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[Experimental substantiation of a precision technic of creating an interintestinal anastomosis in acute intestinal obstruction].

Two kinds of intestinal sutures performed with the use of a precision technique were investigated on models of acute intestinal obstruction. One-row (serous-muscular-submucosal) and two-row (serous-musculo-submucosal and submucosal-mucosal) sutures provide an exact layer-after-layer connection of the intestinal wall layers and a sufficient mechanical firmness of the anastomosis with little traumatization. The dynamics of microcirculation changes in the anastomosis zone was followed with the help of contact intraoperative biomicroscopy. Symptoms of the traumatic inflammation were cupped off within 5 days and changed by reparative processes.

Acute Disease↗

[Total aortic root replacement exclusively with full-thickness suturing].

This paper describes two cases of total aortic root replacement using a valved conduit with a side branch. The full-thickness suturing technique was exclusively used at all anastomotic sites, and some technical devices are also presented. The conduit and a Hemashield Woven Double Velour graft used to make it were found very beneficial for the operation of this kind, and our procedure will equally provide every surgeon with a good result.

Aged↗

[Bone fracture and vascular lesion (author's transl)].

Combined lesions of bone and blood vessels require a high degree of diagnostic skill and of therapeutic care (routine clinical examination of the vascular status and if necessary angiography). From a therapeutic point of view, all major vascular lesions proximal to the knee or elbow should have vascular continuity restored (artery and vein). Primary internal fixation of shortened long bones is an important technical principle which, in most cases, will allow direct vascular suture in a stable operating field.

Arm↗

Incisional hernia: challenge of re-operations after mesh repair.

BACKGROUND AND AIMS: The widespread use of meshes for the repair of incisional hernia is currently followed by an increasing number of re-operations. The incidence of incisional hernia recurrence after mesh repair varies between 3 and 32%. The problem of mesh failure and options for another surgical intervention seem rather unattended. METHODS: We present our experience of 77 re-operations after previous mesh repair that were performed between 1995 and 2004 out of a total of 1,070 operations for incisional hernia. The retrospective analysis focused on recurrence in relation to location, material of the previous mesh repair and the surgical procedure to resolve the problem. RESULTS: The locations of the preceding meshes were epifascial as onlays (n=23), retromuscular as sublays (n=46), within the defect as inlays (n=6) or intraperitoneally (n=2). The direction of the incision was vertical medial (n=41) or horizontal crossing the linea semilunaris (n=36). Recurrences after median incisional hernia mesh repair mainly occurred at the cranial border of the mesh subxiphoidal. Except for two patients, all recurrences manifested at the margin of the enclosed mesh. CONCLUSIONS: Re-operation after previous mesh repair is a surgical challenge. The type of revision procedure has to consider the position and material of the previous mesh. In our clinic recurrences, heavyweight polypropylene meshes were mostly treated with mesh exchange and lightweight polypropylene meshes could be treated by extension with a second mesh. In contrast to suture techniques, deficient mesh repairs are more evidently related to technical problems.

Aged↗

All-inside suture technique using two posteromedial portals in a medial meniscus posterior horn tear.

Up to two thirds of patients with anterior cruciate ligament rupture have a combined medial meniscus posterior horn tear. Researchers have proven the importance of repairing this tear to enhance stability after anterior cruciate ligament reconstruction. However, repairing the meniscal tear can be sometimes cumbersome and difficult or even impossible in certain circumstances, especially in places such as the posterior horn of the medial meniscus. We devised a simple and easy method of all-inside suturing of medial meniscus posterior horn tears using a 2-posteromedial portal system. Furthermore, with a modification of our technique, a clinician can not only suture single but also double longitudinal medial meniscus posterior horn tears.

Arthroscopes↗

Arthroscopic biceps tenodesis using a bioabsorbable interference screw.

Arthroscopic biceps tenodesis has rarely been reported. The purpose of this study is to present our technique of arthroscopic biceps tenodesis using the Bio-Tenodesis (Arthrex, Naples, FL) screw system. This system uses a uniquely designed screwdriver that allows manipulation of the biceps tendon subacromially and intra-articularly, facilitates placement and maintenance of the biceps tendon at the base of the bone socket during interference screw insertion, and assures an adequate bone-tendon-screw interface.

Absorbable Implants↗

Review of cyanoacrylate tissue glues with emphasis on their otorhinolaryngological applications.

