Nonabsorbable Suture Material 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.

Comparison of the Efficacies of Vicryl Rapide and Prolene Sutures in Transcolumellar Incision.

<b><br>Introduction:</b> Septorhinoplasty aims to enhance nasal function and appearance. This common but complex procedure has demonstrated advancements with both open and endonasal approaches. The selection of sutures can impact patient comfort and scar outcomes, presenting both advantages and disadvantages.</br> <b><br>Aim:</b> This study was conducted to compare the cosmetic outcomes of the use of absorbable polyglactin 910 (PG) (Vicryl Rapide 5/0; Ethicon Inc.) and nonabsorbable polypropylene (PP) (Prolene 5/0; Ethicon Inc.) in open septorhinoplasty in terms of surgical scarring.</br> <b><br>Methods:</b> The sample of this prospective, randomized, single-blind study consisted of 42 patients who underwent open septorhinoplasty. The patients were randomized into the vicryl rapide (n = 16) and prolene (n = 26) suture groups. The groups were comparatively evaluated by two surgeons in terms of surgical scarring, pigmentation, level difference, indentation, and general appearance based on patient photographs taken in the 2nd week, 6th weeks and 12th week post-op.</br> <b><br>Results:</b> The mean age of the vicryl rapide and prolene groups was 26.9 5.7 years and 24.6 3.9 years, respectively. There was no significant difference between the groups in any of the parameters investigated within the scope of the study in postoperative week 2, 6, and 12 (P > 0.05). On the other hand, intragroup analyses revealed that suture scar significantly decreased in the vicryl rapide group in the 6th and 12th weeks compared to the 2nd week (P < 0.05), while no significant difference was observed in the prolene group in the suture scars in week 6 and 12 compared to week 2 (P > 0.05).</br> <b><br>Conclusions:</b> Inverted V trans-columellar incisions sutured with rapidly absorbable suture material resulted in significantly less suture discomfort and did not significantly increase the risk of postoperative infection compared to nonabsorbable suture material. However, there was no significant difference between the two suture materials in terms of scar appearance.</br&gt.

MORPHOLOGICAL PATTERN OF BONE TISSUE DURING IMPLANTATION OF DISPERSED BIOCOMPOSITE BASED ON WOLLASTONITE

The purpose of the study is to analyze the structure of the bone tissue surrounding a tooth under normal conditions, after tooth extraction and after placing wollastonite / hydroxyapatite scaffolds into the mandibular alveolus of a test animal (rabbit).
 Materials and Methods. Female New Zealand White rabbits (n=9), raised on a farm, were used as test animals. The animals were 12 months old, and weighed 1.7–3 kg. Surgeries were performed in a veterinary clinic in Vladivostok, under combined anesthesia. Mandibular lateral incisors were extracted in test animals. The surgery was followed by alveoli augmentation with wollastonite/hydroxyapatite scaffolds. After surgical procedures, the wounds were tightly sutured with nonabsorbable suture material (Vicryl, USA). Surgical wounds were debrided for 15 days (0.9 % NaCl solution). During first 24-hours after the operation, the animals were on a soft no chew diet. The rabbits were under dynamic observation throughout the experiment.
 Results. Alveoli augmentation of the extracted incisors with wollastonite / hydroxyapatite scaffolds had a positive effect on bone regeneration. It led to a significant restoration of the cortical plate thickness and preservation of the bone beams volume of the mandibular alveolar process. This is evidenced by the results of a morphological study of histologic specimen obtained from experimental subjects (mandibular alveolar process). No toxic effects on surrounding tissues were detected.
 Conclusion. The study allows us to confirm the bioactive qualities of the synthesized wollastonite/hydroxyapatite scaffolds and prove the lack of toxic side-effects on surrounding tissues.

