Plication Technique Research Articles

Peyronie disease: Our first experience with Ducket Baskin tunica albuginea plication (TAP) technique.

IntroductionPeyronie's Disease is a deformity of the penis. Surgical procedure options for Peyronie's disease treatment include grafting (curvature >60°) or plication (curvature <60°). This case report emphasizes the curvature degree and therapy options chosen, such as tunica albuginea plication instead of grafting.Case presentationA 55-year-old male complains about a curved penis during erection. Examination shows penile bending 70° ventrally with ±15 cm length and 2x4cm size. The patient underwent Ducket-Baskin tunica albuginea placation (TAP). Postoperative unbent penis size decrement of ±3 cm, neither pain nor erectile dysfunction felt.Clinical discussionTunica plication is usually recommended in Peyronie's disease patients with curvature less than 60°, without an hourglass or hinge if grafting is not available. This technique is more simple, safe, the higher success rate of curvature correction (> 80%), low recurrency, low complication rate of penile hypoesthesia (approximately 10%), as well as low risk for postoperative erectile dysfunction.ConclusionIn our case, the tunica albuginea plication technique gives a good outcome in Peyronie's disease reconstruction.

DORSAL Plication Technique for the Treatment of Congenital Ventral Penile Curvature: Long-Term Outcomes of 72 Cases

A total of 78 patients aged 11 to 17 years were diagnosed with congenital ventral penile curvature and underwent surgery with the dorsal plication technique between 2005 and 2014. To investigate the long-term outcomes of 72 patients who underwent dorsal penile plication for the treatment of congenital ventral penile curvature without hypospadias. In all cases, the intervascular space between the deep dorsal vein and dorsal artery was dissected, and tunical plication was carried out with non-absorbable 3-0 polyamide sutures and the complication and satisfaction rates of the patients were determined in the postoperative seventh year. At the final postoperative follow-up, the patients' satisfaction with the operation was found to be 95.8%. Shortening of the penis (0.5-1 cm) in five cases, recurrence with less than a 20-degree curvature in two cases, palpable sutures in two cases was observed and no patients reported erectile dysfunction. The limitations of our study can be considered as the absence of pharmacological erection in the preoperative evaluation, failure to evaluate penile length at the last postoperative follow-up due to the continued development of the penis, inability to evaluate erectile function at the beginning, postoperative erectile capacity being assessed in only some of the operated cases, all operations being performed by a single surgeon in the same center, and the absence of standardized questionnaires for postoperative satisfaction or adverse events. According to the results of this study, dorsal plication is a relatively simple method with a low risk and high success rate for the treatment of congenital ventral penile curvatures.

Correction of Severe Crossover Toe Deformity By Plantar Plate Tenodesis, Arthroscopic Release of Lumbrical and Plication of Lateral Capsuloligamentous Complex

Plantar plate deficiency is the major cause of instability of the metatarsophalangeal joint, and plantar plate tenodesis can provide dynamic stabilization of the plantar plate. In case of crossover toe deformity, incorporation of arthroscopic release of the medial capsuloligamentous complex and the lumbrical tendon can eliminate the medial deforming force. However, in case of severe deformity, the lateral capsuloligamentous complex is attenuated. The purpose of this Technical Note is to incorporate the technique of arthroscopic plication of the lateral capsuloligamentous complex into the technique of plantar plate tenodesis and arthroscopic release of the medial capsuloligamentous complex and the lumbrical tendon.

Hip Capsular Plication With Crossed Mattress Stitch Configuration for a Revision Hip Arthroscopy in the Setting of Capsular Insufficiency

The hip capsule is an important static stabilizer of the hip joint. Perioperative capsular management during hip-preservation surgery is critical to maintain hip stability. Many biomechanical and clinical studies have demonstrated the importance of performing a comprehensive capsular closure to restore normal hip kinematics. For this reason, capsular closure or plication is now routine practice for many hip arthroscopists. The purpose of the technique is to describe a capsular plication technique using a mattress stitch configuration performed in the revision setting.

Clinical and penile Doppler outcomes using a modified, tourniquet free, Nesbit plication for severe Peyronie's disease.

