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At least 1,351 records · Page 75Linked to original sources
PubMed2003

Incisional hernias. I. Related risk factors.

Incisional hernias represent one of the most frequent complications of abdominal surgery. The incidence is probably underestimated. The pathogenesis is complex and not fully understood, implying patient-related factors (i.e., collagen biochemistry, obesity, age) as well as technical factors, including, among others, wound infection, suture material, and types of incisions and closures. In this paper, the first of two, the authors review the literature emphasizing the current knowledge concerning the pathogenesis of incisional hernias. The second article is focused on the treatment.

Digestive System Surgical Procedures↗
PubMedDate not supplied

Complicated infective endocarditis: surgical treatment.

The destructive intracardiac complications of infective endocarditis present a continuing problem even though the mortality from the disease is decreasing. Osler in 1885 correctly described it as a malignant process. Tissue necrosis secondary to infection can cause destruction of valve leaflets and abscess formation in the valve annulus; the process may extend into adjacent parts of the heart and may even perforate into the pericardial cavity. For surgery to succeed it is necessary to excise all necrotic tissue, to replace the valve, and repair annular or other defects and suture the prosthesis to healthy tissue. The technical considerations in achieving a successful surgical result are illustrated and discussed in relation to a patient suffering from severe aortic valve regurgitation and a ventricular septal defect due to active infective endocarditis.

Aortic Valve↗
PubMed1977

[Technical failures in small bowel surgery (author's transl)].

A certain amount of relaparotomies after small bowel surgery is caused by technical failures, such as the technique of suturing the anastomosis and the kind of re-establishing the continuity of the bowel. An end-to-end-anastomosis with sufficient vascularisation at the cut ends, tension free, and without an overdone inversion will guarantee a more successful suturing of the bowel than a side-to-side-anastomosis. At first the whole small bowel should be explored to recognize multiple lesions. Postoperative malabsorption due to the exclusion of more less extended segments of the bowel--by bypass anastomoses or construction of blind loops--can be repaired successfully by corrective laparotomies. Special problems in operative tactics and technique of Crohn's disease are discussed.

Blind Loop Syndrome↗
PubMedDate not supplied

[Evaluation of the results of neurorrhaphy using microsurgical and ordinary technics (experimental study)].

For comparative assessment of an ordinary epineural suture and neurorrhaphy with the use of neurosurgical techniques operations were conducted on rabbits with a subsequent histological examination. It was established that the granulation tissue containing fine collagen fibers formed more rapidly when microsurgical techniques were used than in the controls. Besides, the rate of growth of the nerve elements in the region of the anastomosis was higher and by the end of the study the newly formed myelin axons acquired a clear linear direction.

Animals↗
PubMedDate not supplied

Arthroscopic repair and augmentation of the anterior cruciate ligament in cadaver knees.

An experimental method for arthroscopic repair and augmentation of the anterior cruciate ligament (ACL) was designed by experiments on fresh cadaver specimens. The procedure was performed arthroscopically. No arthrotomy or patellar dislocation was necessary. Established principles of ACL surgery were strictly applied, e.g., placement of holes; internal splinting; preservation of blood supply; utilization of ACL remnants at the tibial attachment. As much of the normal anatomy of the knee as possible was preserved, and some of the undesirable features of major knee surgery were avoided. With further research and development of materials (e.g., an implantable hook and either freeze-dried fascia or biodegradable suture for the internal splint), the described technical ideas have potential application as an effective arthroscopic procedure for the treatment of ACL deficiency.

Arthroscopy↗
PubMed1997

[Prolapse surgery through the vagina with the help of Endo Stitch. Technical note and preliminary study].

OBJECTIVE: Vaginal cure of genitourinary prolapses is a reliable technique. We propose a technical simplification: the use of the laparoscopic suturing instrument Endo Stitch. Bladder neck suspension can be performed in this way without supra-pubic incision. Sacrospinous suspension is sometimes difficult with a risk of sciatic nerve, pudendal artery or rectum trauma. This is also performed more easily using Endo Stitch. SUBJECTS AND METHODS: Twenty patients with genitourinary prolapse were treated by one surgeon using the Endo Stitch. The patients were followed for 6 to 18 months. RESULTS: No per- or postoperative complications attributable to the use of Endo Stitch were encountered. With two recurrent genital prolapses and one persistent urinary stress incontinence, anatomic and functional results seem to be similar to reference series, but must be confirmed with more follow-up.

Adult↗
PubMed2000

Arthroscopic meniscal repair with use of the outside-in technique.

