Suture Closure Research Articles

Allometry of human calvaria bones during development from birth to 8 years of age shows a nonlinear growth pattern

Pediatric skulls change rapidly in size and shape during development, especially for children up to 8 years of age. This project was developed to address the gap in understanding of the three-dimensional growth parameters of the human skull during this period and the impact these growth patterns have on fontanelle closure and suture formation. This study offers novel data on the dynamic changes in the anatomy of the skull with the intention of providing better guidance for pediatric surgical care. Craniometric landmarks defined on three-dimensional computed tomography reconstructions were used to map skull development in children aged 0 to 8 years old. A total of 364 datasets were analyzed and statistically representative 3D skulls with anatomical craniometric features such as head shape, bone size, suture and fontanelle closure time were generated for 17 age groups spanning birth to 8 years of age to provide a comprehensive neuroanatomical understanding of how the pediatric skull changes over time. This study indicates that the cranial bones follow a non-linear growth pattern, with the occipital and frontal bones driving the directionality of fontanelle closure and delivers a 3D visualization of the developmental characteristics of the skull providing a landmark resource for understanding the growth dynamics of the human skull. While clinical measurements remain valid approaches for the planning of surgical interventions, these 3D models may provide a more accurate planning paradigm.

Exploring Risk Factors for Post-operative Complications in Laparoscopic Common Bile Duct Exploration: A Literature Review.

Gallstone-related diseases, particularly common bile duct (CBD) stones, pose a significant global health challenge. The emergence of laparoscopic common bile duct exploration (LCBDE) has transformed the management of these conditions by offering a less invasive alternative to traditional open surgery. This literature review aims to analyze published literature to identify and understand the risk factors associated with LCBDE. The study aims to offer valuable insights that could potentially enhance patient care and outcomes in managing CBD stones. A comprehensive search of English-language studies from the past 20 years was conducted using PubMed, focusing on peer-reviewed primary research, systematic reviews, and meta-analyses. From 830 initial articles, 25 were selected based on relevance and availability. The review identified several key risk factors influencing LCBDE outcomes, including patient-related factors such as advanced age, high comorbidity scores, narrow bile ducts, and complex stones, which increase the likelihood of complications. Surgeon experience also plays a crucial role, with lower complication rates observed among surgeons who have performed at least 70 LCBDE procedures over a 10-year period. Additionally, procedure-related factors such as the transcystic (TC) approach, primary suture (PS) closure, and intraoperative imaging were found to reduce complication rates. LCBDE remains a promising approach for managing bile duct stones, particularly when patient, surgeon, and procedural factors are optimized.

Papilla Access Tunnel Combined With the Laterally Closed Tunnel: A Technique for Treatment of Deep Gingival Recession in the Anterior Mandible.

Treatment of gingival recession in the anterior mandible is more complex due to unique anatomic features including excessive tension due to frenal and muscle attachments, thin tissue, shallow vestibule, and narrow interdental space. These features are particularly limiting in the presence of deep recession and negatively impact the success most routine soft tissue grafting procedures. The recently proposed laterally closed tunnel combined the benefit of tension management from tunneling rather than incising papillae with lateral closure of deep recession to minimize the need for coronal advancement. This is an effective, although technically demanding procedure. This report presents a method of facilitating tunnel preparation by utilizing superficial papillary access incisions bilaterally in the papilla between the lateral incisor and canine. This papilla has the least tension and most robust interdental volume and blood supply. This incision creates a mini flap that facilitates tunnel dissection and graft placement. Because the mini flap is used for graft insertion, the suturing for lateral closure can be performed before graft insertion. The result is reduced technical difficulty.

Advancements in Vascular Closure Devices for Effective Hemostasis in Femoral Artery Interventions.