BackgroundPenile curvature (PC) can be surgically corrected by plication techniques or Nesbit corporoplasty. These shortening techniques can be complicated by post-operative: penile shortening, recurrent PC, palpable suture knots and erectile dysfunction. Furthermore, Nesbit procedures require the use of a penile tourniquet to avoid intraoperative bleeding. This observational study aims to assess the results of Nesbit modified corporoplasty, avoiding intraoperative use of tourniquet without risk of bleeding. The objective is to reduce penile ischemic anatomical and functional damages such as long-term erectile dysfunction.MethodsBetween January 2010 and March 2019, a total of 64 patients with congenital penile curvature (CPC) and Peyronie’s disease (PD) underwent surgical correction with a Nesbit modified technique first time described by Rolle et al., with minimal technical differences. The operation notes were retrospectively reviewed. In particular, we evaluated pre- and post-operative erectile functions using IIEF-5 score, penile Doppler ultrasonography and overall patient satisfaction.ResultsDuring operations, no intraoperative bleeding was noted, and no short-term complications such as hematomas or neurovascular bundle lesions were reported. At 6 months, no palpable subcutaneous indurations and no sensory change were detected. Post-operative penile shortening was reported in 38 (59.4%) patients (mean 0.83±0.79 cm), but it did not influence the high overall satisfaction rate of 91.4%. Only 2 patients reported a slightly partial recurrence of curvature (<15%) with no need for a redo surgery. Mean IIEF-5 score increased from 17.1±5.2 to 20.8±3.9 at 6 months and 21.8±3.4 at 12 months (P<0.001 in both cases). Mean PSV also significantly increased at the end of follow-up (28.5±6.1 at baseline vs. 31.0±7.1 at 12 months, P=0.03).ConclusionsConsidering the optimal results in terms of erectile functions increasing and absence of PC recurrence (>15°), we think that Nesbit modified corporoplasty without tourniquet application during reconstruction is a safe and effective surgical procedure for all kind of shortening corporoplasty to reduce the time of penile ischemia, preventing even serious consequences for the normal physiology of erection.

Comparison of the two techniques for involutional lower eyelid entropion: A retrospective study

Evaluation of the surgical outcome and the patient satisfaction between the modified Wies technique and the Jones retractor plication technique for involutional lower eyelid entropion without horizontal eyelid laxity.Patients who underwent the modified Wies technique (group 1) and the Jones retractor plication technique (group 2) for correction of involutional lower eyelid entropion without horizontal eyelid laxity between January 2014 and January 2020 were retrospectively reviewed. Patients with horizontal eyelid laxity; cicatricial, congenital or iatrogenic entropion; and less than 6 months of follow-up time were excluded. The main outcome measures were the recurrence rate, correct anatomical position of the eyelid, symptom relief, and postoperative complications for both groups.37 patients (41 eyes) in Group 1 and 34 patients (34 eyes) in Group 2 were enrolled in the study. Mean age ± SD was 75.6 ± 8.5 years in Group 1 and 73.4 ± 7.9 years in Group 2 (p:0.255). The mean follow-up time (range) was 24.3 (6–80) months in group 1 and 25.3 (6–78) months in group 2 (p:0.818). Two patients in Group 1 and seven patients in Group 2 had a recurrence during the follow-up period (p:0.07).Based on the results of the study, it seems that the modified Wies technique may be a good alternative in suitable patients, as it has satisfactory surgical results.

Comparative Study between Medial Rectus Muscle Resection versus Plication When Coupled with Lateral Rectus Muscle Recession in Treatment of Exotropia

Abstract Background: There are many reasons to perform a stra-bismus surgery, either to provide binocular single vision, improve cosmosis, restore normal eye contact and/or enhance the quality of life. Aim of Study: The purpose of this study is to compare between medial rectus muscle plication versus resection when coupled with lateral rectus recession as regard efficacy and possible complications in treatment of exotropia. Patients and Methods: This study was carried out in Ophthalmology Department at Aswan University Hospital between 2019 and 2020 on 40 patients with exotropia. The first 20 pateints were operated by the plication procedure, while, the other 20 patients were operated by the resection procedure. This study was a randomized controlled study. Results: Plication technique was comparable to resection technique as there were no significant differences as regard post-operative results, but plication technique could be safer in prevention of lost muscle and anterior segment ischemia. Also, plication technique was of shorter operation time. Conclusion: MR muscle plication is an alternative easier, safer and faster technique to resection when coupled with lateral rectus recession in treatment of exotropia.

