Vicryl Sutures Research Articles

V07-06 SINGLE-PORT ROBOTIC TRANSVESICAL SIMPLE PROSTATECTOMY STEP BY STEP

You have accessJournal of UrologyCME1 Apr 2023V07-06 SINGLE-PORT ROBOTIC TRANSVESICAL SIMPLE PROSTATECTOMY STEP BY STEP Joshua Jue, Alexa Meyer, and Lee Richstone Joshua JueJoshua Jue More articles by this author , Alexa MeyerAlexa Meyer More articles by this author , and Lee RichstoneLee Richstone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The single-port robotic transvesical simple prostatectomy was first described in 2020, but the operation has not been widely adopted. With promising early results, the single-port robotic transvesical simple prostatectomy is an alternative approach to this operation with distinct advantages. METHODS: We detail the instruments required for this procedure, as well as the surgical technique to perform a simple prostatectomy using the single-port robot. Intraoperative and robotic video demonstrates all aspects of the technique, and postoperative photos illustrate the healed wound. RESULTS: A 3 cm transverse incision is made 3 fingerbreadths above the pubic symphysis and a longitudinal cystotomy is made. The Roll Wound Retractor rolling ring is inserted into the bladder lumen, with the Access Port, SP Short Entry Guide and AirSeal trocar within it. The robot is then docked to the SP cannula, and the bladder is insufflated to 8 mmHg. A semilunar incision is made through the bladder mucosa using the monopolar scissors along the posterior aspect of the bladder neck or median lobe. The forceps can be used to retract the prostatic adenoma, while using the monopolar scissors to further bluntly dissect the adenoma from the capsule. The prostatic adenoma can be removed en bloc, but is usually removed en lobe. A vesicourethral mucosal advancement flap is performed with 3-0 V-lock suture from apex to base at 3 o-clock and 9 o-clock; a double-arm 3-0 v-clock suture is then used to approximate the bladder and urethral mucosa, by running from 6-o-clock to 12-o-clock. The cystotomy is closed in 2 layers with 3-0 vicryl suture. The patient is observed for 2 hours on continues bladder irrigation to determine ambulatory discharge eligibility. Follow up is in 3-7 days for trial of void. CONCLUSIONS: Single-port robotic transvesical simple prostatectomy is a safe and effective way to surgically remove benign glands larger than 80 cc. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e597 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Jue More articles by this author Alexa Meyer More articles by this author Lee Richstone More articles by this author Expand All Advertisement PDF downloadLoading ...

V09-07 HOW TO USE A MESH SLING SAFELY AFTER THE POST-VESICOVAGINAL FISTULA REPAIR REPAIR PATIENT WITH STRESS URINARY INCONTINENCE

You have accessJournal of UrologyCME1 Apr 2023V09-07 HOW TO USE A MESH SLING SAFELY AFTER THE POST-VESICOVAGINAL FISTULA REPAIR REPAIR PATIENT WITH STRESS URINARY INCONTINENCE Micheal Breen Tamatave, Madagascar, Ly Hoang Roberts, and Larry Sirls Micheal Breen Tamatave, MadagascarMicheal Breen Tamatave, Madagascar More articles by this author , Ly Hoang RobertsLy Hoang Roberts More articles by this author , and Larry SirlsLarry Sirls More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003317.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with complicated obstetric fistulas may have stress urinary incontinence (SUI) after vesicovaginal fistula repair (VVF), especially if the urethra in involved. Various techniques to treat post-VVF SUI have low success rates or is technically challenging due to thin and scarred peri-urethral tissue. We describe a technique to place a midurethral mesh sling outside of the pre-existing vaginal mucosa. METHODS: With the patient in dorsal lithotomy under spinal anesthesia, a foley catheter is placed into the bladder and the labial majora is retracted for adequate exposure. A rectangular area of the same size as the mesh sling (3x1cm) at the midurethra is marked. A number 15 scalpel is used to incise the vaginal mucosa at the marked lines, and Metzenbaum scissors are used to dissect and mobilize the edges. The dissection is then carried out laterally to be behind the inferior pubic bone. This is done on both sides. The island of vaginal mucosa is then superficially scored using low power bovie cauterization to allow for mesh adhesion and tissue ingrowth. The mesh is sutured to the island of skin using a 3-0 Chromic or vicryl suture at the mesh edges in 4 areas. 0- prolen sutures are then placed on each lateral edge of the mesh in a running stitch. The Metzenbaum scissors are then used to enter into the endopelvic fascia behind the pubic bone to develop the retropubic space. Next, a suprapubic incision is made 1cm cranial to the pubic bone down to the rectus fascia. The Stamey needle is passed in a top-down approach approximately 2cm from midline and end delivered into the vaginal incision. To check for bladder perforation, a metal catheter is placed into the bladder and swept laterally to evaluate for any metallic noise indicative of contact. The prolene suture is passed up to the suprapubic incision and the same is done contralaterally. Bladder is backfilled with sterile saline with methylene blue by gravity and foley removed. Sutures are tied together midline with the sling tension adjusted while patient performs a Valsalva. Suprapubic incision is then closed in multiple layers. The vaginal incision is closed with mobilization of the proximal vaginal mucosa and reapproximation to the distal edge. For larger incisions, a Singapore flap can be done for adequate coverage. RESULTS: Successful managment of SUI. CONCLUSIONS: For challenging cases of SUI after a post-VVF repair, this technique can be an option. Further investigation is needed for clinical outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e839 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Micheal Breen Tamatave, Madagascar More articles by this author Ly Hoang Roberts More articles by this author Larry Sirls More articles by this author Expand All Advertisement PDF downloadLoading ...