Cyanoacrylates were first synthesized by Ardis in 1949. However, it was not until Coover in 1959 discovered their adhesive properties that an interest arose in using these substances in surgical procedures. Over the past two decades the use of cyanoacrylates has been varied and widespread among the surgical specialties. methyl 2-cyanoacrylate (Eastman 910 Monomer), Isobutyl-cyanoacrylate (Bucrylate), and 2-cyano-butyl-acrylate (Histoacryl) were the most widely used. Because of its tissue toxicity methyl 2-cyanoacrylate was discarded. The consensus of various investigators was that the higher homologues, in particular Histoacryl could be safely used in human applications. The authors thought it would be important to ascertain how the academic departments of Otolaryngology perceived the role of cyanoacrylates within their specialty. A questionnaire was distributed to 115 academic centers: 47% of the departments responded and, of those, 34% indicated a current working knowledge of the cyanoacrylates. This response confirmed a very active interest in these tissue adhesives despite a lack of F.D.A. approval. The otologic applications of these adhesives has been well documented, but the literature is devoid of studies using cyanoacrylates in other aspects of Otolaryngology. The authors feel that these adhesives (in particular Histoacryl) have a role as an adjunctive technique in facial reconstructive and cosmetic surgery for autogenous cartilage grafting. A study using rabbits was designed to determine if Histoacryl could be used safely to overcome the technical difficulties (graft migration during healing and cartilage fracture during suturing) often encountered when performing autogenous onlay cartilage grafting. On the left ear of each rabbit, a cartilage graft was harvested and reimplanted at a second site on the same ear by suturing the perichondrium of the graft to the perichondrium of the donor site. On the right ear the graft was secured to the donor site with Histoacryl. The histological analysis of the rabbits' ears sacrificed at weekly intervals from 1 week to 1 month failed to demonstrate cartilage damage or tissue toxicity in the ears where Histoacryl was used. In conclusion, the authors contend that a role exists for the use of Histoacryl as an adjunctive technique in facial reconstructive and cosmetic surgery. The study will be continued to assess the long-term results of using Histoacryl for autogenous onlay cartilage grafting.

Animals↗

[Skin approximation using Nd: YAG laser in head and neck surgery].

Laser is useful for surgery to cut, coagulate, vaporize and weld the tissue. Recently, low power laser was utilized for the treatment of ulcer, pain and vascular anastomosis. We applied low power Nd: YAG laser irradiation for skin approximation. An experimental study was carried out by using the Nd: YAG laser in approximating the surgically cut skin wound of guinea pigs. Healing of the wound was observed on post operative days of 3, 7 and 21, respectively. Laser approximation for the incised skin showed less scaring and faster healing than conventional suture technique. This laser technique will be beneficial as one of the new procedures of skin suture in clinical practice. The results were discussed from either technical or cosmetic standpoint.

Adult↗

[G.S. Toprover's gastrostomy].

Based on the analysis of 76 case reports of esophageal cancer (55 patients), cancer of the cardiac portion of the stomach (15 patients) and other organs, in which the G.S. Toprover gastrostomy was performed, the main drawbacks of the operation were revealed, and the causes of lethal issues following the operation after this technic are analysed. It is emphasized that putting in circular sutures on the gastrostome conus results in their cutting through with subsequent impairment of the fistula hermeticity, and some modified more improved methods of gastrostomy are recommended.

Adult↗

Tissue reconstruction with nonpenetrating arcuate-legged clips. Potential endoscopic applications.

A new system for tissue approximation consisting of a nonpenetrating arcuate-legged clip applied to everted tissue edges to form an elastomeric flanged joint is described. The flanged joint has unusual physical and morphologic properties. Novel systems for tissue eversion, clip application and clip removal have been tested at the micro scale in blood vessels and the rat vas deferens (vasovasostomy). Human applications have been successful (cerebrovascular reconstruction, free-flap transfer, skin grafting, A-V access). The system is biologically and technically equivalent to or superior to the needle-and-suture technique. Avoidance of intimal or mucosal penetration or intraluminal foreign body is associated with prompt wound healing and the reconstitution of tubular integrity. The system is readily adaptable for endoscopic surgical reconstructions, providing the surgeon with enhanced reconstructive abilities.

Anastomosis, Surgical↗

Experimental osteoporosis--different methods of ovariectomy in female white rats.

UNLABELLED: Rats are currently principal laboratory animals, used to investigate osteoporosis. The aim of the study was to present and compare two operative methods of inducing osteoporosis in rats. MATERIALS AND METHODS: Ten 3 months old female Wistar rats were divided into two groups with five animals in each group. In the first group, ovariectomy was preceded by a mid-line dorsal skin incision, 3 cm long. After removing the ovary, the previous incision of the muscle required suturing. In the second group, ovariectomy was performed by two dorso-lateral incisions, approximately 1 cm long above the ovaries. With the use of a sharp dissecting scissors, the skin was cut almost together with the dorsal muscles and the peritoneal cavity was accessed. There was no need of muscle suturing. CONCLUSION: The operation, performed in the second group, was technically easier, less time consuming and less harmful for the used female white rats.

Animals↗

[Endometriosis of the lower abdominal wall. Report of two cases secondary to cesarean section].

The paper describes two cases of cutaneous endometriosis in correspondence with the surgical scar following cesarean section. The cases formed part of a series of 500 abdominal operations performed during the period 1988-89, of which about 200 were cesarean sections, with a 1% frequency. In line with the hypothesis regarding the spread of endometrial tissue during surgery and with that concerning peritoneal metaplasia, the authors recommend paying special attention during the technical procedure of extracting the fetus, and performing an introflexed suture of the uterine incision and of the parietal peritoneum.