Endoscopic revision of gastric bypass using plication technique: an adjustable approach.

Video 1This video case presentation highlights a 65-year-old woman with weight regain after Roux-en-Y gastric bypass and a dilated gastrojejunal anastomosis who presented for endoscopic revision of her gastric bypass involving a plication technique, followed by gastrojejunal anastomosis stenosis dilation.

Long-Term Functional Outcomes After Surgical Correction of Congenital Penile Curvature

ObjectivesTo present the surgical results and the functional outcomes after surgical correction of congenital penile curvature (CPC) by different plication techniques. MethodsAll consecutive patients operated for CPC from 2010 to 2019 in a university hospital of Lyon, France, were retrospectively identified and included for analyzing surgical results. They were proposed to answer a questionnaire (between January 2020 and May 2020) that included questions of the Peyronie's Disease Questionnaire (PDQ), the Erection Hardness Score (EHS), and the Internal Index of Erectile Function (IIEF5), along with non-validated specific questionnaires. ResultsA total of 31 patients were included, their mean (SD) age was 21.2 (4.9) years, their mean (SD) follow-up of 55.5 (33.7) months. The principal curvature was ventral for 25 (80.6%) patients. After the surgery, 28 (90.3%) patients had straight penis or a residual curvature less than 15°, and 2 (6.5%) required a second surgery.A total of 23 (74.2%) patients answered the post-operative questionnaire. The mean (SD) scores were 1.2/16 (1.8) for PDQ-Bothered Score, 1.5/24 (2.1) for PDQ Psychological and Physical, and 1.7/30 (2.7) for PDQ pain. The mean (SD) IIEF5 was 22.7/25 (4.6). All patients had an EHS of 4/4. There were 10 patients who never had sexual intercourse before the surgery and 4 who still had not when answering the questionnaire. All patients (23/23) were either “satisfied” or “very satisfied” with the outcomes of the operation, and 13 (56.5%) reported improvement of their sexual life after surgery. ConclusionThis study confirmed the favorable outcomes of surgical plication for CPC with low morbidity. A concomitant sexological care may be useful for some patients.

Linear plication and external wrapping in ascending aortic aneurysm in well-selected patients: Surgical technique

An aortic aneurysm is known as a bulging or dilatation of the aorta for more than one and half of its normal diameter result in making the wall of the aorta thinner and at the risk of dissection or rupture. For a long time ago surgeons have worked hard to find the best surgical technique to treat this pathology. Open surgery with the replacement of the aneurysmatic segment by a synthetic graft is still the standard surgical treatment method. In the past, some surgeons tried patching the aneurysmatic segment with synthetic patches. This technique was not accepted by many surgeons. In our cardiovascular surgical center, we perform linear plication and external wrapping (LPEW) surgical technique for more than ten years in well-selected patients whose aortic aneurysm diameter is less than 6 cm with normal aortic root and who has not any connective tissue disease, dissection, or rupture. Our results are satisfying with low morbidity and mortality.

Penile Plication in Peyronie’s Disease: Technique Evolution and Recent Advances

Penile plication is an important option when considering the surgical management of Peyronie’s disease (PD). In this review, we discuss the evolution and recent advances in the use of penile plication to treat PD. Recent studies have demonstrated the successful application of penile plication to severe PD, which is often managed with more invasive procedures. Penile plication has been successfully combined with excision procedures to address severe forms of PD. In addition, a non-degloving approach was shown to be a safe, non-inferior alternative to degloving in penile plication. New plication techniques have addressed common postoperative complaints such as palpable knots and penile shortening. Updated recommendations to reduce the need for surgical revision were published. Data on long-term patient and partner sexual satisfaction was reported. Finally, the cost-effectiveness of plication was compared to other treatment options. Penile plication remains an important, cost-effective option for the treatment of PD. Recent data shows that penile plication can be used in complex PD cases, and with recent technique refinements, it can be performed with a minimally invasive approach to decrease associated complications.

