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PubMedDate not supplied

Dystrophy of the media with aneurysmal tendency in the abdominal aorta-iliac segments (13 cases).

The authors report 13 cases of aneurysm of the abdominal aorta and common iliac arteries similar to those described by Leriche. The main morphological abnormality was major dystrophy involving the media, giving a special pathological appearance to these structures, long considered a mere morphological anomaly. In this part of the arterial system at least, they seem to evolve towards aneurysm and rupture (thin-walled aneurysm). This course requires echotomographic supervision of cases not submitted to immediate surgery, owing to the widespread nature of the process and the fact that some lesions resemble large arteries rather than aneurysms. The classic surgical technique of aortic and iliac aneurysms should often also include special technical devices. First, unilateral by-pass operation before the resection stage, and secondly aortic suture on a prosthesis to avoid tearing the arterial wall which is affected by media-spongiosis. The ten cases operated here all had a favourable course with a follow-up period of 1 to 9 years.

Aged↗
PubMed1992

[Quantifying suture tension of corneal sutures with the suture forceps with strain gauge strips].

To achieve uniform tensions on corneal stiches a modified tying forceps was developed. This forceps provides the possibility to measure the tension which is put to a nylon thread (10-0) by means of surface mounted strain gauges detecting the forceps jaws' bending. The results are registered and displayed electronically. To obtain a preselected tension, a limit value switch and a tare unit is used. A first series of registrations showed reproduceable values and confirmed a linear correlation between forceps jaw bending and traction force. A prototype and possibilities of technical improvement are demonstrated.

Corneal Transplantation↗
PubMed1990

[Comparative experimental study of nerve repairs by classical suture or biological adhesive].

The respective possibilities of nerve reparation with classical microsutures or biological glue (bioglue) were compared on experimental rat sciatic nerve lesions. Seventy rats were operated upon, and 69 results can be interpreted. 22 had a microsuture, 47 anastomosis with bioglue (Tissucol). The animals were followed for 120 days, and the results assessed on muscular testing, electrostimulation, optic microscopic histology, and morphometry. Five anastomosis dysjunctions occurred in the bioglue group, because of technical errors. All other animals improved from the 60th day. From the histological view point, the results with bioglue were more satisfactory, because of the absence of foreign body reaction to sutures; the authors conclude that because of the equivalent results on nerve function, and better histological results with bioglue, its use is preferable to repair nerves, especially when microsuture is technically difficult.

Animals↗
PubMed2001

Postinterventional transcutaneous suture of femoral artery access sites in patients with peripheral arterial occlusive disease: a study of 930 patients.

The purpose of this study was to evaluate a percutaneous vascular suture (PVS) device in patients with peripheral arterial occlusive disease (PAOD) for achievement of immediate hemostasis at the vascular access site and early ambulation of fully anticoagulated patients after peripheral interventional procedures. From June 1995 to March 2000, a vascular suture using a PVS device (6-10 Fr) was applied in 930 patients with PAOD. All patients had received an endoluminal intervention in the pelvic and/or the contralateral femoropopliteal region via a retrograde access through the common femoral artery (CFA). The incidence of complications within 12 hr after intervention, prior to discharge, and at 30-day follow-up was assessed employing clinical examination, treadmill test, and color Doppler ultrasound and the safety of the PVS device was determined. The efficacy of the system was measured by the percentage of achieved immediate hemostasis and early ambulation. PVS was technically successful in 92.2% independently from the degree of calcification at the access site. In 7.8%, an appropriate suture delivery could not be performed and these patients were successfully treated by conventional compression technique. Device malfunction or insufficient suture closure occurred in 1.7% and 2.1%, respectively. In 7.0%, groin-related complications occurred. Ambulation within 2-4 hr after successful suture was possible in 96.1%. All patients were free of any local symptoms at 30-day follow-up. The PVS device provides a safe and effective solution to achieve immediate hemostasis, thus permitting early ambulation in fully anticoagulated patients with PAOD after peripheral interventional procedures.

Arterial Occlusive Diseases↗
PubMed1982

Resection and sutured colo-anal anastomosis for rectal carcinoma.

Resection with preservation of the anal sphincters is new widely accepted as providing satisfactory treatment for carcinoma of the upper rectum. However, restorative resection is less widely performed for tumours of the lower rectum because anastomosis can be technically difficult when performed low in the pelvis. Between 1973 and 1980, 76 patients with rectal carcinoma underwent rectal resection and restoration of bowel continuity by means of a sutured anastomosis between colon and anal canal. The pathological characteristics of these tumours were similar to those of all cases of carcinoma of the rectum treated at St. Mark's Hospital between 1948 and 1972. Two patients developed pelvic sepsis following colonic necrosis and anastomotic breakdown. Eight developed pelvic sepsis without major anastomotic breakdown. No patient died as a result of pelvic sepsis. Sixty-nine of the 70 patients who were able to be assessed were either completely normal functionally or had only minor deficiencies of bowel function. Six patients have been observed to develop recurrent pelvic tumour, localized to the pelvis in 4 patients and concurrent with the development of widespread metastases in 2. Twenty-one of 32 patients are alive 3 years and 12 of 19 patients are alive 5 years after a curative operation for rectal carcinoma. These results are comparable with those seen following total excision of the rectum and pelvic floor for similarly sited tumours.

