Synthetic Absorbable Suture Research Articles

A Retrospective, Multicenter, Observational Real World Post Market Clinical Follow Up Study to Evaluate Acute Safety and Device Procedural Success of ADVAMRYL (Poliglecaprone 25) Surgical Suture. (ADVAMRYL PMCF Study)

In this real-world experience Post-Marketing Clinical Follow-up study conducted in accordance with EU MDR 2017/745 in 70 subjects from >60 surgical centers across various surgical specialties, ADVAMRYL (Poliglecaprone 25) monofilament, synthetic absorbable sterile surgical sutures demonstrated excellent suture, needle, and overall performance. No wound complications or adverse events were reported in this study during the follow-up period of 3 months, and there were no reports of prolonged or repeat hospitalization. ADVAMRYL (Poliglecaprone 25) sutures are a safe and effective option for a very wide variety of surgical procedures in a diverse population.

A Retrospective, Multicenter, Observational Real World Post Market Clinical Follow up Study to Evaluate Acute Safety and Device Procedural Success of ADVACRYL RAPID (Braided Coated Polyglactin 910) Surgical Suture. (ADVACRYL RAPID PMCF Study)

In this real-world experience Post-Marketing Clinical Follow-up study conducted in accordance with EU MDR 2017/745 in 70 subjects from >50 surgical centers across various surgical specialties, ADVACRYL RAPID (Polyglactin 910) braided, synthetic absorbable sterile surgical sutures demonstrated excellent suture, needle, and overall performance. No wound complications or adverse events were reported in this study during the follow-up period of 3 months, and there were no reports of prolonged or repeat hospitalization. ADVACRYL RAPID (Braided coated Polyglactin 910) sutures are a safe and effective option for a very wide variety of surgical procedures in a diverse population.

A Retrospective, Multicenter, Observational Real World Post Market Clinical Follow Up Study to Evaluate Acute Safety and Device Procedural Success of ADVAPD (Polydioxanone) Surgical Suture. (ADVAPD PMCF Study)

In this real-world experience Post-marketing Clinical Follow-up study conducted in accordance with EU MDR 2017/745 in 70 subjects from >55 surgical centers across various surgical specialties, ADVAPD (Polydioxanone) monofilament, synthetic absorbable sterile surgical sutures demonstrated excellent suture, needle, and overall performance. No wound complications or adverse events were reported in this study during the follow-up period of 3 months, and there were no reports of prolonged or repeat hospitalization. ADVAPD (Polydioxanone) sutures are a safe and effective option for a very wide variety of surgical procedures in a diverse population.

A Retrospective, Multicenter, Observational Real World Post Market Clinical Follow Up Study to Evaluate Acute Safety and Device Procedural Success of ADVACRYL PLUS (Triclosan Coated Triclosan Coated Polyglactin 910) Surgical Suture. (ADVACRYL PLUS PMCF Study)

In this real-world experience Post-Marketing Clinical Follow-up study conducted in accordance with EU MDR 2017/745 in 103 subjects from >80 surgical centers across various surgical specialties, ADVACRYL PLUS (Triclosan Coated Polyglactin 910) braided, synthetic absorbable sterile surgical sutures demonstrated excellent suture, needle, and overall performance. No wound complications or adverse events were reported in this study during the follow-up period of 3 months, and there were no reports of prolonged or repeat hospitalization. ADVACRYL PLUS (Triclosan Coated Polyglactin 910) sutures are a safe and effective option for a very wide variety of surgical procedures in a diverse population

Analysis of early morphological and functional perivulnar changes in the mucosa of the cecum after suturing with different surgical threads

