Closure Of Perforation Research Articles (Page 1)

Investigate frequency-specific audiometric outcomes following tympanoplasty without ossiculoplasty using different grafting materials and techniques. A multi-institutional review of patients who underwent tympanoplasty via either medial or lateral graft techniques from May 2017 to August 2022 was performed. Frequency-specific audiometric outcomes were analyzed using multivariable logistic regression. A total of 88 patients (93 ears) met criteria (mean age 46 years). Median follow-up was 6.7 ± 6.1 months. Perforation closure was achieved in 87% cases and did not vary between graft materials. Loose areolar fascia (LAF) was used in 32% of tympanoplasties (N = 30) and temporalis fascia (TF) in 48% cases (N = 45). Compared to TF, LAF was associated with better low-frequency (500 and 1 kHz) pure-tone average (PTA) improvement (12.4 dB vs 1.6 dB, P < .001) and air-bone gap (ABG) closure (11.4 dB vs 1.6 dB, P = .003). PTA improvement and ABG closure were superior in medial technique cases compared to lateral technique (P < .001for both). When considering only medial underlay technique, ABG closure were comparable for both grafting materials (9.5 dB in LAF vs 10.5 dB in TF, P = .7). Multivariable logistic regression accounting for graft material, identified surgical technique as a significant predictor of postoperative audiometric outcomes. Loose areolar fascia may be associated with better low-frequency hearing than TF following tympanoplasty. However, when using only medial underlay technique, both materials offered similar improvements, suggesting surgical technique may be more crucial than the choice of grafting material.

S4350 Boneless but Not Harmless: Endoscopic Closure of Steak-Induced Upper Esophageal Perforation

Comparison of tympanostomy tube insertion with and without radiofrequency ablation eustachian tuboplasty for treating chronic otitis media with effusion.

Comparative outcomes between endoscopic and microscopic approaches in pediatric type-1 tympanoplasty.

Traction clip closure of small bowel perforation during single-balloon enteroscopy in a patient with surgical altered anatomy

Anatomical success of myringoplasty using platelet-rich fibrin membrane in pediatric patients: A prospective study.

PurposeThis study investigates risk factors for recurrence in patients who underwent laparoscopic primary closure (PC) for pyloroduodenal ulcer perforation (PUP).MethodsWe retrospectively analyzed data from patients who underwent laparoscopic PC with or without highly selective vagotomy (HSV) for PUP at a tertiary hospital from 2010 to 2019. Demographics, surgical outcomes, proton pump inhibitor (PPI) use, Helicobacter pylori status, and endoscopic findings were reviewed. Long-term (5 years) endoscopic and clinical outcomes regarding ulcer and perforation recurrence, were collected.ResultsA total of 139 patients were included in the analysis. Of these, 109 (78.4%) were male, and 76 (54.7%) were current smokers. Ninety-five patients (68.3%) underwent PC only, while 44 (31.7%) received PC + HSV. During the follow-up period, ulcer recurrence was observed in 19 patients (13.7%) and perforation recurrence in 9 (6.5%). In Cox proportional analysis for ulcer recurrence, smoking (hazard ratio [HR], 6.476; 95% confidence interval [CI], 1.834–22.873; P = 0.004) and older age (HR, 1.049; 95% CI, 1.012–1.088; P = 0.009) were identified as significant factors. For peptic ulcer perforation recurrence, smoking (HR, 19.129; 95% CI, 2.048–178.702; P = 0.010) and older age (HR, 1.062; 95% CI, 1.009–1.118; P = 0.021) were significant. No significant associations were found between sex, duration of PPI therapy, H. pylori eradication success, or surgery type and the risk of either ulcer or perforation recurrence.ConclusionSmoking and age are important factors for recurrence following laparoscopic PC for PUP. These findings emphasize the need for smoking cessation and close postoperative monitoring.

