Tube Ligation Research Articles

Reversible Mechanical Contraception and Endometriosis Treatment Using Stimuli-Responsive Hydrogels.

Female sterilization via fallopian tube ligation is a common procedure; However, after the operation, over 10% of women seek re-fertilization, which is frequently unsuccessful. In addition, there is evidence that fallopian tubes contribute to the spread of endometriotic tissue as they serve as channels for proinflammatory media entering the abdominal cavity via retrograde menstruation. Here, stimuli-degradable hydrogel implants are presented for the functional, biocompatible, and reversible occlusion of fallopian tubes. The hydrogel implants, designed with customized swelling properties, mechanically occlude fallopian tubes in a high-performance manner with burst pressures reaching 255-558mmHg, exceeding normal abdominal pressures (95mmHg). Their damage-free removal can be achieved within 30 min using near-visible UV light or a glutathione solution, employing a method akin to standard fallopian tube perfusion diagnostics. Ultrasound-guided implant placement is demonstrated using a clinical hysteroscope in a human-scale uterus model and biocompatibility in a porcine in vivo model. Importantly, the prevention of live sperm as well as endometrial cell passage through blocked fallopian tubes is demonstrated. Overall, a multifunctional system is presented that constitutes a possible means of on-demand, reversible contraception along with the first-ever mechanical approach to abdominal endometriosis prevention and treatment.

Baerveldt glaucoma implant with Supramid© ripcord stent in neovascular glaucoma: a case series.

To report the outcome of Baerveldt glaucoma implant (BGI) with Supramid© ripcord use in neovascular glaucoma (NVG). We retrospectively evaluated the surgical outcome of the BGI with Supramid© 3/0 ripcord stent in patients with NVG. No tube ligation or venting slits were performed. Supramid was removed after 3mo if the target intraocular pressure (IOP) was not achieved. Surgical success was defined as IOP≤21 mm Hg with (qualified success) or without IOP-lowering medications (complete success). Twenty-six eyes from 24 patients were included in the study. The median duration of follow-up was 4 [interquartile range (IQR)=1-5]y, ranging from 0.5 to 5y. IOP decreased by a mean of 24.2 mm Hg (59.7%); from a mean of 40.5±12.6 mm Hg at baseline to 16.3±11.9 mm Hg, P≤0.001. The number of glaucoma medications reduced from a median of 5 (IQR=5-6) to 1 (IQR=0-2, P≤0.001) at the final follow-up. Overall success rates were 88.0% at 1y, 34.8% at 3y, 66.7% at 4y, and 50% at 5y. Hypertensive phase (HP) in the first 3mo occurred in 15/26 eyes (57.7%) with a mean IOP of 31.1 mm Hg. BGI with Supramid© ripcord stent gives close to 90% of the overall survival rate at the final follow-up without significant early hypotony. However, early HP is still a challenge.

Influence of the postoperative restrictive methodologies and efficacy of the Baerveldt 350 implant after 12 months follow‐up

