Prolene Suture Research Articles

V11-03 ROBOTIC PARTIAL NEPHRECTOMY WITH INFERIOR VENA CAVA THROMBECTOMY

You have accessJournal of UrologyRenal Oncology II (V11)1 Sep 2021V11-03 ROBOTIC PARTIAL NEPHRECTOMY WITH INFERIOR VENA CAVA THROMBECTOMY Ali Merhe, Laura Horodyski, Chad Ritch, Oleksandr Kryvenko, and Mark Gonzalgo Ali MerheAli Merhe More articles by this author , Laura HorodyskiLaura Horodyski More articles by this author , Chad RitchChad Ritch More articles by this author , Oleksandr KryvenkoOleksandr Kryvenko More articles by this author , and Mark GonzalgoMark Gonzalgo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002073.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This is a case of a 55 year old female with an incidentally discovered right renal mass. CT scan showed a 4 cm low density lesion extending from the renal cortex into the renal vein and inferior vena cava (IVC) (level 1 thrombus) with fat content, suggestive of possible angiomyolipoma. Objective: To demonstrate the surgical steps of robotic partial nephrectomy with IVC thrombectomy. METHODS: After trocar placement, the da Vinci Xi Robot system was docked in the standard manner, and the procedure was initiated with mobilization of the colon then identification of the right ureter and gonadal vein. The gonadal vein was followed proximally to its insertion into the IVC. The renal vein and artery were subsequently identified and dissected. A vessel loop was passed around the renal vein to ensure proximal control of the tumor thrombus during excision of the mass. Intraoperative ultrasound was used to identify the location and depth of the mass prior to excision. Bulldog clamps were placed sequentially over the renal artery and renal vein. Traction was applied with the vessel loop and suction irrigator to ensure proximal control of the tumor thrombus. Excision of the mass was accomplished utilizing a combination of sharp and blunt dissection. An incision was made into the branch of the renal vein containing the tumor thrombus. The incision was extended circumferentially to facilitate mobilization and complete en bloc removal of the renal mass and thrombus. The renal vein defect was then closed in 2 layers with 4-0 Prolene suture. Prior to closure of the first layer, the clamp over the renal vein was temporarily released to permit venous backflow in order to minimize the risk of air embolism. The tumor bed defect was closed in 2 layers in a continuous manner with 3-0 V-lock suture. A sliding clip technique was then performed with 3-0 V-lock suture in an interrupted manner to re-approximate the edges of the kidney and complete the reconstruction. RESULTS: Estimated blood loss was 70 cc with a warm ischemia time of 45 minutes. The patient was discharged from the hospital on postoperative day number 1 without complications. Final pathology demonstrated a 2.1 cm angiomyolipoma with negative margins. CONCLUSIONS: Robotic partial nephrectomy with IVC thrombectomy is a feasible and safe surgical option for patients with benign renal masses with extension of tumor thrombus into the IVC. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e858-e858 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali Merhe More articles by this author Laura Horodyski More articles by this author Chad Ritch More articles by this author Oleksandr Kryvenko More articles by this author Mark Gonzalgo More articles by this author Expand All Advertisement Loading ...

Traumatic extracranial internal carotid-jugular fistula leading to serious injury: a case report in forensic assessment

Traumatic carotid artery jugular vein fistula is a rare entity that is not usually detected during the acute injury phase. We presented 1 cases of traumatic carotid–jugular fistula. A 52 years old man that was referred to us because of an expanding neck hematoma. There was a 1×1 cm ulcer with a clot in zone II right neck and a thrill was palpated. We clamped the proximal and distal site of injury (Arteriovenous fistula), then divided the fistula and primarily repaired the artery (transversely) and the vein with 7-0 prolene suture. We placed two hemovac drains and then repaired the subcutaneous and skin and covered the site with gauze and then the patient was transferred to ICU. He was extubated the next day and physical exam was completely normal without any neurologic deficit. Carotid–jugular fistula should always be treated early to avoid the complications associated with the injury.

Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case report

BackgroundInterventricular septal hematoma is an extremely rare complication following congenital heart surgery. During cardiac surgery, interventricular septal hematomas can be detected only by intraoperative transesophageal echocardiography. Here, we report an interesting case of interventricular septal hematoma that was accidentally found in an infant following ventricular septal defect (VSD) closure.Case presentationTransesophageal echocardiography images were acquired from a 1-month-old boy after surgical repair of a large (6.5 mm) perimembranous outlet VSD with interventricular septal flattening. Surgical correction was performed with auto-pericardium and 7–0 Prolene sutures. The patient was successfully weaned from cardiopulmonary bypass, and transesophageal echocardiography showed no VSD leakage and good ventricular function. However, approximately 30 min later, two anechoic masses were found within the interventricular septum, which were suspected to be interventricular septal hematomas; the larger mass measured 1.51 times 1.48 cm. The swollen interventricular septum showed decreased contractility and compressed both the right and left ventricles. However, there was no change in the size of hematomas or a significant hemodynamic instability for 30 min of observation. Therefore, expecting spontaneous resolution of the hematomas, the interventricular septum was not explored, and the patient was removed from cardiopulmonary bypass. On postoperative day 4, follow-up transthoracic echocardiography revealed thrombi filling the hematomas. The patient was discharged on postoperative day 15 and followed up with regular echocardiographic evaluations.ConclusionsWe describe a unique case of interventricular septal hematoma after VSD closure. Surgical manipulation of perimembranous VSD and injury of the septal perforating artery may contribute to the development of an interventricular septal hematoma. Moreover, conservative treatment and serial echocardiographic evaluation generally show gradual hematoma resolution in hemodynamically stable patients. Pediatric cardiac anesthesiologists should be aware of this rare complication after VSD repair.

Surgical wounds in reduction mammoplasty: a comparison of Monocryl and Prolene sutures on scars.

The type of suture material affects the quality of scars. The aim of this study was to find the superior suture material for reduction mammoplasty between Prolene and Monocryl based on the comparison of scars. A prospective observational study was conducted at a university-based hospital in Mashhad, Iran between October 2015 and September 2017. Monocryl and Prolene suture materials, used for closing the outermost layer in mammoplasty, were compared. Patients' incision scars were assessed objectively according to the Patient and Observer Scar Assessment (POSAS) criteria. The relevant CONSORT guideline was used for reporting this study. Seventy-eight women with a mean age of 36.8±9.5 years were entered into the study. The frequency of wound healing in both groups was 97.4% 1 month after surgery and by the third visit, 3 months after surgery, only one patient had a stretched scar. Moreover, wound inflammation in the first two visits was less frequent in the Prolene group that healed completely 3 months after surgery (after excluding the one patient with wide scar inflammation). The frequency of itching of the wound in the Monocryl group was 24.4%, 11.5% and 12.8% in the three follow-up visits, respectively, and the values for the Prolene group were 24.4%, 9.0% and 6.4%, respectively. No significant difference was seen between the two groups in terms of wound healing, inflammation and itching (p>0.05). Overall, 94.8% of patients were satisfied with the surgery. Our study revealed that there was no significant difference between Monocryl and Prolene. Hence, either of the two suture materials can be used for wound closure in reduction mammoplasty.

Intra-abdominal propylene suture fragment leading to complete small bowel obstruction: A case report.

IntroductionPropylene sutures are non-absorbable sterile surgical sutures, which when present intra-abdominally act as a foreign body leading to adhesion formation. Post-operative adhesions are a common cause of bowel obstruction, with complete closed loop obstruction presenting as a surgical emergency.Case detailsA 66-year-old man who had undergone a laparotomy for bowel obstruction two years back, presented to our emergency department with features of complete bowel obstruction. Midline laparotomy revealed propylene suture and intra peritoneal adhesions acting as a constricting band around the jejunum to be the cause.DiscussionAdhesions are common perturbing problem after surgeries. The presence of a foreign body further incites the process of adhesion formation by causing hindrance to the fibrinolysis process. In this case, the adhesive bands acted synergistically with the encircling prolene suture material from the previous surgery in causing a complete loop obstruction.ConclusionPropylene sutures used in routine surgical procedures can migrate intra-abdominally, and lead to adhesion formation. Adhesions along with the non-absorbable suture can cause complete bowel obstruction.

Novel method of tuboplasty using a thread stent

Background: Women who have undergone tubectomy for sterilization seek reversal of sterilization for various reasons. The success rate of the traditional method used for recanalization has been compared to our novel method of using a stent. Objective: The aim of this article is to evaluate the success rate of a novel method of tuboplasty using a threaded stent. Materials and Methods: Twenty-one tuboplasty surgeries for reversal of sterilization done at our center were reviewed. All the patients underwent open abdominal tuboplasty using 4× Loupes for magnification. 6-0 Prolene (Johnson & Johnson) suture was used for tubotubal anastomosis with seromuscular sutures. In 11 patients operated on after the year 2010, a 1-0 Ethilon (Johnson & Johnson) thread was used as a “stent.” Before the year 2010, we used to do the anastomosis similarly but without a stent. Eight such patients operated upon before 2010 without stent were evaluated. Two patients operated upon after 2010, in whom the stent could not be placed satisfactorily, were also included in this group of unstented patients. Results: Of the 11 patients who could be stented successfully, 8 (72.7%) conceived a uterine pregnancy. Two patients (18.2%) from the stented group did not conceive. From the group of patients who were not stented or could not be stented (n = 10), only two (20%) conceived. Conclusion: Our novel method of tuboplasty using a thread stent can improve the pregnancy rate to 72.7%.

