Interrupted Suture Group Research Articles

Standardised models for inducing experimental peritoneal adhesions in female rats.

Animal models for adhesion induction are heterogeneous and often poorly described. We compare and discuss different models to induce peritoneal adhesions in a randomized, experimental in vivo animal study with 72 female Wistar rats. Six different standardized techniques for peritoneal trauma were used: brushing of peritoneal sidewall and uterine horns (group 1), brushing of parietal peritoneum only (group 2), sharp excision of parietal peritoneum closed with interrupted sutures (group 3), ischemic buttons by grasping the parietal peritoneum and ligating the base with Vicryl suture (group 4), bipolar electrocoagulation of the peritoneum (group 5), and traumatisation by electrocoagulation followed by closure of the resulting peritoneal defect using Vicryl sutures (group 6). Upon second look, there were significant differences in the adhesion incidence between the groups (P < 0.01). Analysis of the fraction of adhesions showed that groups 2 (0%) and 5 (4%) were significantly less than the other groups (P < 0.01). Furthermore, group 6 (69%) was significantly higher than group 1 (48%) (P < 0.05) and group 4 (47%) (P < 0.05). There was no difference between group 3 (60%) and group 6 (P = 0.2). From a clinical viewpoint, comparison of different electrocoagulation modes and pharmaceutical adhesion barriers is possible with standardised models.

Continuous Absorbable Intradermal Sutures Yield Better Cosmetic Results than Nonabsorbable Interrupted Sutures in Open Appendectomy Wounds: A Prospective, Randomized Trial

Acute appendicitis is the most common reason for abdominal surgery in young adults and children. Open appendectomy is still the treatment often chosen because it is simple, safe, and effective. Our aim was to study whether cosmetic results of appendectomy wounds are better after using continuous absorbable intradermal (A) sutures compared with wound closure with interrupted nonabsorbable (NA) sutures. A total of 206 adult patients with clinically suspected appendicitis were allocated to the study and prospectively randomized into two wound-closure groups: the interrupted NA suture group and the A suture group. Of these, 193 patients with sufficient data were invited to the outpatient clinic for cosmetic analysis. Cosmetic results were evaluated after a median of 14 months. For subjective scar assessment, the Vancouver scar scale, the patient and observer scar assessment scale (POSAS), and a visual analog scale (VAS) were used. Objective evaluation was carried out by measuring surface area, average width, and estimated concentration change (ECC) of hemoglobin and melanin in the scar using spectrocutometry. For statistical analyses we used the Mann-Whitney test and Student's t test. Both objective and subjective analyses showed better cosmetic results for absorbable intradermal suturing. The difference between the two groups was statistically significant as regards POSAS in both patient (p = 0.032) and observer scales (p = 0.001), and VAS (p = 0.002). Scar surface area was significantly smaller in group A than in group NA (p = 0.002). ECC measurements showed higher values for melanin in group NA than in group A (p = 0.034). Continuous intradermal absorbable suturing yields a better cosmetic result than interrupted nonabsorbable suturing in lower abdominal transverse appendectomy.

Randomized controlled trial comparing subcuticular absorbable suture with conventional interrupted suture for wound closure at elective operation of colon cancer

Subcuticular closure provides a superior cosmetic result in clean wounds. The aim of this work was to investigate the safety in terms of postoperative infection and cosmetic effectiveness of subcuticular wound closure after elective colon cancer surgery in clean-contaminated wounds. Patients who underwent elective resection of colon cancer were randomized to interrupted subcuticular and interrupted transdermal suture groups. The large bowel was prepared by mechanical washout with polyethylene glycol. All patients received metronidazole and kanamycin orally and flomoxef sodium once parenterally for antimicrobial prophylaxis. The primary end point was the incidence of incisional surgical-site infections within 30 days after operation. We assessed noninferiority of subcuticular suture within a margin of 10%. Analysis was by intent-to-treat. Secondary objectives include comparison of wound closure time, comfort, and cosmesis of the scar and satisfaction of patients. This study was registered with UMIN-CTR, UMIN000003005. A total of 293 patients were randomized to the two groups. Incisional surgical-site infection rates were 11.0% (90% confidence interval 7.0-16.3%) for both groups. The relative risk of subcuticular suture was 1.00 (0.58-1.73, one-tail P = .57). Interrupted subcuticular suture was noninferior to interrupted transdermal suture (P = .0088). Throughout 6 months after operation, patients expressed a significant preference for the subcuticular suture technique, noting rapid relief from pain, decreased vascularity, and smaller width, although the procedure took twice as long. Subcuticular suture did not increase the incidence of wound complications in elective colon cancer operation. Patients preferred a technique of interrupted subcuticular closure, citing better cosmetic results, and less pain.