The evolution in the surgical management of Peyronie's disease.

Peyronie's disease (PD) is due to a fibrotic alteration of the tunica albuginea of the penis. It is responsible of penile pain, angulation, and possible erectile dysfunction (ED). Despite almost three centuries have passed since the first description of the disease, etiology still remains uncertain. This fact has led to the lack of a truly effective medical therapy and to date the surgical treatment, although not yet standardized, is the only one that offers acceptable outcomes in terms of function and overall patient's satisfaction. Since the beginning of the surgical experience in this field, two different currents of thought have developed: the first, involved the proposal of a number of different plication techniques, applied on the healthy side of the penis, opposite to the sick side, with the sole purpose of correcting the curvature; on the other side, efforts have focused on treating the "focus" of the disease, thus developing the so called "plaque surgery." If with the passing of the decades neither of the two "philosophical" currents has prevailed, this probably depends on the fact that is still not clear which is the lesser of evils: the frequent onset of ED which may follows the plaque surgery or rather the penis shortening that inevitably occurs if any technique of plication has been applied. Our contribution aims to offer an historical retrospective of the surgical treatment of this disease as well as to discuss the latest international guidelines on this topic. The reader will also find some notes about our personal experience in this field.

The Triangular technique for abdominal myofascial plication.

Abstract:Introduction: Abdominoplasty has two main principles: First: removal of abdominal wall excess fat and skin. Second: narrowing of the waistline. Myofascial plication is a fundamental part of abdominoplasty that is done by most surgeons to strengthen the weakened abdominal wall as well to achieve a narrow waistline. Despite numerous techniques were depicted for anterior abdominal wall plication, there is no general agreement among plastic surgeons about the ideal technique. In this article, the authors are demonstrating and evaluating the triangular technique for myofascial plication. Patients and Methods: Between January 2019 and February 2020, the authors applied the triangle plication technique on 19 women with rectus muscle diastasis who underwent anterior abdominal wall plication as a part of conventional abdominoplasty. The patients were followed up for 7-12 months post-operative. The results were assessed mainly by measuring the reduction in the waist to hip ratio, patients' satisfaction on a scale of 0 to 10, and by an external observer using the Global Aesthetic Improvement SCORE (GAIS). Results:Patients’ satisfaction, were graded as excellent in 95% of cases and the GAIS ranged between 4 – 5 in 95% of cases with 17.3% average reduction of ratio waist to hip measures and 19.3% average reduction of the vertical length of the rectus sheath.Conclusion:Abdominal myofascial triangular plication is a simple technique that results in improvement of the trunk contour with a narrower waistline and facilitates tension-free closure of abdominoplasty incision and with high patients’ satisfaction rates. Keyword: Abdominoplasty, Myofascial, Plication, triangle technique

Vertical plication: A penile curvature correction technique that reduces the need for urethral plate transection in penoscrotal hypospadias

Penile curvature (PC) is a frequent component associated with hypospadias. Medial corporal rotation by interrupted suturing without incising the corporal bodies is well described in patients with epispadias and we think that it is an alternative technique for the management of patients with ventral PC, with or without hypospadias. We describe a PC correction technique which reduces the need for urethral plate transection in penoscrotal hypospadias. The main steps of "vertical plication" technique are following: The Buck's fascia at the maximum point of curvature was incised longitudinally at 12-o'clock position and then dissected from tunica albuginea from medial to lateral on each side. Minimal and precise dissection just enough to allow plication is essential to avoid injury to the neurovascular bundle. No incisions were made through the tunica albuginea. Corporal rotation was performed by approximating with polyester sutures which were placed 5mm apart at and around the point of maximum curvature. Three to 5 sutures were enough for full straightening of PC in our cases. Follow-up range was 1.5-4.5 years (mean: 3 years). 17 patients underwent this technique. 16 of them had a penoscrotal hypospadias and one patient had congenital PC without hypospadias. Full PC correction was achieved in 15 patients and residual curvature below 10° was seen in two patients. We were able to perform single-stage repair in 13 (81,25%) of our penoscrotal hypospadias cases without transection of urethral plate. High recurrence rates were reported in dorsal plication technique when compared to ventral corporal lengthening in patients with PC>30°. In the presence of high grade PC, a penile elongation technique is the preferred option for many authors. However, it requires incision of tunica albuginea. Although the variations of medial corporal rotation to correct ventral PC has been described in the past, they did not gain popularity. This technique allows the surgeon to proceed with single stage repair in patients with proximal hypospadias associated with high grade PC. Narrowing is the only disadvantages of our technique, which can easily be resolved by de-epithelialized flap coverage harvested from foreskin. No parents subjectively reported nor we detected narrowing, recurrence or shortening during follow-up.

