Plication Technique Research Articles

Lateral rectus resection versus lateral rectus plication in patients with residual esotropia

Background Muscle resection or plication is a common treatment for strabismus by strengthening the muscle. Lateral rectus muscle resection is a basic surgical technique for correcting residual esotropia. Plication approach is an alternative surgical technique to resection. Aim Is to compare the result of lateral rectus plication versus lateral rectus resection in patients with residual esotropia. Patients and methods This is a prospective, comparative, randomized interventional study which was carried on 40 eyes of 20 patients with residual esotropia All the patients underwent surgery to both eyes, they were divided into two groups according to surgical technique. Group A: 20 eyes of 10 patients underwent lateral rectus resection surgery. Group B: 20 eyes of 10 patients underwent lateral rectus plication. Results Postoperative success rate in two groups was 80% with main postoperative angle of deviation higher on group B. Conclusion Lateral rectus muscle plication technique is an alternative to resection that has the same effect as resection as obvious by the similar success rate that can be used on horizontal muscles especially when anterior ciliary vessel sparing is needed.

Integrating SMAS plication and deep plane techniques in facial rejuvenation: A novel approach

IntroductionIn the realm of facial rejuvenation surgeries, deep plane facelift and SMAS plication techniques have been applied with notable efficacy over an extended period, yielding aesthetically pleasing outcomes.Both methods have their own advantages and disadvantages depending on individual circumstances.We endeavored to formulate an effective facelift method by integrating both approaches, aiming to harness the advantageous aspects of each method while addressing their respective drawbacks in a comprehensive manner. MethodsFollowing the preparation of the subcutaneous plane overlying the fixed SMAS, the mobile SMAS was elevated from the deep plane, and a SMAS flap was fashioned.The SMAS flap in the prezygomatic and premasseteric areas was inwardly folded, and a plication procedure was applied using loop sutures from its most medial to lateral aspects. Subsequently, it was secured to the preauricular area with U stitches. The results were statistically evaluated preoperatively and postoperatively using WSRS scores. ResultsA total of 40 patients underwent operative procedures effectively performed by the senior author(F.C.). Preoperative WSRS scores were measured at 4.2 ± 0.52. Postoperative WSRS scores at 3 months were significantly lower at 1.25 ± 0.44 (p<0.05). The facelift procedure was effectively applied in all patients without the development of major complications. ConclusionsThis method combines deep plane facelift and surgical SMAS plication, utilizing the advantages of both techniques to directly address nasolabial folds and achieve gratifying outcomes in facial and neck rejuvenation.

A novel suturing technique for natural tissue repair in cystocele treatment

BackgroundRecently, natural tissue repair has become popular in the treatment of pelvic organ prolapsed. In this study, we compared patients who underwent cystocele repair with the rug-weaving plication technique, a natural tissue repair method implemented since 2022 for anterior prolapse, with those treated using conventional colporrhaphy.MethodsWe retrospectively reviewed the data of 65 patients who underwent anterior vaginal wall repair with the rug-weaving plication technique (n = 33, Group 1) or conventional colporrhaphy (n = 32, Group 2). We recorded the patients’ clinicodemographic and surgical data. At the 6-month postoperative follow-up, we assessed patients’ complaints, degree of prolapse (using the simplified Pelvic Organ Prolapse Quantification system), and pelvic floor muscle strength (using the Modified Oxford Score). Anterior vaginal wall thickness was measured using transvaginal ultrasonography. We compared clinicodemographic and surgical data and postoperative outcomes between the two groups.ResultsThe two groups were comparable in terms of age (p = 0.326), number of pregnancies (p = 0.307), number of parities (p = 0.555), preoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p = 0.380), preoperative apical prolapse simplified Pelvic Organ Prolapse Quantification grade (p = 0.518), postoperative Modified Oxford Score (p = 0.857), operation time (p = 0.809), postoperative haemoglobin (p = 0.674), and amount of bleeding (p = 0.951). Compared with Group 2, Group 1 had significantly higher postoperative anterior vaginal wall thickness (p < 0.001) and significantly lower postoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p < 0.001).ConclusionsThe rug-weaving plication technique may offer a viable alternative for cystocele repair without mesh, using natural tissue and potentially reducing mesh-related complications and recurrence rates.Clinical trial numberNCT06410469 (03/05/2024).

