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At least 1,675 records · Page 93Linked to original sources
PubMed1990

Technique of implantation of the Medtronic-Hall valve and other modern tilting-disc prostheses.

Modern tilting-disc prostheses (Medtronic-Hall, Björk-Shiley Monostrut, and Omniscience) have distinctive mechanical characteristics, including wide-angle disc opening, that require special care about the implantation technique. Proper sizing, suturing, and orientation of the prosthesis are essential if problems of nonstructural valve dysfunction are to be avoided. A number of complications of this type, reported recently, appear to be related to a mismatch between the size of the disc and that of the cavities, whether ventricular or aortic. Based on an institutional experience of over 2,000 Medtronic-Hall valve replacements, described are the technical details of the implantation, centered on the sizing and orientation of the prostheses, including the technique of continuous suture used in mitral valve replacement.

Aortic Valve↗
PubMed1999

Combined resection and recession of a single rectus muscle for the treatment of incomitant strabismus.

BACKGROUND: The treatment of incomitant strabismus is challenging. Traditional approaches include the use of asymmetric bilateral surgery and the fadenoperation (posterior fixation suture). We report our experience with a different approach: combined resection and recession of a single rectus muscle. METHODS: The charts of 12 patients who underwent resection of a single rectus muscle with an equal or greater amount of recession of the same muscle were identified. In 5 patients, the procedure was performed using the adjustable suture technique, and the adjustment was performed later the same day (Group 1). In the remaining 7 patients, permanent sutures were placed at the time of surgery (Group 2). The procedure was performed for horizontal and vertical gaze incomitance, dissociated horizontal deviation, and distance-near disparity. RESULTS: Four of the 5 patients in Group 1 showed stable, long-term correction of their incomitance, both in primary gaze and in gaze in the direction of the muscle operated on. The results for patients in Group 2 showed stable, long-term correction of incomitance in 3 patients; however, these patients also had slight overcorrections in the direction of gaze opposite to the muscle operated on. An additional patient in Group 2 had a shift of her distance-near disparity, shifting from relatively exotropic to relatively esotropic disparity postoperatively. All patients in Group 2 showed at least some decrease in the amount of measured incomitance. We did not encounter complications such as muscle slippage or loss, scleral perforation, or late overcorrection in the field of gaze of the operated muscle. CONCLUSIONS: The technique of combined resection and recession of a single rectus muscle shows promise in the treatment of incomitant strabismus. It offers the advantages of posterior fixation combined with the greater technical ease of a standard hangback recession. The muscle may also be placed on an adjustable suture, allowing for postoperative adjustment in selected patients.

Adolescent↗
PubMed1986

The inguinal darn.

We performed 115 nylon darn repairs in 100 patients with inguinal hernia; 61 were primary and 54 secondary repairs, with 50 patients in each group. The Kinmonth modification of the Moloney darn was used. Thirty-seven percent of secondary repairs were done in patients with two or more previous repairs. Thirteen patients had indirect hernia repairs. The follow-up on 105 repairs in 90 patients averaged 62 months. There were two (3.5%) primary and four (8.3%) secondary repair recurrences. The six failures (5.7%) overall were either technical errors or improper patient selection. Three superficial wound infections (2.6%) healed without complications or suture sinuses. The inguinal darn for recurrent inguinal hernias appears to have a lower recurrence rate than the reported 15% to 30% following other techniques.

Adult↗
PubMed1992

Sutureless laparoscopic rectopexy for procidentia. Technique and implications.

Procedures for treating rectal prolapse may constitute some of the best applications for colorectal laparoscopic techniques. Although the condition is benign, rectal prolapse is often debilitating and frequently progressive in terms of functional limitations. Moreover, many patients are elderly, medically unfit, or both. A technique that afforded relief of prolapse and of incontinence by laparoscopic rectal sacropexy, performed without sutures, using a newly designed laparoscopic sacral tacker and laparoscopic staples, is described. Indications, contraindications, technical details, and surgical implications are discussed. Laparoscopic pelvic suspension procedures are presented as realistic and appropriate objectives for colon and rectal surgeons.

Colorectal Surgery↗
PubMed1989

Freehand homograft aortic valve replacement--the learning curve: a technical analysis of the first 31 patients.

