Safe Repair Research Articles

Staged thoracoscopic internal traction approach for early repair of long-gap esophageal atresia (LGEA) with distal tracheoesophageal fistula (TEF)

BackgroundLong-gap esophageal atresia (LGEA) can complicate the management of esophageal atresia (EA) with or without a tracheoesophageal fistula (TEF). This series describes a short interval, staged, thoracoscopic internal traction approach for LGEA with distal TEF to manage complex anastomotic tension or an anatomically impossible esophageal anastomosis.MethodsA retrospective review (2018–2024) was performed across four tertiary centers to identify patients with LGEA and distal TEF, managed with a staged, thoracoscopic internal traction approach. In the first stage, the TEF was ligated and internal traction sutures were placed between esophageal pouches. In the second stage, patients underwent primary anastomosis. Short and long-term complications and outcomes were measured.ResultsIn total, seven patients were treated with this approach. Gestational ages ranged from 33 to 39 weeks. The average age at the initial surgery was 2.3 days, and the average age at definitive anastomosis was 15.9 days. There were no cases of leak or esophageal dehiscence. Gastroesophageal reflux was a common post-operative complication, occurring in 85.7% of patients.ConclusionsTemporary internal traction sutures allow for a minimally invasive, safe repair of LGEA with distal TEF, under decreased tension. This technique reduces operative time, and potential complications associated with other long-gap anastomotic techniques.Level of evidenceIV.

DNA double-strand break movement in heterochromatin depends on the histone acetyltransferase dGcn5.

Cells employ diverse strategies to repair double-strand breaks (DSBs), a dangerous form of DNA damage that threatens genome integrity. Eukaryotic nuclei consist of different chromatin environments, each displaying distinct molecular and biophysical properties that can significantly influence the DSB-repair process. DSBs arising in the compact and silenced heterochromatin domains have been found to move to the heterochromatin periphery in mouse and Drosophila to prevent aberrant recombination events. However, it is poorly understood how chromatin components, such as histone post-translational modifications, contribute to these DSB movements within heterochromatin. Using irradiation as well as locus-specific DSB induction in Drosophila tissues and cultured cells, we find enrichment of histone H3 lysine 9 acetylation (H3K9ac) at DSBs in heterochromatin but not euchromatin. We find this increase is mediated by the histone acetyltransferase dGcn5, which rapidly localizes to heterochromatic DSBs. Moreover, we demonstrate that in the absence of dGcn5, heterochromatic DSBs display impaired recruitment of the SUMO E3 ligase Nse2/Qjt and fail to relocate to the heterochromatin periphery to complete repair. In summary, our results reveal a previously unidentified role for dGcn5 and H3K9ac in heterochromatic DSB repair and underscore the importance of differential chromatin responses at heterochromatic and euchromatic DSBs to promote safe repair.

Surgical anatomical landmarks for arthroscopic repair of subscapularis tendon tears.

Subscapularis repair has recently garnered significant interest. A thorough understanding of the tendon's anatomy is essential for precise and safe repair. Our objectives were to describe the anatomy of the subscapularis insertion, define its landmarks, and analyze nearby structures to guide arthroscopic repair. We conducted an anatomical study, dissecting 12 shoulders. We evaluated the distance from the footprint to the axillary nerve, the dimensions, and shape of the footprint, and its relationship with the humeral cartilage. The distance to the axillary nerve was 32 mm (standard deviation [SD], 3.7 mm). The craniocaudal length of the footprint was 37.3 mm (SD, 4.6 mm). Its largest mediolateral thickness was 16 mm (SD, 2.2 mm), wider at the top and narrower distally. The distance between the footprint and the cartilage varied, being 3.2 mm (SD, 1.2 mm) in the upper part, 5.4 mm (SD, 1.8 mm) in the medium, and 15.9 mm (SD, 2.9 mm) in the lower part. When performing a repair of the subscapularis tendon, the distance to the cartilage should be carefully evaluated as it varies proximally to distally, and the shape of the footprint (wider proximally, tapered distally) should be considered for implant positioning. The distance to the axillary nerve is approximately 30 mm. Anterior visualization guarantees direct control of all landmarks and allows accurate implant positioning with safe tendon release. Level of evidence: IV.