Off-center staggered leaflet plication technique to prevent residual central regurgitation in aortic valve repair

Off-center staggered leaflet plication technique to prevent residual central regurgitation in aortic valve repair

(166) Surgical Excision and Grafting with Simultaneous Dorsal Plication for Ventral Plaque Accompanied by Urethral Tethering

Abstract Introduction Peyronie's disease, a condition characterized by penile curvature, approximately affects 9% of men. Surgical interventions are often employed to address this bothersome condition, and these can include techniques such as plication of the tunica albuginea, incision, or excision of the plaque with grafting procedures, and penile prosthesis implantation. The recommended treatment options vary depending on the specific constellation of symptoms and underlying conditions experienced by the patient. Objective We present a case of severe ventral curvature and penile shortening due to urethral tethering, resulting in residual curvature even after undergoing plaque excision and grafting. Methods The patient is a 65-year-old gentleman with a history of metastatic renal cell carcinoma, deep vein thrombosis status post inferior vena cava filter placement as well as anticoagulation with apixaban, and diabetes mellitus who presented with a complaint of progressive penile curvature over his past 12 months. His secondary complaints included difficulty and pain with intercourse. He noted a 90-degree ventral erection. He denies any history of penile trauma, surgery, or pelvic radiation, though he did report chest radiation for his metastatic kidney cancer. Penile doppler noted a large ventral mid penile plaque measuring 9.5x7.7x5 mm. Due to the severe, bothersome curvature, the patient was recommended excision and grafting (Tutoplast). Intraoperatively, a 2.5 cm x 3.0 cm plaque was excised and a Tutoplast pericardial allograft was used to cover the corporal defect. However, due to urethral tethering the patient still had residual curvature. We opted to perform a dorsal tunica albuginea plication using the Lue 16 dot technique. Results Penile plication remains a tool in the armamentarium of the reconstructive urologist and andrologist for penile curvature arising from Peyronie’s disease. However, in the setting of severe curvature, the penile length loss arising from plication alone can be prohibitive. Therefore incision, or excision with grafting has been implemented with significant sparing of penile length. On the other hand, there is a limit to which length can be maintained and occasionally the tethering of the corpus spongiosum can result in residual curvature. Contralateral tunical plication is therefore an option to be performed concomitantly with grafting procedures. This combination is uncommon but has been reported. In our approach, the patient’s severe curvature was improved with ventral plaque excision and grafting. However, his residual curvature at this stage was able to be corrected with minimal effect on his penile length by applying a dorsal plication technique with minimal additional risk. During the follow-up after the surgery, the patient reported a smooth recovery without any complications. There was no residual curvature, and the patient was able to achieve normal erections sufficient for intercourse without the need for additional measures. Conclusions The correction of severe ventral curvature deformity can be challenging, the surgeon should be prepared to perform additional correction procedures if penile straightening was limited by the tethering of the neurovascular bundle or urethra. Excision and grafting of ventral plaque with concomitant dorsal tunica plication for residual curvature in settings of urethral tethering is a safe viable and effective option with excellent functional results. Disclosure No.

Advanced Techniques in Upper Blepharoplasty: Cauterization + Plication for Enhanced Surgical Outcomes.

Blepharoplasty is a commonly performed cosmetic surgery worldwide to address the excess skin and fat on the upper eyelids. The purpose of this paper is to present a surgical variation on blepharoplasty, achieving more pleasant outcomes. This paper describes the cauterization + plication technique, which involves using a cauterizing tool to remove excess skin and fat from the upper eyelid before using sutures to create a crease. It provides valuable insights into the advantages and limitations of this technique, drawing on relevant literature and clinical experience. Muscle cauterization and plication technique is an upgrade from the traditional technique, producing more esthetically pleasing results. This study highlights the importance of understanding the different techniques available for blepharoplasty to achieve the best possible outcomes for patients.