Internal closure of a posterior perforation using amniotic membrane: A novel surgical technique

BACKGROUND Necrotizing enterocolitis (NEC) is a prevalent, life-threatening gastrointestinal disease in premature neonates, characterized by intestinal inflammation, ischemia, and potential perforation. Protective measures such as ostomies of various types are a strategy to help patients during recovery from postoperative complications. Protective jejunostomy (PJ) in such cases aims to minimize intraluminal pressure and protect distal anastomoses or compromised bowel segments. However, the optimal timing for closure remains a matter of debate, between balancing bowel rest and avoiding complications associated with prolonged ostomies. CASE REPORT We report an unusual case of a 6-month-old female patient, who presented with NEC and extensive intestinal compromise. Emergency laparotomy revealed multiple areas of bowel perforation and partial ischemia without perfusion. Surgical management included selective resection of non-viable bowel segments, primary closure of smaller perforations, creation of a PJ, and a distal ileostomy. The "clip and drop" technique was not used; instead, distal bowel patency was confirmed by a second intraoperative assessment and through intestinal saline solution injection on the tenth postoperative day due to high stoma output and persistent hydroelectrolyte imbalance. Postoperatively, the patient developed 2 new ileal perforations, requiring reoperation. Following the third surgical intervention, the patient demonstrated gradual recovery without major complications, followed by elective ileostomy closure after 6 months. CONCLUSIONS This case highlights the complexity of the surgical option and timing of PJ closure in complicated NEC in a 6-month-old female patient. Early closure can mitigate complications related to the stoma but carries the risk of compromising the fragile and recovering intestine. Decision-making must be careful and individualized, balancing the risks and benefits.

Intraoperative closure of a large colonic perforation using dual adjustable instrument and channel endoscopy

Background. Closure of a gastric ulcer perforation is often accompanied by the development of severe complications, one of which is incompetence. Purpose of the study. To evaluate the indicators of biochemical blood analysis when using sutureless methods for closing a gastric ulcer perforation. Material and methods. Blood parameters of the laboratory rats after the repair of gastric ulcer perforations when using various methods were studied. Conclusions. It was established that there was no general toxic effect when using fluoroplastic-4 and fibrin glue “Fibrinostat” for sutureless sealing of gastric ulcer perforations.

Background: Tympanoplasty is a surgical procedure performed to repair a perforated tympanic membrane and restore hearing function. Understanding the risk factors associated with graft failure or recurrence is crucial for optimizing surgical outcomes. This retrospective study aimed to analyze the outcomes of tympanoplasty and identify potential risk factors using a tertiary center experience.Methods: A retrospective cohort study was conducted using medical records from King Abdulaziz Medical City in Jeddah. Patients who underwent tympanoplasty surgery between 2017 and 2023 were included. Demographic characteristics, clinical factors, and surgical outcomes were analyzed using descriptive statistics and statistical tests.Results: Among 71 fascia tympanoplasty procedures, the success rate was 83.1%. Among 38 patients with post-operative hearing assessment, 57.9% showed improved hearing gap. Age at the time of surgery and post-operative decibel levels were significantly associated with hearing improvement. Post-operative residual perforation occurred in 16.9% of patients and was associated with changes in hearing gap. Most patients had successful graft uptake. The procedure was safe, with a low incidence of complications.Conclusion: Fascia tympanoplasty demonstrated favorable outcomes in terms of success rate, hearing improvement, graft uptake, and safety. Age and closure of residual perforation were identified as significant factors influencing the surgical outcome. However, the study had limitations such as its retrospective design and the small sample size. Further research with larger sample sizes and prospective designs is needed to confirm these findings and optimize the management of tympanic membrane perforations.

Summary:Nasal septal perforation (NSP) closure is a challenging procedure. In the case of a large NSP, it may be necessary to use tissue from outside the nose; therefore, the decision to perform NSP closure should be made carefully. The indication for NSP closure is whether the patient has nasal symptoms due to the NSP; however, the causes of nasal obstruction are diverse and can be difficult to determine. We performed the septal patch test (SPT) as a simple examination to determine if NSP closure will improve nasal symptoms. The septal patch is created by cutting a piece of filter paper slightly larger than the NSP and adjusting it for a proper fit. Two septal patches are prepared and used to cover the NSP from both the left and right nasal cavities. Nasal breathing symptoms are evaluated using a visual analog scale (N-VAS) before and 3 minutes after SPT. We evaluated 6 cases of NSP. The average N-VAS score was 1.5 preoperatively, 8.16 after SPT, and 8.16 postoperatively. The maximum and minimum NSP sizes were 35 and 5 mm, respectively. Nasal symptoms after SPT were similar to those after NSP closure. We believe that SPT is useful for evaluating the symptom-relieving effects of NSP closure procedures. If a patient with nasal obstruction also has an NSP, performing SPT alongside other assessments may help identify the cause of the nasal obstruction.

