Nonabsorbable Monofilament Sutures Research Articles

Modifications of surgical techniques in laparoscopic percutaneous extraperitoneal closure of inguinal ring for childhood inguinal hernia to achieve zero recurrence and zero subcutaneous stitch granuloma.

To present our technical modifications of single incision laparoscopic percutaneous extraperitoneal closure (SILPEC) of the internal inguinal ring (IIR) for pediatric inguinal hernia (PIH). The prospectively collected data of all children diagnosed with PIH undergoing SILPEC at our center from 2016 to 2023 were reviewed and divided into two groups for result comparison: Group A: before and Group B: after the implementation of full modifications. Our modifications included using a nonabsorbable monofilament suture, creating a peritoneal thermal injury at the internal inguinal ring (IIR), employing a cannula to ensure the suture at the IIR ligates only the peritoneum, and double ligation of the IIR in selected cases. 1755 patients in group A and in group B (1 month to 14 years old) were enrolled. There were no significant differences regarding baseline patient characteristics between the two groups. At a median follow-up of 40 months, the rate of recurrent CIH and subcutaneous stitch granuloma (SSG) was 2.3% and 1.5% in group A vs. 0% and 0% in group B (p < 0.001). There were no hydroceles, no ascended or atrophic testis. Our SILPEC technical modifications can achieve zero recurrence and zero SSG for PIH.

Retrospective study of superficial wound complication comparison between monofilament absorbable versus monofilament nonabsorbable sutures for skin closure in kidney transplant

Retrospective study of superficial wound complication comparison between monofilament absorbable versus monofilament nonabsorbable sutures for skin closure in kidney transplant

46. THORACOSCOPIC REPAIR OF IATROGENIC INJURY TO THE THORACIC AORTA DURING MINIMALLY INVASIVE ESOPHAGECTOMY

Abstract Description of video: Background We present the case of a 75-year-old male patient with locally advanced Siewert Type 2 gastroesophageal adenocarcinoma post neoadjuvant chemotherapy. Inadvertent through-and-through piercing of the lower thoracic aorta with the tip of an energy device just above the diaphragm was sustained during the thoracoscopic esophageal dissection phase of the three-field minimally-invasive McKeown approach. Methods The procedure proceed thoracoscopically. The lower thoracic aorta was dissected and mobilized proximally and distally, and clamped on both ends with the introduction of Debakey clamps directly through separate small incisions in the chest wall. Primary repair of both anterior and posterior defects was then performed with monofilament non-absorbable sutures. Total clamp time was 30 minutes (in 15-minute intervals). Results Post-repair, perfusion status to the distal viscera and lower limbs were verified and intact. The rest of the operation then proceeded uneventfully. A Computed Tomography scan of the thoracic aorta on postoperative day 14 showed a patent thoracic aorta with no intraluminal narrowing or thrombosis. Conclusion Thoracoscopic repair of aortic injury sustained during the thoracoscopic dissection phase of a minimally invasive esophagectomy can be performed safely in well-selected, haemodynamically stable patients. Drpbox link to video: https://www.dropbox.com/s/xbwt6ge23iywr3m/aorta3mus1.mp4?dl&amp;#x003D;0.