With medical technology development, endovascular intervention has been widely used in clinical practice, and the establishment of surgical access through the femoral artery, where most vascular interventions are performed, is a common method. Postoperative hemostasis at the femoral artery puncture site is a key part of interventional procedures and is particularly important to ensure the safety and effectiveness of hemostasis. Some patients undergoing interventional therapy also use anticoagulant and antiplatelet drugs preoperatively and undergo systemic heparin session intraoperatively, which leads to abnormal coagulation, thus increasing the difficulty of hemostasis at the puncture point postoperatively. Certain patients with specific conditions, such as combined vascular calcification, obesity, diabetes mellitus, and renal impairment, present more challenging cases for postoperative puncture point hemostasis. Femoral artery puncture site hemostasis methods include manual compression, arterial compression devices, and vascular closure devices, which are a kind of equipment that helps interventional doctors stop bleeding quickly at the femoral artery puncture site. From the 1990s to the present, vascular occluders with many different concepts and mechanisms have emerged. Based on different hemostatic principles and materials, the mechanisms and principles of action are varied and include sealant occlusion, collagen patch embolization, polyester suture closure, absorbable polyethanol embolic agents, nickel-titanium alloy clips, polydiethanol sealant embolization, and suture bioabsorbable patches. Many studies have compared the hemostatic effect of vascular closure devices with those of manual compression. In this article, we review the hemostatic effects of the 2 modalities and the advances in the use of vascular closure devices in vascular intervention.

A Comparative Study of Tackers Versus Sutures in Transabdominal Preperitoneal Hernia Repair: Tackers Versus Sutures in Mesh Fixation and Peritoneal Closure in Tapp

Background: This study evaluates the surgical outcomes of using tackers versus sutures for mesh fixation and peritoneal closure in transabdominal preperitoneal (TAPP) mesh repair of inguinal hernia, focusing on postoperative pain, quality of life, and other key metrics. Although there are many studies in studying various outcomes of Transabdominal preperitoneal mesh repair (TAPP), there exists only few trials that compare peritoneal closure techniques in TAPP Methods: A prospective comparative study was conducted at Mahatma Gandhi Medical College and Research Institute. Sixty patients undergoing TAPP were divided into two groups: one using non-absorbable sutures and the other using non-absorbable titanium tackers for mesh fixation and peritoneal closure. Intraoperative and postoperative outcomes were assessed, including time taken for procedures, postoperative pain (measured using the Visual Analog Scale), incidence of seroma formation, and short-term quality of life assessed using the Carolinas Comfort Scale. Results: The suture group demonstrated significantly less postoperative pain on postoperative day (POD) 1 and at 3 months compared to the tacker group (p=0.001 and p=0.004, respectively). The time taken for mesh fixation and peritoneal closure was shorter in the tacker group, but the overall operative time was significantly longer in the suture group (p=0.001). The cost of using sutures was substantially lower than tackers. Quality of life scores at 3 months indicated better outcomes in the suture group (p=0.001). Conclusions: Sutures for mesh fixation and peritoneal closure in TAPP repair provide better postoperative outcomes in terms of pain, quality of life, and cost compared to tackers, despite a longer operative time. These findings suggest that sutures may be a preferable option for TAPP inguinal hernia repair.

Isthmocele‑an iatrogenic pathology: A prospective study in a tertiary unit.

Isthmocele, also known as uterine niche, refers to a myometrial defect of the anterior wall of the uterine isthmus, specifically at the site of the previous C-section scar. The prevalence of isthmocele has increased in tandem with the rise in deliveries by caesarean section. Risk factors include aspects related to the surgical procedure. The present study aimed to assess the relationship between various suture types and the development of a niche. The analysis of the present study is based on data collected from the evaluation of 52 patients, 6 weeks post C-section performed in 'Saint Pantelimon' Hospital in Bucharest, Romania. The parameters examined included patient age, the number of previous births by C-section, the type of suture used and uterine anatomy. Out of all the 52 patients, 42.3% developed an isthmocele. The results confirm a significant association between the presence of the niche and the type of suture of the first layer, proving that when non-locking continuous suture was used, the absence of niche was observed in most cases, while using the locking continuous suture was associated with more niches. Using the continuous locking suture for the first layer was associated with severe niches, while no severe niches were observed in patients with the other two types of sutures. There is a statistically significant association between the use of continuous locking sutures for uterine closure in the first layer and the development of a uterine niche. Furthermore, all instances of severe niches were linked to this type of suture, compared with continuous non-locking suture or interrupted suture. Given the escalating rate of C-sections, further research is crucial to identify the suture type that minimizes the risk of isthmocele formation. The present study's limitations revolve around its exclusive focus on a single institution and the relatively small sample size.

