Suspension Sutures Research Articles

In-line Pullout Strength of 2 Acetabular Fixation Methods for Ligamentum Teres Reconstruction of the Hip: A Cadaveric Study.

Background:Ligamentum teres (LT) reconstruction is an appropriate alternative in select cases of LT full-thickness tears, resulting in hip micro- or macroinstability. Graft fixation at the acetabular fossa is critical to achieving the best functional results.Purpose:The purpose of this study is to compare the pullout strength of 2 graft fixation methods used for LT reconstruction of the hip.Study Design:Controlled laboratory study.Methods:In 7 cadaveric specimens, the acetabular socket was prepared after the native LT was transected and the femoral head was removed. Seven separate tibialis anterior grafts were then prepared by suturing a running-locking No. 2 suture on each tail of the graft. Three specimens had fixation of the graft to the acetabulum using an adjustable cortical suspension suture button; the remaining 4 were fixed to the acetabulum using a knotless suture anchor. Specimens were then mounted onto a custom jig within a mechanical test frame to allow for the in-line pull of the graft fixation construct. After a preload of 5 N, each specimen was loaded to failure at 0.5 mm/s. Stiffness and load to failure were measured for each specimen construct.Results:Suture button fixation had a higher mean load to failure when compared with the knotless anchor fixation method (mean ± SD, 438.1 ± 114.3 vs 195.9 ± 50.0 N; P = .01). There was no significant difference in mean stiffness between the methods of fixation (24.5 ± 1.4 vs 26.5 ± 5.8 N/mm; P = .6).Conclusion:In this cadaveric study, the suture button fixation demonstrated greater load to failure than the knotless anchor fixation.Clinical Relevance:Results of this study can guide surgical decision making when selecting an acetabular fixation method for LT reconstruction.

Lipobrachiopexy: Cosmetic Outcomes and Limb Lymphatic Function of a Novel Brachioplasty Technique in Massive Weight Loss Patients.

Many types of brachioplasty techniques have been described in the literature, and the main focus has been scar aesthetics, reproducibility and safety. Little attention has been given to other two aspects of the procedure: overall aesthetic with a focus on the torso-brachial angle and on the lymphatic distress related to the procedure. In this paper, we described a novel technique of brachioplasty called lipobrachiopexy, a lymph-sparing procedure which includes tendon suspension suture to improve cosmetics . Over 18 months, 22 consecutive patients underwent bilateral lipobrachioplasty with circumferential liposuction sparing brachial artery perforators, J-scar dermolipectomy and superficial fascia suspension to the pectoralis major tendon. Aesthetic outcomes, lymphatic function, sensory function and patient's satisfaction were evaluated at 1-year follow-up. The correction of the bat wing deformity and the shape of the transition of the upper arm to the chest was evaluated by quantifying the torso-brachial angle using Photoshop. Lymphatic function was analysed pre-operatively at 1, 6 and 12 months after surgery by indocyanine green lymphography (PDE, Hamamatsu Photonics, Japan). An average of 447.5 cc (range, 350-550 cc) of fat was aspirated for each side. No major complications were experienced. Patients' and surgeons' satisfaction was high to very high in all cases. The lymphatic function was found preserved, with the same physiological linear patterns and tracer progression pre-operatively and 1 year after surgery. The torso-brachial angles showed significant improvements (86.7±14.7-100.7±10.2 right side and 85.4±16.3-101.5±9.9 left side). Lipobrachiopexy is a safe and effective technique that adds to the recent trends in brachioplasty, a reestablishment of the brachial fascial systems and addressing the anatomical etiological factor of the bat wing deformity. 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 .