149. LAPAROSCOPIC HELLER CARDIO-MYOTOMY IS NOT ALWAYS A SAFE OPERATION

Abstract Background Laparoscopic Heller cardio-myotomy is the standard surgical treatment of achalasia. Although POEM (Per-oral endoscopic myotomy) has gained wide acceptance among gastroenterologists, yet many surgeons are still loyal to this operation. One of the complications of the operation which could happen is esophageal or gastric perforation during the myotomy. Intra-operative detection of the perforation and meticulous repair is very important to prevent serious sequelae. Methods Between may 2021 and Jan 2023, 46 cases of achalasia (Type I and II) were treated by laparoscopic Heller cardio-myotomy and anti-reflux procedure (Dor or Toupet). Myotomy was performed using muscles splitting combined with either harmonic or hook diathermy. Intra-operative perforations were reported and were repaired in all cases and tested for absence of leakage. Post-operative follow up of cases having intraoperative perforations and its management were documented. For those having perforations postoperative gastrographin swallow and meal was done and oral fluids intake started second postoperative day. Results Perforations occurred in 11 cases (24%) and were repaired using 3 l0 suture: monofilament non-absorbable suture: prolene (polypropyelene, J&amp;J MedTech) in 4 cases, monofilament absorbable suture monocryl (poliglecaprone 25, J&amp;J MedTech) in 3 cases and vicryl (polyglactin 910, J&amp;J MedTech) in 4 cases. Smooth post-operative recovery was noted in 7 cases having perforations (64%). Four patients (36%) developed Leakage second postoperative day confirmed by investigations. All these cases were repaired with Vicryl. Endoscopic stent was inserted with improvement of the condition in 3 cases (75%). One patient required reoperations twice and expired in the 29th day postoperative from ARDS. Conclusion Although perforations could happen during laparoscopic Heller cardio-myotomy, it has a benign postoperative course in most cases. This doesn’t mean that it is a simple operation. Laparoscopic Heller cardio-myotomy should be done in highly specialized esophageal center because its complications could lead to death if badly managed.

Current Trends in Flexor Tendon Surgery: Results of a National Online Survey

An online survey was conducted and sent out by email to all DGH members. The questionnaire included 7 questions. Participants accessed the survey via a link. 155 hand surgeons from Germany participated in the survey. All of them answered the questionnaire in full and all questionnaires were included in the evaluation. The main question of how many strands are currently used for core suturing was answered as follows: 21% (n=32) of the 155 participants (TN) stated that they use a 2-strand suture, 53% used (n=82) a 4-strand suture and 10% used a 6-strand suture. Regarding techniques, 81 TN used the Kirchmayr-Kessler technique or a modification of it, 9 TN used the M-Tang technique, and 15 TN indicated "other technique". The question about the application of an epitendinous suture was overwhelmingly answered with "yes". Here, 98.2% agreed. Only with regard to the suture material, different opinions were found. 68% (n=106) use an absorbable monofilament suture (such as PDS). Just under a quarter (23%, n=36) use a non-absorbable monofilament suture (such as Prolene). Flexor tendon surgery has changed considerably due to intensive advances in research during the last decades. It was interesting to note in our survey that German hand surgeons have adapted their suture technique within the last years based on the results of the literature. Our results clearly show that convincing scientific data has an influence on the choice of surgical technique and that discussions about new techniques, e. g. in the context of annual meetings, may well stimulate the auditorium to rethink.

Thoracoscopic and laparoscopic approach for pleuroperitoneal communication under peritoneal dialysis: a report of four cases

BackgroundPleuroperitoneal communication (PPC) is a rare complication of continuous ambulatory peritoneal dialysis (CAPD) and often forces patients to switch to hemodialysis. Some efficiencies of video-assisted thoracic surgery (VATS) for PPC have been reported recently; however, there is no standard approach for these complications. In this case series, we present a combined thoracoscopic and laparoscopic approach for PPC in four patients to better assess its feasibility and efficiency.Case presentationClinical characteristics, perioperative findings, surgical procedures, and clinical outcomes were retrospectively analyzed. We combined VATS with a laparoscopic approach to detect and repair the diaphragmatic lesions responsible for PPC. We first performed pneumoperitoneum in all patients following thoracoscopic exploration. In two cases, we found bubbles gushing out of a small pore in the central tendon of the diaphragm. The lesions were closed with 4-0 non-absorbable monofilament sutures, covered with a sheet of absorbable polyglycolic acid (PGA) felt, and sprayed with fibrin glue. In the other two cases without bubbles, a laparoscope was inserted, and we observed the diaphragm from the abdominal side. In one of the two cases, two pores were detected on the abdominal side. The lesions were closed using sutures and reinforced using the same procedure. In one case, we failed to detect a pore using VATS combined with the laparoscopic approach. Therefore, we covered the diaphragm with only a sheet of PGA felt and fibrin glue. There was no recurrence of PPC, and CAPD was resumed at an average of 11.3 days.ConclusionsThe combined thoracoscopic and laparoscopic approach is an effective treatment for detecting and repairing the lesions responsible for PPC.