The technique for implanting the homograft aortic valve is significantly more complex than that of either the bioprosthetic or mechanical valve. During development of the procedure, errors of technique were committed; a critical analysis of the learning experience is presented. In the initial 31 patients, the following problems were encountered: mitral stenosis secondary to inadequate debulking of the homograft (1 patient), prolapse of a single homograft leaflet necessitating valve replacement three days later (1 patient), incorrect homograft orientation with torsion in a calcified aorta necessitating subsequent replacement (1 patient), and aortic sinus perforation (thawing injury) (1 patient). In addition, another 4 patients had diastolic murmurs thought to be secondary to inadequate tension setting of the homograft commissural posts. From this experience, several important technical considerations for homograft replacement of the aortic valve were noted: use of interrupted subannular sutures; careful inspection for aortic perforation (thawing); extensive trimming of the homograft septum and mitral remnant; orientation of the homograft to the recipient aorta to obtain the best commissural and sinus alignment; selection of another type of valve if the size of the recipient annulus is greater than 27 mm; retention of the homograft sinus, which orients to the recipient non-coronary sinus (for a calcified aorta); and exaggerated tension on the homograft commissural posts before initiation of the second suture line. There has been 1 hospital death and no late deaths. Adherence to rigid principles of technique has resulted in no further valve replacements and no incidences of valvular leakage at early or late follow-up.

Aortic Valve↗
PubMed1980

Simple reconstruction of anteromedial rotational knee stability.

A technically simple operation for the restoration of anteromedial rotational knee stability is described. It involves suturing under tension the posteromedial capsule of the knee joint to the semimembranosus tendon at its insertion into the tibia, with the leg held in full internal rotation and with the knee flexed to 60 degrees. This, in combination with the conservative treatment of meniscal injuries and with tightening of the soft tissue structures over the medial aspect of the knee, restored full or almost full anteromedial stability in the knee in 15 out of 16 young men, observed for an average of 19 months after the operation.

Adolescent↗
PubMed2004

A novel technique for the repair of lumbar hernias after iliac crest bone harvest.

BACKGROUND: Lumbar hernia is a clinical entity that has been increasingly more common since the advent of iliac bone harvest for bone grafting procedures. These can be very technically difficult to repair and have a high recurrence rate. METHODS: Using a corkscrew anchor suture device, we have developed a novel and simple way to repair these hernias with no recurrence. Here we present our experience with the corkscrew suture anchor device. RESULTS: This technique has been performed in 2 patients at our institution, and in both cases, the hernia was successfully repaired. Our 1-year follow-up on this technique demonstrates intact repairs with no sign of recurrence. CONCLUSIONS: The placement of corkscrew suture anchors along the iliac crest remnant is a simple technique requiring minimal bony exposure. The anchors facilitate the long-term fixation of mesh despite the lack of fascia in this area. We conclude that this is a simple and effective approach for repair of these challenging hernias.

Bone Transplantation↗
PubMed1999

Laparoscopically assisted abdominal aortic aneurysm repair.

Since the first description of abdominal aortic aneurysms by sixteenth-century anatomist Vesalius, the history of this disease has reflected the remarkable progress of vascular surgery. From initial attempts of ligation and sclerosis to the recent advances of endovascular and laparoscopic repair, present-day vascular surgeons are supplied with a technically evolving choice of therapeutics. None of these procedures is mutually exclusive; currently, great interest lies in the use of laparoscopy to provide extraluminal control at the neck of aneurysms, to work with endoluminal grafts, and to control collateral vessel endoleaks. Laparoscopic vascular surgery must not be introduced into the clinical arena based only on the assumption that it is feasible. Clearly, it is a technically challenging procedure with a steep learning curve that requires specialized instrumentation and sophisticated laparoscopic suturing capability; however, with continued investigation, including prospective randomized trials, laparoscopic treatment of aortic aneurysms may become a standard option for high-risk patients.

Animals↗
PubMed1997

[The history of flexor tendon surgery].

Flexor tendon injuries were already treated in antiquity by Hippocrates, Galien and Avicenne. Since the Renaissance, other surgeons have attempted to repair flexor tendon injuries, but without success due to problems related to unsuitable materials and ignorance of the basic rules of asepsis and the absence of antiseptics until the second half of the 19th century. The first successful flexor tendon grafts in man were performed by K. Biesalski in 1910, E. Lexer in 1912 and L. Mayer in 1916. These three authors published their series of grafts and described in detail the anatomical, physiological and technical principles to be respected. St. Bunnell, in 1918, developed various pull-out direct suture procedures, but faced with the problems of adhesions, he abandoned this technique and proposed not to repair flexors in the digital tunnels but to graft them. He defined the famous zone which he called No man's land, which subsequently became Claude Verdan's zone II, in 1959. In 1960, C. Verdan published his first series of sutures maintained by 2 pins in zone II with comparable results to those obtained after grafting. In 1967, H. Kleinert, with his mobile suture, became the leader of direct tendon repair in zone II. 2-stage grafts were introduced in 1965 under the impetus of J. Hunter, who revised and popularized the studies conducted by A. Bassett and R.E. Caroll in 1950.

