Plication Procedure Research Articles

Congenital penile curvature presenting as unconsummated marriage. Repair by 16-dot plication with subjectively reported patient and partner satisfaction

ObjectiveTo evaluate self-reported patient and partner satisfaction in cases of unconsummated marriage due to congenital penile curvature that was treated by the 16-dot plication procedure. Patients and methodsFrom March 2008 to March 2012, 24 couples presented to our institute with an unconsummated marriage due to congenital penile curvature. All patients were treated using the 16-dot plication operation. Patients were followed up for 3months and were asked, with their partners, to complete a specific questionnaire to evaluate their satisfaction with the outcome of the operation. ResultsThe duration of unconsummated marriage was 2–12weeks. The mean (SD, range) angle of penile curvature was 57.4 (20.3, 30–110)°. All patients were able to consummate their marriage within a mean (SD, range) of 5.3 (1.3, 4–8) weeks after surgery. The overall satisfaction rate with the outcome of the operation among patients was nearly 100% for ‘moderately satisfied’ or greater, and among their partners was nearly 96% for ‘moderately satisfied’ or greater, at 3months. ConclusionThe 16-dot plication technique is an easy procedure for the emergent correction of congenital penile curvature presenting as an unconsummated marriage. Most patients and their partners were pleased with the outcome of the procedure.

Modified thoraco-mediastinal plication (Andrews thoracoplasty) for post-pneumonectomy empyema: experience with 30 consecutive cases†

The aim of our study is to evaluate the results of thoraco-mediastinal plication for the treatment of post-pneumonectomy empyema. From 1 January 1985 to 1 January 2011, 30 patients underwent post-pneumonectomy empyema through a modified thoraco-mediastinal plication procedure (Andrews thoracoplasty). Indications for pneumonectomy included cancer (25 cases), tuberculosis (3 cases), and bronchiectasis (two cases). Rib resection was performed according to the topography of the cavity, ranging between 5 and 10. Neighbourhood muscle flaps were used in 22 cases but extensive mobilization was performed only in our last 4 cases, the aim of the procedure being the complete obliteration of the infected space. Bronchial fistula was present in 14 cases and was closed and reinforced with the use of flaps (intercostal 12 cases, serratus 1 case, and omentum 1 case). Overall mortality was 6.7% (2 cases); 2 patients (6.7%) presented with recurrence of the empyema requiring an open-window procedure and another patient (3.3%) presented with local tumoral recurrence. Intensive care unit hospitalization ranged between 1 and 14 days, with a median of 4 days, while overall postoperative hospitalization ranged between 23 and 52 days with a median of 32 days, the patients being discharged with healed wounds. Kaplan-Meier analysis of the oncologic patients showed a median survival of 41 months from thoraco-mediastinal plication. The presence of bronchial fistula had no statistically significant impact on the immediate outcome (mortality, need for postoperative prolonged mechanical ventilation, intensive care and overall postoperative hospitalization, P > 0.05 for all the parameters). Space-filling procedures are a valuable option for treating post-pneumonectomy empyema. The major advantages are the complete obliteration of the infected space and the quick healing from a single procedure; the major disadvantages are the magnitude of the procedure (with associated mortality and morbidity) and the permanent chest mutilation. Several technical details may improve the results and reduce the chest wall mutilation.

Update on plication procedures for Peyronie’s disease and other penile deformities

Plication techniques are not a panacea for deformities associated with Peyronie's disease or congenital curvature. However, they do provide certain advantages, both theoretic and real, over competing procedures such as grafting. Depending on the technique, plication procedures have minimal risk of de novo erectile dysfunction, minimal risk of injury to the dorsal neurovascular bundle, and may be used for a variety of angulation deformities, including multiplanar curvature and severe degrees of curvature. A variety of incisions may be used, including the classic circumcision with degloving but also ventral raphe, dorsal penile inversion, and penoscrotal. These may be helpful in preventing postoperative morbidity and in sparing the prepuce if desired. Plication may also be combined with procedures such as penile prosthesis for correction of residual curvature. Lastly, despite its complications, plication techniques are very well tolerated, are relatively simple to perform and result in the very high satisfaction rates.