Does the Choice of Suture Materials Affect the Vas Deferens after Hernia Ring Closure in Inguinal Hernia Surgery: An Experimental Study in Rats

IntroductionLaparoscopic inguinal hernia repair is a commonly performed procedure in children. Currently, monofilament polypropylene and braided silk are the two most frequently used materials. Studies have suggested more tissue inflammatory reactions with the use of multifilament non-absorbable sutures. However, little is known about the effects of suture materials on adjacent vas deferens. The aim of this experiment was to compare the effect of non-absorbable monofilament and multifilament sutures on vas deferens in laparoscopic hernia repair. MethodsAll animal operations were performed by a single surgeon under aseptic conditions and anaesthesia. Ten male Sprague Dawley rats were divided into two groups. In Group I, “hernia repair” was performed using 5.0 Silk. In Group II, polypropylene sutures (Prolene®; Ethicon, Somerville, N.J., USA) were used. All animals also received sham operations in the left groin as a control. After 14 days, the animals were euthanised and a segment of vas deferens just adjacent to the suture was excised for histological review by an experienced pathologist who was blind to the treatment groups of the respective specimens. ResultsThe body sizes of the rats in each group were comparable. Group I had significantly smaller vas deferens than Group II (diameter: 0.2 vs. 0.6 ± 0.2, p = 0.005). Silk sutures appeared to cause more tissue adhesion than Prolene® sutures, as graded by blind assessors (adhesion grade: 2.8 ± 1.3 vs. 1.8 ± 0.8, p = 0.1), although this did not reach statistical significance. There was no significant difference in the histological fibrosis score and inflammation score. ConclusionThe only effect of non-absorbable sutures on vas deferens in this rat model was the reduced cross-sectional area of vas deferens and increased tissue adhesion when using silk sutures. However, there was no significant histological difference in inflammation or fibrosis caused by either material.

A comparative study of mesh fixation with non-absorbable versus delayed-absorbable monofilament suture in Lichtenstein tension-free hernioplasty in a medical college

Background: Mesh placement and subsequent fixation are an important aspect of hernia surgery. Different methods are available in modern days for fixing the mesh in inguinal hernioplasty surgery in both open and laparoscopic approach. However, sutures are still preferred by most of the surgeons because of its easy availability and cost- effectiveness. Conventionally, non-absorbable sutures are used to fix mesh. Aims and Objectives: The objective of our present study is to compare the post-surgical outcomes of mesh fixation with monofilament non-absorbable sutures versus monofilament delayed absorbablesutures. Materials and Methods: This prospective and randomized study was conducted at the Department of Surgery, ESIC-PGIMSR, Joka during the period of January 2017 –March 2019. Total 160 patients having unilateral uncomplicated inguinal hernia were included in this study; operated by the same surgical team. The patients were divided into two groups, each of 80 patients. In Group I, mesh fixation was done with delayed absorbable sutures whereas, in Group II, mesh was fixed with non-absorbable sutures. The data were analyzed with appropriate statistical tests such as Chi-square test and P &lt; 0.05 that were considered as statistically significant. Results: The development of post-operative pain was more common in Group II. The difference was statistically significant at 6 months post-operative time (P =0.042). When we compared the post-operative par esthesia in both surgical groups, more number of patients developed it in Group II but no significant statistical difference was observed (P-value came as 0.784, 0,221, and 0.385 after analyzing 3 months, 6 months, and 1 year data, respectively). Regarding other complications such ash ematoma, wound infection, seroma formation, and scrotal/ cord edema, no statistically significant differences were observed in either group (P-values were 0.339, 0.149, 0.313, and 0.117, respectively). No patient developed chronic discharging sinus post operatively in either group. No recurrence was noted in any patients included in this study, after 1 year of follow- up. Conclusion: Using delayed-absorbable suture material with air knotting technique for mesh fixation in Lichtenstein tension-free open inguinal hernioplasty causes less chance of post-operative inguinal pain and pare sthesia. Hence, it is a good alternative choice for surgeons; in terms of safety and efficacy.

