Suture Type Research Articles

Impact of permanent versus absorbable suture in vaginal suspension surgery for apical pelvic organ prolapse

To systematically review the literature regarding how permanent versus absorbable suture impacts anatomic failure in women undergoing native-tissue vaginal apical suspension. MEDLINE and EMBASE were searched from their inception through 6/11/21 using pre-identified search terms. Our population included studies of women who underwent native-tissue vaginal apical suspensions (uterosacral ligament suspension (USLS) and sacrospinous ligament suspension (SSLF)). We excluded cadaver, tissue sample, or animal studies. We excluded hysteropexy and McCall culdoplasty. Our intervention was defined as permanent sutures (polytetrafluoroethylene, polypropylene, poliglecaprone 25, mersilene, silk, and nylon), excluding braided polyester suture. Our comparator group was absorbable or delayed absorbable sutures (polyglactin, polydioxanone, and polyglyconate). Outcomes included anatomic failure defined by POP-Q measurements, stage or grade, subjective symptoms of a bulge, re-operations, or re-treatments. A single composite anatomic failure proportion was determined for each study. Adverse events including suture exposure, surgery for suture complication, dyspareunia, and granulation tissue were collected. Abstracts were double-screened using Abstrackr, then full text articles were doubly screened, and then accepted articles were doubly extracted. Quality of studies was assessed using GRADE criteria. In studies using either absorbable or permanent sutures (single-arm studies), random effects meta-analyses of pooled proportions were used to assess anatomic failure. In studies investigating both suture types (comparative studies), random effect meta-analyses of pooled risk ratios were used. Analyses were performed using STATA, v.17 and p<=.05 was considered statistically significant. 4,357 abstracts were screened, 349 full-text papers assessed, and 20 studies met eligibility criteria (Figure 1). 4 studies (all USLS) compared both suture types, and 16 were single arm (8 USLS and 8 SSLF)(6 absorbable and 10 permanent). Mean follow up was 24.3 months. The proportional anatomic failure rate of absorbable suture (n=10) was 9% (95% CI 0.06, 0.13), and permanent suture (n=14) was 15% (95% CI 0.10, 0.20) with high heterogeneity. On meta-analysis, there was no difference in relative risk of failure for permanent sutures versus absorbable sutures (n=4), RR = 0.69 (95%CI 0.20, 2.36) with substantial heterogeneity (Figure 2). Overall, failure rate was low and similar for both absorbable and permanent suture for native tissue vaginal suspension with medium term follow-up.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Pattern of suture use for pelvic organ prolapse surgery

Permanent and delayed suture types may be similar in anatomic outcomes after surgical correction of pelvic organ prolapse; however, surgeon preference could vary. A survey investigating the practice patterns of suture use in female pelvic reconstructive surgery was conducted. An IRB-approved survey was distributed through the Society of Gynecologic Surgeons by a link via email to 278 members and shared on Twitter using #gynecologic surgery, @FPMRS, @Gyn Surgery, and @iugaoffice. Surgeon demographics and suture preference for various pelvic organ prolapse surgeries was queried with 36 questions. Responses were analyzed with descriptive statistics. We received 110/278 (40%) responses from surgeons including 86% urogynecologists, 6% Ob/Gyn, and 8% other. 47% were male, and 52% female. 20% of respondents were 0-4 years in practice, 21% were 5-9 years, 15% 10-15, years 12% 16-20 years, and 33% were >20 years in practice. Most respondents were academically affiliated (73%), whereas 10% were in hospital practice and 15% were in private practice. Most respondents perform >50 prolapse surgeries per year (76%) and 6% perform <20. The majority (99%) were Ob Gyn trained vs Urology trained (1%) and 80% are board certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). The types of sutures used varied between the different surgeries (Table 1). Some surgeries had a strong suture preference among surgeons, with 88% of surgeons preferring to use permanent sutures for sacral attachment during sacrocolpopexy, and 56% using delayed absorbable for the vaginal attachment. Delayed absorbable suture was the most common preference for uterosacral ligament suspension (USLS) 54%, and sacrospinous ligament fixation (SSLF) 54%. There was greater disparity in responses regarding suture preference for anterior colporrhaphy, posterior colporrhaphy, and colpocleisis; however, most surgeons reported a preference for absorbable (38-46%) or delayed absorbable suture (32-49%). In this group of predominantly gynecology trained FPMRS surgeons in SGS, there was a strong preference for permanent suture for the sacral attachment for sacrocolpopexy and delayed absorbable for the vaginal attachment. Delayed absorbable suture was also the preference for apical sutures for USLS and SSLF. We acknowledge limitations of small sample size; however, we did query highly trained, high volume surgeons. Our next step is to expand this survey to capture more respondents.