Book Review: Neck Rejuvenation

Richard Gentile, editor. Neck Rejuvenation. New York, NY: Thieme, 2011. ISBN-10: 1604060565 Neck Rejuvenation , edited by Richard Gentile, is a comprehensive review of aesthetic surgery treatments for the neck. The text includes 173 pages and 12 chapters written by 13 authors. Although two coauthors are plastic surgeons, the writers are primarily facial plastic surgery specialists, perhaps making it particularly important reading for our specialty. The book clearly bears the footprint of its editor, Dr. Gentile, since he authored or coauthored five of the 12 book chapters. Strengths of the publication include its comprehensiveness. Individual chapters are devoted to anatomy, patient consultation, and preoperative evaluation as well as to discussions on a wide variety of procedures addressing the lower face and neck. This includes liposculpture, SMAS imbrication and plication procedures, direct excision of neck skin, and submental platysmaplasty techniques performed either as isolated procedures or concurrent with facelift surgery. There is very little that this book does not cover in aesthetic surgery of the lower face and neck. Drilling down into the content of each chapter, the quality is sometimes mixed. As is so frequent in textbooks authored by multiple surgeons, topics are occasionally redundant. On the positive side, the majority of authors do a fine job in reviewing …

Left Atrial Reduction Plasty: A Novel Technique

We describe a novel technique of left atrial volume reduction in a patient presenting with severe dyspnea from severe mitral insufficiency, giant left atrium, and compressive symptoms of dysphagia and dysphonia. Resection involved circumferential excision of the left atrium anterior to the pulmonary venous vestibule and posterior to the mitral valve and fossa ovalis, including the left atrial appendage. A chordal-sparing bioprosthetic mitral valve replacement, tricuspid valve annuloplasty, and coronary bypass were also performed. Significant reduction of left atrial volume by 50% was achieved and clinical resolution of compressive symptoms was seen at 6-month follow-up.

Barrett's esophagus: endoscopic treatments I

The following on endoscopic treatments of Barrett's esophagus includes commentaries on indications for endoscopic treatments; endo-luminal plication procedures; the cellular modifications induced by the endoscopic ablation therapies; eradication by banding without resection; the evaluation of complete ablation; recurrence after ablation; association of antireflux surgery; radiofrequency ablation; and nondysplastic Barrett's esophagus.

Management of Peyronie’s Disease in the Aging Male

Peyronie’s disease (PD) is an acquired inelastic scar of the tunica albuginea of the penis, resulting in penile pain, curvature and other deformities, and sexual dysfunction, as well as significant psychological morbidity and relationship/partner issues. Contemporary data suggest an incidence of one in 20 men, with peak occurrence between ages of 50–55 years. Initial diagnosis of PD is made by thorough medical history and examination of the external genitalia; early referal to an urologist experienced in PD management is recommended. Evidence for nonsurgical treatment options is limited; the most commonly used, vitamin E, has not been shown to have benefit over placebo. Recent double-blinded placebo-controlled evidence suggests a role for oral pentoxifylline as a first-line agent. Intralesional injection therapy with verapamil is a frequently utilized option, as first- or second-line treatment, or in combination with other modalities. IFN-β2binjections into the penile plaque have also shown benefit over placebo in decreasing penile curvature, plaque size, penile pain and plaque density. Penile traction is currently under investigation for a potential role in PD management. The gold standard treatment for clinically significant deformity after PD has stabilized remains surgery. Several surgical options are available, including minimally invasive plication procedures, incision of the plaque and grafting or a penile prosthesis (when concurrent treatment-resistant erectile dysfunction is present).

