Fast-absorbing Suture Research Articles

SUTURE TECHNIQUES AND MATERIALS FOR FASCIAL CLOSURE OF ABDOMINAL WALL INCISIONS: HOW DO THEY COMPARE IN A SYSTEMATIC REVIEW AND META-ANALYSIS?

Abstract Background The aim of this meta-analysis was to evaluate closure of laparotomy using different suture-materials and techniques. Methods A literature search was conducted till 11 October 2023. All randomized controlled trials (RCTs) and prospective cohort studies (PCSs) on laparotomy closure were included. The study quality was evaluated using the ROB2 and ROBINS-I checklists. The primary outcome was incisional hernia (IH), and secondary outcomes were fascial dehiscence (FD), combined-FD+IH, and surgical site infection (SSI). Meta-analyses were performed using random-effects models. Results A total of 73 RCTs and 26 PCSs were included. Slowly-absorbable suture materials were associated with a lower risk of IH (OR: 0.64; 95%CI: 0.47–0.86) and combined-FD+IH (OR: 0.76; 95%CI: 0.58–0.99) when compared to fast-absorbable sutures (5 studies, 2,262 patients). Non-absorbable suture material was not superior to any other suture material. Continuous-suturing was not superior to interrupted-suturing, neither was mass-closure superior to layered-closure for any of the outcomes. Small-bites technique with a slowly-resorbable suture in the elective-setting resulted in significantly less IHs (OR 0.42; 95%CI: 0.28–0.62), combined-FD+IH (OR 0.39; 95%CI: 0.22–0.72) and SSIs (OR 0.67; 95%CI: 0.52–0.83) compared to a large-bites technique (8 studies, 1,168 patients). In the emergency setting, the continuous Smead-Jones suturing significantly reduced the risks of IH (OR 0.22; 95%CI: 0.08–0.59), FD (OR 0.20; 95%CI: 0.11–0.34), combined-FD+IH (OR 0.08; 95%CI: 0.03–0.19), and SSI (OR 0.45; 95%CI: 0.26–0.79) compared to continuous-suturing (6 studies, 265 patients). Conclusions Closure of laparotomies using the small-bites technique is superior to large-bites techniques. In the emergency setting, the Smead-Jones technique seems a valid alternative.

Flexor Tendon Repair with Fast-Absorbable Sutures: A Rupture Incidence-Focused Analysis of a Case Series and a Review

Flexor Tendon Repair with Fast-Absorbable Sutures: A Rupture Incidence-Focused Analysis of a Case Series and a Review

A Randomized, Single-Blind Study Comparing the Clinical Equivalence of Truglyde Fast® and Safil Quick® Polyglycolic Acid Fast-Absorbing Sutures for Episiotomy Repair Following Vaginal Delivery.

Episiotomy, the deliberate surgical incision on the vaginal orifice during vaginal delivery, requires prompt repairing of the incised tissue. It may be associated with bleeding, infection, dehiscence, dyspareunia, short-term pain, and prolonged hospital stay. The outcome of surgery depends on the suture material and technique to repair the episiotomy. We aim to subjectively assess perineal pain and maternal morbidity following episiotomy repair with Truglyde Fast®(Healthium Medtech Limited, Bengaluru, India) and Safil Quick® (B. Braun Medical Private Limited, Mumbai, India)polyglycolic acid fast-absorbing suture. This multicentric, prospective, randomized (1:1), two-arm, parallel-group, single-blind study was started in August 2020 and completed in March 2021. Ninety-nine primiparous or multiparous eligible women requiring episiotomy were recruited to Truglyde Fast® (n=51) and Safil Quick® (n=48) groups. The primary outcome measure was post-episiotomy perineal pain to be assessed using a visual analog scale (VAS). Secondary endpoints included evaluation of local anesthesia (quantity), intraoperative suture handling, number of sutures utilized, time spent for episiotomy repair and complete healing, analgesic number and dosage, early and late wound complications, presence of residual suture and frequency of re-suturing, resumption of sexual activity and dyspareunia, and adverse events. The threshold to discriminate significant from non-significant outcomes was p<0.05. At all visits, a non-significant change in perineal pain was noted between Truglyde Fast® and Safil Quick® groups. A significant difference (p<0.05) in the number of sutures used and intraoperative handling characteristics was observed between thegroups. Results of other secondary endpoints showed non-significant differences. Truglyde Fast® and Safil Quick® polyglycolic acid fast-absorbing sutures are clinically equivalent. Both sutures are safe and effective for episiotomy repair following vaginal delivery with minimal perineal pain and risk of maternal morbidity.