Introduction. The article addresses the issue of selecting effective materials for tympanoplasty – the surgical restoration of the integrity of the tympanic membrane in cases of chronic purulent tubotympanic middle otitis. The challenge of choosing an effective plastic material (graft) remains unresolved among otosurgeons globally. The primary reason for this issue is that there are no tissues in the human body analogous in structure to the tympanic membrane.Aim. To conduct a literature review on materials used in tympanoplasty for the closure of tympanic membrane perforations and the formation of a neotympanic membrane, as well as a comparative analysis of their characteristics and properties. Materials and methods. A literature review on tympanic membrane surgery was conducted. The review includes data from surgical guidelines on middle ear surgery.Results and discussion. Various types of grafts are discussed: autografts (such as the fascia of the temporal muscle and perichondrium of the tragus), allografts (including the dermal matrix AlloDerm), xenografts (such as bovine and equine pericardium), and other non-biological materials. A critical part of the study involves comparing different materials concerning their physical and anatomical properties similar to those of the tympanic membrane. The advantages and disadvantages are analyzed. The article discusses engraftment, mechanical compatibility with the tympanic membrane, provides comparative statistics on the long-term outcomes of tympanoplasty using various types of grafts, and the possibility of their use in complex clinical cases.Conclusion. The authors emphasize the need for further research to determine the most effective and safe materials for tympanoplasty, which will enable sustainable results in hearing restoration and prevent disease recurrence. Thus, the article presents a comprehensive analysis of the problem of selecting materials for tympanoplasty, substantiating the need for an individualized approach in each clinical case, with a focus on the biological, physical, and functional aspects of the materials used.

Objective: To investigate the clinical and paraclinical characteristics of patients with perforated duodenal ulcers and to evaluate the outcomes of single-port laparoscopic closure of the perforation. Subject and method: A cross-sectional descriptive study combined with a prospective interventional longitudinal follow-up was conducted on 87 patients with perforated duodenal ulcers who underwent single-port laparoscopic closure from January 2021 to January 2024. Result: Among the 87 patients, the mean age was 52.3 ± 10.7 years, with males accounting for 60.9%, primarily in the 41-60 age group (51.7%). A history of peptic ulcer disease was the most common comorbidity (36.8%). In 79.3% of cases, symptoms began abruptly within 12 hours, with abdominal pain (97.7%) and peritoneal signs (92.0%) as the predominant features. Most patients were classified as Boey score 0 (80.5%). The perforation was located on the anterior duodenal bulb in 63.2% of cases, with a size of 5-10 mm in 66.7%. Diagnosis was mainly based on upright abdominal X-rays (74.7%) and CT scans (67.8%). Closure was performed using an X-stitch in 63.2% of patients, with drain placement in 97.7%. The mean operative time was 74.5 minutes. The complication rate was low (4.5%), and no mortality was reported. Conclusion: Duodenal ulcer perforation predominantly affects middle-aged men and typically presents with classic clinical symptoms and a short onset time. Simple suture closure combined with drainage via single-port laparoscopy yields favorable surgical outcomes.