Reinforced duct-mucosa anastomosis (REDMA). New alternative after cephalic duodepancreatectomy

IntroductionOf the possible complications after a cephalic duodenopancreatectomy (CPD), the clinically relevant postoperative pancreatic fistula (PPF) is the most important, especially in patients with pancreas of a soft consistency. The main objective of this work is to analyze the different postsurgical complications, with special emphasis on the rate of PPF on soft pancreas with a risk of moderate/high PPF, and its incidence between the two different types of sutures used by our group (classic vs reinforced duct-mucosa anastomosis [REDMA]). MethodsRetrospective observational study, between January 2017 and March 2020, of patients undergoing CPD in our unit after applying the inclusion and exclusion criteria. Analysis of preoperative, intraoperative factors and postoperative complications observed during follow-up. ResultsSample of 34 patients; 67.6% (n = 23) of them under the classic protocol and 32.4% (n = 11) with REDMA. The only post-surgical complication in which we obtained statistical repercussion, without differences between cases and controls in terms of the risk of FPP, in favor of the REDMA anastomosis is that of FPP. Thanks to this surgical innovation, both the complications from stage IIIb, according to the Clavien-Dindo classification, and the mean hospital stay have also been reduced with statistical significance. ConclusionsWhen REDMA reduces the rate of PPF in patients with moderate/high surgical risk of it, we consider it to be a useful alternative to consider in the reconstruction of transit after CPD.

Modified laparoscopic gastrostomy tube placement in children: Does subcutaneous suture type matter?

Laparoscopic gastrostomy tube (GT) placement carries the risk of early tube dislodgement and is often modified with absorbable subcutaneously-tunneled transabdominal tacking sutures that can aid in tube replacement. However, these buried sutures may increase the risk of surgical site infection (SSI). This study sought to evaluate SSI rates associated with different types of transabdominal tacking sutures used in modified laparoscopic GT placement. A single-institution, retrospective review was performed of all patients ≤18 years-old undergoing modified laparoscopic GT placement between September 2016 and March 2020. Patients were stratified into three groups by suture type used, and the primary outcome was SSI within six weeks of surgery. Demographic and perioperative data were analyzed by chi-square or Fisher's exact test. A total of 113 modified laparoscopic GT placements were performed at a median age of 9 months (interquartile range 3 months to 3 years). Prophylactic antibiotic use was similar between groups. Eleven patients (10%) developed an SSI, and all were treated with antibiotics alone. No SSIs were observed with the use of poliglecaprone suture (n=46), and higher SSI rates were observed with use of polyglactin (n=17) and polydioxanone (n=51) suture (18% polyglactin vs. 16% polydioxanone vs. 0% poliglecaprone, p<0.05). No differences were observed in rates of early postoperative dislodgement, leakage, or granulation tissue. Absorbable braided and long-lasting monofilament transabdominal tacking sutures may increase risk of SSI following modified laparoscopic gastrostomy tube placement. In this cohort, the use of poliglecaprone (Monocryl) suture was associated with no SSIs and similar rates of postoperative dislodgement, leakage, and granulation tissue. Treatment Study, Level III.