Emerging Gene Therapeutics for Epidermolysis Bullosa under Development.

The monogenetic disease epidermolysis bullosa (EB) is characterised by the formation of extended blisters and lesions on the patient's skin upon minimal mechanical stress. Causal for this severe condition are genetic mutations in genes, leading to the functional impairment, reduction, or absence of the encoded protein within the skin's basement membrane zone connecting the epidermis to the underlying dermis. The major burden of affected families justifies the development of long-lasting and curative therapies operating at the genomic level. The landscape of causal therapies for EB is steadily expanding due to recent breakthroughs in the gene therapy field, providing promising outcomes for patients suffering from this severe disease. Currently, two gene therapeutic approaches show promise for EB. The clinically more advanced gene replacement strategy was successfully applied in severe EB forms, leading to a ground-breaking in vivo gene therapy product named beremagene geperpavec (B-VEC) recently approved from the US Food and Drug Administration (FDA). In addition, the continuous innovations in both designer nucleases and gene editing technologies enable the efficient and potentially safe repair of mutations in EB in a potentially permanent manner, inspiring researchers in the field to define and reach new milestones in the therapy of EB.

Nanofibrous hybrid scaffolds based on PCL-borosilicate system by a green sol-gel process

Tissue regeneration is yet a critical issue, and to mimic the natural extracellular matrix (ECM) innovative scaffolds need to be developed to ensure the functional and safe repair of the damaged organs or tissues. Hybrid biomaterials based on the combination of a biodegradable polymer and bioactive glasses (BGs) are potential candidates for tissue engineering (TE), since they exhibit tailored physical, biological, and mechanical properties, as well as controlled degradation behavior. Thus, the main purpose of this research was to develop by electrospinning (ES) a hybrid nanofibrous membrane composed of a synthetic polymeric matrix (PCL) and a boron and calcium silicate glass, formed via in situ sol-gel, and based on a non-aqueous and green fabrication route. Formic acid (FA) and glacial acetic acid (AA) were used as green solvents to dissolve the PCL. Different compositions were prepared: neat PCL and PCL/SiO2–B2O3–CaO with different sol-gel aging times and green solvent systems. All prepared hybrid solutions, except the composition with only AA, were spinnable. Structural features of the hybrids were assessed by ATR-FTIR spectroscopy, which confirmed the presence of siloxane (Si–O–Si) bonds of silica and carbonyl (CO) bonds characteristic of PCL polymer as well as intermolecular hydrogen-bonding interactions between the carbonyls of PCL and the silanol hydroxyls (Si–OH) of silica networks. Boron (B–O–B) and borosiloxane (B–O–Si) bonds were not visible due to the overlapping of PCL bands in the spectra. Only the solid state 11B NMR technique allowed to find peaks assigned to trigonal BO3 and tetrahedral BO4 groups, which evidence the boron linkages to silica. Thermal analysis showed a change in the crystallinity of PCL with the incorporation of inorganic domains, confirming the formation of chemical interactions between the polymer and the inorganic part. Microstructure and chemical analysis, by SEM/EDS, showed a homogenous distribution of Ca and Si elements into the fibers, as well as an increase of the fiber diameter with the incorporation of boron and calcium silicate glass in the PCL. The developed compositions of PCL/boron and calcium-containing silicate were feasible to electrospin into fibrous meshes, proving its potential for further design of multicomponent nanofibrous microstructures closer to extra cellular matrix architectures.

Advanced Gene Therapy Strategies for the Repair of ACL Injuries.