The correct choice of suture material is the key to successful treatment in abdominal surgery, particularly pediatric surgery. Given this, experimental studies on the effect of sutures made with different surgical threads are one of the most urgent surgery needs. The aim - to conduct a comparative analysis of early morphological and functional changes in the perivulnar region of the mucosa of the rabbit cecum after suturing with polyglactin-910 and polycaprolactone modified with L-arginine. Materials and methods. The study was conducted on 25 rabbits aged 8-10 months in compliance with all bioethical standards and recommendations. The control group consisted of 5 animals; the first experimental group, in which synthetic surgical polyfilamentous absorbable suture polyglactin-910 was used to close the wound defect, and the second experimental group, in which monofilamentous absorbable suture polycaprolactone modified with L-arginine was used to close the wound defect, consisted of 10 rabbits each. All stages of surgical access and sampling of intact cecal wall tissues were performed in the control group. The rabbits of the experimental groups underwent colotomy followed by suturing of the large intestine with appropriate suture material. Each experimental group was divided into two subgroups (5 rabbits in each), in which the condition of the perivulvar region was studied on days 3 and 7, respectively. The animals were not euthanised; during the second operation, tissues of the cecum were taken from the sutured area and the formed scar at the appropriate time. Histological, semi-thin serial sections, electron microscopic, morphometric, and statistical methods were used. Discussion. The average thickness of the cecal mucosa after colotomy increased significantly on days 3-7 when using both surgical threads, but when using polycaprolactone modified with L-arginine, the above indicator was 63.06% and 22.46% lower, respectively, due to a decrease in hyperhydration of the connective tissue component of the mucosa, leukocyte infiltration in the perivulnar area and acceleration of reparative processes. Conclusions. Polycaprolactone modified with L-arginine has a positive effect on the course of morphological and functional processes in the perivulnar region of the rabbit cecum's mucosa. In terms of its characteristics, it is not worse than polyglactin-910. No conflict of interests was declared by the authors.

The effect of argon plasma coagulation on surgical suture material

Introduction. In modern surgery, there are many types of different energy used to achieve hemostasis; one of them is the energy of argon plasma coagulation. However, the impact of energy affects not only the bleeding site; it also affects the stitches lying nearby the source of bleeding. The instructions for the use of a suture material or a coagulation tool do not describe the changes that may occur when they interact. A review of the literature found a small number of publications devoted to changes in the physical properties of suture material when exposed to it. This information is not sufficient to predict the effects of argon plasma coagulation energy on the suture material and, as a result, on wound healing or the quality of the postoperative scar.The objective was to determine changes in the biodestructive properties of synthetic absorbable suture materials with argon plasma coagulation in an in vivo experiment.Methods and materials. In the experimental study, the results of biodegradation of monofilament and polyfilament sutures after exposure to argon plasma coagulation energy were analyzed in comparison with control samples in the body of laboratory mice.Results. It can be unequivocally stated that the effect of argon plasma coagulation energy has an effect on the rate of biodegradation of both monofilament and polyfilament synthetic filaments implanted in muscle tissue.Conclusions. Suture material exposed to argon plasma coagulation may not meet the terms of partial or full biodegradation stated by the manufacturer, which may affect the quality of scar formation.

The effect of medical grade honey on tensile strength, strain, and Young's modulus of synthetic absorbable suture material used in equine surgery.

Medical grade honey (MGH) has been introduced as a protective measure against surgical site infections in equine surgery, but the effect on suture material has not been investigated. To evaluate the effect of MGH on the tensile properties of three synthetic absorbable suture materials. In vitro experiments. Ten strands of Polydioxanone USP 2 (PD2), Polyglactin 910 USP 2 (PG2) and Polyglecaprone USP 2-0 (PC2-0) were incubated 1, 7, 14, 21 and 28 days in MGH, phosphate-buffered saline (PBS), equine plasma (EP) and MGH mixed with equine plasma (HP). Mechanical testing was performed recording maximum load at failure (N), strain at failure and Young's modulus (N/mm2 ). The results were reported from a Welch or regular ANOVA. PD2 in MGH had a significantly higher tensile strength compared to PD2 in EP (p < 0.05, mean difference (md) = 16.95 N, CI95% (9.19-24.70 N)) and PBS (p < 0.05, md = 14.48 N CI95% (6.73-22.23 N)) on day 7 and the remaining time points. PG2 incubated in MGH had a significantly higher tensile strength compared to EP (p < 0.05, md = 69.28 N CI95% (64.16-74.40 N)) and PBS (p < 0.05, md = 56.90 N CI95% (51.78-62.02 N)) until day 28. PC2-0 incubated in MGH had a significantly higher tensile strength compared to EP (p < 0.05 md = 12.40 N CI95% (4.59 N-20.20 N)) and PBS (p < 0.05 md = 11.23 CI95% (3.42-19.03 N)) on day 7 and the remaining time points. The sutures were unloaded during incubation and a single cycle to failure test was only performed, which does not reflect the in vivo environment where shear forces are present. MGH did not negatively affect the tensile strength of the suture material and can safely be applied in contact with suture materials commonly used in equine surgery.