Comparing Closure Techniques for Pharyngeal Mucosa After Total Laryngectomy: Manual Suture, Linear Stapler, and Thyroid Gland Flap-A Retrospective Analysis.

Objective: This study aimed to compare the clinical effectiveness of manual suture (group A), linear stapler (group B), and thyroid gland flap (group C) for pharyngeal mucosal closure after total laryngectomy (TL) in laryngeal cancer patients. Methods: The data of laryngeal cancer patients who underwent TL between January 1, 2017, and December 1, 2021, were analyzed. Patients were categorized into group A, group B, and group C based on the closure technique. Various parameters, including general data, hospitalization days, total cost, pharyngeal closure time, pharyngeal fistula, pre- and post-surgical calcium levels, and thyroid function indexes, were compared. Results: The study included 81 patients (mean age: 64.09 ± 9.20 years), the general data of the 3 groups of patients were comparable. Tumor stage and primary tumor location varied significantly among the groups (P = .002 and P < .001, respectively). Group A was more commonly used for advanced-stage tumors with widespread invasion. Group B was primarily used for early-stage tumors localized to the larynx. Group C was preferred for cases with mucosal defects or extensive hypopharyngeal invasion. Group B presented a significantly shorter operation time and slightly lower total cost (P = .006). Pharyngeal fistula incidence was 17.28% (14/81), with comparable rates among the groups [12.35% (10/50) in group A, 12.5% (2/16) in group B, and 13.3% (2/15) in group C]. No dysphagia complications were observed during the 2-to-5-year follow-up. Blood calcium levels and thyroid function indicators showed no significant differences before and after surgery among the 3 groups (P > .05). Conclusion: Thyroid gland flap is a safe option that can be used to repair mucosal defects and close the pharyngeal cavity after TL surgery, but in the absence of mucosal defects and widespread tumor invasion, linear staplers are the most time-efficient method.

Efficacy and safety of the OverStitch endoscopic suturing device for closure of defects after endoscopic submucosal dissection: a systematic review and meta-analysis

Background and AimsEndoscopic submucosal dissection (ESD) is used for closure of gastrointestinal (GI) lesions following endoscopic resection techniques such as endoscopic mucosal resection. Generally, a large defect is left that can increase the risk of postprocedural bleeding or perforation, and has been managed by techniques such as endoscopic placement of clips to reapproximate the defect edges. An over the scope suturing system (OSS), Overstitch created by Apollo endosurgery, has been designed for similar utility in ESD closure. Its design intent aimed for full thickness closure and exchange of suture without endoscopic removal. This paper aims to evaluate the technical success and efficacy of use of OSS in the closure of ESD. MethodsA comprehensive literature review across multiple databases was performed. Studies including Overstitch and ESD information were evaluated, with 7 articles meeting predetermined eligibility of quality for inclusion. Statistical analysis was completed using CMV v 3.0 software. The primary evaluated endpoint was technical success and efficacy of instrument use in patients undergoing ESD closure with OSS. The secondary evaluated endpoint was the overall rate of adverse events related to the use of OSS. ResultsOverall, the pooled rates for instrumental efficacy and technical success were 95.8% (95% CI: 80.6%, 99.2%; P=0.04) and 99.2% (95% CI: 79.8%, 100.0%; P=1.00), respectively. The pooled rate of adverse events was 0.9% (95% CI: 0.0%, 24.8%; P=0.99) with pain reported as the most common adverse event. ConclusionsThe OSS system appears to be an effective and safe tool in the closure of defects after ESD. However, its design also makes it quite large and difficult to maneuver. While it allows for replacement of the suture kit without endoscopic removal, there have been multiple reported episodes of device failure. Further randomized controlled trials warranted as OSS becomes more widely used.