The anterior cruciate ligament (ACL), the principal ligament for stabilization of the knee, is highly predisposed to injury in the human population. As a result of its poor intrinsic healing capacities, surgical intervention is generally necessary to repair ACL lesions, yet the outcomes are never fully satisfactory in terms of long-lasting, complete, and safe repair. Gene therapy, based on the transfer of therapeutic genetic sequences via a gene vector, is a potent tool to durably and adeptly enhance the processes of ACL repair and has been reported for its workability in various experimental models relevant to ACL injuries in vitro, in situ, and in vivo. As critical hurdles to the effective and safe translation of gene therapy for clinical applications still remain, including physiological barriers and host immune responses, biomaterial-guided gene therapy inspired by drug delivery systems has been further developed to protect and improve the classical procedures of gene transfer in the future treatment of ACL injuries in patients, as critically presented here.

Repair of complete atrioventricular septal defect between 2 and 3.5 kilograms: Defining the limits of safe repair

ObjectivesRepair of complete atrioventricular septal defect (cAVSD) is routinely performed at around 3 months of age with good results. However, some patients require earlier surgery due to heart failure or failure to thrive. It is uncertain whether cAVSD repair performed on patients ≤3.5 kg leads to increased mortality and reoperation on the left atrioventricular valve. MethodsAll patients who underwent cAVSD repair from 1990 to 2019 at a single institution were included in the study. Data were obtained from retrospective review of medical records and correspondence with cardiologists. ResultsOf 456 patients, 12.9% (59/456) weighed ≤3.5 kg at time of repair. This group was younger (P < .01) and had greater rates of heart failure (P < .01) and failure to thrive (P = .02). There was no significant difference in early mortality between the 2 groups (1.7% [1/59] vs 3.0% [12/397], P = 1.0). Survival at 20 years was 83.8% in those ≤3.5 kg, compared with 90.4% in those >3.5 kg, with no significant difference between the 2 groups (P = .68). Freedom from left atrioventricular valve reoperation at 20 years was 73.6% in those ≤3.5 kg, compared with 74.5% in those >3.5 kg, with no significant difference between the 2 groups (P = .45). ConclusionsRepair of cAVSD in children ≤3.5 kg appears to be safe, with similar overall survival and freedom from reoperation compared with those >3.5 kg. These findings add further support to an approach of early complete repair in children with severe heart failure or failure to thrive.

Open posterior component separation with transversus abdominis release (TAR) for large incisional abdominal wall hernias: Results from a single center

Transversus abdominis release (TAR) is the newest approach that allows effective myofascial mobilization, creating a large retromuscular space and wide mesh overlap to repair complex and large incisional ventral hernias. This article narrates the technical details and results of the TAR technique performed in a single center. The present study is a retrospective analysis of a prospective dataset from 25 patients who underwent posterior component separation (PCS) with TAR procedure for large incisional ventral hernias between October 2017 and July 2021. The minimum follow-up period was ten months. Twenty-five patients (five male, 20 female) with a mean age of 61.2 years, a mean BMI of 32.2 kg/m2, and a median ASA score of 2.0 underwent the TAR procedure. Fifteen (60%) patients had a history of incisional hernia surgery. The mean surgical time was 248 minutes. The mean total defect and mesh areas were 187.4 (90-500) cm2 and 1141.8 (750-2250) cm2, respectively. The mean visual analog scale (VAS) pain score on the first postoperative day was 4.5 and the median hospital length of stay (LOS) was 5 days. There were three (12%) surgical site infections (SSIs), two of which were deep infections that needed debridement. During the follow-up period (median of 26 months), two (8%) recurrences were recorded. The TAR technique represents an effective and safe repair modality of large and complex incisional hernias. TAR is an essential addition to the repertoire of the surgical community.

