Purse-string Technique Research Articles

Anastomotic bleeding from invaginated pancreaticogastrostomy following pancreatoduodenectomy: incidence, risk factors, treatment and prevention.

Meta-analysis of 10 randomized prospective trials demonstrated a higher risk of postoperative bleeding from pancreaticogastrostomy (PG) compared with pancreatojejunostomy following pancreatoduodenectomy (PD). This study evaluated the incidence, risk factors, and treatment of anastomotic bleeding from invaginated PG. We retrospectively evaluated all consecutive PDs performed between April 1, 2011 and December 31, 2022 using invaginated PG by the double purse-string technique. Multivariate analysis identified risk factors for anastomotic PG bleeding. During the study, 695 consecutive patients with a median age of 66 years underwent PD; the majority was performed for ductal pancreatic adenocarcinomas. Simultaneous vascular resections were performed in 328 patients. Postoperative mortality was 4.1%. Bleeding from PG occurred in 33(4.6%) patients at a median interval of 5 days (range, 1-14) from surgery, leading to reoperation in 21(63%). PG bleeding-related mortality was 9.0%. Multivariate analyses identified a soft pancreatic texture and Wirsung duct > 3 or ≤ 3mm (Class C and D, respectively, of the ISGPS) (odds ratio [OR]: 2.17, 95% confidence interval [95% CI]: 1.38-3.44; P = 0.0009) and wrapping of the invaginated pancreas (OR: 0.37, 95% CI: 0.17-0.84; P = 0.01) as independent risk factors for PG bleeding. In a large volume setting, anastomotic bleeding from invaginated PG occurred in ~ 5% of patients and was associated with soft pancreatic parenchyma and small wirsung duct. The reduced rate of PG bleeding observed with wrapping of the invaginated pancreatic stump warrants further evaluation in a prospective randomized study.

Rationale and tips and tricks for transgastric robotic pancreaticogastrostomy by the double purse-string technique.

Pancreaticogastrostomy (PG) is a viable option for selected patients needing a pancreatic anastomosis. The double purse-string technique can facilitate the construction of transgastric PG but in a minimally invasive approach can lead to complications due to lack of tactile feedback. We present an adaptation of double purse-string PG for the robotic surgery, with several modifications. Firstly, the inner purse-string suture is tied through the anterior gastrotomy to improve the approximation of gastric and pancreatic serosae. Secondly, all-around-the-clock intragastric interrupted mattress sutures of e-PTFE are used to secure the pancreatic remnant to the stomach, enhancing improve hemostasis. Thirdly, e-PTFE sutures precise tension calibration due to their elastic properties and resistance to robotic manipulation. Fourthly, retroperitoneal vessels are preemptively covered by passing the pancreatic remnant through a small opening in the omentum, which is rotated upward in the omental bursa. This technique was employed in 20 PGs with no grade C postoperative pancreatic fistula. It offers a viable option robotic pancreatic anastomosis.

Comparison of purse-string technique vs linear suture for skin closure after ileostomy reversal. A randomized controlled trial.

Protective stoma after rectal surgery has been associated with important complications. The most common is surgical site infection (SSI) high rates after stoma reversal reported in literature. Our study compared the rate of SSI of two skin closure techniques, linear closure, and purse string closure. We carried out a single center, prospective, randomized controlled trial in the Department of Colorectal Surgery of Fondazione Policlinico Campus Bio-Medico of Rome between January 2018 through December 2021, to compare LC vs PS closure of ileostomy sites. A total of 117 patients (53.84% male) with a mean age of 65.68 ± 14.33years were finally evaluated in the study. 58 patients were included in the PS group and 59 patients in the LC one. There was a marked difference in the SSI rate between the two arms of the study: 3 of 58 patients in the purse-string arm versus 11 of 59 in the control arm (p = 0.043). The outcome of cosmesis was also higher in PS, with a statistical significance (mean ± DS 4,01 ± 0,73 for PS group vs mean ± DS 2,38 ± 0,72 for LC group, p < 0,001). Our study demonstrated that the PS technique had a significantly lower incidence of stoma site SSI compared with LC technique. Our findings are in line with other randomized studies and suggest that PS closure could be considered as standard of care for wound closure after ileostomy reversal.