Aortic Valve Replacement Using Continuous Suture Technique in Patients with Aortic Valve Disease

BackgroundThe continuous suture (CS) technique has several advantages as a method for simple, fast, and secure aortic valve replacement (AVR). We used a simple CS technique without the use of a pledget for AVR and evaluated the surgical outcomes.Materials and MethodsBetween October 2007 and 2012, 123 patients with aortic valve disease underwent AVR alone (n=28) or with other concomitant cardiac procedures (n=95), such as mitral, tricuspid, or aortic surgery. The patients were divided into two groups: the interrupted suture (IS) group (n=47), in which the conventional IS technique was used, and the CS group (n=76), in which the simple CS technique was used.ResultsThere were two hospital deaths (1.6%), which were not related to the suture technique. There were no significant differences in cardiopulmonary bypass time or aortic cross-clamp time between the two groups for AVR alone or AVR with concomitant cardiac procedures. In the IS group, two patients had prosthetic endocarditis and one patient experienced significant perivalvular leak. These patients underwent reoperations. In the CS group, there were no complications related to the surgery. Postoperatively, the two groups had similar aortic valve gradients.ConclusionThe simple CS method is useful and secure for AVR in patients with aortic valve disease, and it may minimize surgical complications, as neither pledgets nor braided sutures are used.

Two different suturing techniques in distal hypospadias repair using tubularized incised plate urethroplasty

Background: Hypospadias is one of the most common congenital anomalies, occurring in Bone of 200 to one of 300 live births. Tubularized incised plate (TIP) urethroplasty or the Snodgrass procedure has gained worldwide acceptance for distal hypospadias repair because of its low complication rate and technical simplicity. Objective: We compared two refinements in TIP repair for primary distal hypospadias, namely, a subcuticular uninterrupted suturing technique and full-thickness interrupted sutures. In addition, we compared the impact of these surgical modifications on the complication rate and surgical outcome of the Snodgrass procedure. Patients and methods: Eighty boys with primary distal hypospadias were treated using the TIP procedure between January 2009 and December 2011. Patients were prospectively randomized into two equal groups on the basis of the suturing technique. A neourethra was constructed using a subcuticular uninterrupted suturing technique (group A) or using full-thickness interrupted sutures (group B). All patients were subjected to the same preoperative, operative, and follow-up protocols. Both groups were compared as regards the complication rate. Results: The age ranged between 8 and 48 months, with a mean age of 13.6 ± 6.9 months at the time of repair. The overall success rate was 90% (97.5% for group A and 82.5% for group B). Late complications in the form of a urethrocutaneous fistula, meatal stenosis, and wound dehiscence or infection developed in eight (10%) patients (one patient of group A and seven of group B). The mean follow-up duration was 8.1 ± 2.4 months (range 4–13 months). Conclusion: The subcuticular uninterrupted suturing technique seems to have a lower complication rate when compared with the use of full-thickness interrupted sutures in the repair of distal hypospadias by TIP urethroplasty. Keywords: Hypospadias, Tubularized Incised Plate, Urethroplasty