VP019 TESAR - TOTALLY ENDOSCOPIC SUBLAY ANTERIOR REPAIR - IN MIDLINE DEFECTS REPAIR

Abstract Aim In recent years, many minimally invasive techniques have been presented in abdominall wall repair. Since 2018 we have been using TESAR techinque, an anterior endoscopic approach with mesh sublay, published in 2019 from our group. Material and Methods From May 2018 to May 2021 58 Patients referred to our Unit for clinical and radiological diagnosis of ventral defect (Midline hernia, Incisional hernia, Diastasis Recti&amp;gt;5 cm). Exclusion criteria were: maximum defeact width 8 cm, and contraindications to general anesthesia Results All the patients underwent midline repair with TESAR technique. Three TAR were performed, with defect of 8 cm width previously treated with botox. No conversion to laparotomy occured, no intraoperative complications were registered. Total mean operative time was 156 +- 21,5 min. No postoperative major complications, 3 subcoutaneous seromas occurred ,all treated conservatively. The mean Hospital stay was 2.7 + 0.8 days. Conclusions TESAR is a feasible technique for extraperitoneal repair of midline defects with a totally endoscopic approach, allowing a safe repair with good outcomes in terms of resolutions of symtoms and postoperative complications. The video shows the main steps of the technique in diastasis recti and complicated ventral hernia repair.

Paraconduit Hiatal Hernia Following Esophagectomy: Incidence, Risk Factors, Outcomes and Repair

Paraconduit hiatal hernia (PCHH) is a known complication of esophagectomy with significant morbidity. PCHH may be more common with the transition to a minimally invasive approach and improved survival. We studied the PCHH occurrence following minimally invasive esophagectomy to determine the incidence, treatment, and associated risk factors. We retrospectively reviewed records of patients who underwent esophagectomy at an academic tertiary care center between 2013-2020. We divided the cohort into those who did and did not develop PCHH, identifying differences in demographics, perioperative characteristics and outcomes. We present video of our laparoscopic repair with mesh. Of 49 patients who underwent esophagectomy, seven (14%) developed PCHH at a median of 186 d (60-350 d) postoperatively. They were younger (57 versus 64 y, P< 0.01), and in cases of resection for cancer, more likely to develop tumor recurrence (71% versus 23%, P= 0.02). There was a significant difference in 2-y cancer free survival of patients with a PCHH (PCHH 19% versus no hernia 73%, P< 0.01), but no significant difference in 5-y overall survival (PCHH 36% versus no hernia 68%, P= 0.18). Five of seven PCHH were symptomatic and addressed surgically. Four PCHH repairs recurred at a median of 409 d. PCHH is associated with younger age and tumor recurrence, but not mortality. Safe repair of PCHH can be performed laparoscopically with or without mesh. Further studies, including systematic video review, are needed to address modifiable risk factors and identify optimal techniques for durable repair of post-esophagectomy PCHH.

Easy and safe repair of quadriceps tendon rupture through transosseous sutures: A technical note

Many repair techniques have been used for quadriceps tendon rupture. Transosseous sutures are the golden standard since they can offer the safest and most stable tendon reattachment. Drilling in parallel to the patella’s longitudinal axis while avoiding the articular surface can be particularly challenging. In addition, drilling the patella has been shown to increase the possibility of an intraoperative fracture, especially if large diameter drills are being used. The present technical note demonstrates a simple, safe, cost-effective, and reproducible technique for quadriceps tendon repair. This technique is based on the use of a cruciate ligament reconstruction tibial tip aimer and guide wires with eyelet. After the accurate patella, entry and exit points for transosseous suturing are defined, the eyelet guide wires enable the passing of the sutures through the patella. Finally, the free ends of each suture are pulled and secured distally. This technique allows efficient and proper tendon fixation while minimizing potential complications.

Reviewing the Interaction Between Cost, Quality, and Outcomes for Safe and Effective Hernia Repair: Which Technique Is Best?

Reviewing the Interaction Between Cost, Quality, and Outcomes for Safe and Effective Hernia Repair: Which Technique Is Best?