The Outcome of Purse-string Versus Conventional Wound Closure Techniques in Patients Undergoing Stoma Reversal: A Randomized Controlled Trial

BackgroundPatients undergoing stoma reversal may experience surgical site infections and poor scarring. A purse-string closure approach may lower the incidence of surgical site infections due to its inherent ability to drain wound exudates. This study compared the frequency of surgical site infections and the cosmetic outlook of the scar among patients undergoing stoma reversal with linear and purse-string skin closure techniques. Setting and durationDepartment of Pediatric Surgery, University of Child Health Sciences Lahore with a duration of one year (June 2021 to June 2022). MethodsThis randomized controlled trial (TCTR20210417001) was conducted with IRB approval. A total of 124 patients undergoing stoma reversal were randomly assigned to two groups (62 in each): Group A received conventional linear skin closure, while Group B received purse-string wound closure. The study evaluated surgical site infection, cosmetic outcome, and length of stay. ResultsBoth groups had similar age, gender ratio, indication for surgery, and length of stay. The purse-string group had a significantly lower incidence of SSI (38.7 % vs. 14.5 %; p = 0.002) and better scar quality (Manchester scar scale showed 'good' scar quality in 63 % of patients vs. 22.6 % in the linear closure group, p-value <0.0001). ConclusionThe purse-string technique for skin closure resulted in fewer surgical site infections and improved scar appearance.

Sequential breast and nipple-areolar complex reconstruction after soft tissue necrosis following augmentation mastopexy: a case report

Breast augmentation mastopexy is a common procedure in cosmetic plastic surgery. Augmentation mastopexy has proven to be a relatively safe operation, but surgeons should be aware of and able to cope with disastrous complications such as soft tissue necrosis and nipple loss. The most important consideration in breast reconstruction is the recovery of breast shape and symmetry, as well as the maintenance of the shape of the nipple-areolar complex without any complications. We experienced a case of sequential breast and nipple-areolar complex reconstruction, in which the purse-string suture technique was used to repair medium-sized circular defects accompanied by nipple loss in the central area of both breasts and to preserve the shape of both breast mounds. Modified CV flaps were performed for left nipple reconstruction, and the Elsahy method and the purse-string suture technique were used to reconstruct the right nipple. Tattooing was performed on both breasts for areolar reconstruction. Through sequential reconstruction, the patient achieved satisfactory aesthetic results. In medium-sized, round defects on the central breast accompanied by nipple loss, the pursestring technique is a simple and effective reconstructive option that enables maintenance of the breast mound shape without requiring additional incision or distortion of surrounding structures.

Successful endoscopic closure of a large esophageal perforation using the purse-string technique.

Successful endoscopic closure of a large esophageal perforation using the purse-string technique.

BS P05 Laparoscopic repair of internal hernia post Roux-en-Y Gastric Bypass: Our tricks and technique

Abstract Background The incidence of internal herniation (IH) post Roux-en-Y gastric bypass (RYGB) is variable across literature (0.5–11%). This may be partially related to the difference in the operative techniques of RYGB. Routine closure of mesenteric and Petersen's defects has shown noticeable decline in the incidence of IH over last few years. Nevertheless, it didn't prevent the development of IH at long-term follow up. Methods We describe a video of a case with a large non-obstructing mesenteric internal hernia post RYGB. A 33 years old female patient presented to our bariatric clinic with recurrent attacks of post-prandial abdominal pain over 6 months. She had RYGB 2.5 years before this presentation, with EWL of 65%. Of note, the mesenteric and Petersen's defects were closed in the original RYGB operation. CT scan showed suspicious findings of internal herniation without obstructing signs. Patient had a laparoscopic exploration which showed a large internal herniation through mesenteric defect containing more than two thirds of bowel length. Closure of the defect was done by a purse string technique using non-absorbable prolene 2/0 stitch after reduction of the bowel. Patient had an uneventful postoperative recovery. She denied any further attacks of abdominal pain at her follow up till 6 months postoperatively. Conclusions Diagnosis of non-obstructing internal herniation post RYGB is very challenging. Low threshold for laparoscopic exploration in suspicious cases of remittent abdominal pain is highly recommended. CT scan can't rule out IH completely due to its intermittent nature. Laparoscopic repair remains the optimal approach, even in the large IH, with favourable outcomes. Appropriate identification of the bowel configuration is the key step in such procedure.