1324 A RANDOMIZED STUDY OF VESICO-URETHRAL ANASTOMOSIS COMPARING RUNNING SUTURE WITH CONVENTIONAL INTERRUPTED SUTURE IN PATIENTS WITH RETROPUBIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 20121324 A RANDOMIZED STUDY OF VESICO-URETHRAL ANASTOMOSIS COMPARING RUNNING SUTURE WITH CONVENTIONAL INTERRUPTED SUTURE IN PATIENTS WITH RETROPUBIC RADICAL PROSTATECTOMY Hideyasu Matsuyama, Shigeru Sakano, Takahiko Hara, Hiroaki Matsumoto, and Yoshihisa Kawai Hideyasu MatsuyamaHideyasu Matsuyama Ube, Japan More articles by this author , Shigeru SakanoShigeru Sakano Ube, Japan More articles by this author , Takahiko HaraTakahiko Hara Ube, Japan More articles by this author , Hiroaki MatsumotoHiroaki Matsumoto Ube, Japan More articles by this author , and Yoshihisa KawaiYoshihisa Kawai Ube, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1706AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although interrupted suture is a standard technique of vesico-urethral anastomosis in open retropubic radical prostatectomy (RRP), urine leakage from anastomosis could delay the catheter removal, and may influence postoperative unfavorable events including urethral stricture, or recovery of continence. Objectives of the study is to study if different suture techniques of the vesico-urethral anastomosis may influence the postoperative condition. METHODS Totally, 108 patients who had undergone retropubic radical prostatectomy at our hospital from 2008 to 2011 were included in this study. Patients were randomly assigned to running suture group (RS, 54 pts.), or interrupted suture group (IS, 54 pts.). IS was performed by conventional 6 (1, 3, 5, 7, 9, 11 o'clock) interrupted suture using 2-0 polyglactin. RS was performed by 12 bite running sutures starting from 6 to 12 o'clock direction using 3-0 poliglecaprone. Urethro-cystography was routinely performed on POD 5-7. Removal of the catheter was postponed until disappearance of extravasation. Primary endpoint of the study was frequency of extravasation at first urethra-cystography, and secondary endpoints were frequency of postoperative stricture, % incontinent volume at discharge, Social continence rate (0-1 pad/day) at 1, 3, 6, and 12 months after surgery. RESULTS The mean age of the patient was 66.6 year. There was no statistical difference of patient background (clinical stage, biopsy Gleason score, D'Amico risk classification) between two groups. There was no statistical difference of suturing time between two groups (RS: 23.3min. vs. IS: 19.9min., p=0.1282). Frequency of extravasation and % incontinent volume at discharge was significantly higher in IS group as compared with that in RS group (38.5% vs. 9.8%, p=0.001, 38.4 % vs. 24.6%, p=0.0228, respectively). Postoperative hospital stay of IS was significantly longer than that of RS (p=0.037). Social continence rate of RS group at 3month were significantly higher than that of IS group (73.8% vs.45.8%, p=0.0336), although not significant at 6 (82.1% vs.68.0%), 12 months (93.8% vs. 88.6%). As for complication, urethral stricture for which postoperative intervention was needed was noted in 4 (7.7%) in IS, 2 (3.9%) in RS, respectively. CONCLUSIONS Running suture of vesico-urethral anastomosis may be feasible technique even in non-laparoscopic RRP, and is likely to have an advantage of early recovery of continence. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e537 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hideyasu Matsuyama Ube, Japan More articles by this author Shigeru Sakano Ube, Japan More articles by this author Takahiko Hara Ube, Japan More articles by this author Hiroaki Matsumoto Ube, Japan More articles by this author Yoshihisa Kawai Ube, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Reliability of Continuous Suture of Pancreaticojejunostomy after Pancreaticoduodenectomy

Currently, there seems to be no optimized method of pancreaticojejunostomy, and numerous modifications have been used to reduce postoperative pancreatic fistula after pancreaticoduodenectomy. The aim of the present study was to assess the efficacy of continuous sutures for duct-to-mucosa pancreaticojejunostomy in pancreaticoduodenectomy and find predictive risk factors of postoperative pancreatic fistula. We retrospectively reviewed the medical records of 112 patients who underwent pancreaticoduodenectomy, which included patient's demographics, disease-related factors and operative risk factors. Between the interrupted suture and continuous suture groups, there was no significant difference in presence of preoperative biliary drainage, pancreas texture, the pancreatic duct diameter and the prevalence of coronary artery disease. Postoperative pancreatic fistula developed in 21 (18.8%) of the 112 patients who underwent pancreaticoduodenectomy. Only preoperative biliary drainage and operation type showed significant differences for developing pancreatic fistula in a multivariate analysis. The study revealed that the incidence of pancreatic fistula was similar in both the continuous and interrupted suture groups of pancreaticojejunostomy. Continuous suture group had shorter operative time, less damage, fewer knots and less tension than interrupted sutures. Therefore, we concluded that the continuous suture method is feasible and safe to apply to reconstructing pancreaticojejunostomy.

