Stab Incision Research Articles

Multiple Stab Incisions and Evacuation Technique for Contrast Extravasation of the Hand and Forearm.

Extravasation of intravenous contrast agents in the hand and forearm during computed tomography scanning is rising with the use of automated pressure injectors. The main concern in such a situation is progression to acute compartment syndrome and necrosis of the overlying skin. Management has been mainly nonsurgical comprising upper limb elevation and orthosis, with surgical techniques such as liposuction and saline evacuation mainly used for large volume (>50 mL) extravasations. We have developed a technique of multiple stab incisions and drainage for the treatment of contrast extravasations.

Laparoscopic Ileocolic Pexy as Preventive Treatment Alternative for Ileocolic Intussusception With Multiple Recurrences in Children.

Idiopathic intussusception is one of the most common causes of small bowel obstruction in children. To decrease subsequent recurrence and to detect a lead point, an early laparoscopy was performed for children with multiple recurrent ileocolic intussusception. Between January 2014 and July 2017, a total of 2561 consecutive children with intussusception were treated and followed. There were 110 patients with multiple recurrences, 61 were treated with ileocolic pexy and 49 were not and the results were compared. Using a 5-mm laparoscope and 2 additional transabdominal wall stab incisions, an appendectomy and an ileocolic pexy with nonabsorbable sutures were performed simultaneously for the children after the last successful enema reduction. The mean operative time was 59.4±13.1 minutes (range, 45 to 85 min). No cases required conversion to an open surgery, blood loss was minimal. There was no operative morbidity. Two patients were found with a Meckel's diverticulum, and were removed by slightly enlarged transumbilical incision. The 61 cases were followed up for 4 to 42 months (mean, 19.3±1.1 mo). In the ileocolic pexy group, 2 of 61 (3.2%) got 2 episodes of recurrences. Among the 25 patients with 3 recurrences without undergoing ileocolic pexy, 18 (72%) had 22 episodes of recurrence. Of the 16 patients with 4 recurrences and without ileocolic pexy, 14 (87.5%) had 17 episodes of recurrence. There was statistical difference in recurrent rate among the 3 groups (ileocolonic pexy group vs. 3 recurrences group, P<0.01; ileocolic pexy group vs. 4 recurrences group, P<0.01). Early preventive laparoscopic ileocolic pexy should be undertaken for the patients with multiple recurrences after the last nonsurgical reduction had been attempted successfully.

Dermal subcision of Nemoto’s ligaments as a long-lasting treatment for forehead and glabellar wrinkles

Ever since the beginning of recorded history, beauty has played a major social role. A youthful look, symmetry, and a soft, smooth skin texture, as well as an even colour, are the main characteristics and parameters of attractive and beautiful faces. The forehead is the first location in the face that shows wrinkles. Facial wrinkles show an increase in depth and severity with age in all faces, in both sexes, but usually, forehead wrinkles develop earlier in men than they do in women. The work published by Nemoto et al. in 2002 revolutionised the concepts about the aetiology and anatomy of forehead wrinkles, thus inspiring the authors to develop a new surgical technique for treatment. Sixty-five patients participated in this study (50 females and 15 males). The age range in this series ranged from 26 to 59 years. Through stab incisions at the hairline level, a standard ENT myringotomy knife was used to cut the fibrous septae connecting between the superficial layer of the galea apponeurotica (that covers the frontalis and glabellar muscles) and the dermis. The results showed a high level of satisfaction among both patients and an objective assessor with no negative comments. Patients rated the operative results excellent in 52.3% of this series, while the operative results were rated excellent in 47.7% of patients by an independent, objective assessment. Kappa analysis showed perfect agreement between the objective and subjective assessments (K = 0.839). The mean Lamperle classification was 3.1 before surgery and 0.7 3 years after surgery. There was a significant reduction in the mean Lamperle classification 3 years after surgery. The cutting (dermal subcision) of fasciocutaneous ligaments of the forehead described by Nemoto et al. is a safe, economical and effective technique for forehead and glabella rejuvenation with long-lasting results. Level of Evidence: Level IV, therapeutic study.

Minimally Invasive Dorsal Cheilectomy of the First Metatarsal: A Cadaveric Study.