A comparative analysis of suture-augmented and standard hamstring autograft single-bundle ACL reconstruction outcomes: short-term functional benefits without long-term impact

BackgroundAugmentation of the biologic graft with nonabsorbable suture material during anterior cruciate ligament reconstruction (ACLR) is a relatively new technique to enhance its biomechanical properties and add additional support to the critical process of healing. We aimed to compare the short-term functional patient-reported outcome measures (PROMs) and complication rates of patients treated with either standard single-bundle four-strand hamstring ACLR or added suture augmentation (SA).MethodsPatients undergoing arthroscopic ACLR between February 2015-January 2017 and in the standard ACLR group, and between February 2017-September 2019 in the SA-ACLR group operated by adding a no.5 FiberWire® (Arthrex, Naples, FL, USA) braided suture to the hamstring autograft, were retrospectively reviewed and the PROMs were compared. Patients were followed up for a 24-month period and PROMs were assessed by the International Knee Documentation Committee (IKDC) Subjective Knee Form and Tegner-Lysholm knee score. Patients’ demographic and clinical characteristics, and postoperative complications including graft retear requiring revision surgery, deep vein thrombois, and surgical site infection were recorded and analyzed.ResultsWe included 79 patients with mean age of 31.6 ± 8.3 years in the standard ACLR group, and 90 patients with mean oge of 30.5 ± 7.6 in the SA-ACLR group. There was no statistically significant difference between the two groups in terms of age, sex, body mass index, and medical comorbidities. The values of the IKDC scores increased to 75.8 ± 18.9 in the standard ACLR group, and 85.6 ± 12.6 in the SA-ACLR group, 24 months after the operation (P < 0.05). The 24-month postoperative Tegner-Lysholm scores escalated to 79.3 ± 21.0 in the standard ACLR group and 91.0 ± 13.7 in the SA-ACLR group (P < 0.05). Four (5.1%) patients in the standard ACLR group and 4 (4.4%) in the SA-ACLR group experienced graft retear requiring revision surgery (P > 0.05). Incidence of surgical site infection and deep vein thrombosis showed no significant differences between the two groups, 24 months after ACLR.ConclusionSA-ACLR is associated with improved short-term functional PROMs compared to the standard hamstring ACLR. Although SA did not reduce the retear rate, and infection and DVT rates did not differ between study groups, superior improvement of PROMs in SA approach, leverages this method for ACLR.

Absorbable vs Nonabsorbable Sutures for Achilles Tendon Repair: A Systematic Review and Meta-analysis.

Nonabsorbable sutures are still the main choice for acute Achilles tendon rupture (AATR) repair due to strength provided. However, the rerupture rates, infection risks, foreign body reaction, and postsurgical recovery differences between absorbable and nonabsorbable suture materials in AATR repair have not been carefully reviewed. A systematic review was done on PubMed, EBSCO, Cochrane Central Register of Controlled Trials, and Embase to find research studies in relation to complications associated with AATR repair using the PRISMA guidelines. The risk of bias from each study included will be assessed using the Cochrane Risk of Bias Tool for randomized study (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) for nonrandomized study. Five studies with a total of 255 patients, 105 in the absorbable suture group and 150 in the nonabsorbable suture group, were included for analysis. Risk of rerupture, infection, and foreign body reaction shown no significant difference between groups, and the mean difference of recovery scores were similar. Existing literature shows that absorbable sutures appear to be associated with similar outcomes to nonabsorbable sutures regarding rates of rerupture, infection, foreign body reaction, and outcomes grading following surgical repair of acute Achilles tendon repair.

An Experimental Design to Compare the Compatibility of Absorbable and Nonabsorbable Suture Materials in the Lateral Canthus Area.

Polyglactin 910 (Vicryl) and polypropylene (Prolene) are common suture materials used in ophthalmic surgical procedures. However, there are limited studies assessing tissue reactions to different sutures in eyelid areas. In this study, these suture materials were used subcutaneously in 10 lateral canthi of 5 pigs. Clinical reactive score (CRS) was assessed 14 days and 60 days after surgery. On histology, subcutaneous tissue reactions were assessed by the presence of different inflammatory cells, and the aggregate tissue irritation score was calculated. CRS and the histology score did not differ between these sutures. None of the suture materials used were superior for use in the lateral canthi of pig eyes. Therefore, we recommend both of these sutures for use in the subcutaneous tissue of the eyelid area in animal experiments or clinical practice.