Knee Arthrotomy Repair With a Continuous Barbed Suture: A Biomechanical Study

We compared knee arthrotomy closures using interrupted biodegradable sutures and running bidirectionally barbed sutures in cadaveric specimens subjected to cyclic loading. During the initial 2000 flexion cycles, both groups maintained closure and no suture ruptured. Suture throws were then sequentially cut to weaken the repairs, and the knees were cyclically flexed after each cut. Both types of suture repairs survived the cutting of the first throw or stitch and subsequent cyclical testing. However, there was a significant difference in the repairs after multiple cuts (log-rank test, P < .003). None of the knees in the interrupted suture group survived more than 3 cuts, whereas in the barbed repair group, it took the severing of as many as 7 throws for failure to occur.

A Comparison of Two Anastomotic Techniques in the Jejunum of the Goat

This study was carried out to test two different anastomotic techniques to identify advantages and disadvantages of each technique in goats. All animals were under local infiltration anaesthesia. A five-cm length of jejunum was resected from the first part of the jejunum and end to end anastomosis using 3-0 Polygalactin-910 with one row of sero-submoucosal interrupted sutures (SSIS) group, and one row of horizontal mattress interrupted sutures (HMIS) group. Two animals from each group were euthanized on the 4th, 14th and 21st postoperative days. A 7-cm segment of jejunum including the anastomosed area was resected from each animal. There was no significant adhesion between anastomosis area and surrounded tissues observed in SSIS animals, while there was significant adhesion between anastomosis area and surrounded tissues which were observed in HMIS animals. Stenosis degree was lower in the SSIS than the HMIS group. The bursting pressure was higher in the SSIS than the HMIS group. Macroscopic evaluation indicated that the anastomotic line mucosa was abridged better with less local edema in the SSIS group. Histological evaluation in the SSIS group showed almost all parameters such as epithelial recovery and repair of submucosal-mucosal layer demonstrated better healing compared to the HMIS group.

Anatomy‐Specific Pancreatic Stump Management to Reduce the Risk of Pancreatic Fistula After Pancreatic Head Resection

The anatomical status of the pancreatic remnant after a pancreatic head resection varies greatly among patients. The aim of the present study was to improve management of the pancreatic remnant for reducing pancreatic fistula after pancreatic head resection. Ninety-five consecutive patients who underwent an end-to-side, duct-to-mucosa pancreaticojejunostomy after pancreatic head resection were included in the study. To approximate the pancreatic stump to the jejunum, the transfixing and interrupted suture techniques were used in 51 and 44 patients, respectively. We modified the interrupted suture technique according to the anatomical status of the pancreatic remnant, i.e., the shape of the pancreatic stump and the location of the pancreatic duct. There was no operative mortality in this study. Overall, 14 patients (15%) developed a clinically relevant pancreatic fistula. Certain anatomical features, including a small pancreatic duct, a soft, nonfibrotic pancreatic gland, and a pancreatic duct adjacent to the posterior cut edge, were significantly associated with pancreatic fistula. The fistula rate in the interrupted suture group was 7%, lower than that (22%) in the transfixing suture group (P = 0.036), and it was not influenced by pancreatic anatomy. Multivariate analysis identified a nonfibrotic pancreas (versus fibrotic pancreas; odds ratio [OR] 12.58, 95% CI 1.2-23.9; P = 0.001), a soft pancreas (versus hard pancreas; OR 4.67, CI 1.2-51.1; P = 0.006), and the transfixing suture technique (versus interrupted suture technique; OR 9.91, CI 1.7-57.5; P = 0.003) as significant predictors of clinically relevant pancreatic fistula. Pancreatic anastomosis modified according to the pancreatic anatomy is effective in reducing the risk of pancreatic fistula formation with end-to-side, duct-to-mucosa pancreaticojejunostomy after pancreatic head resection.