Clinical equivalence of Trusynth fast® and Vicryl rapide® polyglactin 910 fast absorbing sutures on maternal morbidity experienced by women following episiotomy repair: a single-blind, randomized study

Background: Episiotomy procedure enlarges the vaginal outlet to facilitate childbirth. Polyglactin 910 fast-absorbing sutures are widely used for the repair of episiotomy because of their rapid absorption and less inflammatory response. This study was designed for subjective assessment of perineal pain post-episiotomy repair, with Trusynth Fast® and Vicryl Rapide® polyglactin 910 fast-absorbing sutures. Method: This was a single-blind, randomized, prospective study conducted between January 7, 2021 and July 14, 2021 across two centers in India. Primiparous or multiparous women (18—40 years), who required episiotomy during vaginal delivery were included, and either Trusynth Fast® (n=47) or Vicryl Rapide® (n=49) suture was used for their episiotomy repair. The primary endpoint, perineal pain was assessed with visual analogue scale at all follow-up visits. The secondary endpoints, quantity of local anesthesia, number of sutures used, time to repair episiotomy, intraoperative suture handling, analgesics used, early and late wound complications, wound re-suturing, time to complete healing, presence of residual sutures, return to sexual activity, dyspareunia, and adverse events were also recorded. Results: The study showed no significant difference in perineal pain between the two groups at any visit. A statistically significant difference (p&lt;0.05) in total score of episiotomy healing scale on day 2 (0.13±0.34 versus 0.35±0.56) and swelling on day 2 (8.51 versusversus 28.57%) was noted between Trusynth Fast® and Vicryl Rapide® group. Non-significant difference was observed between the groups regarding anesthesia, number of sutures, time to repair episiotomy, intraoperative suture handling, analgesics, puerperal fever, wound infection, dehiscence, hematoma, urinary incontinence, re-suturing, time to complete healing, return to sexual activity and dyspareunia. Conclusion: Trusynth Fast® suture is clinically equivalent to Vicryl Rapide® suture and can be used for episiotomy repair with minimal risk of perineal pain and wound complications. Clinical Trials Registry of India Registration: CTRI/2020/12/029925; Registered on December 18, 2020

A simple method to improve the antibiotic elution profiles from polymethylmethacrylate bone cement spacers by using rapid absorbable sutures

ObjectiveAntibiotic-loaded bone cement beads and spacers have been widely used for orthopaedic infection. Poor antibiotic elution is not capable of eradicating microbial pathogens and could lead to treatment failure. The elution profiles differ among different cement formulations. Although Simplex P cement has the least release amount, it is widely used due to its ready availability. Previous methods aiming to improve the elution profiles were not translated well to clinical practice. We sought to address this by using easily available materials to improve the elution profile of antibiotics from PMMA, which allows clinicians to implement the method intraoperatively.MethodsVancomycin was mixed with Simplex P cement. We used Vicryl Rapide sutures to fabricate sustained-release cement beads by repetitively passing the sutures through the beads and/or mixing suture segments into the cement formulation. Vancomycin elution was measured for 49 days. The mechanism of antibiotic release was observed with gross appearance and scanning electron microscopic images. The antimicrobial activities against MRSA were tested using an agar disk diffusion bioassay.ResultsPassing Vicryl Rapide sutures through cement beads significantly improved the elution profiles in the 7-week period. The increased ratios were 9.0% on the first day and 118.0% from the 2nd day to the 49th day. Addition of suture segments did not increase release amount. The Vicryl Rapide sutures completely degraded at the periphery and partially degraded at the center. The antibiotic particles were released around the suture, while antibiotic particles kept densely entrapped in the control group. The antimicrobial activities were stronger in passing suture groups.ConclusionPassing fast absorbable sutures through PMMA cement is a feasible method to fabricate sustained-release antibiotic bone cement. Intra-cement tunnels can be formed, and the effect can last for at least 7 weeks. It is suitable for a temporary spacer between two stages of a revision surgery.