Does suture material affect cesarean section scar healing?

Background: Sutures are an essential part of any major surgery which serve to hold opposing tissues together and accelerate the healing process, resulting in decreased scarring of the affected areas. In the past, gold, silver, iron, and steel wires, dried animal gut, silk, and plant fibers (e.g., linen, cotton) have been used as suture materials. Obstetricians commonly use synthetic absorbent sutures for uterine closure during CS. This study aim to evaluate the effects of different synthetic absorbable suture materials on cesarean scar defect formation.Methods: After excluding patients who did not meet inclusion criteria and those who declined to participate, the patients were randomly divided in to 2 groups: - study group І: - 35 patients and study group II: - 35 patientsPatients were subjected to the following: Ultrasound evaluation Ultrasound was done to ensure viability, determine the gestational age, the position of the placenta, the presenting part, the amniotic fluid and the estimated fetal weight using convex transducer of (Samsung Medison H60, Korea & 50/60 HZ).Results: Regarding demographic data of the studied patients, Age, gestational age and BMI there were no significant difference between both groups. Regarding time of operation and type of anesthesia there were no significant difference between both groups. There was no significant difference in the preoperative, post-operative and delta Hb concentration between both groups. Regarding post-operative pain, there was no significant difference between both groups. Regarding post-operative hospital stay was no significant difference between both groups. Regarding myometrial thickness, total and residual myometrial thickness was significantly thicker in group II compared to group I.Conclusions: Our results showed that monofilament sutures reduced pathological inflammation during wound healing without increasing costs, operation time, or intraoperative complication rates; resulting in improved uterine scar recovery; and potentially reduced CSD. These findings suggest that gynecological sequelae due to CSD and serious obstetric complications that may occur in subsequent pregnancies can be reduced.

Benefits of Reducing Incision Tension in Hard-To-Close Keloid Surgery.

Benefits of Reducing Incision Tension in Hard-To-Close Keloid Surgery.

Associations between suturing techniques and suture materials with complications of tubularised incised plate urethroplasty: A systematic review and meta-analysis

Tubularised incised plate (TIP) urethroplasty has received widespread acceptability for hypospadias repair. Differences in surgical approach might impact the outcome of TIP urethroplasty. This study was performed to examine the associations between suturing techniques and suture materials with complications of TIP urethroplasty. Following electronic databases: PubMed, ScienceDirect, EMBASE, and Cochrane Library were systematically reviewed for the studies that reported comparisons of interrupted and continuous suturing techniques and comparisons of several suture materials with complication rates during TIP urethroplasty. Risks of bias were evaluated with RoB 2 tool for randomised controlled trials (RCTs) and ROBINS-I tool for comparative non-RCTs. All data were analysed utilising review manager 5.4. Thirteen total studies involving 2,967 patients underwent TIP procedure were included in this study. However only nine studies fulfilled the criteria for quantitative synthesis. In meta-analysis, there was no significant difference of total complications rate among interrupted and continuous suturing techniques (OR 0.86; 95% CI: 0.46–1.59). Subgroup analysis for each complications (urethrocutaneous fistula, infection, dehiscence, meatal stenosis, and urethral stricture) were also not statistically different. The utilisation of absorbable synthetic braided suture compared to monofilament sutures did not increase the complications rate of TIP urethroplasty (OR 1.49; 95% CI: 0.83–2.68). No publication bias was observed in the funnel plot. Our meta-analysis showed that suturing techniques and suture materials had no significance on the complications of TIP urethroplasty. The selection of suturing techniques and suture materials should be based on surgeons or centre's local experience.