Aims/Purpose: To assess the clinical outcomes subsequent to the implantation of a Baerveldt 350 drainage device, utilizing different restrictive methodologies to prevent sudden postoperative hypotony (HT) (IOP <6 mmHg), and their subsequent impact on the incidence of a Hypertensive phase (HP).Methods: A retrospective observational analysis of 71 consecutive eyes that had a Baerveldt 350 implanted. 50 eyes had 6 or 7/0 polyglactin tube ligation (ligature group = LG) and 21 eyes had a 3/0 polypropylene intraluminal tear cord 3/0 added to the ligation (ripcord‐ligature group = RLG), which was manually removed at the surgeon's discretion after spontaneous opening of the polyglactin. Intraocular pressure (IOP) and ocular hypotensive medication (OHM) lowering, failure rate, complete and partial success (CS and PS) and presence of HP were analysed.Results: The mean preoperative IOP was 26.14 (11.34) mmHg with 2.98 OHM for the LG and 28 (8.76) mmHg with 3.35 OHM for the RLG (p = 0.545 and p = 0.397). At the end of the follow‐up, the mean postoperative IOP was 13.35 (3.87) mmHg for the LG and 10.81(2.66) mmHg for the RLG (p = 0.01). The mean reduction of OHM was 2.25 (1.38) for the LG and 2.81 (1.6) for the RLG (p = 0.168). HP was noted in 26 patients (37.14%), 25 of them took place in the LG (50%); however, only 1 took place in the RLG (5%) (p = 0.00023). 35% of the patients who exhibited HP achieved CS, compared to 67.7% of the patients that did not show HP (p = 0.022). The survival analysis for a 12 months follow‐up period, showed that the estimate survival time for the LG was 10.97 (±0.521), and 11.64 (±0.342) for the RLG (p = 0.216). Two predictors were identified for risk of failure and CS: age of the patient before surgery (OR 0.157; 95% CI 0.029–0.865; p = 0.033) and the presence of HP (OR 3.90; 95% CI 1.189–12.794; p = 0.025). Lastly, HT was noted in 55 patients (80.9%), 45 of them took place in the LG (81.8%); however, only 10 took place in the RLG (18.2%) (Pearson Chi‐S p = 0.000225).Conclusions: Baerveldt 350 drainage device implantation has proven to be an effective procedure for glaucoma control. The use of the ripcord added to the absorbable ligature was associated with less risk of HP, and with better IOP results at the 12‐months follow‐up. Nevertheless, further research with larger population and larger follow‐up is needed to obtain robust results.

A Case of Macular Serous Retinal Detachment after Ahmed Valve Implantation in an Eye with Pachychoroid

Purpose: We report a case of macular, serous retinal detachment associated with hypotony in a patient with pachychoroid disease developing after Ahmed valve implantation.Case summary: A 77-year-old male visited our clinic with uncontrolled intraocular pressure (IOP; 32 mmHg) in his left eye despite maximal tolerable medical therapy. A prolapsed vitreous filled the anterior chamber. Swept-source optical coherence tomography (SS-OCT) revealed that the subfoveal choroidal thickness was about 510 μm, indicating pachychoroid. Vitrectomy was performed to remove the prolapsed vitreous. The IOP remained 32 mmHg 3 weeks after vitrectomy. Ahmed valve implantation was performed and hypotony developed 10 days postoperatively. Choroidal detachment was apparent and SS-OCT revealed macular accumulation of subretinal fluid. The subfoveal choroidal thickness increased to a level beyond the SS-OCT measurement range. Partial tube ligation was performed to treat the hypotony 18 days after Ahmed valve implantation; the IOP decreased to 14 mmHg at 6 weeks postoperatively. The macular, serous retinal detachment disappeared and the subfoveal choroidal thickness fell to the preoperative value.Conclusions: Hypotony after Ahmed valve implantation can manifest as serous retinal detachment under the fovea accompanied by an increase in choroidal thickness in an eye with underlying pachychoroid.

Risk factors and management of choroidal effusions.

Choroidal effusions are recognized as a common early postoperative complication of glaucoma surgery, and although often benign, they may cause significant ocular morbidity. This article aims to summarize current research on the risk factors and management of choroidal effusions. Glaucoma drainage device (GDD) implantation and trabeculectomy are the most commonly performed surgeries for the management of moderate to severe glaucoma. Common postoperative complications of these procedures include hypotony and the development of choroidal effusions. Choroidal effusions have recently been associated with the oral administration of certain drugs, including select monoclonal antibody, antiseizure and bisphosphonate medications. Risk factors for effusion development include specific patient characteristics such as pseudoexfoliative glaucoma, older age and hypertension. Although choroidal effusions typically resolve with medical therapy alone, surgical intervention may be required. Various methods of surgical intervention, such as surgical drainage or GDD tube ligation, can be utilized to treat choroidal effusions when conservative management with medical treatment fails, but themselves carry alternative risks that must be considered. Minimizing the incidence and duration of hypotony following ophthalmic surgery and careful monitoring of patients starting certain oral medications are important in limiting the occurrence of choroidal effusions. Risk factors for choroidal effusions have been recently identified in the literature. A better understanding of these risk factors, as well as the outcomes of choroidal effusion management, can help to reduce the occurrence of effusions overall and minimize ocular morbidity.

Novel Surgical Techniques to Control Flow With PreserFlo MicroShunt for Late Hypotony After Baerveldt Drainage Device Implantation.