Endoscopic closure of full-thickness transverse colon perforation with sequential over-the-scope clips including retroflexed deployment

Aim: To share first-hand experience in the surgical treatment of newborns with isolated gastrointestinal perforations. Materials and Methods: This study examines 71 newborns with perforated peritonitis: 53 (74.65%) had necrotizing enterocolitis, 14 (19.72%) had isolated gastrointestinal perforations, and 4 (5.63%) had other intestinal perforations. Diagnosis involved clinical, laboratory, radiographic, ultrasound, and histological examinations of surgical and autopsy samples. Results: The most significant risk factors for isolated perforations of the gastrointestinal tract in newborns were acute birth asphyxia and pathology of the respiratory system, which required tracheal intubation in 100% of children. Isolated perforations were localized in the stomach (n=6), jejunum (n=3), ileum (n=2), duodenum (n=1), colon (n=2). Morphological features of isolated perforations are as follows: a rapid muscle layer wasting of the wall, sometimes with the absence of muscle fragments; vascular malformations in the submucosal layer of the wall; ulcerous defect without necrotic changes; absence of pneumatosis of the intestinal wall. In isolated perforations, the operation of choice was closure of perforation in 11 children. In 2 patients direct interintestinal anastomoses were performed. Case mortality rate was 21.43% (3 newborns died). Conclusions: 1. Clinical and pathomorphological features of gastrointestinal perforations in newborns indicate that isolated perforations are a separate nosological entity. 2. Isolated perforations of the gastrointestinal tract in newborns are characterized by such clinical differences as distress syndrome, prematurity, early onset, local lesions of a hollow organ, moderate peritonitis, favorable course and prognosis. 3. Isolated perforations are secondary to fibromuscular dysplasia of the wall of a hollow organ, indicating congenital pathology. 4. The operation of choice for isolated perforations is the excision of the edges of the perforation and closure of the perforation. 5. The prognosis for the gastrointestinal isolated perforations is favorable. Mortality was 21,43%.

The annual increase in the number of operations for the curvature of the nasal septum is accompanied by a proportional increase in the number of complications, for example, the development of nasal septum perforation (NSP). The frequency of NSP detection varies from 0.5% to 8%. In 60% of cases, NSP is defined as iatrogenic and is the result of surgical treatment or injury to the nose. In 12-47% of cases, NSP is idiopathic and develops as a result of chronic subatrophic rhinitis, uncontrolled use of intranasal decongestants and topical glucocorticosteroids, and in rare cases it is a manifestation of systemic diseases. The tactics of surgical treatment of NSP is a highly debatable issue. Historically, the treatment of nasal septum defects has evolved from the lengthening of small "whistling" perforations to the development of autoloscutes of the mucous membrane to perform plastic closure of nasal septum perforation. Studies conducted over the past 20 years have shown that the use of displaced vascularized mucosal flaps is the most effective method of surgical treatment of NSP. The effectiveness of this approach over the past 10 years has ranged from 70% to 90%. However, plastic closure of perforation with mucosal flaps is a very complex and labor-intensive process, it is possible provided the surgeon is highly qualified and has extensive experience, and careful care is provided during a long rehabilitation period. Modern research on the treatment and rehabilitation of patients with NSP is aimed at improving the effectiveness of the surgical stage, simplifying the surgical procedure, and shortening the rehabilitation period through the use of transplant materials and cellular technologies. Based on this, the purpose of our work was to analyze domestic and foreign studies on the use of biotechnological approaches in the closure of nasal septum defects.

An innovative method of endonasal closure of postoperative perforations of the nasal septum is presented, which is based on the use of a mucoperiosteal flap formed on the branches of the superior labial artery. Since 2023, the described technique has been used in 15 patients (average age 43 years). The duration of postoperative follow-up varies from 4 to 9 months. The assessment of the quality of life of patients before and after surgery was carried out using the SNOT-22 questionnaire. The average duration of the operation was 60 minutes. In 14 (93.3%) of the 15 patients, complete anatomical closure of the perforation was achieved. Complete healing of the donor area was noted 1 month after the operation. There were no postoperative complications (bleeding, infections). The average score for SNOT-22 decreased from 42.3±1.65 to 12.02±2.30 points 3-6 months after surgery (p<0.05), indicating a significant improvement in the quality of life of patients. The high efficiency of the proposed method is demonstrated. The technical accessibility and prospects for wide application in surgical practice are noted. Further studies in large groups of patients are needed to definitively determine the place of this method in surgery for closing nasal septum perforations.

Successful delayed endoscopic management of dislocated hepaticogastrostomy stent with self-expanding metal stent and esophageal perforation closure.