EFFECTS OF RUTIN AND CAFFEINE ON THE ABSORBABLE SUTURE MATERIALS

AIM: To assess the influence of rutin and caffeine on absorbable sutures.INTRODUCTION: Absorbable sutures are initially equal or superior to non absorbable sutures in terms of tensile strength but are absorbed,at variable rates by the action of hydrolysis (1). synthetic absorbable sutures have been recognised as an important step forward in the historymof suture materials. Synthetic absorbable sutures have been approved by the Food and Drug Administration for almost all surgical uses with the exception of certain cardiovascular and neurological procedures (2). Many drinks, including coffee and tea, contain a significant amount of the purine alkaloid caffeine. Antioxidant effects of caffeine and its metabolites theobromine and xanthine have been demonstrated.MATERIALS AND METHODS: Two resorbable sutures ( PGA and Vicryl) were used for the study. The suture materials were coated with rutin and caffeine and were subjected to Scanning electron microscopy, to assess the tensile strength, antioxidant and anti inflammatory activity.RESULTS AND DISCUSSION: According to the study, PGA had higher tensile strength than vicryl at day 14 and is a good suture if tensile strength is needed after that point. Rutin showed relatively higher antioxidant activity when compared to caffeine. caffeine showed good anti inflammatory activity.&#x0D; CONCLUSION: On analysing the tensile strength, PGA suture shows greater tensile strength compared to vicryl suture.

Impact of Fluoridated Mouthwashes on Strength and Durability of Three Different Synthetic Absorbable Suturing Materials: An In Vitro Study

The aim of the current in vitro research was to assess the effect of fluoride-containing mouthwashes on the strength and durability of three different synthetic absorbable suturing materials. Three types of synthetic absorbable suture materials were employed in this research, and every group comprised 20 suture samples. These include group I: Polyglactin 910, group II: Polyglycolic acid, and group III: Poliglecaprone 25. This research utilized 4-0 gauge sutures. Each example was tied using a square surgeon's knot about elastic rubber tubing. The biology of the oral milieu was replicated in vitro through the use of artificial saliva. The medium that was subjected to test prior to inclusion were 0.2% chlorhexidine gluconate as well as 0.044% sodium fluoride. The tensile strength of the specimen suture materials was subjected to test at a particular time intervals: prior to immersion, the 1st day, the 7th day, as well as the 14th day after immersion. Tensile strength was evaluated using a Universal Ultra Test machine. Post-immersion in 0.2% chlorhexidine gluconate mouthrinse, the mean tensile strength of polyglactin (PLG) 910 sutures was 24.48 ± 0.08 at pre-immersion and 4.36 ± 0.01 on the 14th day. The mean tensile strength of polyglycolic acid (PGA) sutures was 24.04 ± 0.26 at pre-immersion and 2.10 ± 0.02 on the 14th day. The mean tensile strength of Poliglecaprone 25 sutures was 23.82 ± 0.11 at pre-immersion and 1.34 ± 0.08 on the 14th day. Post-immersion in 0.044% sodium fluoride mouthrinse, the mean tensile strength of PLG 910 sutures was 24.18 ± 0.02 at pre-immersion and 5.12 ± 0.21 on the 14th day. The mean tensile strength of PGA sutures was 24.88 ± 0.34 at pre-immersion and 4.58 ± 0.10 on the 14th day. The mean tensile strength of Poliglecaprone 25 sutures was 24.48 ± 0.27 at pre-immersion and 5.08 ± 0.14 on the 14th day. A statistically noteworthy difference was noted amid the three types of sutures at dissimilar time points evaluated with p <0.001. The current research arrived at a conclusion that there is a significant difference between the mean tensile strength and purpose of the medium used for immersion as well as the tenure. Polyglactin suture material exhibited superior strength as compared to PGA and poliglecaprone suture substances following immersion in the investigational media. Suture materials are employed in the closure of incised flaps, to aid healing by primary intention, along with control of bleeding. In oral as well as periodontal surgery, the right choice of sutures is very important for good healing. Suture choice for the mouth should be influenced by the requirements of the anticipated repair and the surgeon's fondness.