Continuous Versus Interrupted Suture for Hepatic Artery Anastomosis in Liver Transplantation: Differences in the Incidence of Hepatic Artery Thrombosis

Background Hepatic artery thrombosis (HAT) is a serious complication after orthotopic liver transplantation (OLT) and remains a significant cause of graft loss. HAT following OLT has been reported in 3% to 9% of patients. Among the surgical factors considered to be associated with HAT, arterial reconstruction might be the most important. The goal of this study was to compare the incidence of HAT between interrupted suture (IS) and continuous suture (CS) techniques during hepatic artery reconstruction in liver transplantation. Methods We performed a retrospective analysis of 200 consecutive liver transplantations occurring between May 2002 and December 2006, including medical records for: age, gender, cold ischemic time, warm ischemic time, type and number of arterial anastomosis. Hepatic artery anastomoses were performed using a 7-0 prolene with a running CS in the first 105 patients (CS group), and with an IS in the last 95 patients (IS group). Results Statistical analysis of age, gender, cold and warm ischemia time, and number of hepatic artery anastomoses was not different between the CS and IS groups. Eleven episodes of HAT were identified in the CS group (10%) and two episodes (2%) in the IS cohort, a significant difference (P = .0173). Conclusions Our results suggested that IS might be a better choice for hepatic artery anastomosis with a lower incidence of HAT.

The Effect of Different Suturing Techniques on Astigmatism after Penetrating Keratoplasty

The purpose of this study was to compare the effects on astigmatism after penetrating keratoplasty with three different suture techniques. In this prospective study, 38 eyes of 38 patients underwent penetrating keratoplasty with three suturing techniques: interrupted, single running, and double running. Topographic astigmatism was measured at 2, 6, 12, and 18 months after keratoplasty. During 18 months after surgery, the interrupted suture group had higher astigmatism than the double running suture group. There was no significant difference in the amounts of astigmatism during the first year after keratoplasty between the single running and the double running suture group. However, at 18 months after surgery, when all sutures were out, the double running suture group (3.60±1.58 diopters) showed significantly less astigmatism than the single running group (5.65±1.61 diopters). In conclusion, post-keratoplasty astigmatism was the least in the double running suture group of the three suturing techniques at 18 months after penetrating keratoplasty.

Sutureless Fixation of Amniotic Membrane Patch as a Therapeutic Contact Lens by Using a Polymethyl Methacrylate Ring and Fibrin Sealant in a Rabbit Model

To introduce and evaluate a sutureless technique by using a polymethyl methacrylate (PMMA) ring and fibrin sealant to fix an amniotic membrane (AM) patch on the ocular surface as a therapeutic contact lens in a rabbit model. PMMA rings were fabricated by duplicating an impression of a rabbit conjunctival fornix. The central cornea of the left eye in 16 rabbits was deepithelialized (diameter = 10 mm). A human AM patch was fixed to the ocular surface by using either a PMMA ring and fibrin sealant or interrupted 10-0 nylon sutures. The fibrin sealant was used to create the PMMA ring-AM complex but not to attach the AM/PMMA ring to the ocular surface. The rabbits were followed up with slit-lamp examination and fluorescein staining for 7 days. Reepithelialization and complications were recorded. The corneal epithelial defect was recovered in each rabbit of both groups after 5 days. In the sutureless group, all membranes remained in place and intact during the follow-up period. One eye was noted to have a partial conjunctival epithelial defect caused by exposure to the PMMA ring. In contrast, >50% of rabbits in the interrupted suture group exhibited complications including conjunctival edema, suture loosening, patch detachment, bleeding, and conjunctival epithelial defects. The sutureless technique that uses a PMMA ring and fibrin sealant for AM patch placement has a lower incidence of complications than the interrupted suture method. This sutureless technique may promote increased clinical use of AM patch by alleviating patients' pain and shortening surgical time.