Influence of Suture Materials on Incisional Hernia Rate after Laparoscopic Colorectal Cancer Surgery: A Propensity Score Analysis.

Objectives: Incisional hernia is a common problem after colorectal surgery, and a laparoscopic approach does not reduce the incisional hernia rate. Previous reports have described the risk factors for incisional hernia; however, the impact of suture materials remains unclear. As such, this study compared the incisional hernia rate using different suture materials for abdominal wall closure after laparoscopic colorectal cancer surgery. Methods: Patients undergoing laparoscopic colorectal cancer surgery between January 2014 and December 2016 were included in this study. We separated patients into the following two groups based on the suture materials used for abdominal wall closure: (1.) fast-absorbable group and (2.) non-absorbable group. The primary outcome was incisional hernia rate that was diagnosed using computed tomography. We compared outcomes between these two groups using propensity score matching. Results: Before matching, 394 patients were included (168 in the fast-absorbable group and 226 in the non-absorbable group). After one-to-one matching, patients were stratified into the fast-absorbable group (n = 158) and the non-absorbable group (n = 158). The incisional hernia rate was higher in the fast-absorbable group than in the non-absorbable group (13.9% vs. 6.3%; P = 0.04). The median time to develop an incisional hernia was significantly shorter in the fast-absorbable group (6.7 months vs. 12.3 months; P < 0.01). The incidence of surgical site infection was not different between the two groups, but the incidence of suture sinus was lower in the fast-absorbable group (0% vs. 5.1%; P < 0.01). Conclusions: The use of fast-absorbable sutures may increase the risk of incisional hernia after laparoscopic colorectal cancer surgery.

Prevention of incisional hernia using different suture materials for closing the abdominal wall: a comparison of PDS, Vicryl and Prolene in a rat model

PurposeAn incisional hernia occurs frequently after a midline incision with an incidence of 12.8%. The choice in suture material used for abdominal wall closure is not straightforward and the conflicting literature focuses on clinical outcomes. This study compares a non-absorbable, slow-absorbable and fast-absorbable suture in a rat model, focusing on histological outcomes predicting better fascia healing.Methods33 male Wistar rats, divided over three groups, each received two separate 1 cm incisions closed with either Prolene 4/0, PDS 4/0 or Vicryl 4/0. At 7 days and 21 days, one of the incisions was explanted. Tissue was semi-quantitatively scored regarding inflammatory cells and collagen fibres present. Using qPCR macrophage polarisation, fibroblast activity and vascularisation were evaluated. Data were analysed by Kruskal–Wallis test with Mann–Whitney U post hoc test. A p value of 0.017 was considered significant after Bonferroni correction.ResultsAll animals recovered without complications and completed the 21 days of follow-up. The Vicryl group showed a higher presence of macrophages after 21 days in comparison with Prolene (p = 0.003) and PDS (p = 0.006) and more foreign body giant cells compared to Prolene at 7 days (p = 0.010) and PDS at 21 days (p < 0.001). qPCR showed 2.5-fold higher expression of clec10A in PDS compared to Prolene after 7 days (p = 0.007).ConclusionsThe results of this study carefully support the use of PDS suture, compared to Prolene and Vicryl, in abdominal wall closure based on a favourable macrophage response. The heterogeneity and variability in the data might be explained by the spectrum of the macrophage subtype paradigm.

Laparoscopic Bilateral Cervicosacropexy and Vaginosacropexy: New Surgical Treatment Option in Women with Pelvic Organ Prolapse and Urinary Incontinence.