Survival and Risk Factor Analysis of Arthroscopic Ramp Lesion Repair During Anterior Cruciate Ligament Reconstruction

Background: There is a lack of research on the management of ramp lesions associated with anterior cruciate ligament (ACL) injuries. Furthermore, there has been no report of the risk factors for failure of ramp lesion sutures, linked to either the technique used (all-inside suture implant vs suture hook through a posteromedial portal) or the type of lesion (location in the red zone or meniscocapsular junction, longitudinal extension, partial- or full-thickness tear). Purpose: To evaluate the results of arthroscopic repair of ramp lesions and determine the risk factors associated with ramp lesion repair failure, with special focus on their subtype and the suture technique. Study Design: Case-control study; Level of evidence, 3. Methods: All patients who underwent arthroscopic ramp lesion repair in association with ACL reconstruction between November 2015 and January 2018 were evaluated retrospectively. The following parameters were studied: demographics; clinical history; clinical findings including International Knee Documentation Committee score, complications, time from injury to surgery, side-to-side laxity, and pivot shift; and surgical findings including subtype, surgical management, and type and number of sutures. Failure of the ramp lesion repair was defined at secondary arthroscopy. Results: Among the 248 lesions analyzed, 18 (7.3%) failures were documented. The failures occurred in 21.1% of repairs managed with the all-inside device versus 4.3% of sutures managed with the suture hook (P = .003). Among the 6 factors included in the Cox model, the only one identified as a risk factor for failure was the type of repair (P = .003), with a risk for the all-inside device that was >5-fold higher than that for the suture hook repair (corresponding hazard ratio, 5.1 [95% CI, 1.8-14.5]). No other complications involving the surgical technique or device were registered. Conclusion: An arthroscopic all-inside technique of meniscal repair of ramp lesions appeared to be safe and effective. It provided excellent healing of the repaired meniscus, with an overall failure rate of 7.3%. The type of suture was associated with failure of the ramp lesion repair, with a significantly higher risk with the all-inside device than with suture hook repair sutures.

Absorbable sutures for cardiopulmonary bypass purse strings in pediatric heart surgery

Absorbable sutures, commonly used in general surgery, are not routinely used as purse strings for arterial and venous cannulation for cardiopulmonary bypass in pediatric heart surgery.The general concern is absorbable sutures could predispose to immediate postoperative bleeding; this safety concern has been evaluated in this retrospective study. A single center, retrospective study, was conducted with criteria for inclusion patient <18 years of age, operation on with cardiopulmonary bypass for heart surgery from July 1, 2018 to June 30, 2020, with purse strings for cannulation performed with absorbable sutures. Data collection included demographics at the time of surgery, site of arterial and venous cannulation with absorbable purse strings, bleeding, required reoperation, related hospital mortality, and complications. One hundred and ninety-eight patients, mean ± standard deviation(SD) age of 1597 ± 3021 days, mean ± SDbody weight of 15.9 ± 18.8 kg, were operated on using absorbable sutures for purse strings for arterial and venous cannulation: No bleeding was reported, either intraoperative or in the immediate postoperative period, related to the type of sutures used for purse strings for cannulation. No hospital deaths or complications related to the type of sutures were observed. Based on the results of our analysis, we can conclude that the utilization of purse strings absorbable sutures for arterial and venous cannulation for cardio-pulmonary bypass in children is safe in relationship to the intraoperative and immediate postoperative period.No complications related to the use of absorbable sutures have been observed in a large pediatric patient population.

A multicentre qualitative study of patient skin surgery experience during the COVID-19 pandemic in the UK.

Understanding patient concerns regarding skin surgery during the COVID-19 pandemic is a vital way of learning from individual experiences. A shift towards using superficial absorbable sutures (AS) has been anecdotally observed. We explored patient attitudes to the use of AS, and their experiences and perceptions of attending for skin surgery during the pandemic. In total, 35 participants were interviewed (74% men, 100% white British; mean age 72.5 years, range 43-95 years). Participants reported that they were reassured by precautions taken to minimize exposure and risk from COVID-19. The majority (86%) did not feel that personal protective equipment worn by staff impaired their experience, and 29% reported that their experience of attending for skin surgery during the lockdown period was more efficient and organized than on prepandemic visits. The vast majority (94%) of participants would opt to have AS again or had no strong preference for either suture type. Based on their experiences, most participants would have no concerns about attending for further skin surgery during the pandemic and would opt to have AS.