Reducing complications in reconstruction of the cervical esophagus with anterolateral thigh flap: The five points protocol

Patients suffering from hypopharyngeal cancer commonly present in the advanced stage and undergo a circumferential pharyngolaryngectomy. The possibility to reconstruct the esophagus and achieve an oral alimentation can significantly reduce the additional burden of a jejunostomy. The cervical esophagus is usually reconstructed with jejunal free flap (JFF) or fasciocutaneous free flap such as the anterolateral thigh (ALT) free flap. The latter has proved its donor-site safety and fast recovery. However, it is burdened by a high fistula rate. We present our five points protocol for reducing fistula rate and improving outcome. Twenty-eight patients underwent total pharyngolaryngectomy and required esophageal reconstruction with ALT flap from 2015 to 2020. In each patient, we performed five adjustments: a thicker dermal layer, a two-layer closure, a barrier from the tracheostomy, a nonabsorbable monofilament suture, and two NG tubes to enhance neoesophageal drainage. Twenty-five (89%) patients returned to solid or soft food diet after the reconstruction. Three patients had liquid diet. Contrast media leakage was observed in only 2 (7%) patients during esophagography at three weeks, with only one needing surgical revision. Our five points protocol for ALT reconstruction of cervical esophagus proved to be effective in achieving an incredibly low rate of complications, without the burden of significant donor-site complications.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery Meshless Anterior Repair for the Treatment of Pelvic Organ Prolapse

To demonstrate the feasibility of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) meshless anterior repair for the treatment of pelvic organ prolapse (POP). Stepwise demonstration of the technique with narrated video footage. The vNOTES approach is a recent and rapidly developing technique that allows safe endoscopic transvaginal treatment of benign uterine pathologies [1]. Its use in the treatment of POP is still in its early stages; however, the first results are encouraging in terms of anatomy, functionality, and safety [2]. We describe the vNOTES technique of meshless anterior POP repair using a vaginal plastron [3]. The "vaginal plastron" technique uses an autologous vaginal strip that is left attached to the bladder and suspended from the arcus tendineus. After the delimitation of a 6 cm square vaginal strip, a lateral dissection is performed on each side between the bladder and the vaginal fascia to enter the paravesical space. The vaginal strip is left attached to the bladder wall and will later be fixed laterally to the arcus tendineus with 6 nonabsorbable monofilament sutures, caliber 0 (3 on each side of the plastron). The fixation points on the arcus tendineus concern the internal obturator fascia ventrally and the iliococcygeus fascia dorsally. The sutures are placed under endoscopic view using a transvaginal access platform (GelPOINT V-Path, Applied Medical, Rancho Santa Margarita, CA). After deflation and removal of the platform, the sutures are attached to the vaginal strip. Once the vaginal plastron is secured, the anterior vaginal wall is closed. The vNOTES approach offers an endoscopic anatomic view of the paravesical space, thus reducing any blind surgical procedure. It provides an alternative route in the performance of meshless anterior POP repair.