S1587 Endoscopic Clipping vs Suturing for Mucosotomy Closure in E-POEM and G-POEM: A Systematic Review and Meta-Analysis

S1587 Endoscopic Clipping vs Suturing for Mucosotomy Closure in E-POEM and G-POEM: A Systematic Review and Meta-Analysis

Endoscopic suturing for mucosal defect closure following endoscopic submucosal dissection: Systematic review and meta-analysis.

Background and study aims: Endoscopic submucosal dissection (ESD) is a minimally invasive and effective treatment for gastrointestinal lesions. It carries potential risks such as bleeding and perforation. This meta-analysis was conducted to assess the safety, effectiveness, and feasibility of endoscopic suturing, a promising technique for closing mucosal defects post-ESD. Methods: We reviewed several databases, including MEDLINE/PubMed, Cochrane Library, Web of Science, and Embase up to May 1,2023. We aimed at identifying original studies that provided insightful data on the use of endoscopic suturing in reducing complications post-ESD. Results: In our study, we evaluated 426 publications and included 10 studies involving a total of 284 patients. The pooled technical success rate of endoscopic suturing was 92.6% (95% confidence interval [CI] 0.88-0.96). The pooled rate for sustained closure of mucosal defects post-endoscopic submucosal dissection (ESD) was estimated to be 80.7% (95% CI 0.71-0.88). The pooled mean time required to perform the endoscopic suturing procedure was calculated to be 31.11 minutes (95% CI 16.01-46.21). Among the studies reviewed for the incidence of delayed perforation post-ESD, a singular event of perforation was documented, suggesting a minimal occurrence. The overall rate of delayed bleeding was 5.3% (95% CI 0.30-0.10). Within the subset of patients using antithrombotic drugs, our subgroup analysis identified a delayed bleeding event rate of 6.7% (95% CI 0.02-0.25). Conclusions: Our results underscore the potential of endoscopic suturing as a viable and efficient technique in managing mucosal defects following ESD, highlighting the need for further large, prospective research to corroborate these findings and concentrate on establishing standard methodologies.

Impact of Needle Design and Suture Gauge on Tissue Tearing During Skin Suturing: A Comparative Analysis.

Surgeons face numerous choices in selecting sutures for skin closure, with potential adverse effects such as tissue tearing. To investigate the influence of needle design and suture gauge on tissue tearing during suturing procedures. The authors tested the tear-through force in Newtons for 3 needle types and 3 suture gauges using an artificial skin model and a professional-grade tensiometer. Suture material was secured into the skin model, and force was applied to the suture at a constant rate, resulting in tearing. Force-displacement and force-time curves were generated. Evaluation included conventional cutting (PC-3), reverse cutting (PS-3), and taper point (BB) needles with a 5-0 polypropylene suture. In addition, nylon sutures with a reverse cutting needle (PS-2) were tested at 3 suture gauges (5-0, 4-0, 3-0). The mean tear-through forces for PC-3, PS-3, and BB were 3.26 N, 3.75 N, and 4.07 N, respectively. For the 5-0, 4-0, and 3-0 nylon sutures, the mean tear-through forces were 3.44 N, 3.81 N, and 4.04 N, respectively. Statistical analysis revealed a significant impact of suture gauge size (p < .001) and needle geometry (p < .001) on tear-through force. Larger suture diameter and taper needles minimize tissue tearing.

The current role of barbed sutures in fascial closure of ventral hernia repair: a multicenter study using the abdominal core health quality collaborative database.