We report a new surgical technique for controlling flow with a PreserFlo MicroShunt, in patients with late postoperative hypotony, following a Baerveldt glaucoma drainage device implantation. We present 2 cases with late postoperative hypotony after Baerveldt-shunt implantations. In both cases, the outflow resistance of the Baerveldt tube was modulated by the insertion of a PreserFlo MicroShunt into the lumen of the Baerveldt tube. In the first case, the Microshunt was inserted through the distal opening of the tube in the anterior chamber. In the second case, an end plate, sided approach was chosen after opening the conjunctiva. In both cases, the hypotony was successfully treated. The intraocular pressure rose immediately after the procedure, and it remained well controlled within the targeted range during the first postoperative months without additional pressure-lowering medication. This novel surgical technique provided predictable flow reductions, according to the Hagen-Poiseuille equation. This approach offers a valuable alternative to permanent tube ligation.

Effect of fallopian tube ligation on tubal patency

Among the methods of surgical sterilization of women, ligation of the fallopian tubes is one of the oldest. First used by Lungren in 1880 in a woman with a narrow pelvis, this method, due to its lightness, speed and absence of significant trauma, attracted the attention of gynecologists and quickly found a wide range of applications. Soon, however, reports began to appear in the literature about the unreliability of this sterilization method (Fritsch, Arendt, Nrnberger, Pisemsky, etc.).

Construction of \xe0 la carte QconCAT protein standards for multiplexed quantification of user-specified target proteins

BackgroundQconCATs are quantitative concatamers for proteomic applications that yield stoichiometric quantities of sets of stable isotope-labelled internal standards. However, changing a QconCAT design, for example, to replace poorly performing peptide standards has been a protracted process.ResultsWe report a new approach to the assembly and construction of QconCATs, based on synthetic biology precepts of biobricks, making use of loop assembly to construct larger entities from individual biobricks. The basic building block (a Qbrick) is a segment of DNA that encodes two or more quantification peptides for a single protein, readily held in a repository as a library resource. These Qbricks are then assembled in a one tube ligation reaction that enforces the order of assembly, to yield short QconCATs that are useable for small quantification products. However, the DNA context of the short construct also allows a second cycle of loop assembly such that five different short QconCATs can be assembled into a longer QconCAT in a second, single tube ligation. From a library of Qbricks, a bespoke QconCAT can be assembled quickly and efficiently in a form suitable for expression and labelling in vivo or in vitro.ConclusionsWe refer to this approach as the ALACAT strategy as it permits à la carte design of quantification standards. ALACAT methodology is a major gain in flexibility of QconCAT implementation as it supports rapid editing and improvement of QconCATs and permits, for example, substitution of one peptide by another.

A simple clue to identify bleb function after tube ligation

A simple clue to identify bleb function after tube ligation

NSV OR TUBE LIGATION------ A BETTER APPROACH

This study was carried out at NSV cntre ,Lok Nayak Hospital, Delhi. It was a retrospective analytical study. 2766 patient were taken into this study and comparision were done with tube ligation. It is found that NSV is better approach for sterilization.

Comparative histological study of fallopian tube in pre and post-menopausal women in tertiary care center of Bihar: An observational and prospective study

Infertility an on-going reproductive problem and tubal pathologies are considered as leading causes. Ectopic pregnancy (tubal), salpingitis, genital tuberculosis are serious and very common fallopian tubal pathologies in women of reproductive age group which incidence have been increased in past few decades. Better understanding of fallopian tube anatomy, physiology, function and sperm epithelial interaction is a necessity and also nature of epidemiology and histological pattern is important. Observational and prospective study done on randomly selected 150 females either pre-menopause and post-menopause. Their fallopian tubes as specimen were collected with greatest care and precautions either from Obstetrics & Gynaecology or Pathology Department of IGIMS, Patna. Samples were processed in Histology section of the Department of Anatomy, IGIMS, Patna. The slides were studied under the compound microscope. Data collected from this study was presented in tabular form. Statistical analysis was done using Microsoft Excel Software. Patients were mostly reproductive age group, 26-30 years (26%) and 31-35 years (20.6%) and most of them had completed their family and desired to have contraception mostly tubal ligation. 40 years and above age group patients had menopause and were mostly complaint of dysfunctional uterine bleeding. Samples received by hysterectomy with B/L Salpingo-oophorectomy (43.3%), B/L tube ligation with caesarean section (43.3%), U/L Salpingo-oophorectomy (7.3%), B/L tube ligation (6%). In most of these cases the fallopian tubes were normal. In pre-menopausal patients most of the samples were obtained during pregnancy (63.02%) because caesarean section with or without tube ligation was very common. Followed to interval phase (21.70%) of menstrual cycle because it was the most preferred stage for any planned gynaecological surgery. 11 Premenopausal women while 6 post-menopausal women gave the history of I.U.C.D use during their reproductive years. Patients with past history of oral contraceptives and those with present history of its use in both young and old women.This study concluded that the histology of fallopian tube was normal and the results were consistent with previous similar studies. Histological examination of fallopian tube was normal despite of any past history of IUCD or OCP use or different phases or cyclical changes of menstrual cycle in pre-menopausal women.