Anal Canal↗
PubMed2006

Laparoscopic ureterolithotomy: its role and some controversial technical considerations.

OBJECTIVE: To define the role of laparoscopic ureterolithotomy in the management of urolithiasis and evaluate the controversial techniques of this operation. METHODS: Between July 1997 and December 2004, retroperitoneoscopic ureterolithotomy was performed as a primary procedure in 30 patients who had either large or impacted stones in the upper ureter. The other indications were stones which could not be fragmented by shock wave lithotripsy or the patients could not afford the cost of shock wave lithotripsy. The mean (range) age of the patients was 44.07 years (17-78) and the mean (range) stone size was 19.03 mm (10-40). The ureter was closed with intracorporeal laparoscopic suture without placing a stent. RESULTS: The stone was removed in all but one case. The mean (range) operative time was 121.38 min (75-270). No intraoperative complications were recorded. The mean (range) postoperative drain removal was 2.86 days (2-10). Postoperative complications included prolonged urinary leakage in one patient. On the sixth month of follow up, all patients were stone free without any evidence of ureteral stricture. CONCLUSION: Laparoscopic ureterolithotomy is a minimally invasive treatment and may be considered as the useful first-line management for large impacted upper ureteric stones. The technical recommendations were retroperitoneal access and suturing the ureterotomy incision. Ureteral stent should be placed in only cases of severe inflammation of the ureter or inappropriate suturing.

Adolescent↗
PubMed2005

Recommendations for the implantation of the Pericarbon Freedom stentless valve.

Based on our experience of 1000 subcoronary implants of the Sorin Pericarbon Freedom stentless valve, we give recommendations for the exact implantation technique. This article illustrates basic issues in the implantation technique with respect to continuous and interrupted suture to enable beginners and experienced surgeons to avoid some of the pitfalls. Additional remarks about sizing and early intraoperative echocardiographic findings complete this technical overview.

Heart Valve Prosthesis↗
PubMed2006

Effectiveness of suturing training with 10-0 nylon under fixed and maximum magnification (x 20) using desk type microscope.

BACKGROUND: Microvascular anastomosis using 10-0 nylon needs a higher level of technical dexterity compared with routine neurosurgical maneuvers. Although this technique remains an important part of treating complex intracranial aneurysms or cerebrovascular disease, the surgeon's clinical experience in using this technique is not so common. METHODS: To improve dexterity and maneuverability in the limited clinical case volume, we developed an easily accessible training system, using commercially available desk type microscope and simply suturing neighboring fibers of the gauze with 10-0 nylon under fixed and highest (x 20) magnification. RESULT: This training system is somewhat of a drawback compared to the simulation of a real clinical setting. However, because of the extremely easy availability and accessibility of the dark type microscope repeated training and the accumulation of more than 10000 stitches, on average, was accomplished. This resulted in a steep learning curve of the technique. CONCLUSION: For residency and post-residency year young neurosurgeons, who need to brush up their skills due to lower surgical case volume compared with what senior neurosurgeons have experienced this easily available training would contribute to establishing daily and long-lasting microsurgical practice.

Humans↗
PubMed1987

[Results following a morphologically differentiated surgical technic in inguinal hernia of the adult].

The high recurrence rate after exclusive operation of inguinal hernias of adults by a Bassini suture stimulated us, to develop a morphologically differentiated procedure more than 11 years ago, by which larger defects in the inguinal wall are closed by an implantation of polyester mesh. The conducted reexamination of our patients operated in the years 1976 to 1984 shows a recurrence rate of 0.79% and so the correctness of our technique.

Female↗
PubMed1985

Esophagogastrostomy using the EEA stapling instrument.

A technique of esophagogastric anastomosis using the end-to-end anastamotic (EEA) stapler following esophagectomy is described in detail. Twenty-two patients underwent esophagectomy for carcinoma at various levels. There were no anastomotic leaks and no operative mortalities. Complications included wound infection (3), pneumonia (1), and late stricture (2). The strictures resulted from use of the small (25-mm) cartridge and responded to dilatation. Technical details of the technique include complete division of the esophagus before inserting the stapler, use of the pursestring instrument, use of "guy" sutures to aid in introduction of the anvil, and use of a proximal esophageal "traction clamp" to avoid tearing the esophagus. The 31-mm cartridge is used whenever possible. It is concluded that EEA is a very safe method of esophagogastrostomy when used with strict attention to technical details.

Adult↗
PubMed1980

[Primary flexor tendon suture].

Our experience with primary tendon repair in no-man's-land are reported. 25 patients with 28 tendon lesions were treated in our service since 1974. In 2/3 of the cases a good functional result was obtained. This technique can also be recommended for replantation cases and complex injuries. A clear indication, consequent postoperative treatment and the avoidance of technical failures result in less complications and postoperative problems.