Barbed sutures (BS) have been increasingly used in the last two decades across surgical disciplines but little is known about how widespread their adoption has been in ventral hernia repair (VHR). The aim of this study was to document the use of barbed sutures in VHR in a multicenter database with associated clinical and patient-reported outcomes. Prospectively collected data from the Abdominal Core Health Quality Collaborative database was retrospectively reviewed, including all adult patients who underwent VHR with fascial closure from 2020 to 2022. A univariate analysis compared patients with BS against non-barbed sutures (NBS) across the preoperative, intraoperative, and postoperative timeframes including patient-reported outcomes concerning quality of life and pain scores. A total of 4054 patients that underwent ventral hernia repair with BS were compared with 6473 patients with non-barbed sutures (NBS). Overall, BS were used in 86.2% of minimally invasive ventral hernia repairs and about 92.2% of robotic surgery compared to only 9.6% of open procedures. Notable differences existed in patient selection, including a higher BMI (32 vs 30.5; p < 0.001), more incisional hernias (63.3% vs 51.1%; p < 0.001), wider hernias (4cm vs 3cm; p < 0.001), and higher ASA score (p < 0.001) in patients with BS. Outcomes in patients with BS included a shorter length of stay (mean days; 1.4 vs 2.4; p < 0.001), less SSI (1.5% vs 3.6%; p < 0.001), while having similar SSO (7.6% vs 7.3%; p = 0.657), readmission (3.0 vs 3.2; p = 0.691), and reoperation (1.5% vs 1.45%; p = 0.855), at a longer operative time (p < 0.001). Hernia-specific questionnaires for quality of life (HerQLes) and pain in patients with BS had a worse preoperative score that was later matched and favorable compared to NBS (p = 0.048). PRO concerning hernia recurrence suggest around 10% at two years of follow-up (p = 0.532). Use of barbed sutures in VHR is widespread and highly related to MIS. Outcomes from this multicenter database cannot be reported as superior but suggest that barbed sutures do not have a negative impact on outcomes.

The Effect of Fascial Closure With Triclosan-Coated Sutures on the Incidence of Abdominal Wall Dehiscence: An Individual Participant Data Meta-Analysis.

Wound closure with triclosan-coated sutures (TCS) appears to reduce the risk of surgical site infection (SSI). Because there is a strong association between postoperative SSI and the development of acute abdominal wall dehiscence (AWD) after laparotomy, we hypothesized that the use of TCS for wound closure after laparotomy may also reduce the risk of AWD. The MEDLINE, Embase, and CENTRAL databases were searched from their inception to 01 November 2022. Randomized trials that compared the use of TCS with identical but uncoated sutures for fascial closure were eligible if they could provide individual participant data (IPD) on AWD. From these trials, we only included in the analysis those subjects who underwent open abdominal surgery. The primary outcome was the incidence of AWD within 30days postoperatively, requiring emergency reoperation. The certainty of evidence was assessed using the GRADE methodology (PROSPERO: CRD42019121173. We identified twelve eligible trials. Eight studies shared IPD. The incidence of AWD within 30 days after surgery was 27/1,565 (1.7%) in the TCS group vs. 40/1,430 (2.8%) in the control group (Relative Risk: 0.70 [95% confidence interval (CI) 0.44-1.11, I 2 = 0%, τ2 = 0.00]). The certainty of evidence was moderate after downgrading for imprecision. The incidence of incisional SSI was 163/1,576 (10.3%) vs. 198/1,439 (13.8%), RR 0.80 (95% CI 0.67-0.97). We found no conclusive evidence to support the use of triclosan-coated sutures for the prevention of acute abdominal wall dehiscence after laparotomy. In these selected studies, a significant reduction in incisional SSI was observed.

Age estimation from median palatine suture using computed tomography reconstructed 3D images: a comparison of Northern and Southwestern Chinese populations.