The effects of cerclage suture type on pregnancy and neonatal results: Mersilene Suture and Prolene Suture

Aim: The aim of this study is to compare pregnancy and neonatal results with regards to the thickness of the suture material used in the transvaginal cerclage operation. Materials and Methods: Patients who were subject to transvaginal cervical cerclage due to cervical insufficiency were evaluated in a secondary care center between 2103 and 2021. The demographic data, cerclage indications (ultrasound induced, prophylactic, or physical examination induced), number of pregnancy weeks at cerclage, type of cerclage suture (prolene, mersilene), type of cerclage (McDonald, Shirodkar), total pregnancy weeks, delivery method (cesarean (C/S), normal spontaneous vaginal delivery) of each patient were recorded. Additionally, birth weight, 1st and 5th minute APGAR scores, and neonatal intensive care unit (NICU) requirements were recorded as neonatal parameters. Patients were divided into two groups with regard to the type of cerclage suture (mersilene or prolene) and maternal, neonatal and pregnancy results were compared between these groups. Results: The study included 151 patients in total. Prolene sutures were used for 69 of the patients (45.7%) and mersilene sutures for 82 patients (54.3%) Cerclage was applied for 18 patients (11.9%) depending on the ultrasound findings, 121 patients (80.1%) depending on emergency and 12 patients (7.9%) depending on history. Gravida increased significantly in the prolene suture group (p=0.021). Pregnancy week was found to be significantly lower in the mersilene suture group [32.5 w (15-40)] compared to the prolene suture group [37.0 w (15-41)] [37.0 w (15-41)](p&lt;0.001). Ratios of birthing below 34 weeks and 37 weeks for the mersilene suture group were found as 57.3% and 80.5%, and for the prolene suture group 11.6% and 40.6% respectively, and a statistically significant difference was observed (p&lt;0.001). Fetal weight, 1st and 5th minute APGAR scores in the mersilene suture group were significantly lower (p&lt;0.05). Ratios of newborn intensive care requirements and preterm premature rupture of membranes (PPROM) in the mersilene suture group were found to be significantly higher compared to the prolene suture group (p=0.016, p&lt;0.001 respectively). Conclusion Although the mersilene sutures have been preferred by doctors for many years, the prolene suture was found to be more effective in the amelioration of pregnancy and neonatal results. Nevertheless, future research comprising other variables that may affect the success rates of cerclage sutures shall be helpful in determining the superiority of the suture type used in cerclage procedures in induced pregnant women.

Effect of Incisional Negative Pressure Wound Therapy Following Incisional Hernia RepairA Randomised Controlled Trial

Introduction: Incisional hernia is one of the common complications following abdominal surgery in patients undergoing laparotomy. Various surgical procedures are performed by creating a potential space and placing a foreign body (mesh), which may render the wound susceptible for many postoperative complications. It is clinically important to evaluate the efficacy of Incisional Negative Pressure Wound Therapy (INPWT) in reducing wound complications. Aim: To compare the efficacy of INPWT dressing with traditional gauze dressing in reducing postoperative complications following meshplasty in incisional hernia repair. Materials and Methods: This was a hospital-based randomised controlled trial, conducted in the Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, from October 2013 to July 2015. 64 consenting patients with incisional hernias undergoing meshplasty were included in this study. After being randomised into the two study groups, they had their postoperative wounds dressed with either INPWT (Group A) for five days, or traditional gauze (Group B) based dressings. Operative parameters like duration of surgery, type of dissection and type of skin sutures used were studied and analysed. Also, postoperative outcomes like Surgical Site Infection (SSI), seroma, duration of drain, hospital stay were analysed using Chi-square or Fisher’s-exact test. Results: Out of total 64 patients, there was a statistically significant reduction in the volume of drain (p=0.004) and duration of wound drainage (p=0.029) with the use of INPWT. There was also a reduction in the incidence of SSI (6.7% vs 17.6%) and seroma (6.7% vs 11.8%) and the duration of postoperative hospital stay (6.03±1.99 days vs 7.09±2.31 days) in the INPWT group, which were however not statistically significant. Age, comorbidities, Body Mass Index (BMI), duration of surgery, type of dissection and type of skin sutures were not found to have any effect on the parameters assessed. Conclusion: Incisional negative pressure wound therapy in postoperative wounds, following meshplasty for incisional hernia significantly reduces the volume and duration of wound drainage. It also reduces the incidence of SSI, seroma and the duration of hospital stay