Outcome of Prolene Sutures and Skin Staples for Mesh Fixation in Inguinal Hernioplasty - A Comparative Study

<p><strong>Background and Objective:</strong> Inguinal hernia is one of the most common type of hernia affecting both genders. New surgical interventions to repair hernia are being developed for the better outcome of patients by reducing the operative time and postoperative complications. The objective of this study was to compare the prolene sutures and skin staples for mesh fixation in inguinal hernioplasty with mean operative time and post-operative pain as outcome determinants.</p>
 <p><strong>Methods:</strong> This randomized controlled trial was conducted in the Department of General Surgery, DHQ Teaching Hospital, Sahiwal Medical College, Pakistan from January 1st, 2019 to December 31st, 2019. A total of 180 patients admitted for hernioplasty were recruited after institutional ethical approval. The study participants were randomized into group A and B. Mesh fixation was done by using prolene suture in group A, while skin staples were used in group B. The duration of procedure and post-operative pain after 1 week was noted using visual analogue scoring system. The comparison between groups was done through independent sample t-test. p-value < 0.05 was considered to be statistically significant.</p>
 <p><strong>Results: </strong>Mean age of the patients in group A and B was 39.21 ± 11 years and 40.16 ± 5.72 years respectively. The mean operative time was 52.15 ± 9.78 minutes in group A and 36.92 ± 3.95 minutes in group B (p = 0.000). Post-operative pain after 1 week was reported in 26.7% cases in group A while it was seen in only 10% cases in group B (p = 0.004).</p>
 <p><strong>Conclusion:</strong> The outcome determinants of mean operative time and postoperative pain after inguinal hernioplasty were better achieved in cases treated by skin staples as compared to prolene sutures.</p>

A new patch technique for valve-sparing aortic root repair in acute type A aortic dissection.

Valve-sparing aortic root replacement is an attractive option for younger patients with acute type A aortic dissection. This study aimed to design a new patch technique for reconstructing the aortic root and preserving the aortic valve following aortic dissection. Between July 2017 and December 2018, 35 patients underwent valve-sparing aortic root repair using this new patch technique. All participants were in the supine position, transesophageal echocardiography and median sternotomy were routinely performed. After thrombi at the aortic root were removed in acute type A dissection, the luminal aortic intimal dissection was removed until the aortic condition was normalized. In each aortic sinus involved in the dissection, a Dacron-graft patch with the shape corresponding to the defect was sutured to the normal remnant vascular wall or aortic annulus in the aortic sinus using 5-0 Prolene suture to reconstruct the aortic root. A total of 2 patients died, and 1 cerebral infarction, and 3 cases of transient brain dysfunction were recorded. The sinus tube junction and sinus diameter were within the normal ranges when they were reexamined 3 months after surgery. This new patch technique circumvents the redesign of the spatial 3D structure of the aortic valve, is simple to operate, and easy to master. It completely removes the diseased dissection tissue, avoids the use of glue, and is an alternative surgical technique, especially for beginners.

An Intracardiac Foreign Body: A Retained Suture in an Operated Infant with Congenital Heart Disease

Intra-cardiac foreign bodies are a rare occurrence and there is minimal literature on retention of sutures following cardiac surgery. This is an unusual case of a retained intracardiac prolene suture following surgical correction of Tetralogy of Fallot in a 6 month old patient. The patient had an uneventful post-surgical recovery but a foreign body was identified on a routine post-operative transthoracic echocardiogram. Due to the uncertain nature of the structure, the patient underwent fluoroscopy, chest X-ray and a cardiac CT which were unable to identify the nature of the structure. The best modality for identification was echocardiography, which consistently demonstrated the origin, and course of the suture. Due to a high level of suspicion and consistent findings on echocardiograms, the patient underwent surgical exploration 10 days following surgery and a prolene suture was identified originating in the right upper pulmonary vein extending though the mitral and aortic valve to the transverse aortic arch. This was thought to be from the purse string suture used for the left ventricular vent inserted via the right upper pulmonary vein during surgery.