Gastric plication: preclinical study of durability of serosa-to-serosa apposition

Background Vertical gastric plication is a novel surgical approach for reducing the stomach capacity. Anterior surface plication and greater curvature plication are variations of vertical gastric plication that reduce the gastric capacity through infolding of the anterior surface or greater curvature of the stomach, respectively. These approaches have been tested, with positive results in a small number of preclinical and clinical trials. A key step toward greater investigation of vertical gastric plication as a viable bariatric procedure would be confirmation that the apposed serosal tissues can be securely and durably bonded. We compared the short-term durability of gastric plications and serosal bonds using a variety of fastening devices and techniques in a university hospital and private company setting. Methods A total of 30 anterior surface plication and 8 greater curvature plication procedures were performed using an open or a laparoscopic surgical technique in 38 hound dogs. The fastening devices used were T-tags, buttressed T-tags, 2 types of suture, and 4 types of staple-based fasteners. The density of the fastening devices was varied among the dogs. With 3 exceptions (2 in keeping with the study design and 1 due to complications), the dogs were followed up for 8 weeks. Histologic examinations and tensile testing were performed postmortem. Results All fastening devices created durable plication folds, except for 1 technique. The only technique that did not produce durable serosa-to-serosa adhesions was a staple/suture combination. Intentional abrasion of the apposed sites had no demonstrable effect on the bonds between the tissues in any group. Increasing the fastener density and number of rows increased the adhesions within the folds. Conclusion Our findings have confirmed the short-term durability and development of dense fibrous appositions of the serosal folds for fastening approaches that create fixed serosal apposition. Additional studies are needed to identify the optimal fastening modality for anterior surface plication, greater curvature plication, and, ultimately, clinical applications of this procedure.

Thoracoscopic diaphragmatic plication in small infants

Introduction: Diaphragmatic eventration often causes progressive dyspnea on exertion or respiratory infection in small children, especially those under 2 years of age. Diaphragmatic plication by minimally invasive surgery is evaluated for quick recovery and has been performed on small children. Methods: Nine patients ranging in age from 1 to 33 months and in weight from 3 to 12 kg were treated by thoracoscopic diaphragmatic plication. Six of them needed preoperative support from a respirator or nasal directional positive airway pressure. Three patients had congenital heart disease with right-to-left shunt. The operations were performed with three ports. We put the optical port at the sixth intercostal space and had enough view with artificial pneumothorax at 4 mmHg using carbon dioxide. Single-lung ventilation was never used. The redundant diaphragm was pulled and plicated with non-absorbable 3-0 sutures. Results: The thoracoscopic approach was successful in all nine patients. No conversion was needed. All patients were recovered well postoperatively, except for one patient with a pneumothorax. The patients who needed respiratory support before the operation no longer required it within 8 d of surgery. Conclusion: In conclusion, we showed the feasibility of performing the thoracoscopic plication procedures on small infants. In our series, six out of nine patients were <6 kg and four of them were as young as 1 month old. We placed the optical port near the diaphragm, and this may have been a major factor in helping the surgery succeed. In conclusion, early thoracoscopic plication should be considered even for the small infants with diaphragmatic eventration.

Transoral gastric volume reduction for weight management: technique and feasibility in 18 patients

Background Endoluminal suturing to reduce the gastric volume might provide an additional option for the treatment of obesity. Potential advantages of a nonoperative endoluminal intervention include less pain, the ability to perform it as an outpatient procedure, and a high level of patient acceptance. The purpose of the present pilot study was to demonstrate the feasibility and procedural safety of transoral gastric volume reduction (TRIM procedure) using the Restore Suturing System in patients with a body mass index of 30–45 kg/m 2. Successful completion of the procedure and adverse events were evaluated at academic/university hospitals. Methods This was a nonrandomized feasibility study performed at 2 institutions. After institutional review board approval, the patients underwent the TRIM endoluminal gastric plication procedure with the Restore Suturing System (Restore device). Gastric plications were completed to approximate the anterior and posterior gastric walls to achieve restriction of the upper stomach. The number and location of successful plications were recorded, and patients were monitored for complications. The present report described the short-term procedural results (≤24 hours after the procedure) of the studied cohort. Results A total of 18 patients were enrolled in the present study. The TRIM procedure was successfully completed in all patients, with placement of 4–8 plications (average 6 per patient). The average procedure time was 125 ± 23 minutes, and no serious or significant procedure-related complications occurred. After the procedure, common patient complaints were nausea, vomiting, and abdominal discomfort. The first 10 patients enrolled were kept overnight according to the study protocol, and the remaining 8 patients were discharged on the day of the procedure. Conclusion Endoluminal suturing using the TRIM procedure and the Restore device was technically feasible, and no serious or significant procedure-related complications were reported. Weight loss, co-morbidity improvement, and durability are under assessment.