Use of monofilament sutures and triclosan coating to protect against surgical site infections in spinal surgery: a laboratory-based study

PurposeWe investigated bacterial propagation through multifilament, monofilament sutures and whether sutures coated with triclosan would exhibit a different phenomenon.MethodsOne centimetre (cm) wide trenches were cut in the middle of Columbia blood Agar plates. We tested a 6 cm length of two Triclosan-coated (PDS plus®, Vicryl plus®) and two uncoated (PDS ®, Vicryl ®) sutures. Each suture was inoculated with a bacterial suspension containing methicillin-sensitive Staphylococcus aureus (MSSA), Escherichia coli (E. coli), Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA) at one end of each suture. The plates were incubated at 36C for 48 h, followed by room temperature for a further 5 days. We established bacterial propagation by observing for any bacterial growth on the Agar on the opposite side of the trench.ResultsBacterial propagation was observed on the opposite side of the trench with both suture types, monofilament PDS and multifilament Vicryl, when tested with the motile bacterium (E. coli). Propagation was not observed on the other side of the trench with the monofilament PDS suture following incubation with MSSA and S. epidermidis, and in 66% of MRSA. With multifilament suture Vicryl, propagation was observed on the other side of the trench in 90% (MSSA), 80% (S. epidermidis), and 100% (MRSA) of plates tested. No bacterial propagation was observed in any of the triclosan-coated sutures (monofilament or multifilament).ConclusionsMonofilament sutures are associated in vitro with less bacterial propagation along their course when compared to multifilament sutures. Inhibition in both sutures can be further enhanced with a triclosan coating.

Comparison of Postoperative Healing Using Commercially Available Fibrin (Reliseal®) and Vicryl Suture Following Periodontal Flap Surgery: A Split-mouth Study

Comparison of Postoperative Healing Using Commercially Available Fibrin (Reliseal®) and Vicryl Suture Following Periodontal Flap Surgery: A Split-mouth Study

Closure of the appendix stump with two different suture materials in laparoscopic appendectomy in children

Purpose: To evaluate the outcomes of the closure of the appendix base using two different suture materials that we used in our clinic with those published in the literature.
 
 Materials and methods: The study retrospectively reviews 36 cases of children who underwent laparoscopic appendectomies. The patients were divided into two groups: the Vicryl suture group and the silk suture group. Laboratory results, diagnostic algorithms, surgical techniques, and complications were investigated.
 