Minimally invasive dorsal cheilectomy (MIDC) for hallus rigidus is gaining in popularity. The optimal position for the stab incision for MIDC is dorsomedial to allow an ergonomic sweeping movement of the burr, potentially putting the dorsomedial cutaneous nerve (DMCN) to the hallux at risk. We aimed to quantify the risk of using this minimally invasive technique with a cadaveric study. A total of 13 fresh-frozen cadaveric specimens amputated below the knee were obtained for this study. After the procedure, the specimens were dissected, and structures were inspected for damage. The DMCN to the hallux was cut completely in 2 specimens (15%). All the extensor hallucis longus tendons were intact, although in 1 specimen, the tendon showed some fraying on the underside of the tendon. The average distance of the stab incision from the first metatarsophalangeal (MTP) joint was 17.7 (range, 10-23) mm. The relationship of the DMCN to the stab incision was variable. The average distance of the DMCN to the incision was 3.8 (range, 0-7) mm. The danger zone for damaging the DMCN was at one-third the length of the first metatarsal proximal to the first MTP joint. The DMCN has been well studied by several authors and has a variable course. This nerve was damaged in 15% of our specimens following MIDC. We believe patients should be made aware of this risk when considering surgery. A carefully made working capsular pocket for the burr and marking this nerve before making the incision if palpable could mitigate this risk.

Minimally Invasive Dorsal Cheilectomy of the first metatarsal

Category: Other Introduction/Purpose: Traditionally, a dorsal cheilectomy of the first metatarsophalangeal (MTP) joint is performed with an open approach through a dorsomedial or midmedial incision. It is now possible to perform minimally invasive dorsal cheilectomy (MIDC) of the first metatarsal with a wedge burr. The stab incision for MIDC needs to be dorsomedial to allow an ergonomic sweeping movement of the burr. This potentially puts the dorsomedial cutaneous nerve (DMCN) to the hallux at risk. There have been no clinical or cadaveric studies to date quantifying the risk to the DMCN and the surrounding structures when a Wedge burr was used for MIDC. We aim to determine this by using fresh-frozen cadaveric specimens in a “high-risk” situation in which most of the surgeons were novices to the technique. Methods: A total of 13 fresh-frozen cadaveric specimens (7 right, 6 left) amputated below the knee were obtained for this study. 13 foot and ankle surgeons (2 left handed, 11 right handed) who had no or minimal experience in MI surgery participated in this study. After a demonstration by an experienced MI surgeon and a practice on sawbones by participants, each surgeon performed a MIDC over the first metatarsal. Fluoroscopic guidance was available throughout the procedure. After the procedure, the specimens were dissected and the DMCN and the extensor hallucis longus (EHL) were inspected for damage. The same dissection steps were used for each specimen. The relationship of the DMCN to landmarks were measured. All measurements were made to the nearest millimetre. Results: Dissection of the specimens revealed that the DMCN to the hallux was cut completely in two specimens (15%). All the EHL tendon were intact, although in one specimen, the tendon showed some fraying on the underside of the tendon, estimated to be 15%. The average distance of the stab incision from the first MTP joint was 17.7 (range: 10 – 23) mm. In terms of the relationship of the DMCN to the stab incision in specimens where the DMCN was not cut, the DMCN was superior in five specimens and inferior in six specimens. The distance of the DMCN to the incision was 3.8 (range: 0 -7) mm. Conclusion: The DMCN to the hallux has been well studied by several authors and has a variable course. This nerve is at high risk of being damaged with open surgery and is a commonly reported complication of surgery to the hallux with rates reportedly as high as 45%. This nerve was damaged in 15% of our specimens following MIDC in a “high-risk” situation. Patients need to be specifically made aware of this risk when being consented for surgery. A carefully made working capsular pocket for the burr and marking this nerve before placing the incision if palpable could mitigate this risk.