Effect of Scar Deformation on Long-Term Outcomes of Suturing Perforated Pylorobulbar Ulcers

Despite the use of modern anti-ulcer therapy, the percentage of unsatisfactory results after suturing perforated ulcers ranges from 4.8 to 57% [1, 2, 3]. It is necessary to search for reasons explaining such significantly different values in the long-term treatment outcomes of patients with perforated ulcers. Cicatricial changes in the pylorobulbar area leading to a violation of the motor-evacuation function and, as a consequence, ulcer recurrence may be one of the causes.The aim of the study was to investigate the effect of a suture row and a type of suture material on the long-term outcomes in suturing perforated ulcer. Materials and methods. The study involved results of suturing perforated ulcers in 280 patients. When suturing, a single-row and double-row sutures, absorbable and non-absorbable suture materials were used. In the immediate postoperative period, the main attention was paid to the suture failure. In the long-term period, the results were evaluated in 106 patients, which accounted for 37.8% of the operated patients. The results were analysed according to the Visick score modified by M.Y. Pantsyrev [4]. Fibrogastroduodenoscopy findings in the long-term period were also analyzed in 56 patients; 31 of them were performed suturing with a single-row suture technique using absorbable threads, 25 patients were performed suturing with a double-row suture technique using dacron or silk threads. The severity of cicatricial deformation of the pylorobular area was evaluated based on B.P. Dergachev classification (1982) [5].Results. Evaluating the immediate results of suturing, no significant increase in the percentage of suture failure was registered when using a single-row suture technique and absorbable suture material (p=0.2). In the long-term postoperative period, the number of patients with excellent results according to the Visick score was significantly higher in the group where a single-row suture was performed (p=0.023). Analyzing endoscopic examination findings, the authors obtained the following results: no pronounced scar deformation was detected under fibrogastroduodenoscopy in patients who were performed a single-row suturing. In three cases (9.7%), no signs of scarring were found. Endoscopic signs of scar deformation were detected in all cases in patients of the second group, who were performed a double-row suturing. Of these, 6 (24.0%) patients had pronounced scar deformity. After performing a double-row suturing with non-absorbable suture material, an ulcerative defect with the ligature at the bottom was detected in the duodenum under fibrogastroduodenoscopy in two cases.Conclusion. Application of a single-row suture and absorbable suture materials is a reliable option to close perforation without increased suture failures; it results in improved long-term treatment outcomes. The use of a double-row suture and non-absorbable suture materials results in a more severe deformation of the suturing area and is one of the risk factors for ulcer recurrence.

Diş Hekimliğinde Kullanılan Dikiş Materyallerinin Çekme Direncinin Değerlendirilmesi

Aim: The aim of this study was to compare the mechanical properties of sutures used in dentistry according to different materials in vitro. &#x0D; Material and Methods: Eight 3-0 different absorbable and non-absorbable suture materials with 3-0 gauge (Polytetraflouroethylene, polypropylene, polyester, polyglactin 910, polyglycolic acid, poliglecaprone 25, polydioxanone, and silk) were compared in terms of mechanical strength. All sutures were tied with a simple suture technique. Each material contained 10 samples per group, with a total sample size of 80 specimens. Failure load was measured in N while elongation was measured in µm using a microtensile testing device. A one-way analysis of variance (ANOVA) was used to analyze the difference in failure loads and elongation values.&#x0D; Results: Polydioxanone was significantly more resistant to tensile forces among all tested materials (p

INCIDENCE OF SURGICAL SITE INFECTION/ WOUND GAPING IN SUTURED VS STAPLED CLOSURE OF ABDOMINAL INCISION: A COMPARATIVE STUDY