The outside-in technique of arthroscopic repair is effective for repair of most meniscal tears. The overall indications for the use of this technique are similar to those for the commonly used inside-out technique. The outside-in technique is especially useful for suturing the anterior horn of the meniscus as well as for suturing meniscal replacement devices such as a collagen meniscal implant or a meniscal allograft. Other specific advantages of this technique include the ability to predictably avoid neurovascular injury without the need for a large posterior incision. A particular disadvantage is the difficulty of achieving perpendicular orientation of sutures when a tear is adjacent to the site of attachment of the posterior horn. Use of the inside-out technique or an all-inside implant is suggested for these tears. The use of this suturing technique is facilitated by attention to several technical points. The knee should be maintained in flexion for repair of tears of the lateral meniscus (to avoid injury to the peroneal nerve) and in nearly full extension for repair of the posterior aspect of the medial meniscus (to avoid injury to the saphenous nerve and its branches). Care must be taken to avoid tying the sutures around a branch of the saphenous nerve during repair of the medial meniscus. The sutures should be retrieved through a cannula in the anterior portal to avoid the entrapment of the sutures in soft tissue. A probe can be used to prevent displacement of the inner fragment of a bucket handle tear when the needles are placed across the tear, as the entering needles may push the torn fragment into the knee. A vertical suture orientation is preferred in order to evenly co-apt the meniscus to the capsule. If knot-end sutures (so-called Mulberry knots) are used, 2 sutures can be vertically stacked, with 1 on each surface of the meniscus. If a mattress suture is used, a vertical orientation is easily achieved with the outside-in technique. Use of an exogenous fibrin clot is suggested for isolated tears. The clot can be secured to the site of repair by a suture that has been placed through a spinal needle with the outside-in method. Delayed weightbearing should be considered as postoperative management for patients who have had repair of a tear with a radial component or repair of a complex tear in which a fibrin clot was used. Previous studies have demonstrated that the location of the tear and the condition of the anterior cruciate ligament are important factors in determining the success of meniscal repair. The overall results with use of the outside-in technique are comparable with those reported with use of the inside-out method. Patients with concomitant tears of the medial meniscus and the anterior cruciate ligament should have combined meniscal repair and reconstruction of the anterior cruciate ligament. As healing was demonstrated in 8 of 13 patients with an unrepaired tear of the anterior cruciate ligament, consideration should still be given to meniscal repair in patients who refuse reconstruction of the anterior cruciate ligament. In this setting, it may be advisable to use multiple permanent sutures, and the patient must be counseled regarding the higher rate of failure with this approach. Repairs of the lateral meniscus have a higher rate of success, and repair of the lateral meniscus should be considered even in the presence of injury of the anterior cruciate ligament.

Anterior Cruciate Ligament↗
PubMed2003

Novel technique of Vest suture vesicourethral anastomosis in morbidly obese patient undergoing radical retropubic prostatectomy.

PURPOSE: The urethrovesical anastomosis can be a technically challenging procedure in the morbidly obese patient. We successfully overcame this challenge using a Vest suture technique. MATERIALS AND METHODS: After the completion of radical prostatectomy a Stamey needle is passed through the perineum under bimanual control. Vest sutures are placed and tied with a Foley catheter in place. RESULTS: This technique was used in a morbidly obese patient. Postoperatively continence was excellent. CONCLUSIONS: In the morbidly obese patient this novel technique of Vest suture placement should be considered to facilitate urethrovesical anastomosis after the completion of radical prostatectomy.

Anastomosis, Surgical↗
PubMed1996

Prospective study of hand-sutured anastomosis after colorectal resection.

A total of 370 patients underwent colorectal resection: 320 had a primary single-layer seromucosal anastomosis without a protective colostomy, 22 had Hartmann's procedure and 28 abdominoperineal resection. There were 260 elective procedures and 110 patients had peritonitis and/or bowel obstruction at the time of surgery. Overall the mortality rate was 2.7 per cent, the morbidity rate was 18.3 per cent and clinical anastomotic leak rate 3.4 per cent. After elective operation, the leak rate for intraperitoneal anastomosis was 0.6 per cent and for low extraperitoneal anastomosis 7 per cent. The mortality rate was 1.2 per cent and morbidity rate 11.9 per cent. Patients with peritonitis had a significant increase in morbidity rate (46 per cent) in comparison with those having elective surgery (chi 2 = 31.5, 1 d.f., P < 0.0001). Patients who had bowel obstruction and no bowel preparation had a significantly higher morbidity rate of 26 per cent and mortality rate of 7 per cent, compared with those having an elective procedure (chi 2 = 11.2, 1 d.f., P < 0.001; chi 2 = 8.7, 1 d.f., P < 0.005 respectively). Patients having palliative surgery had the highest mortality rate (19 per cent), compared with those operated on with curative intent (1.5 per cent) (chi 2 = 28.7, 1 d.f., P < 0.0001). Cost-saving hand-sutured anastomosis is effective and, in experienced hands, technically feasible after all kinds of colorectal resection and should remain the standard in colorectal surgery.