Matrix-associated Stem Cell Transplantation (MAST) in Chondral Lesions at the Ankle as Part of a Complex Surgical Approach

Category: Ankle Introduction/Purpose: The aim of the study was to assess the 5-year-follow-up after matrix-associated stem cell transplantation (MAST) in chondral lesions at the ankle as part of a complex surgical approach. Methods: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral defect that were treated with MAST from April1 2009 to September 30, 2011 were analyzed. Size and location of the chondral defects and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at follow-up were analysed. Stem cell-rich blood was harvested during the procedure from the ipsilateral pelvic bone marrow with a Jamshidi needle (10 x 3 mm, Cardinal, Dublin, OH, USA) and a special syringe (Arthrex-ACP, Arthrex, Naples, FL, USA) through a stab incision. The syringe was centrifuged (10 minutes, 1,500 rotations per minute). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Gide, Geistlich, Wollhusen, Switzerland) that was cut to the size of the cartilage defect roughly before and definitely after. The matrix with stem cells was fixed into the chondral defect with fibrin glue (Tissucoll, Deerfield, IL, USA). Results: Sixty-six patients with 69 chondral defects were included in the study. The age of the patients was 35 years on average (range, 12-64 years). VAS FA before surgery was 48.9 on average (range, 16.5-75.9). The defects were located as follows, medial talar shoulder, n=28; lateral talar shoulder, n=28 (medial and lateral talar shoulder, n=3), tibia, n=3. The defect size was 1.4 cm2 on average (range, .6 - 6 cm2). 60 patients (91%) completed 5-year-follow-up. No patient was converted to fusion or total ankle replacement. The VAS FA improved to an average of 78.2 (range, 60.8-100; p=.01). Conclusion: MAST as part of a complex surgical approach led to improved and high validated outcome scores in the mid-term-follow-up. No method related complications were registered. Even though a control group is missing, we conclude that MAST as part of a complex surgical approach is an effective method for the treatment of chondral lesions of the ankle for at least five years.

Clinical and Radiological Outcomes of Modified Mini-Open and Open Transforaminal Lumbar Interbody Fusion: A Comparative Study.

Study DesignRetrospective cohort study.PurposeTo compare the clinical and radiological outcomes of modified mini-open transforaminal lumbar interbody fusion (modMOTLIF) and open TLIF (OTLIF).Overview of LiteratureMinimally invasive transforaminal lumbar interbody fusion (MTLIF) is associated with less blood loss, shorter hospital stay, and less pain. However, it has concerns like increased radiation exposure, steep learning curve, and instrumentation cost. We modified the MTLIF technique by direct freehand insertion of pedicle screws using stab incisions without tubular retractors.MethodsThe study included 24 patients in the modMOTLIF group and 27 patients in the OTLIF group. The average follow-up period was 25.6 months. Clinical outcomes were measured using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. Serial X-rays were acquired at 1, 3, 6, 12, and 24 months to assess the union and presence of instability. We also compared blood loss and length of hospital stay in both groups.ResultsAll patients showed progressive improvement in VAS and ODI scores. No differences were observed in the preoperative and postoperative ODI and VAS leg scores between the groups. The immediate postoperative VAS back score was significantly higher in the OTLIF group than in the modMOTLIF group; however, no difference was observed at 1 and 2 years. Radiological analysis showed nonunion in one and two patients in the OTLIF and modMOTLIF groups, respectively. The average blood loss was 63 mL in the mod-MOTLIF group and 254 mL in the OTLIF group. The mean hospital stay was 3 days for the modMOTLIF group and 5 days for the OTLIF group.ConclusionsmodMOTLIF was associated with reduced blood loss and shorter hospital stay compared with OTLIF. No significant differences were observed in the clinical and radiological outcomes between the groups after 2 years despite reduced back pain in the immediate postoperative period in patients who underwent modMOTLIF.

Buttock Lifting Using Elastic Thread (Elasticum®) with a New Classification of Gluteal Ptosis.

Conventional buttock lifting is invasive, so it is difficult to recommend it to patients especially to those who do not have severe gluteal ptosis. In addition, the gluteal area is a large area change among the joints. Therefore, this surgery can cause pain during hip flexion after lifting using a conventional thread. The authors report on buttock lifting using an elastic thread with high satisfaction from patients. From July 2016 to June 2017, 60 patients were enrolled in this study. The degree of gluteal ptosis was graded from Grade 0 to Grade 6. All patients underwent lifting of both buttocks using Elasticum®. We drew a circle along the outer edge of the buttock and another small circle inside the first circle. A stab incision was done at 5 points (A, B, C, C', and D), and then according to the circle, lifting was done. Postoperative grade changes and complications were evaluated. Grades 2-5 were lifted to at least Grade 2 after surgery, but Grade 6 was at most Grade 3 (14.2%), with 85.8% of these to either Grade 5 or Grade 6. Seven patients (11.67%) complained of postoperative pain, and 6 patients (10.00%) showed skin dimpling or creases 10days after surgery, all of which disappeared at 1month after surgery. Buttock lifting with elastic thread is effective in pre-ptosis to moderate gluteal ptosis. Because of the elasticity of the thread, postoperative pain is low on hip flexion, so the lifting is done naturally. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Early experience of placing image-guided minimally invasive pedicle screws without K-wires or bone-anchored trackers.