Continuous versus interrupted suture for end-to-end biliary anastomosis during liver transplantation gives equal results

Biliary complications following orthotopic liver transplantation have been reported in 10% to 30% of patients. Most surgeons perform an end-to-end choledochocholedochostomy with interrupted sutures for biliary reconstruction. The goal of this study was to compare biliary complications between interrupted suture (IS) and continuous suture (CS) techniques during liver transplantation in which an end-to-end choledochocholedochostomy over an internal biliary stent was performed. A retrospective cohort study of 100 consecutive liver transplants occurring between December 2003 and July 2005 was conducted. An end-to-end choledochocholedochostomy over an internal biliary stent was performed during liver transplantation. Data were analyzed using Kaplan-Meier methods, t tests, and chi-square tests of proportions. IS and CS techniques were used in 59 and 41 patients, respectively, for biliary reconstruction during liver transplantation. Mean follow-up time for the CS group was 17 +/- 8 months and 15 +/- 7 months for the IS group (P = .21). The overall biliary complication rate was 15%. There was no difference in the proportion of leaks (CS = 7.3%, IS = 8.5%; P = .83) or strictures (CS = 9.8%, IS = 5.1%; P = .37) between groups. Kaplan-Meier event rates show no difference in leaks (P = .79), strictures (P = .41), graft survival (P = .52), and patient survival (P = .32) by anastomosis type. In conclusion, there was no difference in biliary complications, graft survival, or patient survival between the 2 groups. CS and IS techniques for biliary reconstruction during liver transplantation yield comparable outcomes.

Spatulated end‐to‐end bile duct reconstruction in orthotopic liver transplantation

Biliary complications continue to be a major source of morbidity following orthotopic liver transplantation. The aim of this study was to analyze the incidence and management of biliary complications related to the technique of bile duct reconstruction. The patients were stratified into two groups: group I (n = 39) had bile duct reconstruction performed by an end-to-end single interrupted suture choledochocholedochostomy (EE-CDCD) and group II (n = 38) had a spatulated end-to-end CDCD (spEE-CDCD) reconstruction; both groups had an intraductal stent. The groups were similar in age, gender, liver transplant indications and Pugh score. Ten biliary complications (26%), including five bile leaks (13%) and five biliary strictures (13%), were observed in the EE-CDCD group, while one biliary stricture (2.6%) occurred in the spEE-CDCD group (p < 0.05). Subsequent imaging studies and endoscopic retrograde cholangiopancreatography were performed less often in patients undergoing spEE-CDCD reconstruction (p < 0.05). The technique of a spatulated end-to-end bile duct reconstruction provides a significant improvement in lowering biliary complication rates in liver transplant patients. Despite the modest number of cases in this study this technique shows promise and has become the technique of choice in our institution.

Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography

Ultrasound examination is an objective method for assessment of uterine scar defects. The present study was conducted to compare single-layer interrupted sutures (Group A) with double-layer interrupted sutures (Group B) and our new method (Group C) as well as other perioperative parameters in relation to risk of wedge defects in scars. We have introduced a new myometrium closure procedure consisting of continuous suture with decidual closure followed by interrupted myometrium suture. In this prospective study, women undergoing cesarean operation (n = 137) were examined by transvaginal ultrasound one month after surgery to assess the appearance of lower uterine scars. Multivariate logistic regression analysis was performed to identify associations of perioperative parameters and methods for lower myometrium closure with abnormal wedge formation. Wedge defects were observed in a total of 27 patients (19.7%). The analysis revealed Groups B and C to have reduced risks with odds ratios of 0.28 and 0.077, respectively, as compared to Group A. Furthermore, increasing gestational week at delivery, plural fetal pregnancies, premature rupture of membranes and pre-eclampsia were also linked with an increased risk, with odds ratios of 1.4-8.9. The incidence of uterine scar defects 1 month after cesarean sections varies with the method applied for myometrial suture and perioperative variables. The data suggest that methods for myometrium closure as well as other factors influence the condition of myometrial healing.

Continuous Suture Technique for Freedom Stentless Valve: Reduced Crossclamp Time

The Pericarbon Freedom stentless valve has shown excellent hemodynamics. A continuous suture technique at the inflow site may reduce cardiopulmonary bypass and crossclamp times and affect postoperative hemodynamics. In a prospective case-matched study, interrupted and continuous suture line techniques were used in 68 and 71 patients, respectively. Isolated valve replacement was performed in 70.4% of the continuous suture group and 67.6% of the interrupted suture group. Hemodynamic data were obtained by echocardiography (mean and peak gradients, regurgitation) at discharge and after 1 year. Overall mortality was 5.0% and due to non-valve-related causes. Bypass and crossclamp times were shorter by 22.4 and 20.6 min, respectively, in the continuous suture group. The suture technique at the inflow site did not result in significant differences in the mean (11.8 +/- 6.3 vs. 12.5 +/- 6.2 mm Hg) or peak gradients (21.0 +/- 9.6 vs. 22.0 +/- 10.9 mm Hg), or degree of regurgitation. Follow-up showed a further decrease in the gradients.