 Results:
 Sixteen (44%) of the cases were male, and twenty (56%) were female. All patients' mean hospital admission time was 2.22±1.6 days (range: 1–7 days). The mean WBC and CRP levels were 14.67±5.8x109/L, 139.3±120 mg/L in the vicryl group and 15.36±6.4x109/L and 86±80 mg/L in the silk group. Small bowel obstruction was observed in nine patients in the vicryl group and six patients in the silk group. Ultrasonography was performed in 31 of the cases, the appendix was visualized in 21 cases (67%).Intravenous contrast-enhanced CT imaging was applied in 25 cases. At laparoscopic exploration, 20 cases were classified as complicated—17 due to perforation, and 3 due to gangrene. All cases were treated with broad-spectrum antibiotics. The mean follow-up period was 43 months (range: 10-117 months); none of the patients experienced intraoperative complications, and only two patients had minor complications in the postoperative period. 
 
 Conclusion: In all circumstances and regardless of the appendix's diameter, the appendix stump can be securely closed with both silk and vicryl suture material.

Comparison of Postoperative Chronic Groin Pain After Repair of Inguinal Hernia Using Nonabsorbable Versus Absorbable Sutures for Mesh Fixation.

Inguinal hernia repair is one of the most common operations performed in general surgery. Lichtenstein mesh hernioplasty is a commonly practiced technique for open inguinal hernia repair. Out of many other complications postoperatively, chronic groin pain is one of the patients' most common postoperative complaints. There is no direct evidence to explain the cause of post-mesh hernioplasty pain. Only a few studies have been done to judge the effect of suture material used for mesh fixation on chronic groin pain. To compare the postoperative groin pain level in mesh hernioplasty using nonabsorbable versus absorbable sutures for mesh fixation at predetermined intervals using a visual analog scale (VAS) score. A prospective, single-center, non-randomized, observational study was conducted. All patients per inclusion and exclusion criteria of inguinal hernia planned for surgery were admitted electively on the day of surgery and were operated on in minor OT under local anesthesia for open mesh hernioplasty. The VASscore assessed the postoperative pain level. This observational study was done to look for any difference in postoperative chronic groin pain after mesh fixation with either nonabsorbable, prolene sutures (PS) or absorbable vicryl sutures (VS). One hundred and ten patients fulfilling the department of general surgery inclusion criteria were admitted to the study. In our study, postoperatively, the incidence of chronic groin pain was assessed and followed up to six months. After six months,25%of patients had pain.Of this 25%, the majority (70%) of patients had mild pain, 15% had moderate pain, and 15% had severe pain. There was no statistically significant difference between the two groups of mesh fixation by nonabsorbable versus absorbable sutures. Inguinal hernia is one of the most typical conditions seen in general surgery clinics with male predominance. Definitive management of inguinal hernia is surgery. There is no difference in postoperative chronic groin pain with either type of suture material i.e., nonabsorbable or absorbable (prolene vs vicryl) sutures. To conclude,fixation material for mesh does not influence chronic inguinodynia. However, further studies are required for the same.

Modification of the properties of a suture thread with a tough gel coating: Abaseline ex-vivo study.

The mechanical properties of sutures are important for wound closure and meniscus repair. A tough gel coating technology has been developed to modify and functionalize sutures, but its effects on suture degradation remain unexplored. Our aim is to investigate how a tough gel coating mediates the properties of the suture. The Polyglactin910 (Vicryl) suture was chosen because it is widely used, strong, easy to handle, and degradable. This study compared six pristine Vicryl sutures and six coated Vicryl sutures at 0, 2, 4, and 6 weeks. All the sutures were soaked in phosphate-buffered saline (PBS), to mimic degradation in physiological conditions, and tensile strength was tested at each time point. The pH of the soaking mediums was measured weekly and compared at 4, 5, and 6 weeks. No significant difference (p = 0.059 and p = 0.576) was found between the absolute and normalized breaking force of coated and pristine Vicryl sutures at 0, 2, 4, and 6 weeks. After 4 weeks of immersion, the soaking medium became more acidic for both suture types. The decrease in pH was less significant for coated Vicryl sutures than for pristine ones (p < 0.001) at 4, 5, and 6 weeks of immersion. Although coating does not affect the strength of Vicryl sutures soaked in PBS, it can effectively act as a buffer to the acidic environment caused by suture degradation, which could help reduce inflammation. Hydrogel coating is a promising technology to modify suture characteristics.