(191) Excision and Grafting with Concomitant Dorsal Plication for Ventral Plaque with Urethral Tethering

Abstract Introduction Peyronie's disease, a condition characterized by penile curvature, approximately affects 9% of men. Surgical interventions are often employed to address this bothersome condition, and these can include techniques such as plication of the tunica albuginea, incision or excision of the plaque with grafting procedures, and penile prosthesis implantation. The recommended treatment options vary depending on the specific constellation of symptoms and underlying conditions experienced by the patient. Objective We present a case of severe ventral curvature and penile shortening due to urethral tethering, resulting in residual curvature even after undergoing plaque excision and grafting. Methods The patient is a 65-year-old gentleman with a history of metastatic renal cell carcinoma, deep vein thrombosis status post inferior vena cava filter placement as well as anticoagulation with apixaban, and diabetes mellitus who presented with a complaint of progressive penile curvature over his past 12 months. His secondary complaints included difficulty and pain with intercourse. He noted a 90-degree ventral erection. He denies any history of penile trauma, surgery, or pelvic radiation, though he did report chest radiation for his metastatic kidney cancer. Penile doppler noted a large ventral mid penile plaque measuring 9.5x7.7x5 mm. Due to the severe, bothersome curvature, the patient was recommended excision and grafting (Tutoplast). Intraoperatively, a 2.5 cm x 3.0 cm plaque was excised and a Tutoplast pericardial allograft was used to cover the corporal defect. However, due to urethral tethering the patient still had residual curvature. We opted to perform a dorsal tunica albuginea plication using the Lue 16 dot technique. Results Penile plication remains a tool in the armamentarium of the reconstructive urologist and andrologist for penile curvature arising from Peyronie’s disease. However, in the setting of severe curvature, the penile length loss arising from plication alone can be prohibitive. Therefore incision, or excision with grafting has been implemented with significant sparing of penile length. On the other hand, there is a limit to which length can be maintained and occasionally the tethering of the corpus spongiosum can result in residual curvature. Contralateral tunical plication is therefore an option to be performed concomitantly with grafting procedures. This combination is uncommon but has been reported. In our approach, the patient’s severe curvature was improved with ventral plaque excision and grafting. However, his residual curvature at this stage was able to be corrected with minimal effect on his penile length by applying a dorsal plication technique with minimal additional risk. During the follow-up after the surgery, the patient reported a smooth recovery without any complications. There was no residual curvature, and the patient was able to achieve normal erections sufficient for intercourse without the need for additional measures. Conclusions The correction of severe ventral curvature deformity can be challenging, the surgeon should be prepared to perform additional correction procedures if penile straightening was limited by the tethering of the neurovascular bundle or urethra. Excision and grafting of ventral plaque with concomitant dorsal tunica plication for residual curvature in settings of urethral tethering is a safe viable and effective option with excellent functional results. Disclosure No.

Temporary external skin plication: a helpful new technique in gynecomastia surgery.

The aim of this study was to elucidate the external temporary skin plication (ETSP) technique in gynecomastia surgery and evaluate its role in mitigating complications and enhancing cosmetic outcomes. This study was conducted on patients diagnosed with gynecomastia, explicitly falling under Rohrich Grades IIB and III, with dermal quality being a crucial determinant. Between September 2018 and November 2021, surgical interventions were performed on 96 qualifying patients by the senior author. The operative protocol consisted of ultrasonic and suction-assisted liposuction, supplemented by lateral periareolar piecemeal gland excision. Within the cohort, 42 patients were subjected to the novel ETSP technique. In contrast, the remaining 54 patients underwent standard treatment, serving as the control group for subsequent comparative assessment. One patient required revisions for contour irregularities, while partial nipple necrosis was observed in two patients but healed without surgical intervention. However, saucer-like deformity and total nipple necrosis were not observed in our series. The overall complication rate in our series was 19%, with 9.5% of cases requiring revision. In our control group, the overall complication rate in our series was found to be 22%, with 13% of cases requiring revision. ETSP provides a homogeneous spread of the excess skin and greatly reduces or eliminates the amount of skin fold formation. ETSP reduces the need for possible skin excision and reduces visible scars and incisions, and it helps improve the results of skin-protective surgeries that are widespread today.

Tranexamic Acid in Tumescence for Cervicofacial Rhytidectomies.