To investigate the potential of computed tomography (CT) images of median palatine suture (MP) for adult age estimation in the Northern and Southwestern Chinese populations. A total of 1110 cranial CT scans from individuals aged 10-79years, including 557 northern Chinese and 553 southwestern Chinese, were collected for analysis. After volume reformation and multiplanar reconstruction, a total of 20 slices of median palatine suture were selected from each individual. The closure of sutures was analyzed into four stages, and the cumulative scores of 20 slices were recorded as the suture closure score (SCS). The correlations between SCS and age were compared among the two Chinese populations residing in diverse geographic regions. Regression models were established for age estimation. The estimation accuracy was evaluated based on the test set. The mean absolute error (MAE) and the correlation between predicted age and chronological age were calculated to evaluate estimation accuracy. The SCS of MP exhibited a significant correlation with age (0.613, northern male; 0.678, southwestern male; 0.730, northern female; 0.704, Southwestern female; 0.662, total). Furthermore, there were statistically significant differences in SCS among different regions and sex groups (p < 0.001). The cubic regression model had the highest R2 value in all subjects, especially among Northern females and Southwestern males, while the power and quadratic regression models showed the highest R2 value in Northern males and Southwestern females, respectively. In the test set, the Northern cohort demonstrated a lower MAE (9.06 ± 7.32years, males; 9.17 ± 5.28years, females) compared to the Southwestern cohort (9.19 ± 7.49years, male; 10.61 ± 6.83years, female). Additionally, it was observed that males exhibited a lower MAE than females in both regional groups. This study demonstrated the potential utility of CT images of the MP for age estimation in Chinese populations, emphasizing the significance of incorporating regional and sex factors within this context.

Efficacy and safety of the VASCADE® MVP venous vascular closure device in patients undergoing percutaneous left atrial appendage occlusion with WATCHMAN.

The VASCADE MVP venous vascular closure system is commonly used for percutaneous venotomy closure in catheter-based procedures utilizing sheath sizes 6-12 French. However, its application with larger sheaths such as ones required in left atrial appendage occlusion (LAAO) has yet to be explored. This study compared the efficacy and safety of VASCADE MVP versus conventional Figure-of-8 sutures (Fo8) for femoral venotomy closure in patients undergoing Watchman LAAO. This single-center retrospective analysis included patients who underwent post-LAAO femoral venotomy closure with either VASCADE MVP or Fo8 sutures. The primary efficacy endpoint was time to hemostasis (TTH). Primary safety endpoints were 30-day access site-related readmissions and major complications. Minor access-site-related complications were also assessed. 107 patients underwent post-LAAO femoral venotomy closure with VASCADE MVP, of which 101 were successful (94.4%). 99 patients underwent conventional closure with Fo8 sutures and supplemental manual pressure. Baseline characteristics were similar between groups. TTH was significantly shorter with VASCADE MVP (152.9 vs. 335.8 s, p = 0.001). Major safety outcomes were comparable. However, the conventional group experienced a higher incidence of ecchymosis (16.2% vs 4.7%, p = 0.007) and 30-day all-cause readmission (18.2% vs 8.4%, p = 0.038). VASCADE MVP significantly reduced TTH compared to Fo8 sutures after LAAO. While demonstrating a similar safety profile, VASCADE MVP may offer a more efficient approach to femoral vein closure in this patient population.

WP1.14 - Evaluation of mesh closure of laparotomy and extraction incisions in open and laparoscopic colorectal surgery: A systematic review and meta-analysis

Abstract Background In colorectal surgery, postoperative evisceration and incisional hernia (IH) were not only noted after open procedures, but also at extraction incision (EI) sites used in laparoscopic resections. Few techniques, including using different sutures, closure techniques, and surgical meshes, have been evaluated in the literature to prevent the occurrence of IH and postoperative wound failure. This systematic review investigates the efficacy and safety of using prophylactic mesh on closure of midline laparotomy or extraction incision (EI) in colorectal oncological and non-oncological resections. Method Literature databases, including PubMed, Cochrane, Science Direct and Google Scholar, were searched for studies comparing the use of prophylactic mesh to conventional suture closure in colorectal operations, either in laparotomy closure in open surgery or EI closure in laparoscopic procedures, regardless of the indication; oncological and non-oncological. Primary endpoints were identified as incisional hernia (IH), and postoperative evisceration. Other outcomes included surgical site infection (SSI), seroma formation and length of hospital stay (LOS). Results Six studies fulfilled the inclusion criteria and studied 1,398 patients. Occurrence of IH was significantly reduced on using mesh closure compared to suture closure (OR 0.23, P=0.00001), while there was no statistically significant difference in evisceration rate (OR 0.51, P=0.25). Additionally, no notable difference was identified between both groups in terms of SSI (OR 1.20, P=0.54), postoperative seroma (OR 1.80, P=0.13), and LOS (MD -0.54, P=0.63). Conclusion The use of prophylactic mesh on closing laparotomy incision or EI for open and laparoscopic colorectal resections reduces the risk of developing IH. There were no significant safety concerns; however, further randomised trials may provide more creditable results.