Robotic total gastrectomy with thrombectomy and portal vein reconstruction for gastric cancer and portal vein tumor thrombus

BackgroundGastric cancer with portal vein tumor thrombus (PVTT) is poor prognosis, and the treatment remains challenging. Regarding surgery, there are only reports of highly invasive laparotomy. We report some techniques of the completely robotic total gastrectomy with thrombectomy and portal vein reconstruction for the patient with gastric cancer and PVTT for the first time.Case presentationA 79-year-old man was diagnosed with a 5-cm gastric cancer on the side of the lesser curvature from the middle of the gastric body to the cardia. Computed tomography revealed a massive PVTT extending from the left gastric vein to the portal trunk (28 x 16 mm). There were no other distant metastases. After 3 cycles of the chemotherapy, the PVTT shrank to 19 x 12 mm. After obtaining informed consent from the patient, robotic total gastrectomy with regional lymphadenectomy and thrombectomy were performed. We used the da Vinci Xi Surgical System. A 3-cm incision was made at the umbilicus, and a wound retractor was placed. Five additional ports were placed. The right side suprapancreatic lymph nodes were performed at the time of the thrombectomy. It was important to identify the precise extent of the PVTT with intraoperative ultrasonography before the thrombectomy. After PVTT identification, the portal trunk was clamped above and below the tumor thrombus with vascular clips. The membrane on the anterior wall of the portal trunk around the PVTT was carefully incised with da Vinci Scissors. The tumor thrombus was completely enucleated without separation. The incised part of the portal trunk was reconstructed with continuous 5-0 synthetic monofilament nonabsorbable polypropylene sutures. After removing the vascular clamps, we made sure there was no leakage from the portal vein and no tumor thrombus remnants with intraoperative ultrasonography. Robotic total gastrectomy with lymphadenectomy and Roux-en-Y reconstruction were performed. The patient was discharged without complications. The patient has remained alive for 30 months after surgery.ConclusionsRobotic total gastrectomy with thrombectomy and portal vein reconstruction is a safe, minimally invasive, and precise surgery. It may contribute to improved prognosis of gastric cancer with PVTT when combined with chemotherapy.

Post-operative Pain Outcomes of Laparoscopic Ventral Hernia Repair (LVHR): An eight-year experience

Objective:To evaluate post-operative pain, recovery time and standard of living in patients undergoing LVHR in detail. Study design and Setting: This prospective cohort study was conducted at a tertiary care hospital of Karachi, Pakistan,after getting approval from the “National Medical Centre EthicalReview Board”, from January 2011 to December 2019, Methodology: Total n= 577 patients undergoing standard LVHR procedure (defect closed with non-absorbable monofilamentsuture, reinforced with intra-abdominal dual layer mesh, anchored with non-absorbable tacks &amp; sutures). Patient demographics,perioperative &amp; postoperative findings and post-operative pain analysis were investigated and presented as descriptivestatistics. Follow-up was carried out at 1stweek, 2ndweek, 3rdmonthly, 6 monthly and 12 monthly post-operative appointments. Results: During the study period of nine years (January 2011 to December 2019), 577 patients (primary ventral hernia n=232, recurrent ventral hernian=188 patients, incisional hernian=157) underwent LVHR. Mean post-operative hospitalstay was 1.53 ± 1.8 days. Mean post-operative pain assessment onvisual analog scale (VAS) after surgery (0-3days) wasreported to be 38.5±29 by 65 patients out of 577 (11.26%), which significantly decreased at the end of 1st week to 27.9 ± 25.6. Only 3 patients (0.51%) reported chronic pain during the span of 3-6 months. Conclusion: LVHR was associated with considerably less post-operative pain, shorter hospital stay and reduced time of convalescence. It is demonstrated that LVHR to be a safe and superior approach for the repair ventral hernias

Management of traumatic laryngotracheal separation: Case series and review.

Laryngotracheal separation injuries are a rare but serious condition, as survival from such injuries relies on proper airway management. As a result, recommendations for management have been based on small case reports and expert opinion. We reviewed our last 10 years of experience with managing laryngotracheal separation injuries and identified 6 cases for chart review. Awake tracheostomy or videolaryngobronchoscopy was used in each case to initially obtain the airway. Surgical repair was then performed immediately using nonabsorbable monofilament suture or a miniplate, and a low fenestrated tracheostomy was placed. All of our patients who followed up were decannulated, eating regular diets, and had satisfactory voice quality at 3 months postoperatively. Review of the literature revealed that, while management strategies have changed over time, treatment still varies widely depending on surgeon preference and the details of each injury. Outcomes from our series suggest that our described techniques and management strategies can be used with good outcomes. We believe that this is due to securing a safe airway, early surgical intervention with no unnecessary tissue dissection, effective reconstruction of the airway, and the fenestrated tracheostomy technique.