Objective: Sacrocolpopexy (SCP) is the gold standard for apical prolapse treatment. However, the technical performance of each SCP is strongly dependent on the surgeon's own discretion and comparison of clinical outcomes with respect to urinary incontinence (UI) is difficult. We developed a comprehensible laparoscopic surgical technique for the treatment of apical prolapse with UI.Methods: A total of 120 women with UI underwent laparoscopic bilateral SCP for apical prolapse. Thereby, the uterosacral ligaments (USLs) were bilaterally replaced by polyvinylidene fluoride (PVDF) tapes of identical length and shape, which were fixed at defined anatomical landmarks (cervix/vaginal vault and S1).Results: The restoration of apical vaginal support was achieved in 116 patients (97%); restoration failed in the first 4 patients owing to the use of fast-absorbable sutures. Seventy-eight patients (65%) with mixed and urgency UI symptoms before surgery achieved continence. The mean hospitalization was 3 days; no major complications were observed intraoperatively.Conclusion: The advantage of laparoscopic cervicosacropexy (laCESA) and laparoscopic vaginosacropexy (laVASA) lies in the comprehensible surgical technique (clearly defined technique) and the minimal amount of material used (no polypropylenes). The possibility of a short operating time and short hospitalization depicts this laparoscopic bilateral USL replacement as one treatment alternative in patients with apical prolapse suffering from UI.

Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications.

Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications.

Performance of Fast Absorbable Sutures and Histo‐Glue for Closing Incisions in Brown Trout

AbstractTelemetry has become a standard tool in fish research, but tagging methods still need refinement to achieve better results and to improve animal welfare. One of the problems reported from evaluations of surgical implants is unsatisfactory wound closure. Thus, researchers struggle to find better ways to close incisions, typically for tags implanted under field conditions. Problems are regularly encountered when closing incisions with traditional absorbable or nonabsorbable sutures, including decreased growth, slow wound healing, and erythema and necrosis at the suture site. We compared survival, growth, tag expulsion rate, and incision healing among three groups of dummy transmitter‐tagged wild Brown Trout Salmo trutta for which incisions were closed with two types of suture material (absorbable and fast absorbable) and histo‐glue. The tagged fish were kept in seminatural ponds for 20 d. Survival did not differ among groups, but growth of the tagged fish was lower than that of the control group. Histo‐glue gave the best healing but resulted in a high tag loss rate (33%). The fast absorbable sutures did not disappear faster than normal absorbable sutures, and healing and tag loss were similar. The use of fast absorbable sutures may hold potential for improving the procedure and should be further tested.

Contraction of abdominal wall muscles influences size and occurrence of incisional hernia

Incisional hernias are a complication in 10% of all open abdominal operations and can result in substantial morbidity. The purpose of this study was to determine whether inhibiting abdominal muscle contraction influences incisional hernia formation during the fascial healing after laparotomy. We hypothesized that decreasing the deformation of the abdominal musculature would decrease the size or occurrence of an incisional hernia. Using an established rat model for incisional hernia, a laparotomy through the linea alba was closed with 1 mid-incision, fast-absorbing suture. Three groups were compared: a sham group (sham; n=6) received no laparotomy, and the saline hernia (SH; n=6) and Botox hernia (BH; n=6) groups were treated once with equal volumes of saline or botulinum toxin (Botox, Allergan) before the incomplete laparotomy closure. On postoperative day 14, the abdominal wall was examined for herniation and adhesions, and contractile forces were measured for abdominal wall muscles. No hernias developed in the sham rats. Rostral hernias developed in all SH and BH rats. Caudal hernias developed in all SH rats, but in only 50% of the BH rats. Rostral hernias in the BH group were 35% shorter and 43% narrower compared with those in the SH group (P<.05). The BH group had weaker abdominal muscles compared with the sham and SH groups (P<.05). In our rat model, partial paralysis of abdominal muscles decreases the number and size of incisional hernias. These results suggest that contractions of the abdominal wall muscle play a role in the pathophysiology of the formation of incisional hernias.