Adult↗
PubMed1992

Endoscopically controlled placement of urethrovesical anastomotic sutures after radical retropubic prostatectomy.

Radical retropubic prostatectomy is a challenging surgical procedure. One of the technically demanding aspects of this surgery is the urethrovesical anastomosis. We have used a 21F cystoscope in selected patients to enhance the quality of our urethrally placed anastomotic sutures. This technique may be a beneficial adjunct in those cases in which delineation of the transected urethral margin is difficult to identify secondary to urethral retraction and should be considered an addition to the presently available armamentarium of maneuvers used to make the urethrovesical anastomosis technically easier and more precise.

Anastomosis, Surgical↗
PubMed2005

Arthroscopic repair of glenoid fractures using suture anchors.

Anterior glenoid fractures associated with glenohumeral instability are normally treated with open fixation of the fragment. However, recent technical development enables this procedure to be performed under arthroscopic control using screws or even suture anchors if the fragment is small enough. We developed a unique method of stabilizing a larger fragment with suture anchors and the use of a clear imaging method of three-dimensional computed tomography (3D-CT) with the humeral head eliminated, preoperatively and postoperatively. In the present article, we report a detailed method of arthroscopic stabilization for a consecutive series of 8 patients, with an average of 27% bone loss (fragment size) against the lower part of the circular glenoid portion, using suture anchors.

Arthroscopy↗
PubMed1990

[Our experience with the treatment of congenital megacolon using mechanical sutures].

The DUHAMEL operation is widely used for the treatment of HIRSCHSPRUNG disease. Recently, technical modifications using stapled instruments have been introduced. The results of 12 patients treated between 1985 and 1989, performing the DUHAMEL procedure are reviewed. We perform with mechanical sutures, both surgical stages, e.g. abdominal and perineal. The technique for the procedure is described. Since we introduce the technique, we have observed several advantages consisting in a shorter surgical time, earlier normal life pattern, less postoperative complications and better results in clinical evolution.

Colostomy↗
PubMed1997

Results of laser tissue soldering in vasovasostomy and epididymovasostomy: experience in the rat animal model.

UNLABELLED: The use of microsurgical techniques (vasovasostomy and epididymovasostomy) for vasectomy reversal has now enabled surgeons to perform both procedures with certainly acceptable success rates. However, these operations are technically demanding and require special training in microsurgery. PURPOSE: A new method of performing these procedures using laser tissue soldering is described and results are evaluated. Laser tissue soldering is different from laser welding in that it involves the laser activation of a protein solder with a dye specific for the specific wavelength of laser light; therefore, surrounding tissue is not affected by the laser. MATERIALS AND METHODS: Ten rats underwent bilateral vasovasostomy and eleven underwent bilateral epididymovasostomy. In each rat, a sutured anastomosis was performed on one side while laser tissue soldering was performed on the other. Animals were sacrificed after one month and anastomoses were evaluated for patency and presence of sperm granulomas. Histologic analysis was also performed. RESULTS: Patency rates were 8/10 (80%) for sutured vasovasostomy versus 9/10 (90%) for the laser technique. Epididymovasostomy patency rates were 8/11 (73%) for sutured versus 9/11 (82%) for the laser technique. Mean operative times were significantly shorter for lasered anastomoses when compared to controls. The frequency of granuloma formation did not significantly differ between laser and control groups. CONCLUSIONS: Laser tissue soldering resulted in similar patency when compared to a conventional 2 layered sutured anastomosis while decreasing operative time. In addition, since fewer sutures are placed, the laser method is less technically demanding.

Animals↗
PubMed1990

Technical advantages of a ringed intra-luminal graft in the management of difficult aortic aneurysms.

The ringed intra-luminal graft has been designed for aortic repair with non-sutured anastomosis. The graft and technique of insertion are described. It is proposed that this type of prosthesis might have advantages over conventionally sutured grafts for the surgical management of thoraco-abdominal, suprarenal and dissecting aneurysms, and occasionally for infrarenal aneurysms when the neck is ectatic or excessively friable. This proposition is supported by reference to five patients with complex aneurysms which were repaired successfully with non-sutured grafts. The importance of appropriate patient selection and attention to technical detail is stressed.

Aged↗