“Scarless” excision of a nipple adenoma case report—a good aesthetic outcome after a circular nipple excision with purse-string closure technique

: Complete surgical excision of nipple adenoma with clear margins offers the lowest risk of recurrence of this locally infiltrative yet benign entity. A thorough triple assessment including histological assessment is crucial to exclude any malignant pathology, and confirm the diagnosis. There are many excisional and ablative techniques published that can give clear resection margins, but there remains a paucity of data on acceptable aesthetic outcomes. It is important to balance between adequate surgical margins to prevent recurrence and a good aesthetic outcome, particularly in a young patient. We wish to highlight a good aesthetic outcome following a simple circular excision with purse-string closure of the nipple defect. We present a 28-year-old lady with a progressively ulcerative lesion that involved the entire nipple. Ultrasound did not show any other underlying lesions or intraductal extension. Punch biopsy confirms the diagnosis of a benign nipple adenoma. She was counselled for complete nipple excision and the defect was primarily closed with purse-string technique. This may not be a novel technique as it has been described for closure of other defects. However, the benefit of a purse-string closure of a circular nipple excision defect to reduce scarring may be underreported in the literature. This technique helps to conceal the scar within the areola, retain its natural corrugated appearance, and prevent distortion to the overall shape of the areolar complex. The final outcome of a complete nipple excision resembles that of a ‘scarless’ excision and remains aesthetically pleasing. We hope to allay fears of clinician and patients faced with similar condition by offering a safe, easily reproducible, single staged technique that offers high patient satisfaction in selected patients. Using this technique may even preclude the need for further nipple reconstruction.

The "purse string" technique for anterior glenohumeral instability: long-term results 7-13-year follow-up.

The "Purse-String Technique" (PST) is an arthroscopic horizontal mattress suture technique for recurrent anterior shoulder instability that uses a single double-loaded suture anchor at the 4-o' clock position, achieving a Bankart labral repair and an infero-superior capsular shift. In this study, we describe the long-term results of the PST. The study included 69 individuals (70 shoulders), with a mean age of 30years, who had recurrent post-traumatic anteroinferior instability. Apurse-stringsuture anchor at the 4-o'clock position was used to address the Bankart lesion and capsular laxity, recreating the anterior glenoid bumper. All patients were assessed via telephone interview at a mean of 116months after surgery (7-13-year follow-up). Postoperatively, the mean Constant score was 94, mean Rowe score was 93 and mean Walch-Duplay score was 89. 89% of patients resumed their preinjury sport activities, with 61% of patients achieving preinjury levels and most professional athletes returning to full activity. Seven patients had recurrent dislocation postoperatively (10% failure rate). Of these patients, three had revision arthroscopic stabilization, one patient had revision arthroscopic stabilization with remplissage, two had a Latarjet procedure, whereas one patient decided to seek no further treatment. The long-term results of PST are promising, with a low failure rate, high patient satisfaction and a high rate of return to sport. Level IV; Case series; Treatment study.

Comparative study of wound healing following purse-string closure versus conventional linear closure for stoma reversal

Stoma closure is associated with several complications, wound infection being the most common. This study is done to establish that purse string suture closure method for stoma closure is superior to the conventional linear mattress closure and is associated with better wound healing cosmesis. This Prospective randomized controlled study enrolled 80 patients who underwent stoma closure from April 2021 to March 2022 in department of General Surgery in IGIMS, Patna. Patients were divided in two groups inclusive of ileostomy and colostomy based on type of closure technique. Conventional linear closure method was applied to Group A and purse-string technique applied to Group B patients. All Patients were followed regularly upto three months after operation. Rate of infection, pain as assessed by VAS score and satisfaction as assessed by POSAS Score were done. Purse string Closure had better outcome in terms of wound infection rate and Cosmetic results over a 3 months follow up. Ten patients in Group A and 2 from Group B out of 40 patients had wound infection. Patients with purse-string suture had statistically significant greater satisfaction over 3 months. Medium operative time of Group A was 100 minutes and that of Group B was 98 minutes. There were no significant difference in regards duration of hospital stay was more in Linear Group than Purse String (Group B). Purse-string closure was associated with better cosmesis and lower infection rate in comparison to Linear conventional closure.

Analysis of mechanical complications in urgent-start peritoneal dialysis.