Zaragoza technique of laparoscopic appendicectomy

IntroductionAppendectomy is one of the most frequent emergency surgical procedures, currently with a preference for laparoscopic management worldwide. ObjectiveTo report a new laparoscopic appendectomy technique and its results. Material and methodsCohort study of patients with a diagnosis of appendicitis who are managed laparoscopically. In a total 1063 patients, 148 were operated on with the Zaragoza technique during the period from January 2002 to December 2018. The technique consists of making a window in the appendicular base between the meso and the appendicular wall, two prolene or silk sutures are placed, and the cecal appendix is cut between the two sutures, finally the mesoappendix is sectioned with a harmonic scalpel or bipolar clamp. ResultsFrom our results, we had 1.4% residual abscesses, 1.4% umbilical surgical wound infection and 0% mortality. DiscussionVarious laparoscopic management methods for appendectomy are reported in the literature, with a wide range in the results. We have obtained good results in patients subjected to our technique. ConclusionsThe Zaragoza technique for laparoscopic appendectomy is an effective and safe option that prevents excessive manipulation of the inflamed appendix and is easily reproducible.

Experience with bioresorbable splints for treatment of airway collapse in a pediatric population.

ObjectiveTo report our experience with novel external tracheal and bronchial placed bioresorbable splints in children with severe symptomatic airway collapse.MethodsRetrospective review of patients undergoing bioresorbable splint placement.ResultsBetween July 2018 and February 2020, 14 patients received 16 external splints (trachea, n = 8; left bronchus, n = 7; and right bronchus, n = 1). Preoperatively, 7 patients had a tracheostomy; 6 of them were receiving mechanical ventilation with ventilator settings so high that they required an inpatient setting, often in an intensive care unit. Median age at implant was 14.5 months (range, 2 months-14 years). Splints were formed from moldable bioresorbable plates (RapidSorb; Synthes, Oberdorf, Switzerland) and were customized intraoperatively around a Hegar dilator. A series of Prolene sutures were placed through into the airway cartilage under simultaneous bronchoscopic and direct visualization and then tied securing the airway within the splint. Concomitant procedures were also performed in the region of the airway splints, consisting of airway reconstruction, cardiovascular procedures, and/or esophageal rotation (related to posterior tracheopexy). Median follow-up was 20 months (interquartile range, 12-21 months). Four patients required no further intervention. Although not necessarily in the splinted region, 7 patients required additional procedures, including posterior tracheobronchopexy (n = 2), temporary tracheal stent placement (n = 1), tracheal resection with end-to-end anastomosis (n = 1), closure tracheostomy (n = 1), and tracheostomy placement (n = 2). One patient required splint replacement and in 1 patient, the splint was removed later. All patients (except 2 deaths from unrelated causes) were discharged home. Three patients required mechanical ventilation at lower settings that allowed home ventilation (1 of those only at night), and 4 patients required tracheostomy collar. Indications for tracheostomy included subglottic stenosis, vocal cord paralysis, pulmonary insufficiency, small airway malacia, and laryngomalacia.ConclusionsAn external bioresorbable splint can provide temporary external support while allowing the age-proportional growth of the airway. We applied readily available bioresorbable plates that were custom-molded based on the location, shape, and length of the collapsing airway in selected patients presenting with severe tracheobronchomalacia from loss of structural support and/or cartilage deformation. Further study that includes long-term outcomes are necessary to define the best role for these external splints as part of comprehensive airway management.

Safety and Efficacy of Current Sclera Fixation Methods for Intraocular Lenses and Literature Overview.