Cervicofacial rhytidectomies are one of the most common procedures in the United States. There are many different methods and techniques involved, but all aim to minimize blood loss and procedure time. In our study, we investigated the addition of tranexamic acid (TXA) to tumescent anesthesia during rhytidectomy procedures. Our objective was to analyze the difference in mean procedure time and estimated blood loss in patients undergoing both general and other anesthesia types, with and without the addition of TXA, while maintaining patient safety. Seventy-four patients underwent a standard superficial musculoaponeurotic system plication technique rhytidectomy, with 60 patients undergoing general anesthesia and the remaining 14 undergoing other anesthesia types. Forty patients were treated without TXA, whereas the remaining 34 were treated with TXA. Although the difference was not statistically significant, the addition of TXA resulted in a lower procedure time and estimated blood loss. Within anesthesia type, there was also a slight difference that TXA decreased blood loss and procedure time. We did find that general anesthesia type does significantly impact procedure time and estimated blood loss, when compared with other anesthesia types, independent of TXA use. The use of tumescent TXA may allow for a faster procedure with less blood loss, although further studies with a larger sample size are needed.

Left Atrial Reduction Plasty and Sinus Rhythm Restoration in patients undergoing Mitral Valve Surgery with Chronic Atrial Fibrillation

Objective: To assess outcome of Left Atrial reduction plasty and sinus rhythm restoration in patients undergoing Mitral valve surgery with chronic Atrial Fibrillation. Study Design: Longitudinal study. Place and Duration of Study: Adult Cardiac Surgery Unit, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Jan 2017-Jun 2022. Methodology: Thirty three (n=33) patients with mitral valve disease were recruited via convenience sampling, all of whom exhibited an enlarged left atrium and pre-operative Atrial Fibrillation (AF). Pre-operative cardiac evaluations were performed using Transthoracic Echocardiography (TTE). Pre- and post-surgery trans-esophageal echocardiography studies were conducted as a routine procedure. Follow-up echocardiographic assessments were carried out at intervals of 1 month, 3 months, and 6 months, alongside Electrocardiograms (ECGs). During surgery, median sternotomy was done. Cardiopulmonary Bypass (CPB) time was established followed by cardiac arrest. After Mitral valve Repair/Replacement (MVR), Left Atrial (LA) plication was done by a double needle. Results: Out of thirty three (n=33) patients, 25(75.7%) females and 8(24.2%) male patients, with mean age of 44.3±15.5 years, underwent mitral valve surgery(repair/replacement) followed by LA reduction &amp; sinus rhythm restoration procedure. Complete restoration of sinus rhythm with re-appearance of “a” wave on echocardiography, signifying LA transport function through mitral valve was observed in 31(93.9%) patients on 3rd month and only 1(3.0%) individual continued to have persistent AF after 6 months. (83.70±2.50 mm vs. 47.50±1.08 mm) (p&lt;0.001).................. Conclusion: Left atrial reduction by “Plication technique” followed by “Diathermy Fulguration” as a part of mitral valve surgery has yielded ...............

Tape Eyelid Closure: An Effective Solution for Nocturnal Lagophthalmos in Patients with Ptosis and Poor Bell's Phenomenon.

Poor Bell's phenomenon is often considered a relative contraindication for ptosis surgery, as it increases the risk of corneal exposure and dry eye symptoms after surgery. However, the Bell's phenomenon may vary in different individuals and sleep stages, making it inaccurate to predict the position of the eye during sleep based on awake examination. This study aimed to investigate the role of Bell's phenomenon in ptosis surgery and the management of nocturnal lagophthalmos. We conducted a retrospective case series of 23 patients with ptosis and poor Bell's phenomenon who underwent different surgical techniques at Xijing Hospital from April 2020 to June 2021. We assessed Bell's phenomenon at different stages of sleep and collected data on ptosis degree, surgical approach, lagophthalmos, complications, and outcomes. Of the total 23 patients originally considered for study, 9 with frontalis muscle advancement technique, 8 with conjoint fascial sheath suspension, 4 with levator resection technique, and 2 with levator aponeurosis plication technique. All patients achieved satisfactory correction of ptosis. One patient had prolonged lagophthalmos and underwent reoperation to lower the eyelid height. Other complications were minor and resolved with conservative treatment. We conclude that poor Bell's phenomenon is not a relative contraindication for ptosis surgery. Nocturnal lagophthalmos should be monitored after ptosis surgery regardless of the Bell's phenomenon results. Tape eyelid closure can be an effective solution to protect the corneal surface during nocturnal lagophthalmos. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Surgical Options for End-Stage Achalasia.