Peritoneal dialysis (PD) is an excellent, but underutilized dialysis technique. Thus, its implementation may depend alsoon the chance to offer this modality of treatment to patients referredlateto the nephologists. This approach has recently been named "urgent-start peritoneal dialysis" (UPD). The main barrier to this practice is represented by the fear of early mechanical complications. All prevalent patients needing urgent-start PD at our institution between 1 January, 2009 and 31 December, 2019 were included in the study. During this period, 242 peritoneal catheters were inserted in 222 patients. In all patients, an anti-leakage/dislocation suture was made. PD was started within 24h from catheter placement. The early incidence of leakages, catheter dislocations, omental wrappings, bleedings, peritonitis and exit-site infections was 11/242 (4.5%), 5/242 (2%), 3/242 (1.2%), 2/242 (0.8%), 6/242 (2.5%) and 4/242 (1.6%), respectively. No bowel perforations were observed. Nearly one third of the late complications (13/45; 35.2%) resultedin discontinuation of PD, while one fourth (11/45; 24.4%) required surgical revision. The remaining episodes (21/45; 46.6%) were successfully managed by a conservative approach. The survival of the catheter at 3, 6, 12, 24, 36 and 48months was 93.6, 91.2, 84.8, 77.4, 65.5 and 59.3%, respectively. The technique survival at 3, 6, 12, 24,36 and 48months was 97.2, 94.9, 87.6, 78.9, 66.6 and 60.0%, respectively. The main causes of PD drop-outincludedinfectious complications (36.8%) followed by mechanical complications (17.5%). A tight seal between deep cuff and surrounding tissues (double purse-string technique) in association with a starting low-volume exchange scheme allows to minimize early and late mechanical complication in UPD.

Comparison of three purse-string suture techniques for prevention of anal leakage during surgery

To compare 3 anal purse-string suture techniques for resistance to leakage and to identify the suture technique requiring the fewest tissue bites to create a consistent leak-proof orifice closure. 18 large-breed canine cadavers. 3 purse-string suture techniques (3 bites with 0.5 cm between bites [technique A], 5 bites with 0.5 cm between bites [technique B], and 3 bites with 1.0 cm between bites [technique C]) were evaluated. Each technique involved 2-0 monofilament nylon suture that was placed in the cutaneous tissue around the anus and knotted with 6 square throws. Standardized 2.0-cm-diameter circular templates with the designated bite number and spacing indicated were used for suture placement. Leak-pressure testing was performed, and the pressure at which saline was first observed leaking from the anus was recorded. The median and interquartile (25th to 75th percentile) range (IQR) were compared among 3 techniques. Median leak pressure for technique A (101 mm Hg; IQR, 35 to 131.3 mm Hg) was significantly greater than that for technique C (19 mm Hg; IQR, 14.3 to 25.3 mm Hg). Median pressure did not differ between techniques A and B (50 mm Hg; IQR, 32.5 to 65 mm Hg) or between techniques B and C. Placement of an anal purse-string suture prevented leakage at physiologic colonic and rectal pressures, regardless of technique. Placement of 3 bites 0.5 cm apart (technique A) is recommended because it used the fewest number of bites and had the highest resistance to leakage.

COMPARAÇÃO ENTRE O FECHAMENTO DE OSTOMIA EM BOLSA VS. GRAMPEAMENTO LINEAR EM CRIANÇAS

Type of ostomy closure has connection with some complications and also cosmetic effects. This study aimed to compare result of colostomy closure using purse-string method versus linear method in terms of surgical site infection, surgical time, and patient satisfaction. In this study, 50 patients who underwent purse-string ostomy closure and 50 patients who underwent linear closure were included. Two groups were compared for surgical time, wound infection, patient satisfaction, scar length. A p-value <0.05 was considered significant. Wound infection was not reported among purse-string group compared to 10% in linear group (p=0.022). Scar length was 24.09±0.1 mm in purse string and 52.15±1.0 mm in linear group (p=0.033). Duration of hospital admission was significantly shorter in purse-string group (6.4±1.1 days) compared to linear (15.5±4.6 days, p=0.0001). The Patient and Observer Scar Assessment Scale scale for observer (p=0.038) and parents (p=0.045) was more favorable among purse-string group compared to linear. Purse-string technique has the less frequent surgical site infection, shorter duration of hospital admission, less scar length, and more favorable cosmetic outcome, compared to linear technique.

