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PubMed1993

Cellular proliferation at sutured and sutureless colonic anastomoses.

Elevated cellular proliferation in the vicinity of an anastomosis may explain the enhanced susceptibility to carcinogens. The aim of this study was to determine whether anastomotic cellular proliferation was altered by different suture materials and whether a rise in cell turnover also occurred after a "sutureless" closure. A transverse descending colon enterotomy was repaired with interrupted sutures of 5/0 silk (n = 20), stainless steel (n = 20), or Vicryl (Ethicon, Inc., Somerville, NJ) (n = 20) or by a sutureless technique (n = 20). Using a stathmokinetic technique, crypt cell production rates (CCPR) were calculated at the anastomosis and in the adjacent colon at varying intervals between one week and six months after treatment. Overall colonic cellular proliferation appeared to be elevated at a sutured colotomy for at least three months (P < 0.05). In contrast, no significant elevation in cellular proliferation was observed at sutureless anastomoses. The duration of elevated proliferative response varied among the sutures.

Anastomosis, Surgical↗

PubMed1999

Gastrointestinal sutureless anastomosis in pigs using absorbable intraluminal stents, stent placement devices, and fibrin glue - a summary.

INTRODUCTION AND METHODOLOGY: To develop a practical gastrointestinal sutureless anastomosis technique, 164 end-to-end and end-to-side anastomoses were performed on the small intestine (SI), large intestine (LI), rectum, esophagus and gallbladder in 109 female Landrace pigs weighing 25 kg and 35 kg. There were 116 fibrin glue (FG) and 48 sutured anastomoses. The end-to-end SI and LI anastomoses were divided into five groups: sliding absorbable intraluminal nontoxic stent (SAINT); SAINT placement device (SAINT-PD); nonsliding SAINT (nST); sutureless stapler (SS); and sutured controls. The SAINT had a sucrose base, with some having reinforcing fibers. RESULTS: No deaths from dehiscence occurred in any group except one FG-cylinder attempt in the colon (technique abandoned). Statistical analysis of gross pathology indices showed no significant group differences. However, trends favored the SAINT in many indices, including grade-0 intraluminal tissue ridge formation (70.8% SI, 84.4% LI) and grade-0 adhesion rates (45.8% SI, 73.1% LI). Histologic examination showed fewer giant cells, less inflammation, less scar tissue formation and faster healing in the SAINT and nST anastomoses than controls. Follow-up of 300-540 days demonstrated no signs of necrosis or stenosis in the SAINT anastomoses. The nST had excellent results; however, it seems impractical in SI anastomoses and unsuitable for LI. CONCLUSIONS: The SAINT-PD has potential for all gastrointestinal sites, but needs larger experimental trials. The SS technique is impractical and had high tissue ridge formation and adhesion rates. These preliminary trials suggest the simplicity, versatility and safety of the SAINT technique; however, the small groups limit result interpretation. The results present a starting point for sutureless FG gastrointestinal anastomosis, and future experimental evaluation with more extensive statistical analyses in larger studies are needed.

Absorption↗

PubMed1990

Sutureless ring graft replacement of ascending aorta and aortic arch.

Complications after aortic replacement that result from prolonged graft insertion time and technical difficulties with suturing through friable, diseased aortic tissue can be addressed with use of the sutureless intraluminal ring graft. Between 1978 and 1989, we replaced the ascending aorta or aortic arch with this device in 49 patients. At no time were we unable to use a sutureless graft during a procedure. Twenty-eight cases of aneurysmal disease and 21 cases of acute or chronic dissection were treated. Twenty-six patients required replacement of the aortic valve, with annuloartic ectasia being the most common indication (71%). Ten patients underwent concomitant coronary artery bypass grafting. The operative mortality rate for ascending aortic aneurysm repairs was 4%, and that for dissections was 18%. Five of 8 patients requiring aortic arch replacement survived. Most patients were studied angiographically before discharge. No complications were related to anastomotic hemorrhage, pseudoaneurysm formation, graft migration, or thromboemboli. Individual cases of phrenic nerve palsy, acute tubular necrosis, and transient ischemic attack, all of which resolved completely, were identified. The actuarial 5-year survival rate is 64%. We conclude that modification of the sutureless intraluminal ring graft to suit the pathology encountered at operation allows the quickest repair with the least chance of anastomotic complication.

Adolescent↗

PubMed1994

Treatment of acute type A aortic dissection with intraluminal sutureless prosthesis.