Biocompatible Materials↗
PubMed2002

Endoscopic partial cystectomy for bladder leiomyoma using retroperitoneoscopic and transurethral procedures.

Retroperitoneoscopic partial cystectomy was performed to remove a leiomyoma in the right wall of the bladder in a 58-year-old man. The tumor was initially circumscribed with a mucosal incision using a transurethral resectoscope, and once the bladder wall had been penetrated with the resectoscope, the remaining procedures were performed retroperitoneoscopically. The bladder wall was closed using a retroperitoneoscopic suturing technique. Endoscopic partial cystectomy using both a transurethral incision and a retroperitoneoscopic resection is technically feasible in the treatment of small bladder tumors.

Cystectomy↗
PubMed1989

Halstedian technique revisited. Innovations in teaching surgical skills.

This paper reviews the laboratory models used to teach fundamental surgical skills in our general surgery residency. The laboratory modules allow supervision and self-instruction, practice, and videotape monitoring of the following techniques: skin incision, suturing, knot tying, hemostasis, vascular anastomosis, and intestinal anastomosis. Pigs' feet simulate human skin for exercises in skin incision, lesion excision, suturing, and basic plastic surgical techniques. Latex tubing and penrose drains allow experience in suturing, knot tying, and hemostasis. Polytetrafluoroethylene vascular prostheses permit quantification of the precision of needle passage and suturing by measurement of leakage of water through a vascular anastomosis. Reconstituted, lyophilized, irradiated bovine arteries and ileum provide models of biologic tissue for creating handsewn vascular anastomoses and sutured or stapled gastrointestinal anastomoses. A headlamp videocamera allows unobstructive recording of the resident's technical performance and provides subsequent visual feedback for self-improvement when compared to reference instructional videotapes. We feel that these innovations may enhance surgical dexterity of residents without the need for animal sacrifice. Our goal is to foreshorten the learning curve for basic surgical skills and improve performance in the clinical operating room.

General Surgery↗
PubMed2006

Laparoscopic splenic autotransplantation.

Since 1990, we have performed splenic autotransplantation in more than 100 patients to treat splenic trauma, portal hypertension, myeloid metaplasia due to myelofibrosis, chronic lymphocytic leukemia, and Gaucher disease. The aim of this present study was to present splenic autotransplantation performed by laparoscopic means. A 33-year-old woman with severe splenic pain due to ischemia caused by multiple focal thromboses of splenic arterial branches was successfully treated by laparoscopic splenectomy and splenic tissue autotransplantation. The spleen was removed and cut in 20 fragments that were sutured to the greater omentum. This procedure was safely conducted with minor bleeding and no technical difficulties or complications. The postoperative follow-up of 12 months has been uneventful; the patient's pain disappeared on the first postoperative day. Hematologic, immunologic, tomographic, and scintigraphic examinations confirmed the functions of the splenic autotransplants. It is feasible and safe to perform splenic autotransplants by laparoscopic means.

Adult↗
PubMed2003

[Methods for reducing risk of complications after Billroth-1 resection of the stomach].

An analysis of surgical treatment of 102 patients with complicated pyloroduodenal ulcers has shown that vast infiltration and scary alterations in the ulcer area, its penetration, stenosis as well as the presence of tension of gastroduodenal anastomosis are risk factors for performing resection of the stomach after Billroth-1. In order to eliminate these factors the author used a technically correct elimination of the deformity of the duodenum. The additional application of extraorganic traction sutures and intraoperative dystopia of the duodenum allowed to complete the operation of resection of the stomach in most patients by putting a direct gastroduodenal anastomosis. In 29.4% of cases it was not possible to eliminate the risk factors in question by the well-known methods. So, the patients underwent resection of the stomach by Billroth-II method.

Duodenal Neoplasms↗
PubMed1989

[Recent developments and technics in eyelid-orbit surgery].

