follow-up period was calculated as 26.1±15.6 months (2 to 47). Other than 1 patient who died, the follow-up of 11 patients still proceeds. VATS approach of sleeve resections, which is performed cautiously even by thoracotomy, is becoming more common. These operations, which could be performed in experienced centers, offer a postoperative period of less morbidity to the patients with the advantage of reduced postoperative pain, drainage time, and hospital stay.

Video review reveals technical factors predictive of biliary stricture and cholangitis after robotic pancreaticoduodenectomy

BackgroundCholangitis due to anastomotic stricture of the hepaticojejunostomy (HJ) following pancreaticoduodenectomy (PD), while uncommon, adversely affects postoperative quality-of-life. While prior studies have identified patient-related risk factors for these biliary complications, technical risk factors have not been systematically examined. Video review of surgical procedures has helped define technical details predictive of postoperative complications in bariatric and hepato-pancreato-biliary (HPB) surgery. Similarly, the present study utilized video review to identify technical factors associated with cholangitis and anastomotic biliary stricture following robotic PD. MethodsThis was an observational study. A blinded experienced HPB surgeon reviewed videos of post-learning-curve HJs performed during robotic PD and extracted 20 technical variables. Other demographic and clinical variables were collected from a prospectively maintained database. Results241 robotic PD videos were reviewed. 29 (12.0%) developed cholangitis and/or biliary stricture, with a median time-to-event of 189 (IQR 78–365) days. Several clinical and technical factors were independently predictive of cholangitis and/or biliary stricture: preoperative radiotherapy, small duct size (<10 mm diameter), increased distance of the HJ (>10 mm) from the hilar plate, and continuous suturing technique. ConclusionPost-hoc video review of HJ is a powerful method to predict biliary complications. Moreover, altering specific technical factors might enable surgeons to improve postoperative outcomes.

Hepatic artery reconstruction in pediatric liver transplantation: Experience from a single group

BackgroundThe reconstruction of hepatic artery is a challenging part of the pediatric liver transplantation procedure. Hepatic artery thrombosis (HAT) and stenosis are complications which may result in ischemic biliary injury, causing early graft lost and even death. MethodsTwo hundred and fifty-nine patients underwent liver transplantation in 2017 in a single liver transplantation group. Among them, 225 patients were living donor liver transplantation (LDLT) and 34 deceased donor liver transplantation (DDLT). ResultsIn LDLT all reconstructions of hepatic artery were microsurgical, while in DDLT either microsurgical reconstruction or traditional continuous suture technique was done depending on different conditions. There were five (1.9%) HATs: four (4/34, 11.8%) in DDLT (all whole liver grafts) and one (1/225, 0.4%) in LDLT (P = 0.001). Four HATs were managed conservatively using anticoagulation, and 1 accepted salvage surgery with re-anastomosis. Until now, 3 HAT patients remain in good condition, whereas two developed biliary complications. One of them needed to be re-transplanted, and the other patient died due to biliary complications. ConclusionsMicrosurgical technique significantly improves the reconstruction of hepatic artery in pediatric liver transplantation. The risk for arterial complications is higher in DDLT. Conservative therapy can achieve good outcome in selected HAT cases.

A Simplified Continuous Two-stitch Suture for Bronchial Anastomosis of Left Single Lung Transplant in Dogs.

Large animal models are essential to pre-clinical trials of pulmonary transplantation and bronchial anastomosis poses a great technical challenge to the procedure. Presented here is a simplified continuous two-stitch suture technique into bronchial anastomosis during the course of left single lung transplantation in canine. Animals were divided into three groups with each group having 6 animals. Left single lung transplantation in canine was performed to assess the feasibility of using this technique for bronchial anastomosis. In the control groups, all anastomoses were done by using traditional technique. Allograft functions and hemodynamic parameters were monitored during a 3-h reperfusion period. Quality of bronchial healing and airway complications were assessed by bronchoscopic surveillance after transplantation. We successfully completed left lung transplantation in 18 dogs, and all the dogs survived the procedures. The new technique substantially simplified the procedures for bronchial anastomosis and greatly reduced the time for bronchial anastomosis (P<<0.01) and the ischemic time of the grafts (P<0.05) compared to the control group. The continuous two-stitch suture attenuated the tissue injury to allografts and led to better blood gas exchange function as compared to the control group (P<0.05). Good bronchial healing (Grade I) was observed in all the groups. A canine left single lung transplantation model is feasible by using the novel suture technique, and the new technique is as safe as the traditional method. The technique is easy to learn, particularly for less experienced operators. Simpler and time-saving, the technique has great potential to be widely employed in clinical lung transplantation.