Shoulder Instability in Patients with Joint Hyperlaxity

Generalized ligamentous hyperlaxity and glenohumeral joint instability are common conditions that exhibit a spectrum of diverse clinical forms and may coexist in the same patient. No single diagnostic test can confirm the presence of these disorders, and a careful clinical assessment is important. Unlike patients with traumatic shoulder instability, patients with hyperlaxity and instability are more likely to experience episodes of recurrent subluxation than they are to have recurrent dislocation. They are more likely to have instability in more than one anatomic plane, and they usually do not have the soft-tissue and osseous lesions associated with traumatic instability. Shoulder symptoms in a patient with hyperlaxity are not always due to instability; other pathological conditions may coexist, with rotator cuff impingement being the most common. Most patients with hyperlaxity have a reduction in instability symptoms after nonoperative treatment, including physical therapy, activity modification, and additional psychological support when necessary. Operative treatment provides reproducibly good results for patients with hyperlaxity who do not respond to a prolonged program of nonoperative measures. Open inferior capsular shift remains the gold standard of operative treatment, although arthroscopic capsular shift and plication procedures are now producing comparable results. Thermal capsulorrhaphy is associated with unacceptably high failure rates and postoperative complications and cannot be recommended as a treatment.

A novel modification of tunical plication by plaque thinning: long-term results in treating penile curvature of Peyronie’s disease

To investigate the efficacy of a novel modified tunical plication procedure in correcting penile curvature of patients with Peyronie's disease. Penile tunical plication was performed, combined with plaque thinning with carbide burs, and 18 patients were available for a long-term follow-up. Preoperative deformity and erectile capacity were accessed, and postoperative cosmetic and functional results were evaluated by physical examination, subjective satisfaction rate, and International Index of Erectile Function-5 questionnaire (IIEF-5). During the initial assessment after 6 months since surgery, complete straightening was achieved in 83.3% patients, and the residual curvatures in the three patients were within 20°. Satisfaction rate was 94.4% while one patient was partly dissatisfied with penile shortening, although the penile shortening occurred in 66.7% patients. No de novo erectile dysfunction was observed, and sexual function was significantly improved with the IIEF-5 scores increasing from 17.3 ± 4.1 to 20.9 ± 3.3 (P = 0.008). After a mean of 50.5-month follow-up (range from 29 to 72 months), although 22.2% patients reported curvature recurrence, neither the recurrence nor the penile shortening affected coitus, and 100% patients were satisfied with the results of the operation. The plication procedure modified by plaque thinning with carbide burs is safe and effective in treating penile deformity due to Peyronie's disease, which characterized in improving the life quality of patients.

The Plication and Splinting Procedure for Idiopathic Sclerosing Encapsulating Peritonitis

Idiopathic sclerosing encapsulating peritonitis (ISEP) is a rare cause of small intestinal obstruction. Histologically, ISEP is characterized by a thick fibrotic membrane encasing the small bowel without any apparent pathophysiological factors. While ISEP is predominantly present congenitally in female adolescents from subtropical region, it has been identified throughout the world. Evidence-based effective diagnostics and treatments are pitifully thin. We experienced six cases, four males and two females, which exhibited symptoms in their later thirties and forties. Five patients presented with acute and subacute intestinal obstruction, and one patient with cryptorchidism and seminoma was referred. Due to the limitation in distention and motility of bowel loops of ISEP, imaging exams may not be very reliable for accurate diagnosis and estimation of obstruction progress. They were successfully treated with the mesenteric plication and intraluminal splinting procedures. Two cases had an uneventful postoperative period, and the returns of normal bowel function were delayed in the other four patients. Two recurrences of small bowel obstructions were noted over a mean follow-up period of 33 months with mild symptoms. This article reviews the patterns of clinical presentations, diagnostic clues, and theories of potential risk factors of ISEP as well as its controversial surgical managements.