OBJECTIVE Image guidance for spine surgery has been reported to improve the accuracy of pedicle screw placement and reduce revision rates and radiation exposure. Current navigation and robot-assisted techniques for percutaneous screws rely on bone-anchored trackers and Kirchner wires (K-wires). There is a paucity of published data regarding the placement of image-guided percutaneous screws without K-wires. A new skin-adhesive stereotactic patient tracker (SpineMask) eliminates both an invasive bone-anchored tracker and K-wires for pedicle screw placement. This study reports the authors' early experience with the use of SpineMask for "K-wireless" placement of minimally invasive pedicle screws and makes recommendations for its potential applications in lumbar fusion. METHODS Forty-five consecutive patients (involving 204 screws inserted) underwent K-wireless lumbar pedicle screw fixation with SpineMask and intraoperative neuromonitoring. Screws were inserted by percutaneous stab or Wiltse incisions. If required, decompression with or without interbody fusion was performed using mini-open midline incisions. Multimodality intraoperative neuromonitoring assessing motor and sensory responses with triggered electromyography (tEMG) was performed. Computed tomography scans were obtained 2 days postoperatively to assess screw placement and any cortical breaches. A breach was defined as any violation of a pedicle screw involving the cortical bone of the pedicle. RESULTS Fourteen screws (7%) required intraoperative revision. Screws were removed and repositioned due to a tEMG response < 13 mA, tactile feedback, and 3D fluoroscopic assessment. All screws were revised using the SpineMask with the same screw placement technique. The highest proportion of revisions occurred with Wiltse incisions (4/12, 33%) as this caused the greatest degree of SpineMask deformation, followed by a mini midline incision (3/26, 12%). Percutaneous screws via a single stab incision resulted in the fewest revisions (7/166, 4%). Postoperative CT demonstrated 7 pedicle screw breaches (3%; 5 lateral, 1 medial, 1 superior), all with percutaneous stab incisions (7/166, 4%). The radiological accuracy of the SpineMask tracker was 97% (197/204 screws). No patients suffered neural injury or required postoperative screw revision. CONCLUSIONS The noninvasive cutaneous SpineMask tracker with 3D image guidance and tEMG monitoring provided high accuracy (97%) for percutaneous pedicle screw placement via stab incisions without K-wires.

Distal biceps tendon repair using both an anchor and a bone tunnel via one and a second stab incision: A retrospective study

Our aim was to evaluate the outcome of our surgical technique for the repair of complete distal biceps tendon rupture in nonprofessional athletes. We examined the effect of our surgical technique in restoring the functionality of 11 injured limbs by correlating the total functional outcome of the repaired limb with their contralateral side.

A technique of minimally invasive aortic valve replacement: an alternative to transcatheter aortic valve replacement (TAVR)

Minimally invasive aortic valve replacement (AVR) is increasingly being adopted worldwide, in which a right mini-thoracotomy (RT) approach plays an important role. Here we reported a novel technique of AVR via RT using sutureless prosthesis, without rib division or groin incision. Surgical access was performed through an anterior right thoracotomy with 5-cm skin incision placed in the third intercostal space. Percutaneous femoral-femoral cardio-pulmonary bypass (CPB) was applied under fluoroscopy guidance to avoid groin incision. A 5-mm stab incision was made in the right chest wall for aortic cross-clamping. A sutureless bioprosthetic valve was utilized in the limited operative field, which reduced the cross-clamp and CPB time. The patient was discharged on post-operative day 2, without obvious cross-valvar gradient, and with no pain or other complication. This report offers a more minimally invasive approach to AVR with proven durable valves, which can benefit high-risk patients.