Background Surgical wound is any wound inicted during surgical process and infection of surgical wound is a relevant complication with an incidence of 1% to 3%. Many factors are responsible for the occurrence of surgical site infections, like age, presence of comorbidities, type of procedure, wound closure method, level of contamination etc. Surgical Site Infection or SSI is associated with a signicant economic burden in terms of extended length of stay and increased costs of treatment. Objectives- To determine whether the incidence of surgical site infections differed after wound closure with non-absorbable suture material vs skin stapler, in elective abdominal surgeries. Methods- A comparative study to determine the incidence of surgical site infections after elective abdominal surgery was conducted in a tertiary care setup for a duration of one year. The study population was divided by random computer method in two arms, consisting of 30 patients each. In one arm the abdominal wound after elective surgery was closed with non-absorbable sutures while in the other with skin staplers. Outcomes were noted in terms of Surgical site infection, i.e, presence of wound gape, burst abdomen, closure duration, duration of hospital stay and interventions like secondary suturing, daily cleaning and dressing (CnD) Results- A total of 60 patients who underwent elective abdominal surgeries were divided into two arms of 30 patients each. Wound closure in one group done by non-absorbable suture material while in the other group with skin stapler. The groups were comparable in demographics, ASA (American society of Anaesthesiologist) grading and CDC (Centre for disease control) class of surgical wound. In our study, Surgical site infections were detected in 33.3 % (10 patients) in the sutured arm of closure of abdominal incision, while SSI were detected in 26.6 % (8 patients) of stapled arm of closure of abdominal incision. No signicant difference encountered in the incidence of SSI in sutured and stapled closure of abdominal wound. 76.7% (23 patients) underwent wound closure within 10 minutes in the stapled arm, while only 20 % (6 patients) in the sutured arm had surgical time duration of wound closure less than 10 minutes (p value &lt; 0.001), the wound closure duration in the stapled arm was signicantly less compared to the sutured arm. Conclusions- There was no signicant difference in the incidence of surgical site infections in both the groups, but the surgical time duration of wound closure was signicantly lower in the stapled group.

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

Arthroscopy Revision of Medial Meniscus Posterior Root (MMPR) Reconstruction Using Gracillis Tendon Graft. A Case Report

The techniques for medial meniscal posterior roots (MMPR) repair can vary in relationship to the surgical approach, type of suture, device used, and fixation technique. Anatomic reduction, meniscal root fixation, and prevent extursion are possible by the trans-tibial pull-out repair procedure for MMPR tears. But it has been found that it has a substantially weaker than the natural root with unsactisfactory healing rates. Objective: We purposed this technique to reduce the failure of meniscus repair with a more anatomical, better healing and reproducible outcome Case Presentation: A 60-year-old female patient with Medial Meniscus Posterior Root tear LaPrade classification type 2. She had arthroscopic transtibial pull-out meniscal root repair using Ethibond No. 5 non-absorbable suture material. Six months after surgery, she had retear on MMPR and we performed the arthroscopic MMPR reconstruction with gracilis tendon graft. 3 months after surgery, patient has a good function and MRI evaluation. Conclusion: This arthroscopic medial meniscus posterior root reconstruction using gracilis graft is provide an anatomical repair, a more strong with a biological healing than previous repair techniques.

The comparison of the suture materials on intestinal anastomotic healing: an experimental study.

This experimental comparative study was to evaluate the local effects of three different suture materials on in-testinal anastomosis healing. Ethical approval was obtained from the University of Ethical Committee (E-60758568-020-176720). A prospective, experimental comparative analysis was conducted on 24 rats. They were divided into three equal groups; Group 1 underwent colonic anastomosis with Vicryl suture material, Group 2 underwent colonic anastomosis with polypropylene suture; and Group 3 underwent colonic anastomosis with polydioxanone (PDS) suture. The second operation underwent the 7th post-operative day. Adhesion score, anastomotic leakage, anastomotic bursting pressure, hydroxyproline levels, and histopathologic examination were evaluated. All animals survived, and no leakage, intestinal obstruction, or wound infection was observed during the experiment. The adhesion score was evaluated according to the Diamond classification and same in all groups. Median anastomotic bursting pressure was 125.75 mmHg (10-241) in the Vicryl group, 159.25 mmHg (113-190) in the polypropylene group, and 154.50 mmHg (20-212) in the PDS group. Hydroxyproline tissue concentrations were in the Vicryl group 1699.92±220.8 ng/mg (range: 1509.81-2186.47), in the polypropylene group 1126.24±607.12 ng/mg (range: 53.22-1815.63), and 1547.86±335.2 ng/mg (range: 973.66-1973.2) in PDS group. There was no difference among groups regarding the inflammatory response evaluated by histopathology. There was no statistical significance in all variables evaluated. This experimental study demonstrates that suture materials did not worsen tissue healing during intestinal anastomosis. Absorbable, slowly-absorbable, and non-absorbable suture materials could be used safely in every situation.