Long-Term Followup of Dermal Grafts for Repair of Severe Penile Curvature

There is some reluctance to use dermal grafts for augmenting the tunica albuginea to correct severe forms of chordee. The main concern is that by violating the integrity of the tunica albuginea venous leakage could presumably ensue and result in erectile dysfunction. We present our long-term followup of dermal grafts used to correct severe penile curvature associated with hypospadias or as an isolated malformation. A total of 16 patients received a single dermal graft harvested from the nonhair bearing inguinal skin fold. Patient age was 1 to 19 years (average 7). Of the patients 14 had hypospadias, which was scrotal in 12 and perineal in 2, while 2 had congenital penile curvature. In the hypospadias group 13 patients underwent primary repair and 1 had undergone 2 previously failed repairs with persistent severe curvature. Additionally, 5 patients in the hypospadias group had associated penoscrotal transposition. Eight patients in the hypospadias group received testosterone injections preoperatively. Average followup was 10 years (range 6 to 15). At the time of the study all patients were postpubertal and 3 had married. Evaluation of the results was based on patient interview reporting of penile straightness, erectile quality and satisfaction with sexual relations, if present. Two of the 3 patients who married reported satisfactory sexual activity and 1 had fathered children. The other 13 patients reported rigid erections. Two patients had mild residual curvature that would not necessitate any further intervention. Some boys with severe penile curvature, particularly those with hypospadias and a borderline size phallus, need a dermal graft rather than a plication procedure to correct curvature. Our study suggests that using dermal grafts is safe for erectile function.

Penisraffplastik zur Behandlung schwerer Penisdeviationen

Penile plication procedure was performed on 27 patients (median age 24 years) to correct marked penile deviation (mean deviation angle 50 degrees). On average 4 (2-10) sutures were necessary. Normal intercourse and potency was restored in all. 26 patients were fully satisfied with the result, while in three there were suture problems (fistula, granuloma). There was one recurrence, three weeks postoperatively, in a patient who failed to follow the recommended six-week period of sexual abstinence. But this recurrence was lastingly corrected by a second penile plication procedure. No lasting complications were noted a mean of 48 months postoperatively. This type of operation is the treatment of choice for significant penile curvature.

Pilot study to determine improvements in subjective penile morphology and personal relationships following a Nesbit plication procedure for men with congenital penile curvature

To determine whether the surgical straightening of congenital penile curvature can improve intromission comfort, penile features, personal relationships and psychogenic erectile dysfunction (ED). Fifty-four patients (mean age 24 years, range 20-31 years) whose congenital penile deviation due to physiological curvature was>or=25 degrees, as measured on a graph, and who were experiencing penetration discomfort were assessed specifically for the present study. Of these, 14 patients suffered from psychogenic ED. The assessment included a case history, an objective examination, a pharmacologically-induced erection with prostaglandin E1 10-20 g, a graph taken during erection, a basal and dynamic Duplex ultrasonograph, penile length measurement, nocturnal penile tumescence recording, hormonal profiles and a psychological interview to evaluate the quality of their personal relationships according to Hinde's parameters (contents, number, features, frequency, ability to perceive limits of mutuality, subjective perception of the other person[s], and reliability). All patients underwent the Nesbit procedure. The initial assessment was repeated at 3 and 12 months after surgery. Data analyses were carried out using the z test. Subjective judgement of cosmetic penile features and vaginal intromission comfort improved significantly after surgery whereas the quality of personal relationships and ED did not. The surgical straightening of congenital penile curvature improved intromission comfort and penile features, but it failed to improve interpersonal relationships or psychogenic ED.