Monofilament vs multifilament suture for uterine closure at the time of cesarean delivery: a randomized clinical trial

Different factors may influence the closure of the uterine wall, including suture material. Suture materials may indeed influence tissue healing and therefore the development of scar defects. To test whether uterine closure using synthetic absorbable monofilament sutures at the time of cesarean delivery would reduce the rate of cesarean scar defects compared with uterine closure using synthetic absorbable multifilament sutures. Parallel-group, nonblinded, randomized clinical trial of women with singleton pregnancies undergoing cesarean delivery at term in a single center in Italy. The inclusion criteria were singleton pregnancy, first or second cesarean delivery, scheduled and emergent or urgent cesarean deliveries, and gestational age between 37 0/7 and 42 0/7 weeks. Eligible participants were randomly allocated in a 1:1 ratio to either the monofilament group (polyglytone 6211 [Caprosyn]; Covidien, Dublin, Ireland) or the multifilament suture group (coated polyglactin 910 suture with Triclosan [Vicryl Plus]; Ethicon, Inc, Raritan, NJ). The primary outcome was the incidence of cesarean scar defect at ultrasound at the 6-month follow-up visit. The secondary outcomes were residual myometrial thickness and symptoms. Overall, 300 women were included in the trial. Of the randomized women, 151 were randomized to the monofilament group and 149 to the multifilament group. However, 27 women were lost to follow-up: 15 in the monofilament group and 12 in the multifilament group. Of note, 6 months after delivery, the incidence rates of cesarean scar defect were 18.4% (25 of 136 patients) in the monofilament group and 23.4% (32 of 137 patients) in the multifilament group (relative risk, 0.79; 95% confidence interval, 0.41-1.25; P=.31). The mean residual myometrial thicknesses were 7.6 mm in the monofilament group and 7.2 mm in the multifilament group (mean difference, +0.40 mm; 95% confidence interval, -0.23 to 1.03). There was no between-group substantial difference found in the incidence of symptoms, including pelvic pain, painful periods, and dyspareunia. In singleton pregnancies undergoing primary or second cesarean delivery, the use of synthetic absorbable monofilament sutures at the time of uterine wall closure was not associated with a reduction in the rate of cesarean scar defect 6 months after delivery compared with the use of synthetic absorbable multifilament sutures.

The Reinforced Ma-Griffith Method Combined with Minimally Invasive Small-Incision Suture for Acute Achilles Tendon Rupture.

ObjectiveTo evaluate the treatment effects of the reinforced Ma‐Griffith method combined with a minimally invasive small incision(M‐G/MISI) in the treatment of acute Achilles tendon rupture.MethodsFrom January 2012 to January 2020, a retrospective study was carried out on thirty‐one patients with acute Achilles tendon ruptures that were treated using the M‐G/MISI. Patient with acute Achilles tendon rupture was operated on in the prone position. The M‐G/MISI begin with making a small incision to debride the stumps of ruptured tendon. Then M‐G/MISI was used to suture the distal and proximal Achilles tendons with the help of a epidural puncture needle and polydioxanone synthetic absorbable suture (PDS) Ⅱ line. Finally the stumps of ruptured tendon was reattached. After the surgery, the affected limb was fixed with either a plaster slab below the knee brace or a functional brace. Removal of plaster external fixation and partial weight‐bearing with crutches five weeks after the operation; Complete weight‐bearing nine weeks after the operation; jogging permitted 12 weeks after the operation; Patients were allowed to resume normal activities six months after the operation.ResultsAll 31 patients in this study were male. Nineteen of these patients had Achilles tendon rupture on the right lower extremity, while 12 had ruptures on the left lower extremity. The patients had a mean age of 33.35 ± 7.13 years (range, 18‐52 years). The mean operation time was 79.58 ± 22.67 minutes (range, 40‐167 minutes). The mean time from injury to operation was 4.19 ± 2.01 days (range, 1‐8 days), and the mean hospital stay was 9.87 ± 3.88 days (range, 5‐22 days). The new technique had a small incision with a mean length of 3.94 ± 1.82 cm (range, 2‐6 cm). The mean intraoperative blood loss was 16.77 ± 13.76 mL (range, 10‐50 mL) and the mean follow‐up time was 21.35 ± 10.18 months (range, 6‐50 months). No wound infection, fistula, skin necrosis, sural nerve damage, deep venous thrombosis or tendon re‐rupture was found. One year after the surgery, all patients reported 97.00 (range, 93‐100 points) AOFAS ankle‐hindfoot score points and the mean ATRS was 97.39 (range, 91‐100) points.ConclusionThe reinforced Ma‐Griffith method, combined with a minimally invasive small incision suture, is a simple, effective, minimally invasive technique and low‐cost surgical method for the treatment of acute Achilles tendon rupture.