Comparison of Running and Interrupted Vesicourethral Anastomoses in a Porcine Model

To compare running and interrupted suturing techniques for porcine vesicourethral anastomosis with regard to procedure time, histopathologic effects, and leakage. Twelve domestic pigs were randomized to a running (N = 6) or an interrupted (N = 6) vesicourethral anastomosis with polyglycolic acid sutures. In each case, the bladder was drained for 7 days. A cystogram was performed immediately after completion of each anastomosis and on postoperative days 7 and 30. Animals were sacrificed on postoperative day 30, and the area of the anastomosis was excised en bloc for histopathologic evaluation. All procedures were completed laparoscopically. The mean operative time for continuous and interrupted suturing were 27.5 and 36.8 minutes, respectively (P = 0.3324). A significant learning curve was noted for both anastomoses, with operative times decreasing with experience in both groups. There was no difference in anastomotic leakage. Histopathology examination revealed more muscle-layer fibrosis in the interrupted- suture group than in the continuous-suture group, with a mean score of 2.17 and 1.67, respectively (P = 0.0325). Both continuous and interrupted vesicourethral anastomoses are feasible. In this in-vivo porcine comparison, there was no difference with respect to procedure time or anastomotic leakage. However, histopathologic grading demonstrated greater muscle fibrosis in the interrupted-suture group.

Impact of Implantation Technique on Hemodynamic Results of the Pericarbon Freedom Stentless™ Valve

The Pericarbon Freedom stentless valve has shown excellent hemodynamic results in the midterm course. However, there is no information as to whether a continuous or interrupted suture technique at the inflow site has an impact on postoperative hemodynamics. 139 patients were enrolled in a non-randomized, prospective matched trial. An interrupted suture line technique was used in 68 patients and a continuous suture line technique was used in 71 at the inflow site. Isolated valve replacement was performed in 70.4% of the continuous and 67.6% of the interrupted suture group. Pre- and postoperative hemodynamics and one-year follow-up were obtained by echocardiography and expressed as mean and peak gradients and grade of regurgitation. No significant difference between continuous and interrupted suture techniques were noted with respect to mean (11.8 +/- 6.3 vs. 12.5 +/- 6.2 mm Hg, p = 0.251) and peak gradients (21.0 +/- 9.6 vs. 22.0 +/- 10.9 mm Hg, p = 0.292) as well as to the degree of regurgitation. Bypass and cross-clamping times decreased by 22.4 and 20.6 minutes, respectively, with the use of the continuous suture technique. One year follow-up showed a further, significant decrease of mean and peak gradients. The Pericarbon Freedom stentless valve appears to offer excellent postoperative performance. The suture line technique at the inflow site does not result in any hemodynamic differences.

Usefulness of combined continuous suture and interrupted tie technique in hindlimb composite tissue allotransplantation in rats

According to our experience of over 100 hindlimb transplantations, in rats, catching the posterior wall with an anterior wall suture is the most common cause of thrombosis and acute transplant failure. It is generally due to inadequate visibility of the lumen and consequent blind suture placement. With an intention to find a superior suture technique, a comparative study between standard end-to-end interrupted and combined continuous sutures and interrupted tie techniques was performed. Twenty hindlimb transplantations to rats' femoral vessels were performed in each group. Anastomosis time, patency, complications, and animal and transplant survivals were compared. In the interrupted suture group (group I), anastomosis failure was encountered in one vein, with 95% of immediate patency rate. A redo of the venous anastomosis was performed and successful. The combined suture technique (group II) had 100% patency rates without complications. The average time for arterial anastomosis in groups I and II was 8.5 and 8.9 min, and for venous anastomosis, 10.7 and 9.6 min, respectively. At 2 weeks, no differences were found between groups as related to transplant and animal survival.