The Effect of Tube Ligature on the Safety and Efficacy of Ahmed Glaucoma Valve Surgery.

In this matched case-control study, ligature of the Ahmed glaucoma valve (AGV) was associated with a reduction in the rate of postoperative complications without affecting the surgical success rate or the visual outcome following the procedure. The purpose of this study was to compare the safety and efficacy of AGV surgery with and without tube ligation. This was a retrospective, matched case-control study. A review was performed of patients who underwent AGV surgery with tube ligation between June 2015 and December 2017 (ligated AGV group). Cases were matched with controls who underwent AGV surgery without tube ligation (nonligated AGV group). Data were compared on postoperative intraocular pressure (IOP), the number of glaucoma medications, surgical success rates, complications, and vision. There were 49 eyes in the ligated AGV group, and 98 eyes in the nonligated AGV group. Baseline characteristics were similar between groups except for the number of glaucoma medications (3.72±0.55 in the ligated AGV group vs. 3.92±0.92 in the nonligated AGV group; P<0.01). At 18 months, IOP was 16.7±6.3 mm Hg in the ligated AGV group and 17.3±8.0 mm Hg in the nonligated AGV group (P=0.76). In addition, the mean number of glaucoma medications was 2.38±1.10 in the ligated AGV group and 1.68±1.51 in the nonligated AGV group (P=0.56). The overall success rate at 12 months was similar between groups (P=0.84). The overall rate of complications was statistically lower in the ligated AGV group (28.6%) compared with the nonligated AGV group (73.5%) (P<0.01). The mean change in logarithm of the minimum angle of resolution acuity was similar between groups (P=0.50). Tube ligation in AGV surgery may be an effective measure that reduces the rate of postoperative complications without affecting the success rate or visual outcomes of the surgery.

Imaging Evaluation of Fallopian Tubes and Related Disease: A Primer for Radiologists.

A wide range of benign and malignant processes can affect one or both fallopian tubes. Familiarity with and recognition of the characteristic imaging features of these diseases and conditions are imperative for accurate diagnosis and prompt patient management. Disorders including pelvic inflammatory disease (hydrosalpinx and pyosalpinx in particular), isolated tubal torsion and ovarian torsion with fallopian tube involvement, endometriosis manifesting as hematosalpinx and adhesions, ectopic pregnancy, and malignancies are the most important entities that radiologists should be familiar with when assessing the fallopian tubes. Some fallopian tube diseases are self-limiting, while others can result in infertility or even potentially life-threatening infection or bleeding if left untreated. Therefore, correct diagnosis is important for appropriate life-saving treatment and preserving fertility. Understanding the physiologic features of the fallopian tube and the role of this organ in the pathogenesis of pelvic neoplasms is equally important. Knowledge of what to expect in a patient who has undergone uterine and fallopian tube interventions, such as uterine ablation and fallopian tube ligation, and of the potential associated complications (eg, postablation sterilization syndrome) also is pertinent. The imaging modalities used for the evaluation of fallopian tube disease and patency range from commonly used examinations such as US, CT, and MRI to other modalities such as hysterosalpingography and hysterosonography performed by using US contrast material. The ability to differentiate fallopian tube conditions from other adnexal and pelvic pathologic entities by using a variety of imaging modalities allows the radiologist to make a timely diagnosis and ensure proper clinical management. Online supplemental material is available for this article. ©RSNA, 2020.