Laparoscopic Repair for Full Thickness Resection of Diaphragm Metastases in Ovarian Cancer

Study Objective To describe the laparoscopic surgical technique to safely repair a full thickness diaphragm ovarian cancer resection, as well as the intraoperative trans-diaphragmatic pneumothorax decompression and lung re-expansion technique. Additionally, the role of minimally invasive surgery to resect diaphragm metastases in ovarian cancer will be discussed. Design Surgical educational video. Setting Tertiary care center at an academic institution. Operating room procedure with patient on lithotomy with reverse Trendelenburg position and a leftward tilt. Patients or Participants Case description of a 39-year-old patient with stage IIIB high grade serous carcinoma of the ovary who presented for interval debulking surgery. Interventions Laparoscopic cytoreduction with resection of diaphragmatic metastases. This video emphasizes the most important surgical steps to safely perform a minimally invasive full thickness right hemi-diaphragmatic defect repair after resection of full thickness ovarian cancer metastases. A trans-diaphragmatic lung re-expansion technique using a suction catheter with purse string suture and Valsalva is shown. Measurements and Main Results N/A Conclusion Laparoscopic resection of diaphragm metastases with intraoperative trans-diaphragmatic pneumothorax decompression is feasible and safe in selected patients. Surgical expertise with adequate laparoscopic needle handling is necessary for a safe repair.

Ремонт наплавкой при дефектах металла трубы и сварных соединений

Cladding repair is the one of the most simple and least expensive repair technologies. It refers to both permanent and temporary repair methods. It reduces work costs and time of repair works while retaining the quality required by the statutory requirements. With the help of cladding repair, a significant number of defects of corrosion-mechanical origin can be eliminated. The problem of improving this technology is of utmost importance. The purpose of the present research is to develop the technology for effective and safe cladding repair of such defects as corrosion damages of pipe metal and such welded connection defects as incomplete groove filling, undercut, pores, strikes, slag inclusion. The following problems were solved to reach this goal: research of thermal cycles in the course of cladding, research of cladding modes, development of multipass repair technology, determination of allowable defect parameters, and detection of methods for optimal quality control of repaired areas. The specialists performed testing of full-scale pipe samples and circular joint of pipes, imitating the surface defects after cladding repair. The test results did not reveal the damage of metal and welded connection areas. Cladding repair allows recovering bearing capacity of pipeline to design level. This technology can be used in the works on shutdown pipelines and on pipelines under operation.

V-Y advancement flap for repair of neglected injuries of the Achilles tendon using 2 mini-incisions

Objective: To find a safe repair site for a proximal mini-incision to expose the fascia at the level of the gastrocnemius medialis (GM) myotendinous junction (MTJ). Methods: Seventeen anatomic specimens of popliteal fossa, leg, and foot fixed in formalin were dissected, and the perpendicular distance from the apex of the medial malleolus to the GM MTJ was measured. Results: The minimum and maximum perpendicular distances from the apex of the medial malleolus to the GM MTJ were 14.00cm and 20.5cm, respectively. Average distance was 16.56cm. Conclusion: We were able to establish a constant value and the average GM MTJ height, which allows for V-Y lengthening through 2 mini-incisions. In reviewing the literature, there was no description of the approaches proposed in this study. Level of Evidence VI; Therapeutic Studies; Case Series.Achilles tendon/surgery

Surgical Results With the ONSTEP Technique Using OnFlex Mesh for Inguinal Hernias: Case Series With Treating 986 Lesions.