The advances in lid and orbital surgery are due to the improvements made in diagnostic equipment and to technical refinements. Modern imaging techniques now provide exact preoperative analyses, especially for orbital disorders. New suture and implant materials have been introduced, and the use of the operating microscope and of various types of lasers has broadened the spectrum of therapeutic possibilities. Surgical procedures have been developed that pay more attention to the specific anatomy, function and pathogenesis of the lids, especially for involutional disorders and loss of tissue.

Eyelid Diseases↗
PubMed1985

Reoperation for postoperative haemorrhagic complications. Analysis of a 10-year series.

All 527 postoperative haemorrhagic complications requiring reoperation from 1971 through 1980 were retrospectively analyzed. These operations constituted 1.2% of the total performed. Gastric resection, mastectomy and thyroid/parathyroid surgery showed significantly higher than average incidence of bleeding complications. No previously unknown cases of bleeding diathesis were detected. Drain was used in 34.5% of the primary operations, but rarely contributed to diagnosis of bleeding and did not reduce delay before reoperation. Shock or preshock was present in 15% of the patients. No source of haemorrhage was detected at 14% of the reoperations. Complications of various types were associated with 13% of the reoperations, with rebleeding and infectious conditions predominant. Complications of reoperation significantly prolonged the hospital stay, but did not raise the mortality rate. Mortality, however, was significantly higher after the reoperations than after the total primary operations during the study period (5.3 vs. 2.7%). Patients who had undergone arterial surgery were analyzed in more detail. There were 1.6% reoperations in this group. The bleeding emanated from anastomosis or arterial suture in only half of these cases and was then of two types--early, from technical causes or delayed, caused by infection.

Adolescent↗
PubMed1985

An original method for isoantiperistaltic jejunogastroplastic operation without intestinal inserts in distal subtotal resection of the stomach.

A novel method for subtotal gastric resection is described with the construction of an isoantiperistaltic artificial stomach formed from the small intestine and the duodenum at Treitz's ligament without any intestinal inserts, Brown's and Roux's anastomoses, and with an invaginated anastomosis between the stomach and the reservoir measuring 1.5-2 cm in length. Fifty-nine operations were performed. No incoherent sutures were observed in the gastric-reservoir anastomosis. In 1 patient, due to a technical fault, duodenal necrosis with fatal outcome was encountered. Two patients developed pancreatic necrosis of the horizontal part of the duodenum. The general condition of all of the followed-up patients is good. They had a weight gain ranging from 2 to 15 kg. When a broad anastomosis (exceeding 3 cm) was constructed, in 6 patients examined by endoscopy done in a horizontal position, small volumes of bile reflux into the gastric stub were found. In gastric resections performed according to Billroth II, a refluent gastritis was observed in 62.3% of the patients.

Gastrectomy↗
PubMed1983

Temporary intraarticular knee stabilization with synthetic material (Polyester-Silicon) in the sheep.

We draw the following conclusions from these animal experiments: a) It is possible to stabilize the knee joint of a sheep after resection of the anterior cruciate ligament by a suitable synthetic band. A foreign body reaction did not occur. b) After replacement of the anterior cruciate by an auto-, homo- or heterologous material, it was not necessary to immobilize the joint. c) In comparison to a control group, it appears that the transformation of the replacement material occurs faster due to the functional stimulation under guided mobility. d) The smooth surface of the synthetic material prevents its incorporation into connective tissue. Therefore, it is possible to remove this synthetic material after sufficient strength of the implanted material has been obtained. e) By fixing the synthetic band on the femoral shaft and the tibial head it can be removed without problems by small skin incisions without opening the joint. f) Kinking, wear and fatigue of the synthetic material can be avoided by rerouting the band around the lateral femoral condyle and the tibial edge. g) These results of animal experiments cannot be transferred to the human knee without great caution. Yet, it seems at least technically possible to achieve primary knee stability by a synthetic band in connection with a suture or replacement of the anterior cruciate.

Animals↗
PubMed1995

Revised technique of isolated lung perfusion in the rat.

Isolated lung perfusion in the rat is a useful research tool. Pulmonary arteriotomy and venotomy repair is required for animal survival. Rat pulmonary vessels are fragile, thin, and small in caliber, making their repair the focal technical point. This technique has been improved. The arteriotomy now is closed with a single suture and the venotomy no longer requires repair. The lung is returned to its original anatomic position then compressed to stop bleeding. These improvements have improved animal morbidity and mortality markedly while reducing operating time.

Animals↗