A Suturing Method without Exposure of Barbs on the Wound Surface Using a Unidirectional Barbed Monofilament Absorbable Suture (STRATAFIX™) in Laparoscopic Myomectomy: A Feasibility Study.

Objectives:We examined whether a new suturing method that used a single-thread unidirectional barbed suture without exposing the barbs on the wound surface was acceptable compared with the conventional suture method during laparoscopic myomectomy (LM).Materials and Methods:This was a retrospective study. The subjects were 26 women who underwent LM for symptomatic uterine fibroids. The operative time, amount of blood loss, and number of threads used were compared between a group in which suturing was performed with a conventional synthetic absorbable suture (conventional suture group, n = 13) and a group in which suturing was performed using a barbed suture (barbed suture group, n = 13).Results:Operative time in the barbed suture group was significantly shorter than that in the conventional suture group, while blood loss during LM in the barbed suture group was significantly lower than that in the conventional suture group. The number of threads used in the conventional suture group was significantly larger than that in the barbed suture group. No complications were observed in both the groups during LM.Conclusion:This new technique using a barbed suture is safe and feasible for LM.

Comparison of suture material and technique of closure of subcutaneous fat and skin in caesarean section

Background: A large number of women undergo caesarean section throughout the world. These women pass through a period of post operative pain and a morbidity period. These women translate into a substantial portion of population and hence there is a load on the financial resources of healthcare system. Use of the appropriate technique to approximate the wound after caesarean section would not only avoid financial load but also help in early recovery of the patient. Aim: The aim of this study is to compare the effects of alternative techniques for closure of subcutaneous fat and skin on maternal health and use of healthcare resources in caesarean section.Material & Methods: The present study was conducted in department of Gyane and Obs. department of J. L. N. Medical College, Ajmer. In this study 200 cases were included during period of July 2020 to December 2020. Patients undergoing Caesarean section were divided in two groups of one thousand patients each. In all the patients, after stitching the uterus, the rectus sheath was stitched with thread vicryl No.1 (synthetic absorbable braided sutures with polyglycolic acid, polycaprolactone and calcium stearate coating), using a round body needle. Then the patients were divided into two groups. In group I, vicryl No.1 thread used in stitching of the rectus sheath was continued into the skin with application of subcuticular stitches, after securing the edges with a knot. In group II, after stitching the rectus sheath with vicryl No. 1, the thread was cut and interrupted sutures were applied in subcutaneous fat with thread vicryl No. 2. Skin was stitched with subcuticular stitches using proline 2, a non-absorbable propylene suture. Results: In our study post CS complications were found in 14% of cases with wound infection has been the most common complication occurring in 6.5% of cases studied. Other complication included were wound seroma (4%), wound dehiscence (2%), wound haematoma (2%), and suture sinuses (0%).Conclusion: On the basis of this study, it was concluded that inspite of using best closure technique and keeping in mind the patient related factors complication arising after C.S. are frequent and most commonly associated with non closure of fat.

Micro‐marsupialization technique with suture thread modification for improving the management of oral mucoceles and ranulas: A case series

AbstractAimMicro‐marsupialization is a technique that can be applied in the treatment of mucoceles located on the floor of the mouth (ranula), lower lip or ventral surface of the tongue. The technique is simple, low cost, little invasive and consists of using sutures to promote mucous drainage. Absorbable sutures may have advantages over regular silk sutures. Herein, we report a case series of oral mucoceles and ranulas treated by the micro‐marsupialization technique using synthetic absorbable suture thread.Material and methodsThe convenience sample consisted of five individuals, three males and two females.ResultsThree individuals had a clinical diagnosis of oral mucoceles and two of ranulas. The treatment resulted in the resolution of all cases. Although there was a slight accumulation of plaque, no signs of inflammatory reaction, pain, bleeding, or recurrence were observed after at least 30 months of follow‐up.ConclusionsThis study demonstrated that the use of absorbable suture thread during micro‐marsupialization can be beneficial, mainly because of its similar performance compared to conventional silk suture thread, without the need for removal.