Subxiphoid Minimally Invasive Epicardial Ablation (Convergent Procedure) With Left Thoracoscopic Closure of the Left Atrial Appendage

The Convergent Procedure is a combined epicardial and endocardial ablation performed by a cardiac surgeon and electrophysiologist to treat symptomatic persistent and long standing persistent atrial fibrillation. The epicardial ablation is performed on the entire width of the posterior left atrial wall using monopolar radiofrequency via a subxiphoid incision. There is no sternotomy and cardiopulmonary bypass is not utilized. The surgical ablation is then followed by endocardial voltage mapping and ablation, allowing for complete lesion set creation. Left atrial appendage exclusion can be performed via left thoracoscopic approach at the same time as the surgical ablation. The Convergent Procedure is a truly hybrid, collaborative procedure which combines the strengths of minimally invasive cardiac surgery and percutaneous electrophysiologic techniques to treat a challenging disease process.

A multipronged approach to prevent Argentinian flag sign in intumescent cataracts.

In this communication, we describe a technique for creation of a single stage, adequately sized capsulorrhexis in intumescent cataracts by depressurizing the anterior and posterior intralenticular compartments in a nonleaky anterior chamber (AC) to prevent capsulorrhexis extension and Argentina flag sign. Initially, an incomplete main-port incision is made by the partial entry of a 2.2-mm keratome. A cohesive dispersive ophthalmic viscosurgical device (OVD) is injected into AC. Standard side-port incisions are made, followed by anterior capsular staining. The fluid cortex in anterior intralenticular compartment is aspirated by puncturing anterior capsule in the center using a 30-gauge needle entered through a separate limbal stab incision. The nucleus edge is gently tipped posteriorly with the needle tip to release the fluid from posterior intralenticular compartment also and as much fluid aspirated as possible. OVD is again injected and capsulorrhexis is performed in a single stage using micro-capsulorrhexis forceps.

Cecal Cannulation in Horse; an Experimental Study

Background: In order to analyze the cecum-colon ecosystem and the treatment of the cecal impaction and hindgut acidosis, cecal cannulation is needed. It is essential to select a simple, fast and inexpensive cecal cannulation method. Because of different complications in general anesthesia, the standing surgery is known as a better option for the horse emergency surgery. Objective: The objective of the present study was to design a simple, fast and inexpensive cecal cannulation method in standing horses.For the standing surgery, a new approach was designed and experimented on four horses. Materials and Methods: For this purpose, at first a cannula with approximately 7cm, 2cm and 2.6cm in length, internal and external diameters, respectively was designed. Immediately before the standing surgery, the horses were sedated with xylazine (1mg/kg) and morphine (0.3 mg/kg). After incising the subcutaneous tissue, the external abdominal oblique, internal abdominal oblique and transverse abdominis muscles were opened by grid incision. The peritoneum was bluntly perforated and the abdomen was exposed. The muscles were separated only enough to permit one hand to enter the abdomen. The cecum was readily identified by palpation of the cecal base and the dorsoventrally oriented tenia. At this stage, a purse string was secured on the serosal surface of the cecum by nylon and a stab incision was made. Then the cannula was inserted into the cecum and the suture was tightened. Results: The surgery was successfully performed for all horses, however, some complications such as increasing body temperature, transient signs of colic, ileus, pneumoperitoneum, subcutaneous emphysema and necrosis of the borders of the skin in the sutural places were detected. All complications were alleviated by proper nursing management. Conclusion: The surgical method was successfully terminated. Therefore, the method is recommended as a simple and inexpensive emergency surgical method for cecum in order to conduct different investigation, diagnosis and treatment techniques.

Matrix-Associated Stem Cell Transplantation (MAST) in Chondral Defects of the Ankle is Safe and Effective - 5-Year-Followup