An Experimental Animal Model for Abdominal Fascia Healing after Surgery

Background: Incisional hernia (IH) is a well-known complication after abdominal surgical procedures. The exact etiology of IH is still unknown even though many risk factors have been suggested. The aim of this study was to create an animal model of a weakly healed abdominal fascia that could be used to evaluate the actively healing fascia. Such an animal model may promote future research in the prevention of IH. Methods: 86 male Sprague-Dawley rats were used to establish a model involving six experiments (experiments A-F). Mechanical testing of the breaking strength of the healed fascia was performed by testing tissue strips from the healed fascia versus the unincised control fascia 7 and 28 days postoperatively. Results: During the six experiments a healing model was created that produced significantly weaker coherent fascia when compared with the control tissue measured in terms of mechanical breaking strength. This new animal model employed myofascial closing after a full thickness abdominal incision using a running suture with fast-absorbable suture material. This technique produced a weak myofascial layer compared with the control tissue measured in terms of breaking strength after both 7 and 28 days. Conclusion: It was possible to create a healed but weak abdominal fascia in rats with a minimum of defects after incision using a running suture technique in the fascia. In contrast to other models, regular tissue defects were absent, and the model can therefore be used to evaluate the changes, both histological and mechanical, in the actively healing fascia, which may lead to incisional herniation. Furthermore, the model may also be used to study interventions performed to promote healing. This contrasts with existing models with regular fascia defects, which are not well suited for this purpose.

Shoulder &amp; Elbow

The October 2012 Shoulder &amp; Elbow Roundup360 looks at: fast-absorbing suture anchors for use in shoulder labral tears; double-row rotator cuff repair; degenerate massive rotator cuff tears addressed with partial repair; open and arthroscopic stabilisation of Bankart lesions; predicting the risk of revision humeral head replacement; arthroscopic treatment for frozen shoulder; and long-term follow-up of the Bristow-Latarjet procedure.

Overlapping of split-thickness skin grafts to prevent junctional hypertrophy

Sir, Splitor partial-thickness skin grafting is one of the oldest procedures performed in plastic surgery [1] and is the most commonly used procedure for reconstructing defects of various sizes and anatomical locations [2]. When defects are large, it is frequently not possible to provide wound coverage with one split-thickness skin graft alone due to limitations in the width of the graft that can be harvested with an electric dermatome or hand-held knife. In these circumstances, it may be necessary to use two or more separate sheets of skin graft in order to resurface the wound. When this is necessary, the technique most commonly employed is to place the two skin grafts side-by-side on the wound so that their edges are apposed, and these grafts are then sutured, stapled or glued together. We have observed that this technique can cause hypertrophy and ridging or delayed wound healing at the junction between the two grafts, as can be seen in Fig. 1. However, we have found that this junctional ridging can be avoided by laying down the two grafts side-by-side with an overlap of 3–5 mm and leaving the junction between the two grafts unsecured. This is demonstrated in Fig. 2 (left panel). The two grafts are secured to the wound edges with fast-absorbing sutures. The excess overlapped skin at the junction between the grafts eventually sloughs off (much like the excess graft along the margins of the wound), and when the graft takes, there is little or no evidence that there were ever two separate grafts on the wound bed, and junctional ridging is thus avoided. This is demonstrated in Fig. 2 (right panel), which is the same patient 4 months postoperatively. To our knowledge, this technique has hitherto not been reported in the literature. We have employed this technique in over fifty patients with large skin defects resulting from

Incisional hernia after abdominal closure with slowly absorbable versus fast absorbable, antibacterial-coated sutures

Incisional hernia remains among the most common complications after midline incision of the abdominal wall. The role of the suture material used for abdominal wall closure remains controversial. To decrease bacterial adherence to surgical sutures, braided suture materials with antibacterial activity (Vicryl plus, Ethicon, Inc) were developed. This is the first study to analyze long-term results using an antibacterial-braided suture material for abdominal wall closure in a large clinical trial. To analyze the effects of Triclosan-coated suture material (Vicryl plus) on the development of incisional hernia, we performed a 36-month follow-up of 1,018 patients who had a primary midline incision for elective abdominal surgery. In the first time period, a PDS II loop suture was used. In the second observation period, we used Vicryl plus. All variables were recorded prospectively in a database. The primary outcome was the number of incisional hernias. Risk factors for the development of incisional hernias were collected prospectively to compare the 2 groups. The overall incisional hernia rate in the 36-month follow-up period was 14.6%. Analyzing the influence of the suture material used on the development of incisional hernia, we did not find differences between the 2 groups (PDS II, 14%; Vicryl plus, 15.2%). In the multivariate analysis of possible factors in the study population, only body mass index (BMI) showed a significant influence on the development of incisional hernias. Despite the incidence of wound infections being less in the Vicryl plus group (6.1% vs 11.9%; P < .05), there were no difference in incidence of incisional hernia between the 2 groups. Fast absorbable sutures with antibacterial coating (Tricosan) do not increase the hernia rate after midline abdominal incision compared with slowly absorbable sutures, when wound infection rates are decreased by coating the fast absorbable suture with Triclosan. The development of incisional hernia is significantly increasing in patients with a BMI >30 kg/m(2).