Suspension sutures facilitate single-incision laparoscopic-assisted rectal pull-through for Hirschsprung disease

BackgroundTo present a surgical technique of single-incision laparoscopic-assisted endorectal pull-through (SILEP) with suspension sutures using conventional instruments for Hirschsprung disease (HD) and its long-term follow-up outcomes.MethodsThe procedure began with a 1 cm transumbilical skin incision. Three separate punctures were made in the fascia with a 5 mm scope in the middle and 5 mm and 3 mm ports for working instruments on the left and right, respectively. The first suspension suture was placed to secure the sigmoid colon to the abdominal wall. A window was created through the rectal mesentery, and dissection around the rectum was carried out. The second suspension suture was performed to suspend the rectovesical peritoneal fold or the rectovaginal peritoneal fold to the abdominal wall. Dissection around the rectum was continued downward to approximately 1 cm below the peritoneal fold. Then, the operation was completed by a transanal approach.ResultsForty patients underwent SILEP from March 2013 to April 2015. The median age was 2.7 months (ranging from 1 to 17 months). The mean operative time was 96 ± 23 min. No conversion to an open operation was required. The average hospitalization time was 4.5 ± 2 days. There were no intraoperative or perioperative complications. Long-term follow-up results were obtained from 38 patients. A frequency of defecation from every other day to twice a day was noted for 33 patients (86.8%) and more often for 5 patients (13.2%). Two patients had enterocolitis (5.2%).ConclusionSingle-incision laparoscopic rectal pull-through with suspension sutures using conventional instruments is feasible and safe for HD with good long-term outcomes.

10 Small bowel entrapment during pelvic reconstructive surgery

The objectives of this video are to describe a case of a small bowel strangulation resulting from bowel entrapment within a uterosacral ligament suspension (USL) suture, to discuss the pathophysiology of small bowel obstruction (SBO), to discuss early recognition of this rare complication, and to recommend practice changes that may help prevent small bowel entrapment during USL procedures. This video presents a case of a small bowel strangulation resulting from bowel entrapment within a uterosacral ligament suspension suture. After reviewing the literature pertaining to the incidence of early small bowel obstruction in gynecology, we will discuss our patient's clinical presentation with a focus on her CT imaging and findings on diagnostic laparoscopy. Next, we use original illustrations throughout the video to illustrate the pathophysiology of small bowel obstruction, closed loop obstructions, and bowel strangulation. Finally, using original illustrations, we discuss practice changes which we have adopted to prevent this rare complication. Through this video we hope to teach clinicians about the presentation and Croton pathophysiology of closed loop small bowel obstruction, which are uncommon complications following uterosacral ligament colpopexy. We hope that this video will encourage clinicians to maintain a very high index of suspicion for this complication in patients who present with obstructive symptoms in the acute postoperative period following a uterosacral ligament colpopexy. In addition to suture removal, we emphasize that abdominal exploration with bowel examination is essential as a necrotic segment of bowel warrants urgent intervention with excision and anastomosis. Through this video we hope to teach clinicians about the presentation and pathophysiology of closed loop small bowel obstruction, which are uncommon complications following uterosacral ligament colpopexy. We hope that this video will encourage clinicians to maintain a very high index of suspicion for this complication in patients who present with obstructive symptoms in the acute postoperative period following a uterosacral ligament colpopexy. In addition to suture removal, we emphasize that abdominal exploration with bowel examination is essential as a necrotic segment of bowel warrants urgent intervention with excision and anastomosis.

The outcomes of ‘8’suture suspension laparoscopic radical hysterectomy for early-stage cervical carcinoma.