Evaluation of tensile strength of surgical absorbable and nonabsorbable suture materials after immersion in different fruit juices: An in vitro study.

Surgical sutures are the most well-known surgical biomaterial device for ligating blood vessels. The primary goal of wound closure is to align wound margins to provide a closed and stable environment. Sutures with lesser tensile strength are susceptible to break throughout the healing process due to edema. To evaluate the tensile strength of absorbable and nonabsorbable suture materials after immersion in fruit juices. In this in vitro study, eight samples of commercially available sutures such as black silk and vicryl were divided into two groups: sample -1 were immersed in grape juice and sample -2 were immersed in lemon juice for 1 week. Universal testing machine INSTRON E300 UTM was used to test the tensile strength of various suture materials. The data are statistically analyzed using an independent t-test. The P < 0.05 was considered to be statistically significant. The mean of vicryl suture after immersion in grape and lemon juice was found to be 34.445 and 43.39; the mean value of black silk after immersion in grape and lemon juice was found to be 36.95 and 33.1. The tensile strength of black silk was slightly lower than the vicryl. Independent sample t-test showed that P = 0.561 (>0.05) which is statistically insignificant. Vicryl suture tested to have the highest tensile strength along with excellent knot holding capacity than black silk suture after immersion in fruit juices.

The Effect of Topical Agents on the Tensile Strength of Absorbable and Non-absorbable Suture Materials-An in Vitro Study.

Topical agents are sometimes applied to surgical wounds after closure; these may include antiseptics or antibiotics. Minimal research has been undertaken to investigate the effect of topical regimens on the tensile strength of suture materials. To investigate the effect of four commonly used wound care regimens on the tensile strength of suture materials. The failure load of 9 different suture materials was tested using the Instron Electroplus E3000 tensile testing machine (Instron Corporation, Norwood, Massachusetts). Tensile strength was represented as the failure load, measured in Newtons (N), and defined as the maximal load that could be applied across the suture prior to failure. Each suture was tested dry and after immersion in one of 4 products for 7days and tested on day 7. The immersion agents tested were: sodium chloride 0.9%, MicroSafe® (Sonoma Pharmaceuticals, Petaluma, CA), Aqueous Povidone-iodine 10% solution (Betadine-Mundipharma), and Fucidin ointment. Sodium chloride 0.9%, MicroSafe®, Aqueous Povidone-iodine 10%, and Fucidin seem to increase the failure load of most absorbable and non-absorbable sutures. However, the failure load of Polyglactin 910 suture (Surgilactin, coated, violet-Ethicon) is reduced by long-term exposure to either sodium chloride 0.9% or MicroSafe®, while the failure load of the Polydioxanone suture (PDS Plus-Ethicon) is reduced by long-term exposure to MicroSafe® only. In our experiment, the commonly used wound care products have been shown to alter the tensile strength of suture materials. Further human studies are required to ascertain the clinical validity and applicability of our findings.

Clinical Features and Treatment of Intra-Tendinous Suture Reaction Following Achilles Tendon Repair Using Nonabsorbable Suture Material: A Retrospective Case Series Study.

We aimed to investigate the clinical manifestations, radiological findings, and therapeutic outcome of treatment for patients with surgically confirmed foreign body reaction following an Achilles tendon repair using non-absorbable suture material. Eight consecutive patients who were confirmed as having an intra-tendinous suture foreign body reaction in the histopathological report were enrolled in this study. Medical records of all patients in terms of clinical and radiological features were retrieved. Also, the outcome of treatment was evaluated at a follow-up of at least 12 months. All the patients complained of pain and a palpable mass around a previous surgical site at mean 25.1 months (range, 4–72 months) after the initial surgery. Magnetic resonance imaging (MRI) or ultrasound were used to detect the lesion. All the patients underwent surgical excision of foreign body reaction tissue and primary repair using absorbable suture material. After the treatment, the wounds were healed completely in all, and the average FAOS (foot and ankle outcome score) was 91.32 at mean follow-up for 22.4 months. In conclusion, intra-tendinous suture reaction is a rare complication following an Achilles tendon repair using nonabsorbable suture material, but it can be treated adequately with only surgical excision of foreign body reaction tissue and primary repair using absorbable suture material.