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: The aim of the study was to assess the 5-year-follow-up of matrix-associated stem cell transplantation (MAST) in chondral defects of the ankle. Methods: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral defect that were treated with MAST from April1 2009 to September 30, 2011 were analyzed. Size and location of the chondral defects and the Visual- Analogue-Scale Foot and Ankle (VAS FA) before treatment and at follow-up were analysed. Stem cell-rich blood was harvested during the procedure from the ipsilateral pelvic bone marrow with a Jamshidi needle (10 x 3 mm, Cardinal, Dublin, OH, USA) and a special syringe (Arthrex-ACP, Arthrex, Naples, FL, USA) through a stab incision. The syringe was centrifuged (10 minutes, 1,500 rotations per minute). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Gide, Geistlich, Wollhusen, Switzerland) that was cut to the size of the cartilage defect roughly before and definitely after. The matrix with stem cells was fixed into the chondral defect with fibrin glue (Tissucoll, Deerfield, IL, USA). Results: Sixty-six patients with 69 chondral defects were included in the study. The age of the patients was 35 years on average (range, 12-64 years). VAS FA before surgery was 48.9 on average (range, 16.5-75.9). The defects were located as follows, medial talar shoulder, n=28; lateral talar shoulder, n=28 (medial and lateral talar shoulder, n=3), tibia, n=3. The defect size was 1.4 cm2 on average (range, .6 - 6 cm2). 60 patients (91%) completed 5-year-follow-up. No patient was converted to fusion or total ankle replacement. The VAS FA improved to an average of 78.2 (range, 60.8-100; p=.01). Conclusion: MAST led to improved and high validated outcome scores at 5-year-followup. No method related complications were registered. Even though a control group is missing, we conclude that MAST is an effective method mid-term for the treatment of chondral defects of the ankle.

Utility of the Ginza forceps for superficial phlebectomy during endovenous laser ablation of the great saphenous vein.

To evaluate the efficiency of using the Ginza forceps (DVx, Tokyo, Japan), which have a long shaft and strong grip, for superficial phlebectomy with the stab avulsion technique, during simultaneous endovenous laser ablation (EVLA) of the great saphenous vein (GSV). The subjects were patients treated with EVLA performed by a single operator at one institution. All patients had a GSV diameter of 4-10mm and an EVLA length of the GSV of >20cm. We compared 59 limbs treated only with the Varady hook (Group A) with 46 limbs treated with the Ginza forceps (Group G). The mean operative times for Groups A and G were 55.4±17.1 vs. 48.5±13.5min, respectively (P=0.002), and the number of stab incisions was 5.9±2.9 (1-13) vs. 3.5±2.3 (1-11), respectively (P<0.001). The rates of nerve injury and thrombophlebitis were 1.7 vs. 0 and 3.4 vs. 0%, respectively. Performing superficial phlebectomy with the Ginza forceps reduced the operation time and the number of stab wounds. These initial results suggest that using the Ginza forceps for the procedure is safe and efficient.

The Burnia: Laparoscopic Sutureless Inguinal Hernia Repair in Girls.

Laparoscopic inguinal hernia repair in children is in evolution. Multiple methods of passing the suture around the peritoneum at the level of the internal inguinal ring exist. Cauterization of the peritoneum at the internal ring is thought to increase scarring and decrease recurrence. We have employed a sutureless, cautery only, laparoscopic single port repair of inguinal hernias and patent processus vaginalis (PPV) in girls. After institutional ethical review was obtained, a retrospective review of sutureless laparoscopic inguinal hernia repairs in girls by 4 surgeons at separate institutions was performed. Patient demographics, intraoperative findings, and postoperative outcomes were recorded and analyzed. The technique involves an umbilical 30° camera and either a separate 3 mm stab incision in the midclavicular line or a 3 mm Maryland grasper placed next to the camera, and the distal most portion of the hernia sac is grasped and pulled into the abdomen and cauterized obliterating the sac. Eighty inguinal hernias were repaired using this technique in 67 girls between July 2009 and September 2015. The ages and weights ranged from 1 month to 16 years and from 2 to 69 kg, respectively. There was one conversion to open approach because an incarcerated ovary was too close to the ring. A single umbilical incision was utilized in 85%. Fifty-seven percent patients had hernias on the right whereas 42% had hernias on the left. Of the patients with presumed unilateral hernias, 22 patients were found to have PPV and were treated through the same incisions, 17/22 were found during a contralateral hernia surgery and 5/22 were found incidentally during appendectomy. Average operative time for unilateral and bilateral hernias was 22 minutes (5-38 minutes) and 31 minutes (11-65 minutes), respectively. No patient required a hospital stay because of the hernia repair. At an average of 25 months follow-up (1.6-75 months), there were no recurrences. The only complication was a single lateral port site hernia on a 2 kg, former 24 week postmenstrual age girl before adapting the technique to single-site surgery for all. Laparoscopic sutureless inguinal hernia repair is safe and effective in girls of all ages. The single-site modification allows for superior cosmetic result and lower complication profile. The Burnia allows for adequate treatment of unilateral and bilateral inguinal hernias with a single incision in the umbilicus.