Evaluation of the three currently most common techniques for intraocular lens (IOL) sclera fixation: (1) Prolene suture with Hoffman sclera pocket (2) four-point GoreTex suture technique (3) sutureless flanged intrascleral IOL fixation with double-needle ("Yamane") technique. Retrospective, clinical case series (chart review) at the Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany. Enrolled in the study were 51 patients with 55 eyes. Best-corrected visual acuity (BCVA); manifest refraction (OR); corneal tomography (central corneal thickness, CCT); biometry; central macular thickness (CMT) by optical coherence tomography (OCT); intraocular pressure (IOP); and IOL type and IOL power were recorded and compared prior to and 3 - 12 months post IOL sclera fixation surgery. Pre- and postsurgery difference analysis was performed by Wilcoxon rank sum testing (z). Intrascleral fixation by GoreTex suture was performed in 14 (25.5%) eyes, by Prolene suture in 19 (34.5%,) and by Yamane technique in 22 (40.0%) eyes. Within the 3 - 12 months follow-up post scleral fixation, a total of 2 (14.3%) eyes from the GoreTex, 3 (15.8%) from the Prolene and 1(4.5%) eye from the Yamane group required refixation. Pre- and post-surgery analysis revealed a statistically significant difference in the total patient population BCVA (exact Wilcoxon test: z = - 3.202; p = 0.001; n = 55) and the Yamane subgroup (exact Wilcoxon test: z = - 2.068; p = 0.001; n = 22). The GoreTex (n = 14) and Prolene (n = 19) subgroups revealed no statistically significant differences versus preoperative baseline. Across groups, there was no statistically significant difference in IOP, CMT, and CCT. No retinal complications were observed, neither intraoperatively nor during follow-up. The volume of IOL revision surgery is increasing. Often, the only option left for visual rehabilitation is scleral IOL fixation. All three scleral fixation techniques studied demonstrated a good safety profile with no statistically significant impact on IOP, CMT, CCT, but with a notable revision rate. Visual rehabilitation to preoperative baseline levels (GoreTex [n = 14] and Prolene [n = 19]) and a statistically significant increase in visual acuity (total cohort [n = 55] and Yamane [n = 22]) seems possible. Unlike iris fixation, scleral fixation is surgically more complex and the surgeon must master a steeper learning curve.

Robotic Right Hepatectomy with Portal Vein Thrombectomy for Colorectal Liver Metastasis (with Video)

BackgroundHepatectomy is the standard treatment for colorectal liver metastases. However, the high recurrence rate is a persistent problem that occurs in up to 65% of patients. Repeat hepatectomy is a feasible treatment and may offer favorable surviva but is technically demanding so minimally invasive repeat hepatectomy has been used in a few patients. Colorectal liver metastases are different from hepatocellular carcinoma and rarely present with macroscopic portal vein tumoral thrombus. To the best of our knowledge, minimally invasive approaches for this rare condition have not yet been reported. MethodWe present here a video of a robotic right hepatectomy in a patient with single colorectal liver metastasis and macroscopic tumor thrombi in the right portal vein. A 61-year-old woman underwent open resection of a transverse colon cancer (T3N0M0) in December 2015. In March 2019, she underwent nonanatomical resection of a liver metastases located in segment 6 also via an open approach. She then underwent adjuvant chemotherapy. However, in September 2020, she presented with a local recurrence and a tumor thrombus in the right portal vein. She was then referred to us for treatment and a multidisciplinary team decided on upfront liver resection due to the risk of left portal vein progression. Liver volumetry showed future liver remnant of 52.5%. Right hepatectomy with portal vein thrombectomy was indicated. A robotic approach was proposed, and consent was obtained. ResultsThe Da Vinci system was used. The operation began with the division of adhesions from previous laparotomies. Intraoperative ultrasound was performed to locate the tumor and to confirm the portal vein invasion. Hepatic hilum was carefully dissected. The replaced right hepatic artery from the superior mesenteric artery was ligated and divided. The common bile duct was dissected and encircled with a vessel loop. The portal vein was dissected, and an enlarged right portal vein with a protruding tumoral thrombus was seen. The left portal vein and portal vein trunk were then temporarily clamped. The right portal vein was carefully transected with robotic scissors being careful not to displace the thrombus. A minimum stump was left to safely suture the portal vein. The portal vein was then closed with a running 5-0 prolene suture. The portal vein clamping was then released, and a patent anastomosis with no leakage was observed. Right liver ischemic discoloration was seen and confirmed with fluorescence imaging after indocyanine green injection. A future line of transection was marked along ischemic area. The liver was divided using bipolar forceps under saline irrigation until it was detached from the retrohepatic vena cava. A right hepatic vein was divided with a stapler to complete the right hepatectomy. The surgical specimen was removed through a suprapubic incision, and the abdominal cavity was drained with a closed-suction drain. The total operative time was 270 min with no transfusion. Pathology conformed the diagnosis with free surgical margins. ConclusionRobotic right hepatectomy with tumor thrombectomy is feasible and safe even in the presence of lobar portal vein invasion. This video may help HPB surgeons perform this complex procedure.