Reinforced Duct-Mucosa Anastomosis (REDMA). New Technique after Cephalic Duodepancreatectomy

Introduction: Of the possible complications after a cephalic duodenopancreatectomy (CPD), the clinically relevant postoperative pancreatic fistula (PPF) is the most important, especially in patients with pancreas of a soft consistency. The main objective of this work is to analyze the different postsurgical complications, with special emphasis on the rate of PPF on soft pancreas with a risk of moderate/high PPF, and its incidence between the two different types of sutures used by our group (classic vs reinforced duct-mucosa anastomosis [REDMA]).

PALEONTOLOGY AND EVOLUTIONARY LINEAGES OF THE DIAGNOSTIC BENTHIC FORAMINIFERAL GENUS ORTHOKARSTENIA

This work is focused on the members of the Late Cretaceous-Early Paleogene (K-Pg) diagnostic benthic foraminiferal genus Orthokarstenia which is regionally important in paleontology and stratigraphic correlations. The large number of tests available and the rapid morphologic changes, offer an opportunity to study evolutionary changes in these foraminiferal taxa over a time span of about 25 m. y. (75-50 Ma). Six species of the genus Orthokarstenia are presented: O. applinae, O. eleganta, O. esnehensis, O. higazyi, O. nakkadyi and O. oveyi, which were recorded in eight localities in the Southern Tethys: Nigeria, Tunisia, Egypt (central and north Africa), Jordan, Saudi Arabia, UAE, Iran and Pakistan (southwest Asia). Evolutionary changes of them are indicated by such criteria, such as changes in the test-size, chambers arrangement, type of sutures, periphery or surface ornamentation. These changes help to define the major faunal change of the Campanian/Maastrichtian (C/M) boundary, K/Pg boundary, and can used in biostratigraphic subdivisions and correlations based on benthic foraminifera, beside planktic foraminiferal zonation.

Outcome of stented versus unstented mid-shaft to distal hypospadias repair

AimsWe compared the outcomes of unstented repair (UR) versus stented repair (SR) in patients with mid-shaft to coronal hypospadias (HS) to elucidate if SR has any advantage over the UR.Materials and Methods:We retrospectively studied our mid-shaft to coronal HS repair patients between January 2013 and January 2018. We recorded variables such as degree of HS, age at repair, surgeon, type of repair, suture used, stent usage, and standard early and late complications. Relative risk (RR) was calculated and P < 0.05 was considered significant.Results:We included 120 patients (63 UR, 57 SR). There was no statistically significant difference in any parameters in both the groups. All had either tubularized incised plate or Thiersch–Duplay procedure. Urethroplasty was done with PDS 6/0 in all cases. Trainees performed two-third of the repairs under variable supervision. Early complications included one UR patient having urinary retention needing insertion of urethral catheter, five SR patients having bleeding/swelling, and three UR having dysuria. All were managed conservatively. For late complications, 98 patients were available (UR: 51, SR: 47) with fistula in 17 (17.3%), UR 8 (15.6%) versus SR 9 (19.1%) (P = 0.5, RR = 1.2) meatal stenosis in 3, UR 3 versus SR 0 (P = 0.06, RR = 6.4) and glanular dehiscence 6, UR 4 versus SR 2 (P = 0.25, RR = 1.8).Conclusion:There were no statistically significant differences in the short-term complications between UR and SR for HS. In the long term, RR for meatal stenosis is higher in UR.