Continuous Meniscal Suture Technique of the Knee

The menisci are fibroelastic structures interposed between the articular surfaces of the femur and tibia. They absorb impact and transmit load. Meniscal injury may compromise function and cause rapid joint degeneration, leading to the development of secondary osteoarthritis. Surgical treatment of meniscal injury is usually performed by arthroscopy, and meniscectomy or meniscal suture may be associated with such treatment. Meniscal suture should be considered when the injury compromises the proper functioning of the meniscus to recover its anatomy and function. Different meniscal suture techniques exist; the most widely used are the inside-out, outside-in, and all-inside techniques. The gold-standard repair technique is the inside-out technique. A drawback of this technique is the need to alternate between intra- and extra-articular structures for every stitch, which makes it even more laborious. We describe the continuous meniscal suture technique, also called “meniscal stitching,” for a medial meniscal bucket-handle injury. This technique is performed from the inside out and allows the surgeon to perform multiple stitches with the same thread quickly and effectively. This surgical technique is performed using a single meniscal suture device that was developed by our group, called the “Meniscus 4 A-II” device.

Comparison of Clinical Outcomes Seprate and semi continus sewing methods during and after Heart valves Surgery

Background and Aims: Various therapies and surgeries are applied in heart valve surgery, including interrupted and semi-continuous suture techniques. Therefore, this study aimed to compare the clinical implications of two methods of interrupted and semi-continuous suture techniques during and after mitral or aortic valve replacement surgery among patients referred to Department of Surgery, School of Medicine, Birjand University of Medical Sciences. Materials and Methods: In this study, the required information of patients was collected through the checklist based on the objectives of the study. The subjects had undergone aortic or mitral valve replacement for heart valve replacement suturing with continuous or interrupted suturing techniques. The patientschr('39') records were examined to investigate the complications, and in case that the required information was not registered, the patient or his relatives were also contacted so that the patient could be examined and referred to the hospital by the patientchr('39')s surgeon. Results: The mean age scores of patients undergoing surgery in the continuous and interrupted suture groups were obtained as 53.06±13.48 and 52.86±12.97 years, respectively. It was revealed that there was a large distribution of heart valve leakage, arrhythmia, heart attack, valve infection, involved valve type, and aortic and mitral valve size in the two groups; however, there was no significant difference (P&gt;0.05). Conclusion: Based on the results of this study, the rate of cardiac function and complications caused by the two techniques of continuous and interrupted suturing were not significantly different from each other; therefore, these two methods were not superior to each other due to the mentioned cases.

THE COMPARISON OF OUTCOMES AFTER LAPAROSCOPIC MYOMECTOMY WITH THE USE OF DIFFERENT UTERINE SUTURE TECHNIQUES

Purpose: to improve the outcomes and speed up the recovery after laparoscopic myomectomy in females with uterine leiomyoma, based on the comprehensive study and comparison of different uterine suturing techniques.&#x0D; Material and methods. The study enrolled 130 patients, including 100 females underwent laparoscopic myomectomy. Based on the simple randomization, the sample of 100 surgically treated females was subdivided into two subsamples depending on the applied uterine suturing technique: group I – extracorporeal knotting (n=50); and group II – intracorporeal continuous suturing (n=50). The control group included 30 apparently healthy females (group III). The clinical examination was performed before surgery in the outpatient setting, and in the hospital – after procedure and at the discharge (day 2). We assessed the parameters of myometrium tissue perfusion and the severity of inflammation in the surgical alteration area 1 month before and 1 month following the procedure. The ultrasound signs of myometrium regeneration completeness in the uterine scar area were determine 3 months after surgery. The late outcomes after myomectomy and catamnesis of reproductive function were evaluated at 6-month and 1-year follow-up.&#x0D; Results and discussion. We established that the use of intracorporeal continuous suturing technique in patients underwent laparoscopic myomectomy was favorable for preservation of microcirculatory bed in myometrium, related to a more uniform distribution of suture tension in the tissue and a more even distribution of pressure exerted on the wound edges, as compared to extracorporeal knotting technique. These advantages of intracorporeal continuous suturing technique over the extracorporeal knotting one are useful for the significant reduce of tissue hypoxia and myometrium ischemia in the alteration area. Additionally, this technique is in favor of the physiological programmed suture absorption and the cell-mediated immunity, and associated with the lower risk of necrotic areas formation. In contrast to the intracorporeal continuous suturing technique, the tight and non-uniform extracorporeal knotting is associated with the suppression of staged elimination of blood microclots and other factors of aseptic inflammation in the surgical alteration area.&#x0D; Conclusions. The use of extracorporeal knotting technique had no advantages over the intracorporeal continuous suturing, and, in the majority of cases, was associated with longer duration of procedure, inappropriate blood loss, as well as excessive consumption of suture material. The intracorporeal continuous suturing is the most optimal technique for uterine wound edges approximation, and associated with the positive outcomes regarding the reproductive function (the reproductive function could be realized in 3 months after the use of intracorporeal continuous suturing technique, in contrast to 6 months – after the extracorporeal knotting one), the minimal frequency of complications and favorable economic profile. The laparoscopic myomectomy in case of myoma sized 10 cm and more is associated with the risk of significant uterine wall defect and excessive blood loss, indicating the need for the intracorporeal continuous suturing technique for closing tissue defects in the area of surgical alteration of myometrium.