Face, Content, and Construct Validity of the Take-Home EoSim Augmented Reality Laparoscopy Simulator for Basic Laparoscopic Tasks.

Background: The eoSim® laparoscopic augmented reality (AR) simulator has instrument tracking capabilities that may be suitable for implementation in laparoscopic training. The objective is to assess face, content, and construct validity of this simulator for basic laparoscopic skills training. Methods: Participants were divided into three groups: novices (no training), intermediates (<50 laparoscopic procedures), and experts (>50 laparoscopic procedures). Three basic tasks were completed on the simulator: thread transfer (1), cyst dissection (2), and tube ligation (3). A questionnaire was completed on realism, didactic value, and usability of the simulator. Measured outcome parameters were as follows: time, distance, time off screen, average speed, acceleration, and smoothness. Results: Mean ± standard deviation scores on realism were positive (Task 1 or T1; 3.9 ± 0.7, P = .13, T2; 3.7 ± 0.7, P = .07, T3; 3.7 ± 0.07), as well as didactic value (T1; 3.9 ± 0.8, P = .71, T2; 3.9 ± 0.8, P = .31, T3; 4.0 ± 0.8, P = .40). Usability was valued the highest, with mean scores between 3.9 and 4.3 (T1; P = .71, T2; P = .80, T3; P = .85). Scores did not differ significantly between groups. Experts were significantly faster (Task 1; P < .001, Task 2; P = .042, Task 3: P < .001) with higher handling speed for tasks 2 and 3 (Task 1; P = .20, task 2; P = .034, task 3; P = .049). Results for other outcome parameters also indicated experts had better instrument control and efficiency than novices, although these differences did not reach statistical significance. Conclusions: The eoSim laparoscopic AR simulator is regarded as a realistic, accessible, and useful tool for the training of basic laparoscopic skills, with good face validity. Construct validity of the eoSim AR simulator was demonstrated on several core variables, but not all.

Outcomes of the Shunt Tube Exposure Prevention Study: A Randomized Clinical Trial

To compare the long-term safety and efficacy of amniotic membrane-umbilical cord (AM-UC) and pericardium patch grafts in reducing glaucoma shunt tube exposure. Multicenter, prospective, randomized clinical trial. Adults with uncontrolled glaucoma undergoing glaucoma drainage device (GDD) implantation. Patients were randomized to receive GDD with either AM-UC or pericardium patch grafts to cover GDD tubes. Patients were followed up clinically with anterior segment (AS) OCT to assess patch graft stability and host-tissue integration prospectively. Tube exposure, graft thinning, and graft-related complications. A total of 81 eyes of 81 patients (50 women, 31 men) with a mean age of 67±13 years underwent GGD implantation using Baerveldt (n= 72) or Ahmed valve (n= 9). Tubes were inserted in the anterior chamber (n= 71), sulcus (n= 6), or pars plana (n= 4). Tube ligation was performed with Baerveldt GDD along with fenestration (n= 51) or orphan trabeculectomy (n= 21). Tubes were covered with AM-UC (n= 41) or pericardium (n= 40). The mean follow-up time was 29±8 months (range, 13-40 months). Tube exposure occurred in 1 eye (2%) in the AM-UC group at 3 months and in 2 eyes (5%) in the pericardium group at 2 and 6 months (P= 0.54). Sequential AS OCT showed better host-tissue integration and significantly less graft thinning in the AM-UC group. Early graft thinning (≤3 months) occurred in 5 eyes (12%) in the AM-UC group and in 17 eyes (43%) in the pericardium group (P= 0.002). Late thinning occurred in 2 eyes (5%) and 11 eyes (28%) in the AM-UC and pericardium groups, respectively (P= 0.007). Graft translucency and cosmetic appearance of the AM-UC graft were superior to those of the pericardium graft. No evidence of graft rejection or infection was associated with the patch grafts in either group. Amniotic membrane-umbilical cord grafts are well tolerated and offer an alternative to pericardium for safe and stable tube shunt coverage. Its high-tensile strength, low immunogenicity, and excellent host-tissue integration significantly reduced graft thinning.