Pancreaticogastrostomy for High‐risk Gland After Pancreaticoduodenectomy: An Eligible Choice? Letter to the Editor

We read with interest the paper published by Dr. Niedergethmann and colleagues [1]. In this study, through ‘‘riskadapted pancreatic anastomosis,’’ the rate of pancreatic fistula (PF) after pancreaticoduodenectomy (PD) has been reduced. We give the authors particular credit for controlling the many variables involved in the performance of a pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG) and congratulate the authors on their work. In this study, PG revealed a PF rate of 7% and PJ accounted for 19% of PF. Patients with high-risk glands received perioperative octreotide until postoperative day 5 and a high dose of pantoprazole. Patients with standard anastomosis received neither octreotide nor high-dose pantoprazole. A meta-analysis of seven identified randomized controlled trials reporting comparisons between the octreotide group and without octreotide group, perioperative octreotide is associated with a significant reduction in the incidence of PF after elective pancreatic surgery [2]. My first question is whether a lower rate of PF after patients receiving PG was conducted by octreotide and pantoprazole. During January 2004 to December 2006, the rate of PF after patients receiving duct-to-mucosa PJ was 22%, but patients receiving duct-to-mucosa PJ showed a lower rate of PF (13%) during January 2007 to December 2008. I find this hard to explain only by RAP. My second question is whether it might be influenced by a learning curve of PG in your institution. A randomized, controlled trial by Bassi et al. reported a total of 151 patients with soft remnant who were randomized to receive PG or duct-to-mucosa PJ. Compared with duct-to-mucosa PJ, PG did not show any significant differences in the PF (13 vs. 16%) [3]. Another randomized, controlled trial by Bassi et al. reported 144 patients with soft residual tissue who were assigned randomly to receive a duct-to-mucosa PJ or a PJ; however, the two methods revealed no significant difference in regards to the PF (13 vs. 16%) [4]. Recently, a number of techniques of managing the soft pancreatic remnant have been studied in relation to the PF. Peng et al. have described a new technique of binding PJ after PD in their randomized, controlled trial. They reported a 0% incidence of PF, which is the lowest ever published in the literature [5]. Subsequently, in a series report, 45 consecutive patients with soft pancreas and nondilated main pancreatic duct underwent a binding PJ, and only four patients (8.9%) developed a PF [6]. An easier method reported by Hakamada et al. for performing a PJ for the soft pancreas using a fast-absorbable suture, PF was noted in 3% of the patients in the duct-to-mucosa contact method group [7]. The surgeon is an important factor for the prevention of PF. The reconstruction of pancreatic digestive continuity after PD performed with fine sutures, minimal handling, and a good blood supply is likely to yield a favorable result. Therefore, we suggested that a meticulous level of surgical skill and perioperative octreotide may be associated with a significant reduction in the incidence of PF. Y. S. Hu D. K. Feng (&) Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, 17 Changle Western Road, Xi’an 710032, Shanxi Province, China e-mail: doukefeng2010@126.com