Hand Injuries↗
PubMed2006

Totally percutaneous aortic aneurysm repair: experience and prudence.

OBJECTIVE: Totally percutaneous aortic aneurysm repair has been shown to be technically feasible, with low morbidity. Complications from percutaneous arterial closure are not insignificant, however, and can be fatal. We sought to evaluate our experience with this technique, compare it with the published literature, and identify factors associated with conversion to open repair and complications. METHODS: A retrospective review of a prospectively collected database was performed. All patients who underwent percutaneous closure of large-bore-sheath (>12F) access sites with off-label use of a suture-mediated closure device (Prostar XL) between December 2002 and August 2005 were reviewed. Outcome measures evaluated were rates of technical success, conversion to open femoral arterial repair, and complications. Axial diameter measurements of the accessed vessels were assessed with computed tomographic (CT) angiography both before and after the procedure. Patient variables were compared by using chi2, Fisher exact, and paired and independent samples t tests where appropriate. The mean follow-up interval was 1.5 years. RESULTS: During the study period, 49 patients underwent percutaneous closure of 79 large-bore-sheath access sites after successful endovascular aneurysm repair. Seven patients (14%) were morbidly obese (body mass index >35 kg/m2). Successful closure was achieved in 74 access sites (93.7%). Percutaneous closure was unsuccessful in five access sites (6.3%), all of which required open femoral repair at the same setting. Two converted patients experienced complications (4.1%): one retroperitoneal hematoma requiring transfusion of blood products and one iliac artery injury leading to death from myocardial infarction. Both of these patients were morbidly obese. Both complications occurred after closure of larger than 20F sheath sites. Morbid obesity and sheath size greater than 20F were associated with a significantly increased complication rate (P = .02 and P = .01, respectively). No thrombotic or infectious complications occurred in this series. Upon comparison of preoperative and postoperative CT angiograms, one (1.3%) small pseudoaneurysm was detected. No arteriovenous fistulas or hematomas larger than 3 cm were detected. The pseudoaneurysm occurred after closure of a 20F sheath access site. There were no significant differences in minimum intraluminal (7.38 +/- 1.8 vs 7.48 +/- 1.8) or maximum extraluminal (11.25 +/- 2.8 vs 12.02 +/- 2.7) diameters between preoperative and postoperative CT angiograms, respectively. CONCLUSIONS: Totally percutaneous aortic aneurysm repair is technically feasible in most cases, with no effect on the luminal diameter of the accessed femoral artery. Complications occur more often in morbidly obese patients and with sheaths larger than 20F. These complications can be minimized with meticulous technique and good patient selection. The capability for expeditious open femoral arterial repair is mandatory with this approach.

Aged↗
PubMed1981

[Marshall-Marchetti-Khrantz operation for stress incontinence. 100 cases (author's transl)].

The authors report a series of 100 cases of stress incontinence of urine in the woman, treated by Marshall-Marchetti-Khrantz operation. In reoperations for urinary incontinence which has already been treated surgically, the authors deliberately opened the bladder in order to clearly visualise the bladder neck and trigone and hence insert the juxta-cervico-urethral sutures in the best possible position. It is of interest to note the severity of Retzius haematomas (even though rare: 3 cases) and the risk of transfixion of the excretory system by a suture which leads to the development of bladder lithiasis. It is above all of interest to note the absence of prolonged dysuria. Results were excellent and may be viewed in three main areas: 1) Patients undergoing their first operation: 76 cases, 70 successes, i.e. 92.2%. 2) Patients undergoing reoperation: 16 cases, 13 successes, i.e. 82%. 3) Finally, neurological bladders: 8 cases with 4 failures. The authors draw the conclusion that neurological bladder with urinary incontinence is a poor indication for incontinence surgery. By contrast, the results of primary or secondary operations appear to be good and they are encouraged to continue. Failures of this operation are due either to an inappropriate indication or essentially to technical errors leading to the breaking away of vaginal fixation: Retzius haematoma, Retzius abscess, the use of absorbale sutures and finally late breakdown. It must nevertheless be noted that deteriorations occurred up to the 2nd postoperative year. In the literature, the authors found reports of non-negligeable deterioration occurring late in a certain number of published series.

Adult↗
PubMed1997

Double interdomal suture in nasal tip sculpturing.

The authors stress that conservative correction should be the main goal in rhinoplasty in general and in the surgical treatment of the nasal tip in particular. After outlining contemporary concepts and criteria relating to the modeling of an aesthetically pleasing nasal tip and the consequent surgical planning for its achievement as well as the specific indications for tip plasty, they go on discuss the technical aspects of tip projection and rotation. A personal technique is proposed for reshaping and sculpturing the tip, completed by a double interdomal suture with different application points during closed rhinoplasty. The technique also involves ancillary procedures consisting in the execution of a series of incisions with a radial pattern at the domal level and, when necessary, in the undersurface of the lateral crus. The procedure is explained in detail and the results are illustrated and discussed.

Esthetics↗