Long-term absorbable versus non-absorbable suture in laparoscopic percutaneous extraperitoneal closure of internal ring for inguinal hernia in children

AimTo compare the results of using long-term absorbable (LTAS) versus non-absorbable suture (NAS) in laparoscopic percutaneous extraperitoneal closure of internal ring (LPEC) for indirect inguinal hernia (IH) in children MethodsProspectively collected data from children undergoing LPEC for IH at our center were retrospectively reviewed to compare group A repaired with NAS (2.0 monofilament polypropylene or braided polytetrafluoroethilene) to group B repaired with LTAS 2.0 polydioxanone. Results481 patients with 499 IHs in group A were compared to 277 patients with 283 IHs in group B. There were no significant differences in terms of age, bodyweight and laterality of IH between the two groups. At a median follow up period of 30 months, the incidence of suture knot reaction (SKR) and hernia recurrence were 3.1% and 1.0% in group A vs. 0% and 6.4% in group B with p = 0.002 and p<0.001, respectively. Monofilament NAS was associated with a low rate of both recurrence and SKR. ConclusionsLPEC repair for pediatric IH using LTAS is associated with no SKR but a higher recurrence rate compared to NAS. Monofilament NAS such as Prolene could be a good choice in LPEC because of its low rate of both recurrence and SKR.

Right pulmonary artery anastomosis. Pulmonary artery anastomosis was performed with a simple continuous suture with 6-0 monofilament non-absorbable sutures

Right pulmonary artery anastomosis. Pulmonary artery anastomosis was performed with a simple continuous suture with 6-0 monofilament non-absorbable sutures

Right pulmonary vein anastomosis. Staple lines of the right superior and inferior veins were amputated and the bridge of them was transected to prepare atrial cuff for anastomosis in the recipient. Then left atrium cuffs of the donor and recipient were anastomosed with a continuous suture with 5-0 monofilament non-absorbable sutures

Right pulmonary vein anastomosis. Staple lines of the right superior and inferior veins were amputated and the bridge of them was transected to prepare atrial cuff for anastomosis in the recipient. Then left atrium cuffs of the donor and recipient were anastomosed with a continuous suture with 5-0 monofilament non-absorbable sutures

Decontamination of Polymeric Surgical Sutures Covered with Bacterial Biofilms Using Nonthermal Plasma

The objective of the study was to investigate the bactericidal effectiveness of atmospheric pressure nonthermal plasma (NTP) on biofilms of Staphylococcus aureus and Escherichia coli formed on the surface of surgical sutures. Tests were carried out for polyamide nonabsorbable monofilament sutures and mid-term absorbable synthetic monofilament sutures made of glyconate. Dielectric barrier discharge reactor providing atmospheric air plasma and constant discharge power density of 70 mW/cm2 was used in the experiments. The colonization/decontamination efficacy was quantified by colony-counting assay. It was shown that decontamination efficacy of the studied surgical sutures was time-dependent i.e. the effect was more visible for longer exposure times ranging from 60 to 360 s. It was proposed to combine plasma treatment with washing the biofilms with a phosphate buffered saline to to allow the plasma to interact with cells in the deeper layers of bacterial biofilm. The application of the original method of treatment of biofilms was more effective than the separate plasma treatment. As a result, the lethal effect was most often achieved after 300 s regardless of the type of suture and biofilm. The results of the comparative studies on the decontamination efficiency of polymeric surgical suture surface by disinfectants and NTP technique have shown unequivocally that plasma treatment is the most effective way to deactivate bacterial cells and ensures a lethal effect for most of the tested cases.