e17519 Background: The mainly causes may due to the use of uterine manipulator and unprotected vaginal incision. To avoid these disadvantages, we modified the procedures by using ‘8’ suture suspension of the uterine instead of the uterine manipulator and vagino-purse-string suture before cutting of the vaginal. The aim of this study is to evaluate surgical data and oncological outcome of LRH without uterine manipulator based‘8’suture suspension method for early-stage cervical cancer. Methods: Patients with cervical cancers who underwent‘8’ suture suspension LRH in our center between January 2018 to August 2020 were retrospective analyzed. Without the use of uterine manipulator, a 2-0 absorbable suture was used to make an‘8’suture at the fundus of the uterine, and then make a coil. Another suture was passed through the coil to manipulate the uterus towards suitable directions. When separating the rectovaginal space, a needle with suture was pierced into the abdominal cavity from the abdominal wall above the pubic symphysis and passed through the coil to pull the uterus upwards and forwards, which was remove when separating the vesicovaginal space. Before cutting of the vaginal, a vagino-purse-string suture was made to prevent the tumor exposure in the abdominal cavity. Surgical data, postoperative complications, relapse rate and disease-free survival rate were evaluated. All operations were performed by the same surgical team. Results: A total of 48 cervical cancer patients were included in this study. Eight patients were stage IA2, 37 patients were stage IB and 3 patients were stage IIA1. There were 37 patients with squamous carcinoma while 11 with adenocarcinomas. The mean operative time was 199min (ranged from 120 to 290min). The median time of hospital stay after surgery was 7 days (ranged from 4 to 17 days). The mean blood loss volume was 40ml (ranged from 5 to 200 ml). The mean of number of removed lymph nodes are 30. The median time of removing urinary tube was 18 days (ranged from 12 to 25 days). The median time of postoperative exhaust time was 3 days(ranged from 2 to 4 days). There were no intraoperative complications, while postoperative complications were observed in 4 patients with fever. The median follow- up times were 16 months. During the follow-up time, there were no recurrence. Conclusions: The‘8’suture suspension LRH is a feasible and safe surgical procedure for early stage cervical cancer, with acceptable surgical and oncological outcomes in the hands of well-trained and experienced laparoscopic surgeons.[Table: see text]

The Unilateral Cleft Lip Nasal Deformity: Revisions within 20 Years after Primary Correction.

As patients grow older, the unilateral cleft lip nasal deformity becomes more noticeable than the repaired lip. The authors assessed nasal revisions over 20 years of the senior author's management of unilateral complete cleft lip. One hundred patients who underwent primary two-stage nasolabial correction of unilateral complete cleft lip between 1991 and 2001 were reviewed. The median patient age was 21 years at the time of analysis. Only 13 percent of patients did not require nasal revision after primary nasolabial repair. One to two nasal revisions were undertaken in 65 percent of patients. The extent of nasal maneuvers during primary labial repair was associated with the number of revisions. Recently treated patients had fewer revisions. Female patients were more likely to undergo several revisions. Of patients who had semiopen suspension sutures at primary repair, 61 percent had this maneuver repeated two or more times. In contrast, patients who had closed suspension sutures at primary repair underwent more nasal revisions and later required more nasal maneuvers. Nasal revision before skeletal maturity was significantly associated with another nasal revision after completion of skeletal growth. Twenty-seven percent of patients eventually required an aesthetic or functional rhinoplasty in adulthood. Patients with a severe initial nasal deformity require multiple revisions. Semiopen suspension sutures are associated with fewer revisions. Revision of the nasal cartilages or alar base can often be performed in the intermediate phase, in combination with other operations. Therapeutic, IV.

Suture Suspension Arthroplasty for Thumb Carpometacarpal Arthritis Reconstruction: 12- to 14-Year Follow-up.

Many surgical procedures have been described for the treatment of thumb carpometacarpal (CMC) joint osteoarthritis, with significant variation. To date, none has proven to be superior. The purpose of this study was to report long-term follow-up results of suture suspension arthroplasty (SSA). The SSA technique uses a single incision, trapeziectomy, and an intra-articular suture suspension sling anchored into the insertions of the flexor carpi radialis (FCR) and abductor pollicis longus (APL), which serves to stabilize the base of the thumb metacarpal, correct subluxation deformity, and maintain arthroplasty space. Ninety of 153 SSA reconstructions (59% recall) were evaluated at long-term follow-up (mean, 12.6 years). Data were analyzed for functional outcomes, including preoperative and postoperative grip and pinch strength, radiographs, complications, and postoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. The mean age at date of surgery was 61.7 ± 7.6 years (82% women). Significant improvement was noted in grip strength (preoperative mean, 25.0 kg; postoperative mean, 28.0 kg; P < .0001), key pinch (preoperative, 4.2 kg; postoperative, 5.1 kg; P < .0001), and tip pinch (preoperative, 2.9 kg; postoperative, 3.6 kg; P < .0001). Radiographic subsidence averaged 35% (0-90). Postoperative QuickDASH scores (mean, 6.6; range, 0-50) revealed good to excellent pain relief and function. One revision was performed, and postoperative FCR rupture occurred in 3 reconstructions. The SSA technique for thumb CMC arthritis reconstruction yields good to excellent long-term clinical outcomes. Potential advantages of the SSA include short operative time, a single incision, minimal cost, and no need for tendon harvesting, pin fixation, or implantable hardware.