Conversion of vesicostomy into continent catheterizable reservoirs in myelomeningocele

ABSTRACTIntroduction:Vesicostomy should be considered in children with neuropathic bladder in case first-line therapies fail. This simple and reversible procedure can reduce febrile urinary tract infections and protect the upper urinary tract (1) until more definitive alternatives can be proposed.We describe in this video how we approach patients that underwent vesicostomy and want it to be converted into a continent catheterizable reservoir.Material and methods:We perform an infra-umbilical longitudinal incision with a semicircular flap where the stoma will be placed (outside vesicostomy). After releasing the bladder, we proceed with usual steps of the Macedo-Pouch technique (2). We perform the reservoir from 35cm of ileum that constructs a catheterizable channel from the same bowel segment from a 3cm width flap from anterior and posterior wall of ileum in the mid part of it. The continence mechanism of the efferent tube is based on angulation and a serous lined tunnel created with 3-4 3.0 prolene sutures. The stoma is placed in the midline (3).Results:Patient had an uneventful evolution and is continent performing CIC every 4 hours with 9 months of follow-up. We have in the last 3 years a consecutive series of 12 patients operated according to this principle.Discussion:Vesicostomy should be regarded as an alternative for patients with neurogenic bladder refractory to clinical treatment at a younger age in order to postpone definitive treatment such as any an enterocystoplasty.This option must be considered as transient, since definitive reconstructive surgery can provide preservation of renal function and continence achievement. In this context, our video demonstrates that performing a bladder augmentation on a patient with a vesicostomy is safe and feasible. We reinforce that our method precludes the need of appendix or creation of a Monti tube as the outlet channel and the whole procedure is performed from a single piece of bowel.

A comparative study of mesh fixation with polypropylene sutures (prolene) versus polyglactin sutures (vicryl) sutures in assessing inguinodynia in open inguinal hernia repair

Background: Inguinal hernia, the most frequently occurring type of hernia globally, Chronic groin pain could be related to nerve mangling while operating. Mesh repair can lead to an inflammatory reaction over a period of time, though it still needs ground work to find out exact cause of pain. So this study aims to compare the effectiveness of polyglactin versus prolene sutures in reducing the post-operative pain in inguinal hernia repair.Methods: A one year hospital prospective study in KLE hospital. A total of 60 adult patients were divided into two groups of 30 each. Mesh fixation with polyglactin sutures was group A (30) and mesh fixation with polypropylene sutures was group B (30) and then post-operative pain, was assessed. Follow-up was for 3 months. Collected data was analyzed using chi–square tests, Mann-Whitney U tests.Results: Our analysis showed that the incidence of postoperative groin pain with mean severity scores of 1.37±0.49 versus 1.43±0.50; 1.40±0.50 versus 1.57±0.73; 1.03±0.61 versus 1.50±0.057; 0.77±0.63 versus 1.30±0.79; at post-operative day 1, 3 in both groups were similar and statistically not significant whereas the 1 week and 3 months follow up in group A and B respectively, were significant (p<0.05).Conclusions: The post-op chronic groin pain is significantly low, hence routine usage of polyglactin sutures to fix a mesh is a safe and effective alternative to polypropylene sutures in Lichtenstein hernia repair.

Adventitial Progenitor Cells of Human Great Saphenous Vein Enhance the Resolution of Venous Thrombosis via Neovascularization.

Background Vascular adventitia contains progenitor cells and is shown to participate in vascular remolding. Progenitor cells are recruited into the venous thrombi in mice to promote neovascularization. We hypothesized that the adventitial progenitor cells of human great saphenous vein (HGSV-AdPC) enhance the resolution of venous thrombosis via neovascularization. Methods Human great saphenous vein (HGSV) was harvested from the patients with great saphenous vein varicose and sectioned for immunohistochemistry, or minced for progenitor cell primary culture, or placed in sodium dodecyl sulfate solution for decellularization. Human venous thrombi were collected from patients with great saphenous vein varicose and superficial thrombophlebitis. Infrarenal abdominal aorta of New Zealand white rabbits was replaced with interposing decellularized vessel, and the patency of the grafts was confirmed by ultrasonic examination. Animal venous thrombi in the left infrarenal vena cava of mice were produced with Prolene suture ligation and ophthalmic force clipping of this portion. After HGSVs were digested by collagenase, the CD34+CD117+ HGSV-AdPC were isolated on FACS system, labelled with CM-Dil, and transplanted into the adventitia of infrarenal vena cava of nude mice. The percentage of thrombus organization area to the thrombus area was calculated as the organization rate. The thrombus cell, endothelial cells, and macrophages in the thrombi were counted in sections. Cell smears and frozen sections of human saphenous veins and venous thrombi were labeled with Sca1, CD34, CD117, Flk1, CD31, and F4/80 antibodies. The CD34+CD117+ HGSV-AdPC were cultured in endothelial growth medium with vascular endothelial growth factor (VEGF) to induce endothelial cell differentiation and analyzed with real time-PCR, Western blotting, and tube formation assays. Results Immunohistochemical staining showed that the CD34+CD117+ cells were located within the adventitia of HGSVs, and many CD34+ and CD117+ cells have emerged in the human venous thrombi. The number of progenitor cells within the marginal area of 7 days mice thrombi was shown to be Sca1+ ≈21%, CD34+ ≈12%, CD117+ ≈9%, and Flk1+ ≈5%. Many CD34+adventitial progenitor cells have migrated into the decellularized vessels. FACS showed that the number of CD34+CD117+ HGSV-AdPC in primary cultured cells as 1.2 ± 0.07%. After CD34+CD117+HGSV-AdPC were transplanted into the adventitia of nude mice vena cava with venous thrombi, the organization rate, nucleate cell count, endothelial cells, and macrophage cells of thrombi were shown to be significantly increased. The transplanted CD34+CD117+ HGSV-AdPC at the adventitia have crossed the vein wall, entered the venous thrombi, and differentiated into endothelial cells. The CD34+CD117+ HGSV-AdPC in the culture medium in the presence of VEGF-promoted gene and protein expression of endothelial cell markers in vitro and induced tube formation. Conclusions HGSV-AdPC could cross the vein wall and migrate from the adventitia into the venous thrombi. Increased HGSV-AdPC in the adventitia has enhanced the resolution of venous thrombi via differentiating into endothelial cells of neovascularization.