The ONSTEP technique is a surgical repair method that uses an anterior approach for inguinal hernias. It is a new surgical technique that spans layers in which the medial side of the mesh is inserted into the peritoneal cavity, and the lateral side is positioned over the internal oblique muscle. Previous reports on this technique have mentioned the use of PolySoft Hernia Patch mesh; however, there have been no reports of surgical outcomes using OnFlex Mesh with absorbent rings. The authors evaluate the results of the ONSTEP technique using OnFlex Mesh. In 2017, this technique was introduced as an outpatient surgical procedure at our institution. In the past 3 years, it has been performed in 941 patients to repair 986 lesions. Recurrences were observed in only 1 patient (0.10%), and complications included subcutaneous hemorrhage in 21 patients, hematoma in 10, seroma in 9, wound infection in 4, and mesh infection in 1. No serious events, such as postoperative ileus, chronic pain, or bladder injury, were observed. Because this technique does not require a procedure to detach the lateral preperitoneal space, the duration of surgery was 27±8 min, which was shorter than other transinguinal preperitoneal repair techniques. The ONSTEP technique using OnFlex Mesh is a simple and safe repair method that can be performed as an outpatient surgical procedure. Although there is still a need to wait for long-term results, favorable short-term to medium-term results have been obtained.

Laparoscopic Repair of Perforated Peptic Ulcer in the Elderly: An Interim Analysis of the FRAILESEL Italian Multicenter Prospective Cohort Study.

The number of elderly patients requiring emergency surgical intervention has increased dramatically. Perforated peptic ulcer (PPU) complications, such as perforation, have remained relatively stable and associated morbidity remains between 10% and 20%. Advances in perioperative care have greatly improved the outcomes of laparoscopic emergency surgery, allowing increasing numbers of patients, even the elderly, to undergo safe repair. The aim of this study was to evaluate the feasibility, safety, and outcome of laparoscopic gastric repair in the elderly using the database of the FRAILESEL (Frailty and Emergency Surgery in the Elderly) study. This is a retrospective analysis carried out on data of the FRAILESEL study. Data on all the elderly patients who underwent emergency abdominal surgery for PPU from January 2017 to December 2017 at 36 Italian surgical departments were analyzed. Patients who underwent PPU repair were further divided into a laparoscopic gastroduodenal repair (LGR) cohort and an open gastroduodenal repair (OGR) cohort, and the clinicopathologic features of the patients in both the groups were compared. Sixty-seven patients fulfilled the inclusion criteria. Thirty-three patients (47.8%) underwent LGR. The LGR patients had less blood loss and shorter postoperative stay, even if the difference was not statistically significant. The mean operative time was significantively higher in the OGR (OGR 96.5±27.7 vs. LGR 78.6±16.3 P=0.000). The rate of death after laparoscopic surgery was similar to the rate of the open surgery. Multivariate analysis indicated that only age (P=0.018), admission haemoblogbin (Hb) level (P=0.006), platelet count (P=0.16), lactate level (P=0.47), and Mannheim Peritonitis Index (P=0.18) were independent variables associated with the risk of overall mortality. LGR is safe and feasible in elderly patients with PPU and it is associated with better perioperative outcomes. However, patient selection and preoperative frailty evaluation in the elderly population are the key to achieving better outcomes.

Symptom persistence after vascular ring repair in children

PurposeVascular rings are often diagnosed after evaluation for swallowing and breathing difficulties. Data regarding symptoms following vascular ring repair is sparse. We sought to determine whether symptoms persist using chart review and a survey. MethodsSixty-three patients underwent open vascular ring repair from July 2007 to May 2018. Data regarding vascular anatomy, demographics, pre- and postoperative symptoms, and chromosomal abnormalities were collected. Freedom from reoperation, 30-day mortality, and complications were assessed. Patient families were contacted for a symptom focused survey. ResultsThe median age of surgical intervention was 14.4 months (IQR 5.8–34.7 months) for single aortic arches with an aberrant subclavian artery (SAA), and 5.3 months (IQR 1.3–10.1 months) for double aortic arches (DAA) (Table). Prior to surgery, all but two SAA were symptomatic. There was no operative mortality. Three patients required re-exploration for chylothorax, and three required late aortopexy. At last follow-up, 45% (18/40) SAA and 65% (15/23) DAA had post-operative symptoms. Fourteen patient families completed the symptom survey (10 SAA, 4 DAA). Five SAA had breathing and swallowing symptoms, and 3 SAA and 3 DAA had breathing difficulties. ConclusionsOpen vascular ring repair remains a safe repair. However, further investigation of the persistent symptoms in these patients is merited. Study Type / Level of EvidenceRetrospective Comparative Study, Level III