Achalasia is one of the most commonly described primary esophageal motility disorders worldwide, but there is significant controversy regarding ideal management of end-stage disease. This article reviews the definition of end-stage achalasia and summarizes past and present surgical treatment. Myotomy of the lower esophageal sphincter remains the mainstay of treatment of achalasia, even in advanced disease. Esophagectomy may have benefit as a primary treatment modality in end-stage achalasia with sigmoid esophagus, but international guidelines recommend consideration of laparoscopic or endoscopic approaches initially in most patients. Novel peroral esophageal plication techniques may provide alternative treatment options in patients with significant esophageal dilation that fail myotomy or esophagectomy. End-stage achalasia is characterized by progressive tortuosity and dilation of the esophagus as a failure of primary peristalsis. Up to 20% of patients with achalasia will progress to end-stage disease. In most cases, laparoscopic or endoscopic myotomy is recommended as initial approach to surgical management.

Superior Vector Plication of the Mobile Anterior Midface: The Delta Facelift.

Traditional plication techniques have been ineffective in addressing the anterior midface when compared to the sub-superficial musculoaponeurotic system (SMAS) "deep plane" approaches. However, by moving the plication much closer to the mobile medial fat tissues, a more effective and long-lasting plication can be accomplished without releasing the SMAS layer. The authors' "Delta facelift" approach combines a rotation vertical advancement of the midface fat with a dual-vector platysmaplasty and deep cervicoplasty as indicated for a harmoniously youthful neck. A retrospective chart review was performed on all patients who underwent facial rejuvenation with the Delta facelift technique between January 1, 2012, and May 30, 2021, for patient demographics, procedure details, outcomes, and complications. A total of 283 patients underwent Delta facelift (273 females, 10 males). The average age was 60.8 years old. Primary facelift was performed in 229 patients, whereas 54 facelifts were secondary or further procedures. Adjunctive procedures included autologous fat grafting (93%), blepharoplasty (52%), and skin rejuvenating procedures (35%). There were 11 self-resolving neuropraxias, 6 minor hematomas, and 6 infections. Nine patients underwent repeat Delta facelift at an average of 9.3 years. The Delta rotation vertical advancement of the anterior facial fat counters the descent and deflation associated with facial aging. Dual-vector platysmaplasty, with or without myotomy, effectively manages the jowl and delineates the jawline. Addition of deep cervicoplasty is recommended for patients with oblique necks or those with subplatysmal volume excess.

Application of jejunal turnover and bowel plication technique in neonatal high intestinal atresia: a retrospective study.

To evaluate the outcomes of jejunal turnover and bowel plication (JTBP) in high jejunal atresia of neonates. The clinical data of neonates met the criteria were retrospectively analyzed from January 2012 to December 2021.The neonates were divided into the JTBP group and control group according to the surgical procedure.Demographics, postoperative morphology of the duodenum and proximal jejunum,intestinal recovery time and complications were compared. 75 patients were allocated to the JTBP (n=30) and control (n=45) groups, respectively. There was no significant difference between the two groups in terms of gestational age, birth weight, age at surgery,the pathological classification,and concomitant disease. UGCS showed that the diameter of the proximal bowel of the anastomotic stoma was normal and the duodenum and proximal jejunumin streamline shape in the JTBP group.While the duodenum dilated, and the shape of Trojan angle was classified into sharp angle and blunt round angle in the control group.The duration of total parenteral nutrition, postoperative oral feeding time and oral feeding time of 40 mL/3 h was significantly different between the JTBP group and control group(sharp and blunt round type): 9.0±3.5d,7.0±2.1d and 11.0±6.0d vs 16.9±4.2 d, 14.0±5.0 d and 19.0±7.4 d vs 11.9±8.3 d, 8.2±3.9d and 15.8±3.6d(P<0.05). JTBP for neonatal high jejunal atresia can significantly change the diameter of the proximal bowel and the course of duodenum jejunum flexure. Postoperative bowel movement was more in line with fluid dynamics, which was conducive to the recovery of the intestinal function and resulted in fewer complications.