A RANDOMIZED CONTROLLED STUDY OF INGUINAL HERNIA USING MONOFILAMENT NON-ABSORBABLE SUTURE VERSUS MONOFILAMENT ABSORBABLE SUTURE IN LICHTENSTEIN TENSION FREE HERNIA REPAIR

Background: The surgical treatment of inguinal hernias has evolved through several stage, history of groin hernia is the history of surgery itself. But, chronic pain is still a major irritating post-operative complain of the patient. The objective of the present study was to compare post-operative outcomes of mesh fixation with monofilament non-absorbable v/s monofilament absorbable suture material in terms of postoperative pain, chronic groin pain, seroma formation, wound infection and recurrence in Lichtenstein hernioplasty. Methods: This is a single centre, prospective randomized controlled study of 152 cases of inguinal hernia comparing post-operative outcomes of mesh fixation with monofilament non-absorbable v/s monofilament absorbable suture material in Lichtenstein hernioplasty at Baroda Medical College and S.S.G. Hospital, between 1st December 2017 to 30th November 2018. Results: Total 152 patients of unilateral or bilateral inguinal hernia were studied 76 in each group. Chronic groin pain mean visual analogue scale score at 3 months was higher in group with non-absorbable suture compared to monofilament absorbable group (1.3±0.9 v/s 0.95±0.8 p value &lt;0.05). Conclusions: Monofilament absorbable suture is associated with less chronic groin pain and compared to monofilament non-absorbable sutures.

The effect of different suturing materials for abdominal fascia wound closure on the collagen I/III expression ratio in rats

BackgroundIncisional hernia is a frequent complication of abdominal wall incision and has a high rate of recurrence. Most of the studies stated that non-absorbable sutures decreased incisional hernia incidences, but some stated otherwise. We aimed to compare the collagen type I/III ratio between monofilament non-absorbable sutures and multifilament absorbable sutures for abdominal fascia closure in Wistar albino rats. MethodsForty rats were divided into four groups. Groups 1 and 3 were sutured with monofilament non-absorbable (polyvinylidene fluoride). Groups 2 and 4 were sutured with multifilament absorbable (polyglycolide). Then, groups 1 and 2 were euthanized on day 4 (POD 4), while groups 3 and 4 were euthanized on day 7 (POD 7). Samples of fascia (1 × 0.5 cm) were taken for analysis. Collagen I/III ratios were measured using immunohistochemistry staining methods. ResultsWhile the expression of collagen I was not significantly different between monofilament non-absorbable and multifilament absorbable at POD 4 and 7 (p = 0.45 and 0.81, respectively), the expression of collagen III reached a significant level with p-values of 0.0003 and 0.0004 for POD 4 and 7, respectively. Moreover, the collagen I/III ratio was also significantly different between the two groups either at POD 4 (0.88 ± 0.23 vs. 0.53 ± 0.08; p = 0.0003) and 7 (1.77 ± 0.65 vs. 1.03 ± 0.28; p = 0.004). ConclusionsMonofilament non-absorbable sutures show a significantly higher collagen I/III ratio than multifilament absorbable sutures for abdominal fascia closure in rats. Our findings imply that the usage of monofilament non-absorbable sutures might have a beneficial effect on decreasing the incisional hernia occurrence.

Delayed postoperative bleeding following lobectomy caused by the sharp tip of a suture: a case report

BackgroundPostoperative bleeding is a rare but serious complication occasionally caused by hard surgical materials, such as staples. Postoperative hemorrhage caused by sutures is very rare.Case presentationA 75-year-old man with lung cancer underwent right lower lobectomy. Eleven days after surgery, he developed a haemothorax. Emergency thoracotomy revealed arterial bleeding from a pinhole injury in the parietal pleura caused by a monofilament non-absorbable suture tip used during the initial surgery.ConclusionsPostoperative bleeding is a serious complication, and as sutures are often used in surgery, it is important to be cautious while using this material.