SP2.11 - Continuous versus interrupted closure of midline laparotomy wound with absorbable suture material - A systematic review and meta-analysis of randomised controlled trials

Abstract Objective The objective of this meta-analysis is to compare the postoperative surgical outcomes of continuous versus interrupted closure of the midline laparotomy wound with absorbable suture material. Methods Randomised control trials (RCTs) reporting postoperative outcomes for patients undergoing closure with continuous versus interrupted closure of midline laparotomy wound with absorbable suture material were selected from medical electronic databases and meta-analysis was conducted by the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results Four RCTs on 2,198 patients reporting postoperative outcomes were included. In the random effect model analysis, the wound dehiscence [odds ratio (OR) 0.93, 95%, CI (0.52, 1.64), Z = 0.26, P = 0.79] was comparable between the two groups with no heterogeneity among the included studies. Incisional hernia was also comparable between the two groups [OR 0.82, 95%, CI (0.59, 1.14), Z = 1.19, P = 0.23] with mild heterogeneity among the included studies. Wound infection was also comparable between the two groups [OR 1.30, 95%, CI (0.78, 2.17), Z = 1.01, P = 0.31] with moderate statistical heterogeneity among the included studies. Conclusion The continuous suturing closure had no superiority over interrupted closure for the midline laparotomy wound on comparing wound dehiscence, incisional hernia and wound infection. Due to the paucity of the RCTs, a major multi-centre RCT is needed to validate these findings.

Letter to the editor: Prospective analysis of STRATAFIX™ symmetric PDS plus suture for fascial closure in spinal surgery: a pilot study.

Spine surgery is essential for restoring alignment, stability, and function in patients with cervical spine injuries, especially when instability, pain, deformity, or progressive nerve damage is present. Effective wound closure is vital in these procedures, aiming to promote rapid healing, reduce infection risks, enable early mobilization, and ensure satisfactory cosmetic results. However, there is limited evidence on the optimal wound closure technique for posterior spine surgery, highlighting the need for innovative approaches. A study by Glener et al. evaluated the effectiveness of STRATAFIX™ Symmetric barbed sutures compared to traditional braided absorbable sutures in spinal surgery. In a randomized trial involving 20 patients, the STRATAFIX™ group demonstrated a shorter mean closure time and significantly fewer sutures used, though without a statistically significant reduction in closure time. No significant differences were observed in postoperative complications between the groups during a six-month follow-up. While the findings suggest potential cost savings and efficiency improvements with STRATAFIX™, the study's small sample size and short follow-up period limit its generalizability. Furthermore, AI-based models, such as the Xception deep learning model, show promise in improving suture training accuracy for medical students, which could enhance surgical outcomes and reduce complications. Despite the promising results, further research with larger sample sizes, extended follow-up periods, and multi-center trials is necessary to validate the effectiveness of barbed sutures like STRATAFIX™ in neurosurgery. The integration of AI in surgical training and continued exploration of innovative techniques are essential to advancing the field and optimizing patient care in spinal surgery.