Outside-In: Intraperitoneal Anterior and Posterior Plication During Prolapse Surgery

To demonstrate a novel technique of intraperitoneal vaginal wall plication combining the benefits of anterior and posterior colporrhaphy with laparoscopic sacrocolpopexy. Video demonstration of laparoscopic anterior and posterior colporrhaphy techniques, highlighting the various clinical scenarios in which they would be beneficial. Sacrocolpopexy is recommended for the treatment of advanced-stage prolapse [1-3]. Frequently, these patients have significant vaginal elongation and laxity that can make reconstruction challenging. This case series performed at a tertiary care hospital highlights a series of women undergoing laparoscopic sacrocolpopexy whose repairs were optimized with the use of intraperitoneal vaginal wall plication. A series of plication stitches using delayed absorbable suture is placed on redundant anterior or posterior vaginal walls. This technique reduces excess vaginal tissue and reinforces the reconstruction. Stitches can be placed vertically or horizontally to narrow the vagina, depending on the repair needs. Vertical plication shortens the vaginal walls and provides additional traction to allow dissection extension to the trigone anteriorly or the rectovaginal septum posteriorly, thus optimizing mesh placement [4]. This plication also adds bulk to the vaginal tissue where the mesh is attached, potentially decreasing the risk of mesh exposure. Intraperitoneal vaginal wall plication is the outside-in version of anterior and posterior colporrhaphy. This novel technique can optimize dissection and mesh placement and provide support for attenuated vaginal walls. It also balances the ratio of mesh to vaginal tissue without increasing mesh burden.

Management of residual penile curvature after penile prosthesis placement.

Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie's disease. Currently, there is a variety of options for the correction of residual curvature, including penile modeling, plication techniques, as well as tunical incision/excision with or without grafting. A literature search of PubMed and Medline databases was conducted from 1964 until 2020, using search terms for all articles in the English language. In this article, we provide a review of the techniques and the outcomes, according to the published literature.

Comparison of medial rectus resection and plication in exotropic patients.

To compare the surgical outcomes of the plication technique with the resection method to treat exotropic patients. In this prospective randomized clinical trial, a total of 52 exotropic patients (27 females and 25 males) who were candidates for medial rectus resection were randomly classified into the plication (n = 24) and resection (n = 28) groups. Comprehensive ophthalmic examination included cyclorefraction, assessment of the best corrected visual acuity (BCVA), evaluation of the extraocular muscle, ocular deviation measurement and stereopsis measured using a Titmus test. Ocular anterior and posterior segments were examined using slit-lamp and indirect ophthalmoscopy. Patients were randomly divided to medial rectus plication and medial rectus resection groups. The plication technique was the same as for resection, but in the last step the muscle was folded. Examinations were repeated at the 1- and 3-day as well as 1-, 2-, 3- and 6-month follow-ups. If the postoperative ocular deviation was in the range of 5 PD esotropia to 10 PD exotropia, it was considered a successful surgical outcome. Results show that there was no statistically significant difference between the two groups regarding near and far deviations (PN = 0.298, PF = 0.103), surgical dose response (P = 0.904) and postoperative success rate (plication, 87% and resection, 89.3%, P > 0.99). Reoperation was needed in 13% and 10.7% of the plication and resection groups, respectively (P > 0.05). Medial rectus plication is an effective and appropriate alternative option for medial rectus resection in exotropic patients.