Surgical management of Peyronie’s disease: Which operation?

Multiple treatment options are currently available for Peyronie’s disease (PD) and include minimally invasive interventions. Surgical treatments are considered the best option when the plaque proves refractory to these treatments, when penile curvature is severe, or when erectile dysfunction is vascular or mechanical. Most surgeons experienced in surgical management of PD use a wide range of procedures including plication procedures, plaque incision/excision with grafting, or implantation of a penile prosthesis. This article assesses the indications for surgery, the various surgical procedures available, when and to whom surgery should be offered, and the expected results and complications.

Satisfactory Results of Diaphragmatic Plication for Bilateral Phrenic Nerve Paralysis

Bilateral diaphragmatic plication was performed in a 44-year-old man who underwent complete resection of a thymoma infiltrating the right lung, bilateral brachiocephalic vein, pericardium, and bilateral phrenic nerves. The plication procedure allowed him to be weaned from the ventilator on postoperative day 4. He demonstrated no restrictive or obstructive pattern of lung function, and after respiratory rehabilitation he returned to work full time 5 weeks after the operation. The present results indicate that ventilatory movement of the thoracic cage can compensate for loss of bilateral diaphragmatic ventilation for at least 18 months.

Long-term patient satisfaction after surgical correction of penile curvature via tunical plication

To assess patient satisfaction and functional results at long term follow-up after surgical correction for Peyronie's disease (PD) and congenital penile curvature (CPC) with the technique of tunical plication. One hundred and two men operated for PD (n = 76) or CPC (n = 26) in four different departments of urology in public hospitals agreed to answer a six-question telephone questionnaire about treatment satisfaction. Tunica albuginea plication procedures represented the standard surgical approach. Subjects under investigation were correction of the deformity, feeling of bumps under the skin, pain during erection, penile sensory changes, development of erectile dysfunction (ED) and postoperative ability for complete vaginal intromission. Subjective response rates were compared using the chi square test on the basis of the etiology of the disease (CPC or PD). Significant differences (p < 0.05) between patients with CPC and PD were noticed in the prevalence of postoperative penile deformity, sensory changes, ED and ability to complete vaginal intromission, PD patients always showing a more pessimistic view. No significant differences (p = ns) were detected in terms of unpleasant nodes under the penile skin or pain during erection. Long-term outcome after surgical correction for PD and CPC with the technique of tunical plication can be poor. Probably patient expectations are above the real performance of surgical techniques. Preoperative information should be more exhaustive.

Peyronie's Disease: State of the Art and Future Perspectives

Peyronie's disease (PD) is characterized by the onset of a fibrous plaque within the tunica albuginea of the penile corpora cavernosa, resulting in pain and bending during the erection, which can make the intercourse difficult or impossible. Evidence from literature supports the autoimmune etiology of PD, and suggests genetic and familiar conditions, penile traumatisms and history of genital tract diseases as risk factors, even though no definitive conclusions arise about the pathogenesis of the disease. Few randomized trials demonstrated that medical therapies, such as Vitamin E, Colchicine, Potassium amminobenzoate, Tamoxifen and injection therapy with Verapamil are effective in stabilizing the acute phase of the disease. Extracorporeal shock wave therapy (ESWT) and ionophoresis cannot be considered as first line or gold standard therapies. Satisfactory results have been published about Nesbit operation in large number of cases with low-stage disease, whereas plication procedures have shown significant rates of relapse. High incidence of long-term penile retraction have been reported in high-stage disease treated with plaque incision and simple graft insertion. Malleable, soft or inflatable prostheses combined with graft implant have given the best results in terms of penile straightening and lengthening and patients’ satisfaction. In conclusion, the PD etiopathogenesis hasn't been clearly understood-yet, no medical therapy is fully effective; surgery remains therefore the gold standard in case of severe deformity and/or erectile dysfunction.