Mid‐face reshaping using threads with bidirectional convergent barbs: A retrospective study

BackgroundMinimally invasive procedures, such as thread suspension techniques, are a growing trend for facial rejuvenation. However, not enough data are available on the efficacy, outcomes, and morbidity of suture suspension techniques in mid‐face reshaping.AimsOur goal was to assess treatment outcomes and patient satisfaction following mid‐face reshaping using threads with bidirectional convergent barbs (DefinisseTM free floating threads).Patients/MethodsWe performed a retrospective analysis of 60 patients who underwent treatment for mid‐face reshaping using DefinisseTM free floating threads. Response to treatment was assessed at 6 months using the mid‐face‐specific Mid‐Face Volume Deficit scale (Allergan®), Global Aesthetic Improvement and FACE‐QTM scales.ResultsSixty patients underwent mid‐face treatment with the suspension thread technique (mean age 51.3, 90% female). No concomitant procedures were done. A reduction by one point or more in the Mid‐Face Volume Deficit Scale (MDFVS) score treatment was seen in all patients after 6 months. Mean overall MFVDS and FACE‐QTM scores were significantly improved. On the GAIS, most patients were rated as improved or better both by the evaluating investigators and during self‐assessment. No major complications were observed, and none of the patients requested the removal of the threads (mean follow‐up 9.8 months, range 6–14 months).ConclusionOur results suggest that mid‐face reshaping with DefinisseTM free floating threads is a safe and reliable procedure characterized by low complication rates and good esthetic results. This minimally invasive procedure is a good alternative for normal or combination skin patients who refuse or want to delay the need for traditional rhytidectomy.

The Wide Suture Suspension Platysmaplasty, a revised technique for neck rejuvenation: A retrospective cohort study.

Restoration of an esthetic neck contour is an integral component of facial rejuvenation. The corset platysmaplasty and the suture suspension neck lift were introduced by Feldman in 1990 and by Giampapa in 1995, respectively. Both techniques are routinely used in current practice with satisfactory and long-lasting results. However, some patients who have undergone the suture suspension platysmaplasty report long-term discomfort, excessive neck tightening, and recurrence of deformity. To achieve an improvement in the Cervicomental (CM) angle and other parameters in patients with a difficult neck and to reduce the probability of long-term discomfort, excessive neck tightening, and a recurrence of deformity. The author developed a new technique that includes a very wide suture suspension with no interlocking. We hereby present a revised suture suspension technique-The Wide Suture Suspension Platysmaplasty. Between the years 2015 and 2017, the senior author performed 286 face and neck rejuvenation surgeries with or without blepharoplasty. Of these cases, 35 patients with a heavy neck were chosen for the new Wide Suture Suspension Technique. This was a single surgeon retrospective cohort study. Patients were photographed in a lateral view preoperatively and 6months postoperatively. Pre- and postoperative photographs were compared in four measured parameters: the cervicomental angle, the jowl angle, the horizontal distance between the mentum and the cervicomental angle and the vertical distance between the mentum and the cervicomental angle. The Wide Suture Suspension Platysmaplasty resulted in pleasing esthetics, with minimal complications in patients with difficult necks. The cervicomental angle decreased by 42° (P<.0001), the jowl angle increased by 12° (P<.0001), the horizontal distance between the mentum and the cervicomental angle rose by 12.4% and the vertical distance between the mentum and the cervicomental angle was reduced by 34.5%. The Wide Suture Suspension Platysmaplasty resulted in improved esthetics, as demonstrated by objective measurements. None of the patients in this series had any secondary intervention during the follow-up period. Particularly in the case of a difficult neck, surgeons should consider this technique.