Abdominal Muscles↗

[Esophago-jejunal anastomosis using an end-to-end anastomosis stapler. Clinico-radiologic study of early complications in 75 cases].

Personal experience with 75 consecutive cases of terminolaterale oesophagojejunal anastomosis by EEA Stapler is reported. A total of 6 intraoperative technical problems were encountered (8%) and consisted either of incomplete suturing of the anastomosis or stapling of the jejunal wall. Postoperative radiology revealed 5 dehiscences (6.6%) and 1 stenosis (1.33%). One patient with dehiscence died (1.33%) of septic complications. One dehiscence of the afferent jejunal stump and minor pleuropulmonary complications were observed in 3 cases. After a brief review of the literature, it is concluded that oesophagojejunal anastomosis by EEA Stapler produces a low incidence of postoperative complications such as the dehiscence, stenosis or bleeding.

Adult↗

[New instruments for laparoscopy].

The author describes new laparoscopic instruments for blunt dissection of tissue, that also make an abdominal wall suture more simple. The instruments are very simple from the technical point of view. They can be manufactured even under very basic conditions. By using these instruments it is possible to spare more advanced and expensive standard laparoscopic instruments as well. They make it possible for the accurate and sensitive tissue dissection. Forestalling thus an injury to biliary duct, the worse complication in laparoscopic operations, to occur. The instrument has been regularly used in clinical practice and proved good.

Humans↗

Laparoscopic hernia repair--what are the results?

The two widely practised laparoscopic groin hernia repairs are: a) trans-abdominal preperitoneal (TAPP) and b) trans-extraperitoneal preperitoneal (TEPP) approaches. Early results are encouraging with both the techniques being associated with low recurrence rates (0% to 2%) comparable to the best, reported for standard open repair (Shouldice and Lichtenstein's). Other complications are higher in the beginning following laparoscopic hernia repair compared to the conventional method. These complications are related to the learning curve and expected to come down significantly with increasing experience of surgeons. Laparoscopic repair of recurrent groin hernia appears to be considerably superior to the conventional technique. The recurrence rates following conventional repair of recurrent groin hernias are between 1.5% and 35% (Table I) compared to none for laparoscopic repair of recurrent inguinal hernias. The disadvantages of laparoscopic repair include greater technical difficulty, higher incidence of serious complications and increased cost. Sutured open repair is associated with high postoperative discomfort, greater difficulty of repairing recurrent hernia with higher societal cost (due to prolonged time-off from work for 12% to 57% of patients operated for various open technique-Table II). The techniques of laparoscopic hernia repairs are nearly standardised today. Laparoscopic surgeons have an obligation to offer the new alternative and to ensure that it is safely used. Laparoscopic repair is another technique used for the repair of inguinal hernias, which is going to stay as a safe and effective alternative to open repair as the learning curve is over. There is an urgent need to have well-designed prospective randomised trials in the near future.

Hernia, Inguinal↗

[8-year experience with force vector rhinoplasty by J.B. Tebbetts: comparative results].

The aim of the present work is to make a contribution in resolving the controversy between the traditional and "open" approaches to rhinoseptoplasty. Over these last few years, particularly in the United States, the Rethi technique (1920) has encountered unceasing opposition among those using the "open" approach and those who, on the other hand, assert that they can achieve equivalent results without resorting to the supplementary columellar incision. Since 1989 we have been using the technique proposed by J.B. Tebbetts in 1987 and published in detail in the July, 1994 issue of "Plastic and Reconstructive Surgery". The authors feel that Force Vector Tip Rhinoplasty has been the only true innovation since Joseph (1931). Moreover, because of its content, this technique has exceeded the general term of open rhinoplasty. Indeed, this term is extremely general and simply indicates what surgical route is used. Nevertheless, the access route alone does not justify the choice of technique. On the other hand, what is truly innovative is the particular philosophy and technical aspects of Vector Rhinoplasty. In fact, by adding particular suture points and cartilaginous graft along calculated, extremely precise force lines, it is possible to modify the nasal skeleton. This is achieved with a steady, direct control and without damaging the delicate structures being supported. The term "Optimized Force Vector Tip Rhinoplasty" clearly depicts the concept, not only of a more complex access route; it also underlines the advantages in terms of intraoperative diagnostics, precision in performance and stability in time.

Humans↗

[Therapeutic approach in ventral hernia].

Laparoceles are diseases of the abdominal wall and their repair does not usually involve technical problems which are difficult to resolve. The use of classic surgical methods, such as direct suture and plastic surgery, enables the parietal defect to be easily repaired in most case. However, cases do occur in which the surgeon is faced with considerable technical and tactical difficulties largely due to anatomopathological causes: the "loss of the right of domicile" of herniated viscera and the loss of musculo-aponeurotic substance. In the former case it is necessary to prepare the peritoneal cavity using pneumoperitoneum. In the event of the extensive destruction of the muscular component, or when the parietal breech is located next to bone or cartilagenous structures, it is essential to use a prosthesis. The paper goes on to describe the indications for the use of various techniques and their respective methods of use under different anatomo-clinical conditions.

Abdominal Muscles↗