APPLICATION OF “DAMAGE CONTROL SURGERY” FOR FIRE INJURIES OF THE INTESTINE

Introduction. The current situation with the armed conflict in the east of the country is characterized by the presence of a significant number of patients with gunshot wounds in general. In the proposed article, the authors summarize the materials presented in the world literature and their own experience in the treatment of wounded servicemen with combat wounds to the abdomen, accompanied by injuries of the small and large intestine, often with traumatic shock, significant blood loss and high mortality. Taking advantage of the opportunities to apply the field or military experience of NATO medical services, we drew attention to the tactics of “Damage control surgery” (DCS), the use of which can significantly improve the effectiveness of treatment and provision of phased medical care in armed conflicts. Material and methods. DCS management were introduced in NATO military field surgery. Its essence is that in severe abdominal injuries, accompanied by traumatic shock III–IV degree, surgery is not performed simultaneously in full, but is divided into several stages. The first stage consists of a minimal amount of surgical interventions aimed at stopping intra-abdominal bleeding and preventing contamination of the abdominal cavity with intestinal contents. To do this, the damaged area of the colon or small intestine is either stitched with a stapler, or tied with a thick ligature, or sutured with one of the types of sutures, but the primary anastomoses are not formed. The internal organs are covered with sterile polyethylene, and the abdominal wall is temporarily closed in one way. The results of the analysis of the effectiveness of surgical treatment of wounded servicemen with gunshot wounds to the abdomen and intestines indicate the effectiveness of staged surgical tactics within the applied DCS tactics. Note that the proven effectiveness and positive results of treatment of the above significant contingent of patients is largely due to the development and use of the original clip, the use of which is convenient, fast, prevents contamination of the peritoneum during the intraoperative period and thus causes the corresponding positive effects of surgical treatment of gunshot wounds or small intestine by the tactics of “Damage control surgery” during the immediate postoperative period. Conclusion. The use of “Damage control surgery” tactics in wounded servicemen with gunshot wounds to the colon or small intestine avoids unwarranted surgical interventions and reduces the time spent on the operation itself and the postoperative period, which in this case runs faster and with fewer complications. The use of the original intestinal clip is effective in performing surgical interventions on wounded servicemen with gunshot wounds of the colon or small intestine according to the tactics of “Damage control surgery”. Key words: combat trauma, Damage control surgery, colon or small bowel injury.

Amount of reoperation following surgical repair of nonsyndromic craniosynostosis at a single center.

Craniosynostosis is a deformity of the skull that occurs as a result of early fusion of one or more cranial sutures and can be accompanied by neurological deficits. Craniosynostosis can be classified as syndromic or nonsyndromic according to the type of suture involved. Surgical treatment of craniosynostosis in infants basically involves loosening and opening the fused sutures to reduce intracranial pressure, allow the brain to grow, and also fix the skull shape. However, in such cases there is a risk of resynostosis after surgery. According to the literature, resynostosis rates vary between 0% and 70%. In this study, we aimed to evaluate the reoperation rate in craniosynostosis cases treated surgically in our clinic. A retrospective analysis of 70 nonsyndromic craniosynostosis cases treated surgically in the Neurosurgery Department of Bursa Uludağ University from 2005 to 2019 was performed. All patients had undergone total cranial vault remodeling surgically and had been followed up for at least a year. The study group included 70 patients, comprising 40 (57.1%) male and 30 (42.9%) female patients. The mean age of the group was 10.9 ± 7.8 months (range 3-34 months). Out of 70 patients, repeat surgery due to resynostosis had been performed once in 5 (7.1%) patients and twice in 1 (1.4%) patient. It should be kept in mind that resynostosis may occur in patients who have been operated for craniosynostosis. Patients should be examined cosmetically and if necessary, radiologically in the follow-up. Further studies based on larger sample size are recommended for more quantitative data and better results.

Myorrhaphy surgical techniques

Although vaginal birth is currently encouraged after a previous cesarean section, the rate of cesarean section has steadily increased in the last 10 years from 5% to 30-32%. As the rates of cesarean section increase, the rates of pathologies associated with uterine scarring increase, as for example pregnancy implanted at the level of the scar or various forms of invasive placenta. Using the search engines of the online libraries such as PubMed, Medscape, UpToDate, Cochrane, we selected studies on the surgical technique used in the caesarean section. For this paper, 8 scientific articles were selected considering both original articles and meta-analyzes, cumulating a total of 9675 patients distributed into two categories, namely single and double layer. Double-layer suture of the uterine incision is preferred over single-layer suture, but both meet medical standards. At present, the benefits of one technique compared to the other (single layer/ double layer) are not unanimously demonstrated; multiple variables must be considered such as the actual technique in making the layers, type of suture used (continuous interlocking or non-interlocking or separate sutures) and the obstetrician’s experience.