Commentary on: An Update on the Posterior Earlobe/Concha Mastoid Suspension Suture to Correct "Pixie Ear" Following Facelift: Review of 40 Cases.

Commentary on: An Update on the Posterior Earlobe/Concha Mastoid Suspension Suture to Correct "Pixie Ear" Following Facelift: Review of 40 Cases.

Guideline No. 413: Surgical Management of Apical Pelvic Organ Prolapse in Women

To compare success and complication rates of apical suspension procedures for the surgical management of symptomatic uterine or vaginal vault prolapse. Women with symptomatic uterine or vaginal vault prolapse seeking surgical correction. Interventions included abdominal apical reconstructive repairs (sacrocolpopexy, sacrohysteropexy, or uterosacral hysteropexy) via open, laparoscopic, or robotic approaches; vaginal apical reconstructive repairs (vault suspensions or hysteropexy, sacrospinous, uterosacral, iliococcygeus, McCall's, or Manchester types); and vaginal obliterative procedures (with or without uterus in situ). Individual procedures or broad categories of procedures were compared: (1) vaginal versus abdominal routes for reconstruction, (2) abdominal procedures for reconstruction, (3) vaginal procedures for reconstruction, (4) hysterectomy and suspension versus hysteropexy for reconstruction, and (5) reconstructive versus obliterative options. The Urogynaecology Committee selected outcomes of interest: objective failure (obtained via validated pelvic organ prolapse [POP] quantification systems and defined as overall objective failure as well as failure rate by compartment); subjective failure (recurrence of bulge symptoms determined subjectively, with or without use of a validated questionnaire); reoperation for POP recurrence; complications of postoperative lower urinary tract symptoms (de novo or postoperative stress urinary incontinence; reoperation for persistent, recurrent, or de novo stress urinary incontinence; urge urinary incontinence; and voiding dysfunction); perioperatively recognized urinary tract injury (bladder or ureter); other complications (mesh exposure, defined as mesh being visible and exposed in the vagina, and non-sexual pelvic pain); and sexual function (de novo dyspareunia and sexual function score according to a validated questionnaire). This guideline will benefit patients seeking surgical correction of apical POP by improving counselling on surgical treatment options and possible outcomes. It will also benefit surgical providers by improving their knowledge of various surgical approaches. Data presented could be used to develop frameworks and tools for shared decision-making. We searched Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase from 2002 to 2019. The search included multiple terms for apical POP surgical procedures, approaches, and complications. We excluded POP repairs using transvaginal mesh and studies that compared procedures without apical suspension. We included randomized controlled trials and prospective or retrospective comparative studies. We limited language of publication to English and French and accessibility to full text. A systematic review and meta-analysis was performed. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). Gynaecologists, urologists, urogynaecologists, and other health care providers who assess, counsel, and care for women with POP. All statements refer to correction of apical vaginal prolapse in the short and medium term (up to 5 years), except when otherwise specified.

Absorbable Versus non Absorbable Suspintion Suture in Patient with Obstructive Sleep Apnea

Absorbable versus non absorbable suspintion suture in patient with obstructive sleep apnea up to the best of our knowledge, there is no evidence knowledge comparing absosbable suture and non absorbable suspintion suture.in patient with obstructive sleep apnea compare between absorbable versus non absorbable suspintion suture in patient with obstructive sleep apnea. A prospective randomized clinical study carried out in benha university hospital from november 2018 to august 2019. Included 36patients who underwent sleep surgeries; anteriore platoplasty .hyoid expantion patients were allocated into tow groups; a, b,). The groups(a) absorbable suspintion sutura compared non absorabable suspintion suturae in patient with osa, regardling the apne hypopnea index(ah) snoring score epworth scaling scale(epss) pain score and satistifacion of the patient.mean pain score was significantly lower in-group a and higher in-group b snoring score give more significant increase ingroup a more than group b .and lowest oxygen saturation incrase significant after absorbable suture groupa more than non absorbable suture groupb,in this study, postoperative pain scores significantly decreased after 1 week postoperative when compared with that reported in the 1st day and pain was controlled by oral analgesic only in first days. Regarding the epss values, they showed significant improvement after absorbable sutures and after non-absorbable sutures .both absorbable and non-absorbable suspension sutures are safe, fast, have low cost, easily applicable and effective procedures for treatment of osa.both absorbable and non absorbable sutures resulted in significant improvement of objective and subjective parameters in patients with osa.