Laparoscopic Purse-String Technique for Containment of Gynecologic Malignancy

Study Objective The objective of this video is to demonstrate a robotic-assisted laparoscopically placed purse-string for containment of gynecologic malignancy. Design Step-by-step demonstration of a laparoscopic purse-string technique to create a vaginal cerclage and contain malignant tumor cells. Setting Academic tertiary referral center. Patients or Participants The patient was a 66-year-old female who presented with postmenopausal bleeding. After undergoing physical examination, biopsy of the tumor, and diagnostic imaging, she was ultimately diagnosed with endometrial cancer. Interventions The patient underwent a robotic-assisted, laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissections, peri-aortic lymph node dissection, and distal omentectomy. Prior to the start of the laparoscopic procedure, methylene blue was injected in the vagina to delineate the most distal portion of the tumor. A purse-string suture was placed to create a vaginal cerclage abdominally prior to creation of colpotomy to help decrease tumor cell dissemination. Measurements and Main Results A purse-string suture was successfully placed to encapsulate tumor cells prior to colpotomy. The patient tolerated the procedure well and did not have any post-operative complications. Conclusion Placement of a purse-string suture laparoscopically is a feasible surgical technique to help minimize tumor dissemination. The objective of this video is to demonstrate a robotic-assisted laparoscopically placed purse-string for containment of gynecologic malignancy. Step-by-step demonstration of a laparoscopic purse-string technique to create a vaginal cerclage and contain malignant tumor cells. Academic tertiary referral center. The patient was a 66-year-old female who presented with postmenopausal bleeding. After undergoing physical examination, biopsy of the tumor, and diagnostic imaging, she was ultimately diagnosed with endometrial cancer. The patient underwent a robotic-assisted, laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissections, peri-aortic lymph node dissection, and distal omentectomy. Prior to the start of the laparoscopic procedure, methylene blue was injected in the vagina to delineate the most distal portion of the tumor. A purse-string suture was placed to create a vaginal cerclage abdominally prior to creation of colpotomy to help decrease tumor cell dissemination. A purse-string suture was successfully placed to encapsulate tumor cells prior to colpotomy. The patient tolerated the procedure well and did not have any post-operative complications. Placement of a purse-string suture laparoscopically is a feasible surgical technique to help minimize tumor dissemination.

The comparisons of three stapler placement methods for intrathoracic mechanistic circular stapling in Ivor Lewis minimally invasive esophagectomy.

To analyze the impact of the reversal penetrating technique (RPT) for intrathoracic gastroesophageal mechanical anastomosis on the development of anastomotic complications in Ivor Lewis minimally invasive esophagectomy (ILMIE), and to further identify the risk factors for the development of anastomotic leakage and stricture. A retrospective observational study was conducted using the clinical data of 316 patients with esophageal carcinoma (EC) who underwent ILMIE from January 2012 to December 2019. The participants were divided into three groups, namely the RPT group, the transoral Orvil technique (TOT) group, and the purse-string technique (PST) group, according to the different stapler placement methods for intrathoracic mechanistic circular stapling. Multivariate analysis was performed to investigate the association of risk factors with anastomotic leakage and stricture. There were 154 patients in the RPT group, 78 in the TOT group, and 84 in the PST group for intrathoracic gastroesophageal circular stapling in ILMIE. There were no differences in intraoperative anastomosis-related conditions including conversion of open operations, and lymph nodes harvested between the three groups. However, the mean total operative time and gastroesophageal anastomosis time in the RPT group were significantly shorter than those in the other groups (both P<0.05). The rates of anastomotic leakage and stricture showed no statistical differences between the three groups (leakage: P=0.875; stricture: P=0.942). Multivariate analysis revealed that the RPT method of anvil placement did not increase the probability of anastomotic leakage [RPT: reference; TOT: odds ratio (OR) 0.422, P=0.341; PST: OR 1.436, P=0.645] and stricture (RPT: reference; TOT: OR 0.579, P=0.376; PST: OR 1.195, P=0.755). The RPT method of anvil placement for intrathoracic gastroesophageal circular stapling does not increase the risk of anastomotic complications in ILMIE, but had significantly shorter surgical time and anastomosis time.

P139. A novel purse-string technique for creating an acellular dermal matrix pocket for implant-based pre-pectoral breast reconstruction

Introduction: Pre-pectoral implant-based breast reconstruction is increasingly being used for patients requiring mastectomy. We describe a novel technique using a purse-string suture to create a pocket from a fenestrated rectangular sheet of acellular dermal matrix (ADM) mesh around the implant prior to positioning on the chest wall.

Abstract No. 591 Purse-string technique for venous closure after large-bore mechanical thromboembolectomy

Mechanical removal of clots in patients with pulmonary embolism and deep venous thrombosis is an attractive alternative to pharmacological treatment or catheter-directed lytic infusion. The most effective mechanical thrombectomy devices have large calibers and require large size venous puncture. The size of venotomy have been a limiting factor for more widespread use of these devices. Almost all of these patients are also on anticoagulation that potentially increases the chance of bleeding and procedural complications.