Long-term Results of Valve-Sparing Aortic Root Replacement and Aortic Cusp Repair

BackgroundLong-term results of valve-sparing aortic root replacement (VSRR) and aortic cusp repair for aortic regurgitation are unclear. MethodsVSRR by reimplantation was performed in 363 patients. Tricuspid aortic valve (TAV) and bicuspid aortic valve were found in 285 and 71 patients, respectively. ResultsAortic cusp repair was performed in 268 patients. Of patients with TAV 129 had central plication of the Arantius node, 36 had free margin resuspension, and 71 had reinforcement. Mean follow-up was 71.4 months. Among TAV patients freedom from aortic valve reoperation at 10 and 15 years was 85.1% and 78.3%, respectively. Freedom from aortic valve reoperation at 10 years was lower in patients with cusp prolapse than without (77.4% vs 93.2%, P = .007). The overall freedom from more than mild aortic regurgitation at 10 and 15 years was 72.4% and 64.0%, respectively. It was also significantly greater in patients without cusp prolapse (78.4% vs 67.7%, P = .02). As for the cusp repair technique the freedom from aortic valve reoperation at 10 years was significantly better in patients who underwent only resuspension or reinforcement techniques compared with patients who underwent only central plication technique (100% vs 72.8%, P = .008). ConclusionsLong-term results of VSRR with aortic cusp repair were satisfactory. The resuspension technique appears to be useful for repairing aortic cusp prolapse in patients with TAV.

The Use of Multifilament Suture for SMAS Plication in Rytidectomy.

In the public's mind, rhytidectomy, better known as a facelift procedure, is the technique most closely associated with plastic surgery. When done correctly, it yields highly satisfactory results. The aim of our study was to retrospectively review results of our patients whose procedures were performed using the superficial musculoaponeurotic system (SMAS) plication technique. Plication was performed with multifilament braided sutures, which provided a sustainable lift and satisfactory results. This study involves a retrospective review of 137 patients who underwent primary or secondary facelift procedures over a period of 46 months. The average patient age was 59 years, with ages ranging from 30 to 77. Patients were reviewed at 6 and 12 months postoperatively. Subjective evaluation based on photographic analysis was performed pre- and postoperatively. All cases included in this study indicated satisfaction with postoperative results on 1 year postoperative review for both the patients and performing surgeons. Four patients presented with a postoperative hematoma that required surgical intervention. One patient developed skin infection that was followed by skin necrosis. Another patient presented with wound infection that resulted in partial wound dehiscence. Both cases were managed conservatively. With the abundance of techniques directed toward the SMAS layer, it has become a pivot point for facelift procedures. This expansion in approaches places emphasis on the SMAS layer and its manipulations. The type of suture material utilized in SMAS plication is, therefore, undoubtedly essential. Our use of braided multifilament sutures for SMAS plication provided satisfactory results at 1-year postoperative review.

Arthroscopic Treatment for Chronic Ankle Instability

Background: Ankle sprain is the most frequent sports trauma. After repeated sprains, Chronic Instability (CAI) occurs and usually requires a surgical procedure. New surgical strategies to treat symptomatic CAI are evolving. In this article we describe a fully arthroscopic technique for CAI treatment. Methods: January 2017 to January 2020, we arthroscopically treated 26 patients for CAI, 21 of these were included in the study. The patient’s average age was 33, 43 years. Median Follow-Up (FU) was 22, 38 months. Using a suture passer or a grasper and knotless anchors, the ligaments were repaired with an arthroscopic technique and reinforced with arthroscopic plication technique. Results: At FU the AOFAS mean was 96, 29; FADI mean was 131, 38; VAS mean was 1, 00. All patients reported subjective improvement in their ankle instability after the arthroscopic repair. Conclusion: Chronic ankle instability can be successfully treated by an arthroscopic repair reinforced with arthroscopic plication technique. It is possible obtain significant functional outcomes with high patient satisfaction.