Evaluation of Double Mesh Modification of Chevrel’s Technique in Management of Midline Incisional Hernia

Background: Chevrel’s technique provides tensionfree repair of midline incisional hernia, but wide skin and subcutaneous dissection increases rate of complications. Here, we evaluate the double mesh modification of Chevrel’s technique in midline incisional hernia repair.
 Methods: 22 patients with midline incisional hernia underwent double mesh modification of Chevrel’s technique. After excision of hernial sac with minimal dissection of the skin and subcutaneous tissue, the anterior rectus sheath is incised on both sides to create medial flaps that are sutured toeach other. Both recti abdominis muscles were dissected off the posterior rectus sheath, opening the retrorectus space. Prolene mesh was fixed in the retrorectus space with prolene sutures, and tailored to cover the bare area of anterior surface of both recti muscles and fixed to the lateral flaps of the anterior rectus sheath with interrupted prolene sutures.
 Results: We observed no recurrences, no skin necrosis, two cases of seroma, one case of superficial wound infection and one case of temporarychronic pain.
 Conclusion: Double mesh modification of Chevrel technique is an efficient method for treatment of midline incisional hernia, with minimal surgical site occurrences.
 Keywords: Chevrel technique, Double mesh technique, Midline incisional hernia

How Does Octyl-2-Cyanoacrylate Tissue Adhesive Compare With Prolene Sutures in Cleft Lip Repair?

Comparative evidence of the usefulness of octyl-2-cyanoacrylate tissue adhesive in cleft lip epidermal skin closure especially in Africans is still lacking. This study aimed to compare the outcome of wound healing after the use of Dermabond tissue adhesive and 5/0 Prolene sutures in cleft lip repair. This was a prospective randomized controlled clinical study. The sampled population was patients undergoing cleft lip repair at a tertiary health facility in Lagos, Nigeria. Study patients were randomly allocated to either group A (Dermabond) or group B (suture). The predictor variable was the type of material used in skin closure; the primary outcome variable was the esthetics of the resulting scar, and secondary outcome variables were wound healing complications. Assessment of the 3-month postoperative wound scar was performed using the cosmetic visual analog scale (CVAS) and the Hollander Wound Evaluation scale (HWES). Calculated sample size was 14 participants per group. Descriptive and comparative statistics were computed, and the P value was set at <0.05. Analysis of result included 38 participants. Median age was 4months and 52.6% were women. Two cases (5.3%) of wound healing complications were recorded (1 in each group). Blinded evaluation of the 3-month postoperative photographs yielded a mean CVAS score of 86.0 (±11.2) and HWES score of 5.0 (±0.9) for group A and a mean CVAS score of 76.5 (±14.5) and HWES score of 4.5 (±1.1) for group B. There was no statistically significant difference between these 2 groups based on the CVAS (P=.052) and HWES (P=.152). The results of this study suggest Dermabond offers a comparable cosmetic outcome as 5/0 Prolene suture in epidermal closure of cleft lip. There was no statistically significant difference in wound complications and wound cosmetic scores between the 2 groups.

Comparison of Surgical Site Infection After Skin Closure by Prolene or Staples in Bilateral Simultaneous Knee Arthroplasty Patients: A Parallel Design Randomized Controlled Trial Protocol.