Prognostic model on niche development after a first caesarean section: development and internal validation

ObjectiveTo develop and internally validate a prognostic prediction model for development of a niche in the uterine scar after a first caesarean section (CS). Study designSecondary analyses on data of a randomized controlled trial, performed in 32 hospitals in the Netherlands among women undergoing a first caesarean section. We used multivariable backward logistic regression. Missing data were handled using multiple imputation. Model performance was assessed by calibration and discrimination. Internal validation using bootstrapping techniques took place. The outcome was ‘development of a niche in the uterus’, defined as an indentation of ≥ 2 mm in the myometrium. ResultsWe developed two models to predict niche development: in the total population and after elective CS. Patient related risk factors were: gestational age, twin pregnancy and smoking, and surgery related risk factors were double-layer closure and less surgical experience. Multiparity and Vicryl suture material were protective factors. The prediction model in women undergoing elective CS revealed similar results. After internal validation, Nagelkerke R2 ranged from 0.01 to 0.05 and was considered low; median area under the curve (AUC) ranged from 0.56 to 0.62, indicating failed to poor discriminative ability. ConclusionsThe model cannot be used to accurately predict the development of a niche after a first CS. However, several factors seem to influence scar healing which indicates possibilities for future prevention such as surgical experience and suture material. The search for additional risk factors that play a role in development of a niche should be continued to improve the discriminative ability.

Open Achilles Tendon Repair.

An open Achilles tendon repair is performed in patients who have suffered an acute rupture. All patients with this injury should be counseled on their treatment options, which include open operative repair and functional rehabilitation. We prefer the use of an open repair in high-level athletes and those who have delayed presentation. Typically, this injury-and the resulting open repair-are seen in young or middle-aged patients as well as athletes. Operative repair of a ruptured Achilles tendon is associated with a much faster return to activity/sport when compared with nonoperative alternatives. This surgical procedure is especially useful in allowing this patient population to return to their previous activity level and functional capacity as quickly as possible. Open repair of a ruptured Achilles tendon begins with a 6 to 8-cm incision over the posteromedial aspect of the lower leg. Superficial and deep dissections are performed until the 2 ends of the ruptured tendon are identified. Adhesions are debrided to adequately mobilize and define the proximal and distal segments of the tendon. With use of a fiber tape suture, a modified locking Bunnell stitch is utilized to secure both ends. The fiber tape is tied securely, and the repair is reinforced with Vicryl suture (Ethicon). Once the tendon is repaired, the paratenon layer is identified and repaired with a running 0 or 2-0 Vicryl suture. This is an important step to minimize postoperative wound complications. The wound is then closed, and the extremity is splinted in maximum plantar flexion. Alternative treatments include minimally invasive surgical techniques such as percutaneous Achilles tendon repair and nonoperative treatment with functional rehabilitation, which can provide excellent outcomes but can also lead to a slight decrease in explosiveness as the patient returns to sport1,2. Nonoperative and operative treatment of Achilles tendon rupture can both result in excellent patient outcomes. Appropriate patient selection is critical. Younger patients hoping to return to more highly competitive athletics should consider operative repair3. Possible differences have been identified in peak torque when comparing operative versus nonoperative treatment, with patients who had undergone operative repair having greater peak torque (i.e., explosiveness)2. Otherwise, findings are similar between treatment options as long as the patients meet the criteria for nonoperative treatment. Overall, the scientific literature demonstrates that the functional outcomes following operative repair are good to excellent. In a study by Hsu et al.4, 88% of patients were able to return to their baseline level of activity by 5 months postoperatively, with a complication rate of 10.6% and no reruptures. In a recent meta-analysis by Meulenkamp et al.5, the authors found that operative repair of Achilles tendon rupture was associated with a reduced risk of rerupture compared with primary immobilization (i.e., conventional cast immobilization with delayed weight-bearing for at least 6 weeks only). However, open surgical repair, minimally invasive repair, and functional rehabilitation all had similar risk of rerupture5. In a review by Ochen et al.6 that analyzed 29 studies with a total of 15,862 patients, operative repair was associated with a significantly lower risk of rerupture compared with nonoperative treatment (2.3% versus 3.9%, respectively). However, operative treatment was also associated with a significantly higher complication rate compared with nonoperative treatment (4.9% versus 1.6%, respectively)6. Finally, in a meta-analysis by Soroceanu et al.7, the authors found that if early range-of-motion protocols and functional rehabilitation were utilized, operative and nonoperative treatment resulted in similar outcomes and equivalent rates of rerupture. To prevent rerupture of an Achilles tendon, remind patients to engage in adequate stretching and warming prior to physical activity.Palpate and locate the tendon defect prior to making the first incision.Immobilize the ankle joint in a splint for 2 weeks postoperatively in maximum plantar flexion.Pitfalls include:○ Poor suture management leading to tangling in the repair.○ Undertensioning or overtensioning of the repair, which can be avoided by sterilely draping out both legs and checking resting tension intraoperatively.○ Failure to close the paratenon, causing scarring of the skin or surrounding tissues, which can be avoided by making a relieving incision on the deep surface of the paratenon.○ Leaving suture knots on the dorsal side of the repair that may aggravate the skin. MRI = magnetic resonance imagingESU = electrosurgical unit.