Experience in the Use of Artificial Fibrillation in the Correction of Postinfarction Left Ventricular Aneurysms as the Most Appropriate Alternative to Pharmaco-Cold Protection of the Heart

Coronary heart disease (CHD) is the leading cause of death in the world. In most cases, the disease is complicated by myocardial infarction (MI) followed by the formation of a left ventricular aneurysm (LVA), ruptures of the interventricular septum, ischemic cardiomyopathy, mitral regurgitation and arrhythmias. Postinfarction left ventricu-lar aneurysm is the most common and severe complication of CHD. There are a lot of methods of LVA surgical correc-tion, including Cooley’s linear repair technique, purse-string technique of Jatene and endoventriculoplasty using the Dor technique. Over the last year, 43 left ventricular aneurysm repair surgeries were carried out at the NatioМешковаnal M. M. Amosov Institute of Cardiovascular Surgery. Depending on the comorbidities, age, left ventricular contractility and other factors, plastic correction was performed using artificial fibrillation (n = 24 [55.8%]) or cardioplegic solution (n = 19 [44.2%]) for myocardial protection. Significant difference in the mean duration of the operation, the time the patient was on the artificial circulation, the amount of inotropic support, the time of mechanical ventilation, and the contractile function of the left ventricle (LV) was observed. In group 1, where artificial left ventricular fibrillation was used for myocardial protection, the mean duration of the surgery was 1.9 ± 0.2 h shorter. Accordingly, the patient’s stay on the artificial circulation decreased by 92.2 ± 0.3 minutes. Also, the duration of mechanical ventilation was significantly shorter: 4.6 ± 0.8 hours and 7.3 ± 0.7 hours in groups 1 and 2, respectively.&#x0D; And most importantly, in the group 1 the ejection fraction increased by 2.3 ± 0.45% compared with 1.17 ± 0.43% in the group 2. However, all the other parameters were similar in both groups. This gives reason to consider artificial ven-tricular fibrillation as the most appropriate method of myocardial protection in the future.

A Comparative Study of Pediatric Inguinal Hernia Repair by Open Technique versus Laparoscopic Repair

Background: Herniotomy / open surgery has been the time honoured treatment for paediatric inguinal hernia. The improvement of paediatric Laparoscopic hernia and increased experience with Laparoscopic technique become an important skill. Laparoscopic repair of inguinal hernias in children is adopted too quickly, cost effective, cosmetically, less invasive, more feasible and less painful. This procedure is that, it could allow contralateral hernia detection and repair in same setting. Aims and objectives: In our study we aimed to compare between the outcome of inguinal hernia repair in two study group open hernia repair and Laparoscopic hernia repair by Z suture or purse string technique and study to the early and late complication. Materials and methods: the current prospective study carried out in Department of General Surgery, SVBP Hospital Meerut which included 40 patients duration of period from September 2018 to September 2019. Among them, 20 patients in group 1 were repaired by Open procedure and another 20 patients in group 2 were repaired by Laparoscopic procedure. Results: The study included 40 patients. The mean time of operation in Laparoscopic repair (41.50 minute) is slightly shorter than that of open repair (47.50 minute) technique. Postoperative pain was much less in LH group then open hernia group. Hospital stay in LH (1.55 days) and in OH (2.20 days). Oral ships were allowed and well tolerated as early in LH (7.3 hrs) and in OH (10.90 hrs), this was statistically significant. Patients financial satisfaction was lower in group 2than in group 1 repair. Conclusion: The data from study confirmed that the results of Laparoscopic technique has advantage of reduced postoperative pain, diagnosis of CPPV with its management in the same sitting, rapid return to everyday activities, better cosmetic results, cost effective, more feasible and less painful.

Pursestring Technique for Treatment of Nulliparous Congenital Inverted Nipple.

Background:Nipple inversion in nulliparous women is often encountered and is a surgical challenge. The challenge lies in the correction of deformity with minimal marks and also in not damaging the lactiferous ducts, which will interfere with future breastfeeding.Aim:To provide a relatively simple technique, which can be easily performed as an outpatient procedure with minimal complications.Materials and Methods:A total of 11 patients were treated with this technique of which 5 patients had bilateral inverted nipples.Results:We had no recurrence and the follow-up period was of minimal of 1 year. One patient had mild stitch infection, which healed conservatively with antibiotics.Conclusion:The pursestring technique described offers a simple surgical option for the treatment of nulliparous women with nipple inversion.