The art of aortic valve repair

The art of aortic valve repair

Suspension arthroplasty in the treatment of thumb carpometacarpal osteoarthritis.

Literature presents several examples of surgical techniques for the treatment of carpometacarpal osteoarthritis. In our study we used a modified Ceruso’s suspended arthroplasty technique. In this study, 53 patients from 2011 to 2017 underwent arthroplasty with trapezius excision and suture suspension between abductor pollicis longus and flexor carpi radialis. The average age at surgery was 69, the participants were 43 women and 10 men. The average total operation time was 59 minutes. The modified CMC suspension arthroplasty technique provides excellent results compared with those in the literature.

Percutaneous Thread Lift Facial Rejuvenation: Literature Review and Evidence-Based Analysis.

Interest in noninvasive facial rejuvenation procedures continues to grow. With the advent of the so-called lunch-time face-lift, suture suspension facial rejuvenation has gained prominence and much popularity largely patient driven rather than data driven. We have published a decade ago a review about this rejuvenation technique. Despite its popularity at that time, serious long-term studies and peer-reviewed data about longevity and patient satisfaction were lacking to our surprise. As 10 years have passed, we have conducted a new systematic PubMed database search limited to the last 10 years interval. The search identified 192 publications. After screening the titles and abstracts, 20 clinical and 2 experimental studies met the inclusion criteria and were selected for this review. Though thread lift facial rejuvenation is considered to be a promising modality, no new evidence has been added to the literature to support its use. Until evidence-based efficacy and robust data are objectively documented, patients requesting percutaneous facial rejuvenation must be well informed about adverse events, longevity of effect, and limited available data on efficacy. 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 .

What’s New in Hand and Wrist Surgery

What’s New in Hand and Wrist Surgery

Surgical Management of the Internal Nasal Valve: A Review of Surgical Approaches.

Nasal valve collapse is relatively common with a lifetime prevalence of up to 13%. Etiologies include prior rhinoplasty, other surgical procedures, facial paralysis, congenital defects, trauma, and aging. Internal nasal valve collapse leads to impairment of nasal breathing, which significantly disturbs quality of life. Many approaches to increase the cross-sectional area of the internal nasal valve have been described. The main categories reviewed in this article are cartilage grafting, implants, and suture suspension techniques. Cartilage grafting techniques include alar batten graft, butterfly graft, spreader graft, autospreader graft, and alar composite graft. The implant technique includes the titanium butterfly implant. The suspension techniques included are the transconjunctival approach, Mitek bone anchor, flaring suture, lateral pull-up, and piriform rim suspension. Surgeons must carefully consider functionality, cosmesis, and technical difficulty when selecting an approach. We review indications, general approach, benefits, and considerations for a number of available techniques to help surgeons decide what approach might be best suited to the individual patient. 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.

Positional awake nasoendoscopic pattern-based surgical decision for correction of retropalatal obstruction in OSA.