The Wholesome Foods Approach to Trabeculectomy Wet Lab Training.

Purpose In an era when trabeculectomy surgeries in the United States are on the decline, ophthalmology residents may have limited opportunities to practice surgical techniques critical to success. However, key steps of trabeculectomy surgery can be introduced in a wet laboratory using a simple surgical model based on food items. Methods A fresh lime and chicken parts with skin, purchased from a grocery store, were utilized to practice trabeculectomy surgery. The white rind of a lime was used as a surrogate for human sclera and was incised to create a trabeculectomy flap. The flap was then successfully sewn down with 10-0 nylon suture using an operating microscope. The skin of the chicken part was used to re-create a fornix-based and limbus-based conjunctival incision, which was then sutured closed using 6-0 Vicryl suture. A survey of wet laboratory participants was conducted to assess the feasibility and efficacy of this technique. Results Survey respondents were divided into two groups, those who had performed ≥40 incisional glaucoma surgeries and those who had performed <40. Both groups rated the simulation a 4 (mode) out of 5 in terms of how well it prepared them for glaucoma surgery on a human eye and how well the materials replicated human tissue, with 1 being not at all and 5 being very well. Similarly, both groups rated ease of setup and material acquisition a 1 out of 5, 1 being not difficult at all and 5 being extremely difficult. Also, 93.5% of the survey respondents recommended implementing this training model at other teaching hospitals, and none of the respondents recommended against it. Conclusion This trabeculectomy teaching model is inexpensive, clean, and safe, and it provides a reasonably realistic substrate for surgical practice. It does not require cadaver or animal eyes, and no fixatives are needed, thus minimizing the risk of contact with biohazardous materials. Wet laboratory materials are easy to obtain, making this a practical model for practicing glaucoma surgery in both westernized and developing countries.

Laparoscopic Inguinal Hernia Repair in a Young Female with Associated Multiple Congenital Defects: A Rare Case

Groin hernias are most common among patients presenting with hernia. Males have more predisposition mainly due to anatomy. However, females with groin hernia present with varied abdominal contents including ovaries and fallopian tubes. The worrisome feature of inguinal hernia with ovaries/fallopian tubes as content is torsion. Uncomplicated groin hernia with ovaries as content is managed with conventional laparoscopic or open hernia repair. Young females with groin hernias need to be evaluated thoroughly for features of androgen insensitivity syndrome or any underlying genetic disorder. A 12 years young female presented to our OPD with chief complaints of swelling in the right inguinal region for 6 months. Patient had not achieved menarche yet, however development milestones were found to be normal. On general physical examinations, deformities were noted in the right ear and left upper limb. On local examination, swelling of approximately 3x3 cm was noted in the right inguinal region. An ultrasonography scan of whole abdomen and pelvis which was suggestive of right inguinal hernia containing right ovary with malposition of the right kidney in the pelvis. Consequently, MRI whole abdomen with pelvis confirmed the findings of USG. Patient was taken for laparoscopic inguinal hernia repair. There was right sided indirect inguinal hernia with right ovary as content and a solid mass was also noted in the right pelvic region suggestive of right pelvic kidney. Right ovary was reduced back to the abdomen with transection of the right round ligament and the defect was closed back with interrupted 3’0 Vicryl sutures. Postoperative course was uneventful. Patient was counselled for genetic analysis to rule out any syndrome association. Uncomplicated groin hernia in young females and paediatric age groups with ovarian content can be easily managed with laparoscopic repair. Early intervention should be advised to prevent ovarian torsion and hence long term morbidity.