Cystocele Repair by a Modified Surgical Technique of Bilateral Pubococcygeus Plication: Long-Term Surgical and Functional Results.

Here we describe our modified surgical technique of bilateral pubococcygeus plication (BPCP) for cystocele repair and assess its safety and long-term outcomes. This is a prospective study of 147 consecutive women who underwent BPCP for cystocele between January 2010 to January 2018. Inclusion criteria was naïve women with symptomatic cystocele ≥ POP-Q 2nd stage. Exclusion criteria: stress urinary incontinence (SUI), urgency urinary incontinence, other associated vaginal wall prolapses ≥ stage 2, neurological diseases, previous SUI surgeries, and previous radiation/surgery of the pelvic area. BPCP was performed by obtaining the medialization of the pubococcygeus muscle fibers of the right and left sides. Statistical analysis was performed. Objective cure was POP-Q < 2nd stage. Subjective cure and functional outcomes were evaluated by validated questionnaires. Patient’s satisfaction was assessed by a Likert-type scale. Mean operative time was 64 min. At a mean follow-up of 82.4 months, objective and subjective success rates were 89.8% and 92.2% respectively. De novo urgency was 3.2%. Surgery did not alter sexual function. Complications occurred in 4.8%, and were: wrong dissection plane, hematoma, and pain lasting between 24–72 h. BPCP for correction of cystocele is safe and effective, with limited risk of complication and good long-term results.

Lateral rectus resection versus lateral rectus plication in patients with residual Esotropia

ABSTRACT This study was aimed to compare the surgical outcomes of lateral rectus plication and resection techniques on patients with residual esotropia. In this randomized clinical trial, a total of 57 patients with residual esotropia (31 females) who were candidates for lateral rectus resection were randomized into plication (n = 27) and resection (n = 30) groups. The inclusion criteria were residual Esotropia after uni- or bilateral medial rectus recession. Subjects with a history of prematurity, lack of central fixation, extraocular muscle palsy, systemic, ocular disorders, history of lateral rectus operation, or follow up less than 3 months were excluded. Ophthalmic examinations were conducted preoperatively and at 1, 3-, and 6-month follow-ups. Surgical success rate was considered postoperative eso- or exotropia ≤10 pd. Based on the study results, there was no statistically significant difference between the two groups regarding the pre- (plication: 27.9 ± 9.8 pd and resection: 26.4 ± 7.6 pd; P = .52) and postoperative mean angle of deviation at far distance in month 3 (plication: 5.1 ± 7.1 pd and resection: 5.4 ± 3.2 pd; P = .82). Postoperative success rate also showed similarity between these two groups at all postoperative follow-ups of months 1, 3, and 6.There was no statistically significant difference between dose responses of these groups in uni- or bilateral operations. In conclusion, lateral rectus plication and resection showed statistically similar results. Each surgical method could be selected according to surgeon’s skill and comfort. We recommend plication method for patients with postoperative probability of anterior segment ischemia.

Using two “V” shaped flaps in penile torsion treatment

Introduction: Penile torsion is a congenital malformation that causes a rotational deformity of the penile shaft. Several techniques have been considered for penile torsion repair. In this study, we described our experience using two separate “V” dartos flaps, which leads to a more satisfying result. Patient and methods: Two young men with severe penile torsion aged 24 and 28 years old were candidates for surgery. During our novel method for penile torsion repair, we degloved the penis and dissected the dartos fascia from the penis shaft, then cut it distally from the sub-coronal region with a longitudinal cut to make two dartos flaps in a “V” shape. With these two flaps, we corrected penile torsion in a more satisfying way without crossing the urethra. Results: Penile torsion and concurrent chordee were completely corrected after surgery. Urine culture was sterile and uroflowmetry indicated a maximal urinary flow of 12 ml/s 3 months after the operation. Both patients were satisfied with ejaculation and their follow-up indicated complete resolution of penile torsion. Conclusions: Penile torsion is a challenging congenital anomaly. We used a two “V” shaped flap passage method to complete penile rotation and chordee correction without performing any plication techniques. Our penile torsion correction procedure resulted in the successful repair of torsion and excellent outcomes. Level of evidence: Not applicable for this multicenter audit.