To evaluate differential surgical interventions for obstructive sleep apnea (OSA) patients with single-level retropalatal based on the preoperative topographical diagnosis using nasoendoscopy with Müller's maneuver during supine position (MM-P). This case series included adult patients with OSA who showed a predominant single-level retropalatal collapse on MM-P. An anteroposterior pattern of collapse was managed by an anterior advancement procedure, while a transverse pattern of collapse was managed by lateral/anterolateral advancement procedures (double suspension sutures). A combined procedure was provided to the concentric type of collapse. All patients underwent evaluation of the polysomnography, Epworth Sleepiness Scale (ESS) values and snoring scores both preoperatively and 6-8months after surgery. Among 102 patients, the most commonly reported pattern of collapse at the retropalatal level was the concentric pattern (48.04%) followed by the transverse pattern (27.45%). The AP-pattern of collapse was reported in 24.51%. In the postoperative follow-up visits, no early or late complications were reported. All included groups showed significant improvement in polysomnographic data (mean AHI and lowest O2 saturation level). Significant improvement of VAS of snoring was reported. The overall success rate was ˃90%. Preoperative differential diagnosis of OSA with MM-P allows for tailored surgical management. Tailored procedures could yield good surgical outcomes when patients are properly selected and the technique is chosen according to preoperative topographical diagnostic assessment. This study might provide an available less-costly and effective preoperative planning for OSA intervention. 4.

Acute spondylodiscitis - A rare presentation of sacrocolpopexy complicated with chronic left iliac fossa discharging sinus

Spondylodiscitis following sacrocolopopexy is a rare complication. Many cases of spondylodiscitis are preceded by infection elsewhere, most commonly the genitourinary tract. Inadvertent placement of bone anchors into the L5-S1 disc space likely results in an L5-S1 inflammatory process with infection often tracking along the suspension sutures attached to the bone anchors. Commonly onset of spondylodiscitis is in <1 year of index surgery (average 4 months) but is reported as late as 8 years. However, the patient presenting with chronic discharging sinus (6 years) and acute spondylodiscitis following sacrocolpopexy is not reported in the literature to the best of our knowledge. To report a case of lumbosacral (L5-S1) discitis in a patient who had a discharging sinus at the left iliac fossa following a sacral colpopexy procedure 6 years back. A 44-year-old female underwent laparoscopic sacral colpopexy for uterovaginal prolapse approximately 6 years back. Approximately 4 months after the surgery, she had abdominal pain and fever, followed by discharge from the left iliac fossa. She presented to the spine surgery outpatient department with severe back pain and difficulty in walking for the last 2 weeks. Magnetic resonance imaging revealed L5-S1 spondylodiscitis. She was managed collectively by a spine surgeon, gynecologist, and gastro surgeon. The principal aims of surgery are to debride infected disc tissue, which is avascular, and excision of the sinus tract along with the removal of the sling along with its anchor. To minimize L5-S1 spondylodiscitis during sacrocolpopexy, it is recommended to start the presacral dissection at the sacral promontory, which generally lies just below the steep lumbosacral angle.

Laparoscopic radical hysterectomy with enclosed colpotomy without the use of uterine manipulator for early-stage cervical cancer.

Background:We report the application of transuterine suspension sutures (TUSSs) for manipulation and vaginal closure before colpotomy in laparoscopic radical hysterectomy for early-stage cervical cancer.Methodology:Eight patients with clinical stage IB1 cervical squamous cell cancer were treated with laparoscopic radical hysterectomy between October 2019 and May 2020. The procedure was performed without a traditional uterine manipulator, and the vaginal cuff was closed with a stapler before colpotomy to prevent tumour spillage.Results:All patients successfully underwent the surgery, with a median hospitalisation of 8 days (range 6–14). All drains and urethral catheters were removed after a median of 7 days (range 5–11) and 16 days (range 12–21), respectively. A median of 26 (range 20–32) pelvic lymph nodes were resected and no lymph-related complications were encountered post-operatively. With an enclosed colpotomy, no visible tumour tissues were exposed to the pelvic cavity, and all vaginal stumps healed well without complications. All pathological examinations of the vaginal margin were negative, and there were no residual lesions. At a median follow-up of 6 months, all patients were alive with no recurrence of disease.Conclusion:We found that laparoscopic radical hysterectomy with TUSS and vaginal closure before colpotomy is a useful and effective procedure to prevent tumour spillage for the treatment of cervical cancer.