Ab interno tube ligation for refractory hypotony following non-valved glaucoma drainage device implantation

PurposeTo report the 2-year outcomes of a novel surgical technique allowing reduction of the intraluminal diameter of the tube without total tube occlusion in order to allow enough increase in outflow resistance to permit resolution of hypotony whilst also achieving adequate IOP control.MethodsThis was a single-surgeon retrospective case note review of all non-valved GDD cases over an 8-year period (2008–2015) that underwent ab interno ligation of the drainage tube in order to manage post-operative hypotony (Baerveldt or Molteno). Twelve eyes of 12 patients (4.4%) developing refractory hypotony that did not respond to multiple intracameral ophthalmic viscoelastic device (OVD) injections were included in this retrospective case series and were treated with our ab interno tube ligation technique. The post-ligation management algorithm consisted of re-instating topical anti-glaucoma agents, laser suture lysis (LSL), or further ab interno ligation.ResultsMean IOP increased from 2.8 mmHg at baseline to 7.8 mmHg, 7.1 mmHg, 9.0 mmHg, 13.6 mmHg, 10.9 mmHg, 13.9 mmHg and 13.6 mmHg at day 1, week 1, month 1, month 3, month 6, year 1 and year 2 respectively, with or without additional topical anti-glaucoma medications. Although hypotony resolution following our technique was achieved in all eyes at 2 years, 8.3% of cases required reinstatement of topical medications to maintain IOP control within the target range.ConclusionsWe propose ab interno partial tube tying as an effective surgical option to achieve an immediate, predictable and sustained IOP elevation either as a primary procedure or when traditional methods have failed to resolve hypotony in eyes with non-valved GDDs.

Biomechanical Analysis of Ligatures and Technique for Managing Drainage Tubes in Pediatric Glaucoma.

Absorbable ligatures are often used with glaucoma drainage tubes to avoid early postoperative hypotony. We sought to measure the force required to ligate a drainage tube, and develop a modified technique to promote earlier release in pediatric patients, where plate encapsulation occurs more quickly than adults. A precision digital force gauge was used to measure the tensile strength of several common ophthalmic sutures, and the necessary tensile force required to achieve tube ligation. A novel technique for tube ligation was devised to allow sutures as small as 10-0 to be effectively used. The mean tensile strengths of unknotted sutures varied from 55.50±8.50 g for 10-0 vicryl to 477±69 g for 6-0 chromic gut. The mean tensile force required to ligate a Baerveldt or Ahmed tube was 35.9±0.9 g. However, 9-0 or 10-0 vicryl could not be reliably used for ligation, because of breakage, unless a modified technique was used, wherein the tube was first stretched to reduce its thickness and diameter. Frictional forces inherent to knot tying make it unfeasible to reliably use 9-0 or 10-0 vicryl to ligate a drainage tube, despite the unknotted threads possessing apparently sufficient tensile strength. Our modified ligation technique overcomes this issue, allowing a wider range of suture choices, and the potential for achieving more rapid release in pediatric cases.

Construct validity of eoSim – a low-cost and portable laparoscopic simulator

Purpose: To examine the construct validity of the low-cost, portable laparoscopic simulator eoSim using motion analysis.Material and methods: Novice and experienced surgeons (≤ 100 and >100 laparoscopic procedures performed, respectively) completed four tasks on the eoSim using the SurgTrac software: intracorporeal suture and tie, tube ligation, peg capping and precision cutting. The following metrics were recorded: Time to complete task, distance traveled, handedness (left- versus right hand use), time off-screen, distance between instrument tips, speed, acceleration and motion smoothness.Results: Compared to novices (n = 22), experienced surgeons (n = 14) completed tasks in less time (p ≤ .025), except when performing peg capping (p = .052). On all tasks, they also scored lower on the distance metric (p ≤ .001). Differences in handedness (left hand compared between groups, right hand compared between groups) were found to be significant for three tasks (p ≤ .025). In general, the experienced group made greater use of their left hand than the novice group.Conclusion: The eoSim can differentiate between experienced and novice surgeons on the tasks intracorporeal suture and tie, tube ligation and precision cutting, thus providing a convenient method for surgical departments to implement testing of their surgeons’ basic laparoscopic skills.