(138) Smaller Tunical Defect With Pre-graft Plication Technique During Peyronie's Disease Surgery May Reduce Postoperative Erectile Function Loss

Abstract Introduction Peyronie’s disease (PD) is a progressive and benign acquired connective tissue disease characterized by disordered wound healing and local fibrosis of the tunica albuginea (TA). PD has two phases: acute and chronic. Surgery is the gold standard option for the correction of penile deformity in the PD chronic phase. Methods used in surgical treatment include plication, graft repair, and penile prosthesis implantation. Plaque incision (PIG) or excision (PEG) and graft placement are performed during graft repair. However, this technique can cause postoperative erectile dysfunction (ED) related to the size of the TA defect. Objective In our clinic, we use a novel "pre-graft plication technique" to reduce disruption of the integrity of the TA in patients with unidirectional curvature &amp;gt; 60 degrees. In this technique, we place 2 or 3 Essed–Schroder sutures on the convex side of the curvature before incision or excision and grafting on the plaque side. Thus, we pull the curvature angle down before PIG/PEG. We aim to improve post-op erectile function by using smaller grafts and TA incisions (figure 1). Our goal for this study was to compare the results of this technique with the standard PIG/PEG technique. Methods All patients who were operated on for PD in our clinic between 2010 and 2021 were screened. Patients aged between 40 and 70 years who underwent grafted PD repair were included in the study. Patients who underwent previous penile surgery or hormonal therapy, had significant preoperative ED (IIEF-5 &amp;lt; 17), or who received diagnoses of malignancy or depression were excluded from the study. We found 45 patients on whom we applied the pre-graft plication technique (group 1) and 32 patients on whom we applied the standard grafting technique who were appropriate for our inclusion and exclusion criteria. Demographic characteristics of the patients, comorbidities, preoperative IIEF-5 scores, stretched penile lengths, plaque sizes detected during surgery, graft sizes and types, postoperative IIEF-5 scores at the 3rd and 12th months, and 3-month postoperative penis lengths were recorded. Penile massage and daily 5 mg tadalafil were recommended as post-op rehabilitation. The results were compared with Student’s T-test. Results There were no significant differences between the groups in terms of preoperative IIEF-5 scores, penile lengths, age, or comorbidities. While there was no significant difference between the groups in the plaque sizes detected during the operation, the graft size used was significantly smaller in Group 1 than in Group 2. At follow-up, the IIEF-5 scores of the Group 1 were, on average, 1.97 and 2.36 points higher than Group 2 at 3 and 12 months of follow-up, respectively. This difference was statistically significant. There was no significant difference between the groups in terms of penile length (table-1). Conclusions Reducing post-op erectile function loss is possible with pre-graft plication technique. The extra plication suture does not cause a significant reduction in penile length. Disclosure No

(406) The “Kiel Knots” Technique for the Treatment of Congenital and Acquired Penile Curvature

Abstract Introduction Penile curvature is not only a cosmetic issue, but can also cause severe organic and psychological problems in the affected patients. It can negatively affect the quality of the person’s sexual life or even ruin a relationship. There are many surgical techniques for correction ranging from the least invasive as plication to more invasive as incision or excision and grafting. Objective We propose a surgical technique for the correction of both congenital and acquired penile curvatures. Our technique is based on modifying and combining the 16-dot and the Essed-Schroeder plication techniques by burying the knots in shallow troughs of the incised tunica albuginea. We entitle this modification as the “Kiel Knots”. In this video, we demonstrate step-by-step the Kiel Knots technique for the correction of a case of dorsal acquired curvature with good erectile function via the subcoronal approach. Methods A circumcising incision is made and the penis is degloved. Buck’s fascia is then incised exposing the tunica albuginea opposite the curvature. Eight dots 5mm apart are marked bilaterally on the tunica albuginea with the point of maximum curvature in the center and a 5 mm superficial incision along the marks is made without cutting into the corpus cavernosum. Instead of plicating with one suture for 4 dots, our modification entails utilizing a separate suture for every two dots with the knot being buried in the shallow trough we created by the scalpel. Results Our average operative time is an hour. An average loss of penile length of 0.5-1cm has been reported in 30% of our patients. All our patients preserved their erectile function. 90% of our patients remained without recurrence of curvature after 2 years of surgery. None of our patients reported problems with their suture knots. Conclusions The Kiel Knots technique achieves penile straightening with minimal loss of length and no erectile dysfunction. We believe that our technique combines the best of Lue’s 16 dot together with the Essed-Schroeder plication techniques while avoiding the downsides of both approaches. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.

3 - Efficacy and safety of native tissue cystocele repair by modified surgical technique of bilateral pubococcygeus plication: A multicenter study

3 - Efficacy and safety of native tissue cystocele repair by modified surgical technique of bilateral pubococcygeus plication: A multicenter study