Introduction:Knee arthroplasty also known as the total knee replacement is an orthopedic surgical procedure done to resurface the knee that has been severely damaged by arthritis. After the completion of the surgical procedure, the skin closure is done. The optimal goal of skin closure after the procedure is to promote rapid healing and an acceptable cosmetic result while minimizing the risk of infection. Skin closure after knee arthroplasty is done by using either of the two widely used sutures i.e., polypropylene (Prolene) sutures or the skin staple sutures. There are no standard guidelines as which type of the suture should be used. The present study aims to compare the incidence of surgical site infections (superficial and deep) for Prolene vs staple sutures in the bilateral knee arthroplasty patients within 6 weeks for superficial and within 90 days for deep infection.Methods:This study will be conducted as an open blinded, parallel design, equivalence randomized controlled trial. The patients would be selected and randomized in 1:1 ratio to receive either of the two interventions i.e., Prolene or Staples. Patients undergoing unilateral or staged total knee replacement (TKR) were excluded.Analysis:The normality assessment will be done using Shapiro Wilk test. Cox proportional hazard regression will be used to check the univariate and multi-variable associations of independent variables with the outcome. Both intention to treat analysis and per protocol analysis would be performed.Ethics and Dissemination:All the required approvals will be taken from the ethical review committee. Informed consent will be taken form the patient to enroll him/her in the study. Results of the study will be disseminated to the study participants, public health and clinical professionals and would also be published in a reputable international journal.The trial is registered at clinicaltrials.gov and UIN of the registry is NCT04492852.HighlightsPost-operative surgical site infections and complications are a major concern nowadays.Skin staples are not widely used as compared to Prolene because they are expensive and not easily available in every hospital.There are no standard guidelines as which type of the suture should be used.The type of sutures is being selected on the orders and wishes of the surgeon at the time of skin closure.

Robotic right hepatectomy with portal vein thrombectomy for colorectal liver metastasis

Presenter: Marcel Autran Machado MD | Nove de Julho Hospital Background: Hepatectomy is the standard treatment for colorectal liver metastases. However, the high recurrence rate is a persistent problem that occurs in up to 65% of patients. Repeat hepatectomy is a feasible treatment and may offer favorable survival. Repeat hepatectomy is also technically demanding so minimally invasive repeat hepatectomy has been used in a few patients. Colorectal liver metastases are different from hepatocellular carcinoma and rarely present with macroscopic portal vein tumoral thrombus. To the best of our knowledge, minimally invasive approaches for this rare condition have not yet been reported. Methods: We present here a video of a robotic right hepatectomy in a patient with single colorectal liver metastasis and macroscopic tumor thrombi in the right portal vein. A 61-year-old woman underwent open resection of a transverse colon cancer (T3N0M0) in December 2015. In March 2019 she underwent non-anatomical resection of a liver metastases located in segment 6 also via an open approach. She then underwent adjuvant chemotherapy. However, in September 2020, she presented with a local recurrence and a tumor thrombus in the right portal vein. She was then referred to us for treatment and a multidisciplinary team decided on upfront liver resection due to the risk of left portal vein progression. Liver volumetry showed future liver remnant of 52.5%. Right hepatectomy with portal vein thrombectomy was indicated. A robotic approach was proposed, and consent was obtained. Results: The Da Vinci system was used. The operation began with the division of adhesions from previous laparotomies. Intraoperative ultrasound was performed to locate the tumor and to confirm the portal vein invasion. Hepatic hilum was carefully dissected. The replaced right hepatic artery from the superior mesenteric artery was ligated and divided. The common bile duct was dissected and encircled with a vessel loop. The portal vein was dissected, and an enlarged right portal vein with a protruding tumoral thrombus was seen. The left portal vein and portal vein trunk were then temporarily clamped. The right portal vein was carefully transected with robotic scissors being careful not to displace the thrombus. A minimum stump was left to safely suture the portal vein. The portal vein was then closed with a running 5-0 prolene suture. The portal vein clamping was then released, and a patent anastomosis with no leakage was observed. Right liver ischemic discoloration was seen and confirmed with fluorescence imaging after indocyanine green injection. A future line of transection was marked along ischemic area. The liver was divided using bipolar forceps under saline irrigation until it was detached from the retro-hepatic vena cava. A right hepatic vein was divided with a stapler to complete the right hepatectomy. The surgical specimen was removed through a supra-pubic incision, and the abdominal cavity was drained with a closed-suction drain. The total operative time was 270 minutes with no transfusion. Pathology conformed the diagnosis with free surgical margins. Conclusion: Robotic right hepatectomy with tumor thrombectomy is feasible and safe even in the presence of lobar portal vein invasion. This video may help HPB surgeons perform this complex procedure.