Reducing the Coefficient of Friction for Fast-Absorbing Gut Suture

Reducing the Coefficient of Friction for Fast-Absorbing Gut Suture

An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture

To clarify the usefulness of a new method for performing a pancreaticojejunostomy by using a fast-absorbable suture material irradiated polyglactin 910, and a temporary stent tube for a narrow pancreatic duct with a soft pancreatic texture. Among 63 consecutive patients with soft pancreas undergoing a pancreaticoduodenectomy from 2003 to 2006, 35 patients were treated with a new reconstructive method. Briefly, after the pancreatic transaction, a stent tube was inserted into the lumen of the pancreatic duct and ligated with it by a fast-absorbable suture. Another tip of the stent tube was introduced into the intestinal lumen at the jejunal limb, where a purse-string suture was made by another fast-absorbable suture to roughly fix the tube. The pancreaticojejunostomy was completed by ligating two fast-absorbable sutures to approximate the ductal end and the jejunal mucosa, and by adding a rough anastomosis between the pancreatic parenchyma and the seromuscular layer of the jejunum. The initial surgical results with this method were retrospectively compared with those of the 28 patients treated with conventional duct-to-mucosa anastomosis. The incidences of postoperative morbidity including pancreatic fistula were comparable between the two groups (new; 3%-17% vs conventional; 7%-14% according to the definitions). There was no mortality and re-admission. Late complications were also rarely seen. A pancreaticojejunostomy using an irradiated polyglactin 910 suture material and a temporary stent is easy to perform and is feasible even in cases with a narrow pancreatic duct and a normal soft pancreas.

The prevention of incisional hernia formation using a delayed-release polymer of basic fibroblast growth factor.

We sought to reduce the high incidence of abdominal wall incisional hernias using sustained release growth factor therapy. Incisional hernias complicate 11% of abdominal wall closures, resulting in 200,000 incisional hernia repairs in the United States each year. Mechanical improvements alone in mesh, suture material, and surgical technique have failed to reduce the high rate of fascial wound failure. Sprague-Dawley rats underwent midline celiotomies that were closed with fast-absorbing suture to induce early biomechanical wound failure and incisional hernia formation. In primary wounds, fascial incisions were closed adjacent to a continuous release polygalactone polymer rod containing basic fibroblast growth factor (bFGF), no growth factor (control-rod), or without rods. In a second group, incisional hernias were repaired with either bFGF or control-rod therapy. Breaking strength was measured on postoperative day (POD) 7, and the incidence of incisional hernia formation was determined on POD 28. Treatment with bFGF rods significantly increased fascial wound breaking strength. In the "hernia-prevention" experiments, incisional hernias developed in 90% of untreated incisions, 60% of control-rod incisions, and only 30% of bFGF-rod incisions (P < 0.05). In the "hernia-treatment" experiments, recurrent incisional hernias developed in 86% of control-rod incisions compared with only 23% of bFGF-rod treated incisions (P < 0.05). Immunohistochemistry demonstrated increased angiogenesis and collagen protein production in bFGF treated incisions. The treatment of abdominal fascial incisions with a sustained-release bFGF polymer significantly lowered the incidence of incisional hernias and the recurrence rate after repair.

Transforming Growth Factor β2 Lowers the Incidence of Incisional Hernias

Background. Approximately 200,000 incisional hernias are repaired annually in the United States. The high incidence (11–20%) and recurrence rate (24–54%) for incisional hernias have not changed appreciably in 75 years. Mechanical advances in suture material, incision orientation, and closure technique have failed to eliminate this common surgical complication. A biological approach to acute wound failure may offer a new strategy.Methods. A rodent incisional hernia model was used. Seventy rats underwent 5-cm midline celiotomies and were closed with fine, fast-absorbing sutures to induce intentional acute wound failure. Group 1 received no other treatment. The midline fascia in groups 2 and 3 was injected immediately prior to incision with 100 μl of vehicle alone or vehicle containing 1 μg of transforming growth factor β2 (TGF-β2). Necropsy was performed on Postoperative Day 28 and the wounds were examined for herniation.Results. Incisional hernias developed in 88% (35/40) and 79% (11/14) of untreated incisions and those treated with vehicle alone. No hernias formed in the TGF-β2-treated incisions (0/16, P < 0.05). Standard histology and immunohistochemistry demonstrated enhanced macrophage, lymphocyte, and fibroblast chemotaxis and increased collagen I and III production in TGF-β2 treated incisions.Conclusions. Treatment of abdominal wall fascial incisions with TGF-β2 prevented the development of incisional hernias in this rat model. TGF-β2 stimulated fascial macrophage and fibroblast chemotaxis as well as acute wound collagen production. A biological approach such as this may reduce the incidence of incisional hernia formation in humans.