353. INNOVATIVE SURGICAL TECHNIQUES TO REDUCE RECURRENCE IN LAPAROSCOPIC RADICAL TREATMENT OF GIANT HIATAL HERNIA

Abstract Background In Japan, there is an increasing trend in the number of esophageal hiatal hernia (EHH) surgeries performed in elderly patients. EHH in the elderly patients are associated with surgical invasiveness and complications, but safe surgery can contribute to improving quality of life (QOL). We report on the safe surgical technique and treatment results for giant hiatal hernia. Methods The most important point to be careful of when suturing the esophageal hiatus is damage to the diaphragm leg. If the esophageal hiatus is large, reducing the pneumoperitoneum pressure as much as possible will reduce the tissue resistance during suturing, allowing suture closure without placing excessive tension on the diaphragm legs. If the esophageal hiatus is large, the pneumoperitoneum pressure should be kept as low as possible to reduce tissue resistance during suturing and prevent damage to the diaphragm legs. Surgery is usually performed with a high pneumo-abdominal pressure of 10 mmHg, but if suture closure of the esophageal hiatus is difficult, suturing is performed with a low pneumo-abdominal pressure of 6 mmHg. We underwent 103 cases of EHH surgery between 2012 and 2022. There were 73 cases (70.8%) of over 75 years old patients, and 71 cases (68.9%) of giant mixed type EHH. We compared the surgical outcomes in the early group up to 2018, in which surgery was performed with high pneumo-abdominal pressure during hiatal closure, and the latter group, from 2019 onwards, in which surgery was performed with low pneumo-abdominal pressure during hiatal closure. Results 67 cases in the early group: 23 cases with sliding type/44 cases with mixed type (65.6%), 36 cases in the latter group: 8 cases with sliding type/27 cases with mixed type (75.0%), the proportion of mixed type was higher in the late group. Mesh was used in 1 case in the early group and 0 cases in the latter group. The recurrence rate was 7 cases (10.4%) in the early group and 1 case (2.8%) in the late group, and although the proportion of mixed type cases was higher in the latter group, the recurrence rate was lower. Reoperation for recurrence was performed in 1 patient in the early group. In one case of recurrent surgery in the early group, the type of recurrence was that the muscle bundle of the diaphragm leg on one side was torn, the hiatus was dilated, and the transverse colon was invaginated into the mediastinum. From this experience, I reaffirmed the importance of reliably suturing the esophageal hiatus without damaging tissue in order to reduce recurrence of giant hiatal hernia surgery. Although there are differences in observation periods, in recent years, appropriate management of intraoperative pneumoperitoneum pressure has been able to reduce recurrence and complications, and it has also been possible to safely improve QOL in elderly patients. Conclusions In giant hiatal hernia surgery, appropriate control of intraoperative pneumoperitoneum pressure can reduce recurrence.

Biparietal expansion with partial suturectomy of the sagittal suture and linear frontal osteotomies for the scaphocephaly correction in children over 12 months of age

Introduction: Sagittal craniosynostosis (SC) has a prevalence of 1: 2500 live births and represents 40-60% of all craniosynostosis. The objective of this work is to share the preliminary results, with the use of the surgical technique mentioned above for the treatment of SC in children older than 12 months. Methods: A retrospective study from April 2019 to September 2023. Four patients with a diagnosis of non-syndromic scaphocephaly were evaluated, who met the following inclusion criteria: (i) age over 12 months, (ii) CT scan with 3D reconstruction, (iii) scaphocephaly due to postoperative restenosis and (iv) patients operated on with this surgical technique. Results: There were 2 females (50%) and 2 males (50%), with an average age of 39.25 months. All four patients had complete closure of the sagittal suture; there was no evidence of entrapment of the superior sagittal sinus by the stenosed suture. Papilledema was evaluated with the modified Frisén scale. All four patients had grade 2 bilateral papilledema preoperatively and this reversed 6 months postoperatively. The cranial index (CI) preoperatively was 64 (range 58-72) and postoperatively 72.25 (range 66-83). There was no need to reoperate on any patient and we had no complications Conclusion: This surgical technique is presented as an option for the treatment of scaphocephaly in children older than 12 months, and in scaphocephaly due to postoperative restenosis, proving to be a reproducible and effective procedure to achieve adequate brain decompression and reach satisfactory aesthetic results.