Training trends and practice pattern of intestinal anastomosis among Nigerian Postgraduate Trainees: A cross-sectional survey

Background: The concept of mentor-mentee skills learning in surgical education has been the bedrock of training and knowledge acquisition over many years. Techniques of intestinal anastomosis are one of the fundamentals skills to be mastered in the early career of trainees in surgery. This study aims to evaluate the training trends and current practice of intestinal anastomosis amongst Nigerian postgraduate trainees. Methods: A cross-sectional survey using a self-administered questionnaire was conducted on surgical trainees who attended the 2020 annual revision course of the National Postgraduate Medical College in Lagos. Results: Response rate was 74.1%. The age range of respondents was 29–52 years with a mean 35.5 ± 4.6 years. Majority of the respondents had their future career interest in general surgery and were in the second (43.3%) and third (38.3%) postgraduate year in surgery. Nontraumatic emergency abdominal conditions (71.7%) were the most common indication for gastrointestinal anastomosis. Majority of the respondents practice prophylactic use of bowel preparation and nasogastric tube placement for elective colorectal procedures. Two-layer anastomosis using synthetic absorbable suture was favored by most respondents. This was the technique of choice regardless of the segment of the bowel involved in the anastomosis. Fifth postoperation day was the most preferred time for the commencement of oral intake. Twenty respondents gave an estimated anastomotic leak rate of 0%–10% and this was attributed to systemic factors by 71.7% of the respondents. Two-third of respondents rated their current anastomotic skills as good even though 86.7% of respondents desired further formal training in intestinal anastomosis. Conclusion: Nontraumatic emergency abdominal conditions were the most common indication for intestinal anastomosis. The traditional two-layer anastomosis with synthetic absorbable sutures was favored over other anastomotic techniques. Majority would commence oral feeding on 5th day postoperation. Self-rated anastomotic leak reported by a third of respondents was ≤10%.

Decontamination of Polymeric Surgical Sutures Covered with Bacterial Biofilms Using Nonthermal Plasma

The objective of the study was to investigate the bactericidal effectiveness of atmospheric pressure nonthermal plasma (NTP) on biofilms of Staphylococcus aureus and Escherichia coli formed on the surface of surgical sutures. Tests were carried out for polyamide nonabsorbable monofilament sutures and mid-term absorbable synthetic monofilament sutures made of glyconate. Dielectric barrier discharge reactor providing atmospheric air plasma and constant discharge power density of 70 mW/cm2 was used in the experiments. The colonization/decontamination efficacy was quantified by colony-counting assay. It was shown that decontamination efficacy of the studied surgical sutures was time-dependent i.e. the effect was more visible for longer exposure times ranging from 60 to 360 s. It was proposed to combine plasma treatment with washing the biofilms with a phosphate buffered saline to to allow the plasma to interact with cells in the deeper layers of bacterial biofilm. The application of the original method of treatment of biofilms was more effective than the separate plasma treatment. As a result, the lethal effect was most often achieved after 300 s regardless of the type of suture and biofilm. The results of the comparative studies on the decontamination efficiency of polymeric surgical suture surface by disinfectants and NTP technique have shown unequivocally that plasma treatment is the most effective way to deactivate bacterial cells and ensures a lethal effect for most of the tested cases.

Vaginal cuff dehiscence with small-bowel evisceration following total laparoscopic hysterectomy – An unusual case

Small bowel evisceration from dehiscent vaginal cuff is unusual subsequent to laparoscopic hysterectomy. This complication is seldom cited in studies and reviews. We present an uncommon case of evisceration of small bowel from vaginal cuff dehiscence (VCD). The event occurred approximately 2 hours subsequent to the first act of coitus performed 3 months after the laparoscopic hysterectomy. Patient was brought to the emergency department for primary treatment. Urgent surgical intervention was planned. Small intestine was reposed after saline wash. Repairing of the vault was done with continuous suture by polyglactin-910 braided synthetic absorbable suture no.1. Patient was sent to home after 5 days of surgery. The strength of vaginal vault in laparoscopic hysterectomy depends on technique of vaginal cuff closure and types of suture materials used during surgery. Postoperative counseling of patients for recommencing physical activity and sexual intercourse is also of utmost significance.