Minimal duration cataract surgery with oblique limbal stab incision technique.

PURPOSE:Small incision cataract surgery (SICS) and phacoemulsification with oblique limbal stab incision technique were studied and compared.SETTING:The study was conducted in the Department of Ophthalmology, Indira Gandhi Medical College, Shimla, for 1 year.DESIGN:This was a prospective randomized study.METHODS:One hundred patients undergoing SICS (6–7 mm) were compared with another age- and sex-matched 100 patients undergoing phaco (2.8 mm) surgery with oblique limbal stab incision technique. These two groups were further subdivided into two groups of 50 each. Patients with traumatic cataract, corneal diseases, and preoperative astigmatism >1.5 D were excluded from the study. The patients were subjected to standard preoperative evaluation. Follow-up was done at 1, 2, 4, 6, and 12 weeks.RESULTS:Mean surgically induced astigmatism at 12 weeks was <1 D in both groups (+0.62 D ± 0.34 in Group A and +0.46 D ± 0.39 in Group B) (statistically significant P < 0.0010). Mean surgical duration was 690.09 s in SICS and 792.29 s in phacoemulsification (statistically significant, P < 0.0010). Visual outcome was between 6/6 and 6/9 in 86% of the patients in Group A and 97% of patients in Group B at 12 weeks.CONCLUSION:SICS and phacoemulsification with this technique yield lesser astigmatism than clear corneal and scleral incisions, with the advantage of extension without suturing in complicated cases of phaco and in patients with rigid intraocular lens phacoemulsification gives better BCVA in a larger proportion of patients at 12 weeks.

Scleral Fixation of Sinking Bag-IOL Complex: A New Surgical Technique

Treatment options for symptomatic subluxated or dislocated IOLs include observation; and repositioning, removal, or exchange of the IOL. We describe a surgical technique of trans-scleral suture fixation for subluxated bag-IOL complex. A 29 year old male; known case of bilateral recurrent tubercular panuveitis underwent left eye phacoemulsification with three piece hydrophobic acrylic IOL implantation a decade ago. He presented with decreased vision and monocular diplopia since one week. A diagnosis of subluxated bag-IOL complex was made. A 9-0 polypropylene suture was passed beneath the opposite scleral flaps and was taken out through superior stab incision. After exteriorizing both the haptics, they were sutured with prolene. Bag-IOL complex was centered and was fixated trans-sclerally under the scleral flaps. The bag-IOL complex remained stable and well centered 12 months following trans-scleral suture fixation with good visual outcome. This technique can be used in any case of postoperative bag-IOL complex subluxation or dislocation to achieve stabilization.

Outcomes of Two Surgical Techniques Using Silicone Rod for Frontalis Sling Suspension to Treat Severe Ptosis.

To compare outcomes of two techniques of frontalis silicone sling surgery. This retrospective, nonrandomized chart review was performed on patients undergoing frontalis sling surgery between 2008 and 2011. Silicone rods were sutured to the tarsal plate through an eyelid crease incision (open method) or stab incisions (closed method). Data were collected on age, gender, type of surgery, preoperative and postoperative margin reflex distance (MRD), and complications. A successful outcome was defined as a postoperative score of 2 to 4 for MRD or an improvement in MRD. A total of 155 eyelids of 146 patients with ptosis were included. There were 60 patients in the open method group and 85 patients in the closed method group, respectively. Successful outcomes were seen in 30 (50%) patients in the open method and 44 (51.8%) patients in the closed method groups. There were 61 (71.8%) patients in the open method group and 45 (75%) patients in the closed method group who had improved MRD at last follow-up. The main complications were exposure keratitis, eyelash ptosis, and eyelid crease abnormalities that occurred only in the closed method group. The silicone frontalis sling procedure had the same success rates in both the open and closed methods. Eyelash and eyelid crease abnormalities were unique to the closed method. [J Pediatr Ophthalmol Strabismus. 2017;54(1):52-58.].