Ремонт поверхневих дефектів на діючих трубопроводах MIG/MAG зварюванням в імпульсному режимі

A significant part of Ukraine’s trunk pipelines have been in operation for a long time and require renovation. The most common method of repair is welding of defective areas with corrosion damage using arc welding. But while performing welding work on active pipelines there is a danger of through-penetration or excessive heating of the pipe wall with the welding arc, which can lead to its destruction by internal pressure. The problem of safe repair of the surface defects in pipelines under pressure can be solved by reducing the thermal effect on the pipe wall. Experimental investigations of heat propagation while welding rollers on a 17GS tube steel plate by manual arc welding and semi-automatic MIG/MAG welding with the controlled transfer of metal in the impulse mode were carried out in the article. At the same time, measurements of temperature changes in the wall of the pipe at six points at different depth were taken, using K-type chromel-alumel thermocouples connected to the Arduino microcontroller, and their subsequent processing. Macrostructural investigations were conducted and the depth of penetration and the zone of thermal impact of the welded rollers were determined. The results of the research have shown that by MIG/MAG welding in impulse mode, the maximum pipe wall temperature is 168 ° C (31 %) lower than with manual arc welding. Also, in this method, the cooling rate is higher. Such reduction in heat input is significant and minimizes the risk of thermal burn of the pipe wall. By welding in impulse mode, the quality of the welded rollers is much better, the depth of penetration decreases and the thermal impact zone is three times smaller. The use of MIG/MAG impulse mode welding of drop transfer of electrode metal in the repair of the surface defects of the pipe wall has been found to be more efficient and productive than the manual arc welding, as well as safer and more economical, as it guarantees quick and efficient repair without the risk of thermal burning of the pipe wall.

Effect of Different Surface Treatments on the Repair of Aged Bulk-Fill Composites: An In Vitro Study

Objectives: The aim of this in vitro study was to evaluate the efficiency of different surface treatments on the microtensile bond strength (µTBS) of aged bulk-fill composite.Materials and Methods: Sixty bulk-fill resin-based composite (RBC) specimens in 5 x 5 x 5 dimensions were prepared. After the aging by thermal cycling for 5000 times between 5 and 55°C, substrate surfaces were abraded with SiC abrasive papers. Specimens were divided into 6 groups according to the surface treatment protocol: no surface treatment (control), control + Single Bond Universal (SBU; 3M ESPE) application, phosphoric acid etching (PA) + SBU, hydrofluoric acid etching (HF) + SBU, aluminum oxide air abrasion (AlO) + SBU, and tribochemical silica coating (TSC) + SBU. Surface roughness values were measured in five different directions using a contact profilometer (n=10). Then, specimens were repaired with a conventional RBC. After the repair, bonded specimens were cut into 1 mm2 beams and µTBS values were determined until failure at a crosshead speed of 0.5 mm/min. Specimen surfaces after surface treatments were observed by SEM. Data were analyzed using ANOVA and Tukey tests (p&amp;lt;0.05). Results: One-way ANOVA revealed significant difference (p&amp;lt;0.001) among the surface treatments. The lowest repair µTBS values were observed for the control group. SBU application alone significantly improved repair µTBS values (p&amp;lt;0.001). The highest µTBS values were obtained for the AlOand TSC, and HF followed. The surface roughness ranking for the five surface treatment protocols was as follows: TSC &amp;gt; AlO &amp;gt; HF &amp;gt; PA = Control. Conclusions: Aged bulk-fill RBCs can be successfully repaired if effective and safe repair protocol is chosen. The highest µTBS values were obtained for the AlO and TSC. The use of universal adhesive alone is promising to facilitate the repair of bulk-fill RBCs.