Achilles Tendon Rupture Repair Using the Mini-Open Approach in a Supine Position.

Achilles Tendon Rupture Repair Using the Mini-Open Approach in a Supine Position.

The comparison of the suture materials on intestinal anastomotic healing: an experimental study.

This experimental comparative study was to evaluate the local effects of three different suture materials on in-testinal anastomosis healing. Ethical approval was obtained from the University of Ethical Committee (E-60758568-020-176720). A prospective, experimental comparative analysis was conducted on 24 rats. They were divided into three equal groups; Group 1 underwent colonic anastomosis with Vicryl suture material, Group 2 underwent colonic anastomosis with polypropylene suture; and Group 3 underwent colonic anastomosis with polydioxanone (PDS) suture. The second operation underwent the 7th post-operative day. Adhesion score, anastomotic leakage, anastomotic bursting pressure, hydroxyproline levels, and histopathologic examination were evaluated. All animals survived, and no leakage, intestinal obstruction, or wound infection was observed during the experiment. The adhesion score was evaluated according to the Diamond classification and same in all groups. Median anastomotic bursting pressure was 125.75 mmHg (10-241) in the Vicryl group, 159.25 mmHg (113-190) in the polypropylene group, and 154.50 mmHg (20-212) in the PDS group. Hydroxyproline tissue concentrations were in the Vicryl group 1699.92±220.8 ng/mg (range: 1509.81-2186.47), in the polypropylene group 1126.24±607.12 ng/mg (range: 53.22-1815.63), and 1547.86±335.2 ng/mg (range: 973.66-1973.2) in PDS group. There was no difference among groups regarding the inflammatory response evaluated by histopathology. There was no statistical significance in all variables evaluated. This experimental study demonstrates that suture materials did not worsen tissue healing during intestinal anastomosis. Absorbable, slowly-absorbable, and non-absorbable suture materials could be used safely in every situation.

The Importance of Early Intervention for Penile Fracture in Forced Flexion - Report of Two Cases at Madinat Zayed Hospital

Background: A penile fracture is a urological emergency that happens when an erect penis sustains a violent trauma, resulting in a tear in the tunica albuginea of one or both corpora cavernosa.&#x0D; Case report: Case 1: A 33-year-old male patient who experienced pain, swelling, and forceful flexion of the penis. The patient reported hearing a cracking sound during masturbation. This case was identified on the basis of clinical presentation and the findings of a physical examination. The emergency surgical repair was performed with an evacuation of the hematoma.&#x0D; Case 2: A 32-year-old male patient who presented to the emergency department 20 hours after the injury with associated complaints of pain and swelling in the penis and scrotum This case was identified on the basis of clinical presentation and the findings of a physical examination. The emergency surgical repair was performed with an evacuation of the hematoma. Tunical defect closure was performed with an interrupted 3.0 vicryl suture. Additionally, the patient developed phimosis and a circumcision was performed to remove the tight fibrotic segment of the foreskin hemostasis and closed by 3.0 rapid sutures.&#x0D; Conclusion: A pre-operative urethrography or flexible cystoscopy should be considered when urethral injury is suspected. Prompt surgical intervention usually leads to satisfactory cosmetic and functional results. Early-stage intervention is required to retain penile function.