The Functional Anatomy of the Cornea and Anterior Chamber in Lampreys: Insights From the Pouched Lamprey, Geotria australis (Geotriidae, Agnatha).

Extant lampreys (Petromyzontiformes) are one of two lineages of surviving jawless fishes or agnathans, and are therefore of critical importance to our understanding of vertebrate evolution. Anadromous lampreys undergo a protracted lifecycle, which includes metamorphosis from a larval ammocoete stage to an adult that moves between freshwater and saltwater with exposure to a range of lighting conditions. Previous studies have revealed that photoreception differs radically across the three extant families with the Pouched lamprey Geotria australis possessing a complex retina with the potential for pentachromacy. This study investigates the functional morphology of the cornea and anterior chamber of G. australis, which is specialised compared to its northern hemisphere counterparts. Using light microscopy, scanning and transmission electron microscopy and microcomputed tomography, the cornea is found to be split into a primary spectacle (dermal cornea) and a scleral cornea (continuous with the scleral eyecup), separated by a mucoid layer bounded on each side by a basement membrane. A number of other specialisations are described including mucin-secreting epithelial cells and microholes, four types of stromal sutures for the inhibition of stromal swelling, abundant anastomosing and branching of collagen lamellae, and a scleral endothelium bounded by basement membranes. The structure and function of the cornea including an annular and possibly a pectinate ligament and iris are discussed in the context of the evolution of the eye in vertebrates.

"A banana a day keeps wound failure away": comparing the utility of fruit, pig, and synthetic skins for suturing practice.

To investigate how suturing orange and banana peels, pig skin, and synthetic skin compares with the experience of suturing human skin. Interventional study of simple interrupted, vertical mattress, and subcuticular suturing on the four test materials. Fifteen consultants and six trainees in surgical and emergency medicine specialties at a New South Wales regional teaching hospital. The primary outcome was completion of simple interrupted, vertical mattress, and subcutaneous sutures. Secondary outcomes (assessed in a questionnaire) were similarity of suturing each material to suturing human skin, suitability of each material for practising each suture type, and similarity of each material to human anatomic skin types. All 21 participants completed simple interrupted sutures in bananas and pig and synthetic skins, and 15 in orange skin (P=0.002). All 21 participants completed vertical mattress sutures in pig and synthetic skins, 18 in bananas, and six in oranges (P<0.001). The numbers of completed subcuticular sutures were lower for the two fruits (orange, zero; banana, two) than for pig and synthetic skins (each, 21; P<0.001). Banana peel was rated as somewhat similar to human skin and recommended for practising simple interrupted and vertical mattress suturing. Bananas are not only useful as healthy snacks between theatre cases, but also for practising and improving simple and vertical mattress suturing skills. However, less portable and nourishing materials are required for subcuticular suturing practice, such as pig skin or synthetic skin.

Elevated intracranial pressure with craniosynostosis: a multivariate model of age, syndromic status, and number of involved cranial sutures.

Children with multiple prematurely fused cranial sutures and those undergoing surgical correction later in life appear to experience worse neurocognitive outcomes, but it is unclear whether higher intracranial pressure (ICP) is implicated in this process. The purpose of this study was to elucidate the effect of age at intervention and number of involved cranial sutures on ICP, as well as to assess which cranial suture closure may be more associated with elevated ICP. The prospective craniofacial database at the authors' institution was queried for patients undergoing initial corrective surgery for craniosynostosis in whom intraoperative measurement of ICP was obtained prior to craniectomy. Age, involved sutures, and syndromic status were analyzed in the context of measured ICP by using multiple linear regression. Fifty patients met the inclusion criteria. Age at procedure (p = 0.028, β = +0.060 mm Hg/month) and multiple-suture involvement (p = 0.010, β = +4.175 mm Hg if multisuture) were both significantly implicated in elevated ICP. The actual number of major sutures involved was significantly correlated to ICP (p = 0.001; β = +1.687 mm Hg/suture). Among patients with single-suture involvement, there was an overall significant difference of median ICP across the suture types (p = 0.008), with metopic having the lowest (12.5 mm Hg) and sagittal having the highest (16.0 mm Hg). Patients with multiple-suture involvement had significantly higher ICP (p = 0.003; 18.5 mm Hg). Patients with craniofacial syndromes were 79.3 times more likely to have multiple-suture involvement (p < 0.001). Corrective surgery for craniosynostosis demonstrated significant intraoperative reduction of elevated ICP (all p < 0.050). Syndromic status, older age at intervention for craniosynostosis, and multiple premature fusion of cranial sutures were associated with significantly higher ICP.