Post-Operative Complications After Repair Of Incisional Hernia

AbstractBackground:-Incisional hernia is frequently met by the general surgeon, itis frequently complicated (3.8-11.5%)of patients after abdominal surgery. Repair oflarge incisional hernia is a difficult surgical problem with recurrence being a common. Numerous methods of repair have been described simple opposition in one layer orcomplex opposition and the use of prosthetic mesh. The aim of this study is to report our experience with the use of mesh repair and risk factors that influence post operative complications.Methods:-A prospective study done in Al-hussain teaching Hospital, Department of Surgery between January 2011 to December 2013.One hundred and ten patients with prosthetic repair of incisional hernia were included in this study. History was taken and thorough examination was done, all patients were asked for history of diabetes mellitus, obesity, corticosteroid use, their original operations,primary or recurrent hernia and examined for their body mass index, size and duration of the hernial defect were recorded. A proforma was completed for each patient, noting prophylactic antibiotics hadbeen given or not, type of the sac and whether opened or inverted, type and size of mesh had been used, intraoperative and postoperative complications and postoperativehospital stay. &#x0D; Results:-Of (110) patients, (62) were females, (48)were males,their median age was(45.5) years for women and (58) years for men,(31)patients(28.2%)weighted more than their ideal body weight and had body mass index equal or more than(30).Forty eight patients (43.6%) were diabetic and (24)patients(21.8%)were corticosteroid used. The original operations were bowel related and gynecological in the majority ofpatients. Previous incisions were long midline in(38) .Twenty patients had one past operation, (13)had two,(5) had three and one patient had four past repair, theremaining were new Incisional hernia patients. The main hernia size was (12.3) cm and (4.6) cm in vertical and horizontal direction respectively. Forty four patients had additional surgical procedures, consisted of Fallopian tube ligation in (12) ,division of small bowel adhesions in (8) ,suturing of small bowel perforation in (4) and abdominoplasty in (20) patients. In the majority of patients (78), standard polypropylene mesh had been used and vicryl-prolene (Vypro) mesh in the remaining (32) patients. The main postoperative complications were seroma formation (17.3%), wound haematoma (10%), wound infection (9.1%), chest infection (6.4%), one patientdeveloped intestinal fistula and mesh need to be removed. Five recurrent incisional hernias occurred. Most patients developed complications were obese, diabetic and corticosteroid used. No death in our series.Conclusion:-Tension free incisional hernia repair using prosthetic mesh is a safe and easy procedure with no major morbidity or recurrence. The patient-doctor should advise weight loss to help reduce risks of surgery and improve the surgical results. Control of diabetes, corticosteroid drug use and smoking cessation are recommended for better results. Rigid sterile condition, precise and meticulous technique with the use of closed suction drains is important.

Is tubal ligation effective on sexual dysfunction?

Objective: Commonly used methods for preventing pregnancy in Turkey are withdrawal (30%), intrauterine device (27.2%), tube ligation (16.7%), condom (15.2), injection (8.9%), and combined oral contraceptive (1.9%). Protection from pregnancy is one of the most important factors affecting women's health. One of the preferred methods to protect against pregnancy is the 16.7% choice of tube ligation. Tube ligation is used as a contraceptive method but this method has some undesirable consequences. Our aim in this study is to investigate whether tubal ligation has effect on sexually dysfunctional and it is related to the process. Material method: We included in our study 161 patients using tubal ligation and 77 non-prevention methods. We recorded the demographic characteristics of these patients. We applied the fsfi scale. This questionnaire is a scale of sexual function assessment consisting of 19 questions evaluating sexual functions. Result: We did not find any difference in the total fsfi (female sexual function index) score between the patients who underwent tubal ligation and those who did not. However, we found a significant decrease in sexual desire and satisfaction in the tubal ligation group. In the subgroup analyzes of the fsfi score, results indicate that the correlation bonds with the subgroups of the tubal ligation group was deteriorated. Conclusion: Tubal ligation is a preferred method for contraception target, and various studies related to the effects on health have been made. Also, this study determined that tubal ligation has no effect on total fsfi scores. However, subgroup work seemed to have an effect on demand and satisfaction. In addition all, the duration of tubal ligation didn’t have any effect on sexual function.