Femoral Hernia in Children as a Rare Pathology: A Retrospective Case Series

Abstract Background: Femoral hernias are uncommon groin pathology among children. The rarity of the pathology results in increased complications, delayed diagnosis and inappropriate inguinal exploration. In this study, we review our experience with this surgical entity over a 10-year period. Materials and Methods: The medical records of seven children who underwent femoral hernia repair between January 2010 and January 2021 at a single tertiary centre were retrospectively analysed. Reviewed data included demographics, pre-operative diagnosis, operative technique, complications and follow-up. Results: Seven children (5 females [71%] and 2 males [29%]) were operated due to femoral hernia. Median age was 8 years (range: 3–16 years). Four (57%) patients had right-sided femoral hernia and three (43%) were on the left side. The correct pre-operative diagnosis was obtained in three (42%) cases. The remaining four misdiagnosed cases were diagnosed as femoral hernia at the surgery. In all cases, the initial presentation was swelling; two (28%) had inguinal pain and three patients (42%) required emergency inguinal exploration due to suspected incarceration. All patients had repair of their hernia by open technique; the femoral canal was closed by mesh plug or Vicryl sutures. All patients were discharged without complications. No recurrence was detected and the median post-operative follow-up period was 24 months (range: 8–48 months). Conclusion: Femoral hernia is a challenging pathology and correct diagnosis requires a high index of clinical suspicion. In equivocal cases, ultrasonography and laparoscopy may be useful. Appropriate pre-operative diagnosis evades complications and delays in treatment. Regardless of the surgical approach recurrences and complications are very rare in children.

Absorbable suture for band tightening of scleral buckling in pseudophakic rhegmatogenous retinal detachment: a modified surgical technique and a 6-month follow-up.

Rhegmatogenous retinal detachment (RRD) is a separation of the neurosensory retina from the retinal pigment epithelium as a result of liquid vitreous passing through a retinal break. Scleral buckling surgery (SB) is a conventional treatment for RRD. In SB, a silicon explant is used to indent the sclera, reduce vitreous traction, and close the retinal break, and an encircling band is used circumferentially, leading to myopia. This study aimed to evaluate the functional and biometric outcomes after SB with absorbable band-tightening sutures in patients with pseudophakic RRD. In this prospective interventional study, we included pseudophakic eyes with RRD treated surgically with SB and a temporary encircling band using a 6-0 absorbable Vicryl suture to tighten the band, instead of conventional permanent suture tightening. Anterior chamber depth (ACD), axial length (AL), intraocular pressure (IOP), spherical equivalent refractive error (SER), and best-corrected distance visual acuity (BCDVA) were measured preoperatively and at 1 day, 2 weeks, 3 months, and 6 months postoperatively. We included 30 eyes of 30 patients with a mean (standard deviation [SD]) age of 66.1 (10.5) years who underwent SB with an absorbable band-tightening suture for pseudophakic RRD. Significant increases in AL and ACD were observed at 2 weeks after surgery, with a significant decline in values thereafter; however, at the 6-month follow-up, the values were significantly higher than those at baseline (all P < 0.05). Based on the Vicryl tension and its hydrolysis, mean (SD) SER at 2 weeks postoperatively was significantly more myopic than at baseline (-5.8 [1.6] D versus +1.3 [1.8] D). However, the mean (SD) SER decreased significantly throughout the 6-month follow-up (all P < 0.05), and it reached -1.8 (0.9) D, which was comparable with the mean baseline SER (P = 0.140). The participants experienced significant improvement in BCDVA throughout the follow-up period (all P < 0.05). Using an absorbable suture to tighten the encircling band in patients with pseudophakic RRD can reduce postoperative myopia without adversely affecting the anatomical or functional outcomes. Future comparative studies with larger sample sizes and longer postoperative follow-up are needed to verify these findings.

Awareness of usage of Vicryl suture material in oral surgical procedures.

Oral surgical procedures constitute a very important part in the broad scope of general dentistry. This necessitates a significant need for dental students to know about the suture materials. This study aims to assess the awareness of Vicryl suture material in dental surgical procedures. The descriptive survey was attended among 237 dental students. Results were analyzed using Microsoft Excel and using SPSS software version 23.0. The majority (96%) of the dental students were aware of Vicryl suture material. Approximately 75% and 66% knew that Vicryl suture was absorbable and braided, respectively. However, only 33% knew that Vicryl suture would get fall off in 2 weeks. According to the statistics, there is no significant difference between gender and awareness of Vicryl suture material (Chi-square; P = 0.14, not significant). Dental students have adequate knowledge about Vicryl suture material.