Does Knot Configuration Improve Tensile Characteristics of Monofilament Suture Materials?

The effects of knot configuration used in surgical procedures are often overlooked when surgeons are looking for an ideal suture material. This study aimed to investigate the mechanical properties of monofilament suture materials used in oral and maxillofacial surgery under diverse knot configurations. A custom-made experimental platform and a microtensile test device were used to evaluate the mechanical properties of the tested subjects. There were 2 predictor variables: suture material and knot configuration. Three types of nonabsorbable and monofilament suture materials with 4-0 gauge, including nylon, polypropylene, and polytetrafluoroethylene, were tested. Four different knot configurations-a surgeon's knot square plus a square knot (2=1=1), a surgeon's knot granny plus a square knot (2×1=1), a reverse surgeon's knot granny plus a square knot (1×2=1), and a reverse surgeon's knot square plus a square knot (1=2=1)-were also used with each of the suture materials. The tensile strength (N) and elongation (μm) of each sample were measured as the outcomes. The data were statistically analyzed using 2-way analysis of variance and Tukey's honestly significant difference tests. The significance level was set at P<.05. Overall, 120 samples were tested. Statistical analysis revealed that the highest tensile strength (28.6N) was found for nylon in the surgeon's knot square plus a square knot (P<.05). Polypropylene showed a similar high tensile strength value (24.7N) in the reverse surgeon's knot granny plus a square knot (P>.05). Polytetrafluoroethylene demonstrated significantly lower values for both tensile strength in tested configurations (within the range of 5.2-8.5N). Under diverse configurations, polypropylene suture samples offered the most stable tensile strength and elongation. The present study demonstrated that different knot configurations might improve the mechanical profile of commonly used monofilament suture materials. The surgeon's knot square (2=1), commonly used by surgeons worldwide, proved to be the most beneficial knot configuration in this study in terms of tensile strength and elongation. Further research on optimal knot configuration may be just as important as seeking an ideal suture material.

Minute Colon Perforation by a Nonabsorbable Suture Knot after Uterine Myomectomy

We report a rare case of suture material-related colon perforation. A 60-year-old woman visited clinics because of the nonspecific abdominal discomfort for several months. There were no specific medical history except previous laparoscopic myomectomy 15 years ago. Colonoscopy and abdomen-pelvis computed tomography revealed an unknown foreign body penetrating the sigmoid colon wall adjacent to the uterus. We performed laparoscopic exploration with foreign body removal and primary colon wall repair. The foreign body was identified as a non-absorbable suture material suggestive of used in previous myomectomy. With recent trends for minimally invasive procedures in the field of pelvic organ surgery, surgeons, especially those without sufficient training have to pay attention to selecting the proper surgical suture materials. (Ewha Med J 2022;45(3):e7)

Vesicovaginal fistula with bladder and vaginal stone.