Economics and safety of continuous and interrupted suture hepaticojejunostomy: An audit of 556 surgeries.

Backgrounds/AimsHepaticojejunostomy (HJ) for bilioenteric continuity is generally performed with interrupted sutures. This study compares the safety, economics, short- and long-term outcomes of continuous suture hepaticojejunostomy (CSHJ) and interrupted suture hepaticojejunostomy (ISHJ).MethodsA retrospective cohort analysis involving all HJs between January 2014 and December 2018 was conducted. Patients with type IV or V biliary strictures, duct diameter < 8 mm and/or associated vascular injury, and liver transplant recipients were excluded. Patient demographics, preoperative parameters including diagnosis, intra-operative parameters including type and number of sutures, suture time, and postoperative morbidity (based on Clavien-Dindo classification) were recorded. Patients were followed up to 60 months. McDonald’s Grade A and B outcomes were considered favorable. Cost according to suture type and number (polydioxanone 3-0/5-0 mean cost, US$ 9.26/length; polyglactin 3-0/4-0 mean cost, US$ 6.56/length), and operation room charge (US$ 67.47/hour) were compared between the two techniques. Statistical analysis was performed using IBM SPSS ver. 22 software.ResultsA total of 556 eligible patients (468 patients undergoing ISHJ and 88 undergoing CSHJ; 47% [n = 261] with malignant and 53% [n = 295] with benign pathology) were analyzed. The two groups were similar. Number of sutures, cost, time, and postoperative bile leak were significantly higher in the ISHJ group. Bile leak occurred in 54 patients (6 CSHJ, 48 ISHJ). Septic shock-induced death occurred in 16 cases (3 CSHJ, 13 ISHJ). Morbidity and the anastomotic stricture rates were comparable in both groups.ConclusionsCSHJ is a safe, economical, and worthy of routine use.

O08 BIOMECHANICS OF MANUAL, STAPLED, AND MANUAL-STAPLED SUTURES ON FASCIA LATA. TIPS FOR ABDOMINAL WALL SURGEONS

Abstract Aim No data on the biomechanical properties of staplers’ use in the repair of abdominal wall defects are available. Our objective is to study prospectively the biomechanical properties of manual, stapled and mixed manual/stapled fascial sutures. Material-Methods Stress/strain tests were performed on 16 human cadaver fascial samples. The data on strength, strain (deformability), Young’s modulus (elasticity), and dissipated energy (toughness modulus) were recorded for each type of suture. Results Stapled and mixed suture showed a significantly higher strength (manual 0.83, stapled 2.10, mixed 2.68 MPa), and a trend towards a higher strain as compared to manual sutures (manual 344, stapled 249, mixed 280%). Stapled and mixed suture were four-fold higher as compared to manual sutures (manual 1.779, stapled 7.374, mixed 6.964 MPa). Manual and mixed sutures showed significantly higher dissipated energy (manual 0.99, vs stapled 0.73, vs mixed 1.35 mJ-mm3). Conclusions Stapled and mixed sutures have better strength performances than manual sutures. On the other hand, stapled and mixed sutures have significantly higher Young’s modulus and lower ultimate strain, showing less deformability, possibly translating in less efficiency in large midline defects, where manual sutures might display higher elasticity. Also, hand-sewn sutures (in manual or over-sewn stapled) appear to increase the ability to absorb mechanical energy, whereas stapled sutures showed to be less tough. Furthermore, an over-sewn stapled suture, as compared to a stapled suture, gains in term of strength, ultimate strain, Young’s modulus, and dissipated specific energy, suggesting the need of over-sewn stapled sutures in case of larger fascial defects.