Fascia Repair with Vicryl Suture in Urologic Surgeries

Background: Closing the fascia after surgery should be quick, easy, and strong but comfortable for the patient. Polydioxanone thread is not available in Iran. Thus, we used Vicryl sutures for almost all patients. Methods: This study was conducted at Imam Reza and Imam Khomeini Medical Centers in Ardabil from January 2018 to January 2020. The fascia was continuously sutured with size 0 or 1 of Vicryl in a double layer for all patients in the Urology Department. Results: Here, 642 patients were evaluated in two years. The fascia suturing was at the site of the inguinal, midline Gibson, and flank areas. The data showed that incisional hernia and infection were more prevalent in obese and diabetic patients. We had no incisional complications in radical cystectomy or even kidney transplantation, which are complicated and time-consuming surgeries. Overall, the surgical site complication rate (including incisional hernia and surgical site infection) was 0.9%, which could be negligible. Conclusions: The fascia repair could be treated with Vicryl suture in a continuous form in all urologic surgeries, with a very low rate of wound infection and hernia at the operation site, sinus formation, and long-term surgical site discomfort. However, we suggest more research to confirm the Vicryl suture safety in urologic fascia repairs.

Variability in wound closure technique in midline posterior lumbar fusion surgery. International survey and standardized closure technique proposal.

Surgical wound complications represent an important risk factor, particularly in multilevel lumbar fusions. However, the literature regarding optimal wound closure techniques for these procedures is limited. We performed an online survey of 61 spinal surgeons from 11 countries, involving 25 different hospitals. The study included 26 neurosurgeons, 21 orthopedists, and 14 residents (Neurosurgery - 6 and orthopedics 8). The survey contained 17 questions on demographic information, closure techniques, and the use of drainage in posterior lumbar fusion surgery. We then developed a "consensus technique." The proposed standardized closure techniques included: (1) using subfascial gravity drainage (i.e., without suction) with drain removal for <50 ml/day or a maximum duration of 48 h, (2) paraspinal muscle, fascia, and supraspinous ligament closure using interrupted-X stitches 0 or 1 Vicryl or other longer-lasting resorbable suture (i.e., polydioxanone suture), (3) closure of subcutaneous tissue with interrupted inverted Vicryl 2-0 sutures in two planes for subcutaneous tissue greater >25 mm in depth, and (4) skin closure with simple interrupted nylon 3-0 sutures. There is great variability between closure techniques utilized for multilevel posterior lumbar fusion surgery. Here, we have described various standardized/evidence-based proven techniques for the closure of these wounds.

8445 Surgical Management of Urethral Prolapse: A Case Report

<h3>Study Objective</h3> To describe a case of acute urethral prolapse presenting with refractory pain and urinary retention, and to demonstrate surgical management, delineating key surgical steps using a surgical video. <h3>Design</h3> Case report demonstrated in a narrated surgical video <h3>Setting</h3> Patient presented to an academic hospital emergency department and required emergent surgical management in the operating room. In the operating room, patient is positioned in dorsal lithotomy with LoneStar retractor in place. <h3>Patients or Participants</h3> This surgical video describes a case report of a 45-year-old perimenopausal female who presented with acute onset refractory pain and urinary retention, as well as inability to tolerate catheterization, secondary to acute urethral prolapse with thrombosis and necrosis. <h3>Interventions</h3> After appropriate patient positioning, healthy urothelium was identified with cystourethroscopy above the prolapsed tissue. Next, normal appearing urothelium was tagged proximal to the prolapse at 3 o'clock, 6 o'clock and 9 o'clock using interrupted 4-0 Vicryl sutures so that this healthy tissue would not retract once the prolapse was excised. The base of the prolapsed portion of the urethral was injected with 1% lidocaine with epinephrine. The prolapsed portion was excised with Bovie electrocautery in quadrants around the urethra. A 16 French transurethral Foley catheter was placed, and the balloon inflated. Normal healthy appearing urothelium was re-approximated to the external urethral meatus epithelium using interrupted 4-0 Vicryl sutures with repair of one quadrant at a time. This was performed over the Foley catheter to ensure patency and prevent stricture. <h3>Measurements and Main Results</h3> The patient presented in this surgical video had immediate and complete resolution of symptoms. <h3>Conclusion</h3> Urethral prolapse rarely requires surgical intervention; however, when surgical treatment of urethral prolapse is necessary, it can be effective with appropriate surgical technique.