IntroductionIn developing countries, Vesico-vaginal fistula (VVF) results following obstetric trauma or iatrogenic during hysterectomy. Large calculus associated with VVF is relatively rare, with the risk factor are presence of foreign body, urinary tract infection, and prolonged duration of disease. Most bladder stones can be found among patients who are bedridden, indwelling urethral catheter, bladder outlet obstruction, infection, and other similar characteristic. We report a case of VVF with bladder and vaginal stone in 37 years old woman and reviews the evaluation and treatment and highlights the role of the healthcare team in managing patients with this condition.Presentation of caseA 37-year-old, P2A0, woman with a history of hysterectomy three years ago. Intermittent small amounts of watery vaginal discharge developed 1,5 years after the operation. A physical examination revealed mild tenderness over the suprapubic area and no evidence of uterine prolapse. Cystography computed tomography scan with contrast confirmed a fistula vesicovagina with a connection between posterosuperior wall of vesica urinaria and anterosuperior wall of vagina with vesicolithiasis, size 15 × 26 × 14 mm and two vaginal stone with size of 7 × 12 × 17 mm and 4 × 4 × 5 mm. Cystoscopy revealed a grayish stone identified in supratrigone with size of 30 × 12 mm.DiscussionA hanging intravesical stone on the dome of urinary bladder is scarce, possibly caused by any synthetic and non-absorbable suture material inside of the bladder were encrusted forming a bladder stone. Important risk factors known, which is specific in developing countries, are poor socioeconomic status, malnourishment, low literacy rate, early marriage and childbearing, and inadequate obstetrical care.ConclusionAlthough the incidence of VVF accompanied by hanging vaginal stone and a large bladder stone is scarce, reports of any case regarding this study can be beneficial to other studies. Due to its harmful effect, the usage of non-absorbable sutures material during surgery isn't suggested. Hence, the absorbable suture material usage with careful dissection is suggested for any gynecological or pelvic surgery.

New surgical model to induce irreversible liver fibrosis by surgical closure of major duodenal orifice in dogs

This study was conducted to induce and evaluate irreversible hepatic fibrosis in dogs by surgical closure of the major duodenal orifice. The study was performed on six healthy local adult dogs. Irreversible hepatic fibrosis was surgically induced in all animals by surgical closure of major duodenal papilla using non-absorbable suture material for 60 days. Induced hepatic fibrosis was evaluated by clinical, ultrasonographical examination, laboratory and histopathological methods. The clinical manifestation of the jaundiced dogs showed reduced food intake, pale-yellowish mucus membrane, inflammatory signs of wound site and severe post-operative pain. Biochemically, there was significant increased values of the aspartate aminotransferase , alkaline phosphatase , alanine aminotransferase , indirect bilirubin, direct bilirubin and total bilirubin especially during first two days after surgery followed by a gradual decrease of these values until the end of the but still higher than normal values. Ultrasonographic examinations showed abnormal change in the liver tissue such as increase in both size and wall thickness of the gall bladder and mottled heterogeneous appearance of the liver during the first two weeks following the surgical induction of the hepatic fibrosis and lasted until the end of the study. Histopathological evaluation of liver samples revealed necrosis of hepatocytes and deposition of eosinophilic material, infiltration of inflammatory cells, recent thrombus in the hepatic vein, fatty change. In conclusion, surgical induction of irreversible hepatic fibrosis in dogs was feasible technique by surgical closure of major duodenal papilla and the results were confirmed by the clinical, ultrasonographical, laboratory and histopathological examination.

Effectiveness of Bovine Tunica Vaginalis Powder in the Prevention of Tendon Adherence Following Tendon Repair Process in Bucks

The current study was designed to investigate the efficacy of lyophilized bovine tunica vaginalis powder on peritendinous adhesion of induced defect in superficial digital flexor tendon (SDFT) in goats. The study was carried out on 18 adult bucks, the surgical procedure was done under highly aseptic conditions. Prior to surgery, animals were sedated by intramuscular injection of 2 % xylazine in a dose 0.5 mg/kg body weight, then the site of the operation is anesthetized by linear infiltration of 2% lidocaine hydrochloride. The surgical incision is made on the skin on the palmer surface of the metacarpal bone of the left forelimb to expose the (SDFT), a (0.1 depth, 0.2 width, and l Long) cm defect is made on the exposed tendon, this gap is filled with drops of sterile normal saline in (9) animals, and mentioned as a control group, while the gap of the rest (9) animals is filled with the lyophilized powder as treated group. Subcutaneous tissue was closed using absorbable suture material by simple continuous suture technique, and a simple interrupted suture mattress using non-absorbable suture material for closing the skin. The macroscopic findings exhibited a significant difference in adhesion scores between the 2nd, and 3rd periods of assessment post-operation in the first and second groups, with no significant differences between groups. The conclusion of this study is the tunica vaginalis scaffold has no obvious effect on decreasing adhesion between a tendon and surrounding tissues.