Sutureless intraluminal aortic graft has been used for substitution of aorta, with the advantages of decreasing the aortic cross-clamp time and decreased blood loss. From January 1991 to December 1992, 10 consecutive patients underwent emergency operations to repair acute type A aortic dissection in which sutureless intraluminal grafts were used for replacement of ascending aorta. There were 5 men and 5 women, with ages that ranged from 40 to 74 years (mean, 51 years). The inclusion method was used in all patients. Modified Cabrol shunts were created in 7 patients. Dacron graft (Meadox Medicals, Inc, Oakland, NJ) was used to wrap the ascending aorta in 7 patients. The circulatory arrest time was 33 +/- 13 (mean +/- standard deviation) minutes, and the cardiac ischemic time was 64 +/- 17 minutes. Retrograde superior vena cava cerebral perfusion during circulatory arrest was performed on 4 patients. All patients survived. One patient had a minor stroke and pneumonia with complete recovery. There was no evidence of pseudoaneurysm formation, graft erosion, graft migration, or aortic bleeding in the postoperative period. No patients had permanent renal deficit. Follow-up (1 to 22 months; mean, 9.6 months) of all patients revealed satisfactory graft function, with no device-related deaths and no known complications attributable to the prosthesis, such as thrombosis, erosion, pseudoaneurysm formation, or hemorrhage. Our experience suggests that grafting of the ascending aorta is less hazardous with the sutureless grafts than with the conventional sutured anastomosis technique. We are now using this method whenever possible in all substitutions of the aorta.

Acute Disease↗

PubMed2005

Retained antibiotic ophthalmic ointment on an intraocular lens 34 months after sutureless cataract surgery.

PURPOSE: To quickly examine the long-term retained oily-like material on the intraocular lens (IOL) of a sutureless cataract surgical patient. DESIGN: Observational case report. METHODS: Fourier transform infrared (FT-IR) and confocal Raman microspectroscopies were used to identify the deposited materials on explanted IOL. RESULTS: A 70-year-old man underwent a sutureless cataract surgery for his right eye. Garamycin ophthalmic ointment was postoperatively applied on the conjunctival fornix. His vision was improved to 20/25 after surgery but declined gradually to 20/400 half a year later. An oily-like hump on the anterior surface of IOL was found and he underwent IOL exchange after approximately 3 years. The oily-like material was identified by using FT-IR and Raman microspectroscopies to be garamycin ophthalmic ointment. CONCLUSIONS: Both FT-IR and Raman microspectroscopies can easily examine the retained antibiotic ophthalmic ointment on the IOL. Direct access of ophthalmic ointment into ocular anterior chamber through the sutureless incision is a potential risk.

Aged↗

PubMed2004

Sutureless videoendoscopic thoracic aorta to iliac artery bypass: the easiest approach to occlusive aorto-iliac diseases.

OBJECTIVE: We designed an animal study to determine the feasibility of videoendoscopic thoracic aorta to iliac artery bypass using a sutureless anastomotic device for proximal anastomosis construction. METHODS: In 12 pigs the descending thoracic aorta was exposed using the thoracoscopic technique. A 4 mm PTFE thin wall graft was used as conduit. The proximal anastomosis was constructed using a mechanical device for sutureless anastomosis inserted through the camera port incision. The prosthesis was passed through the diaphragm in the retroperitoneal space and the distal anastomosis was done with running suture. RESULTS: The operation was successfully completed in 11 animals. One animal died due to hemorrage during anastomosis construction. Mean graft flow was 144 ml/min (range 88-167 mmHg). The angiogram showed no graft kinking or stenosis. Total operative time was 58 min (range 47-68 min). CONCLUSIONS: This approach allows quick and excellent exposure of the entire descending thoracic aorta. The use of the sutureless device to perform the proximal anastomosis dramatically reduces the technical demands of this procedure and could avoid an aortic clamp.

Anastomosis, Surgical↗

PubMed2005

Comparison of clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy and standard 20-gauge vitrectomy for patients with cataract and vitreoretinal diseases.

PURPOSE: To compare effectiveness and outcomes of clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy and standard 20-gauge vitrectomy system for patients with clinically significant cataract and vitreoretinal diseases. SETTING: Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China. METHODS: Clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy was performed in the study group (15 eyes). Patients in the control group (15 eyes) had combined surgery with clear corneal phacoemulsification and the existing 20-gauge vitrectomy system, providing a comparison between 2 groups with regard to preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure, and intraoperative and postoperative complications. The additional outcome measurements in both groups were duration of the surgical procedures, time to return to preoperative corneal clarity, time to achieve stable vision, and subjective ocular irritation postoperatively. RESULTS: Postoperatively, BCVA improved in 12 eyes (80%) in the study group and in 11 eyes (73.3%) in the control group. Mean operative time for opening and closing the sclerotomy was significantly greater in the control group than in the study group. Time to return to preoperative corneal clarity and time to achieve stable vision showed no significant difference between the groups. Compared with the control group, postoperative ocular irritation in patients in the study group was considerably reduced. CONCLUSIONS: Combined sutureless surgery needed shorter setup time for sclerotomy and caused less postoperative ocular irritation than combined surgery with 20-gauge vitrectomy. Therefore, this type of procedure would be a good option for selected cases with cataract and vitreoretinal diseases.

Aged↗

PubMed2006

Clinical outcomes of combined sutureless vitrectomy with triamcinolone stain to manage vitreous loss resulting from posterior capsule rupture during phacoemulsification.

PURPOSE: To investigate the efficacy of sutureless pars plana vitrectomy (PPV) combined with intracameral triamcinolone stain in the management of vitreous loss associated with phacoemulsification. SETTING: Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China. METHODS: This retrospective review comprised the charts of 21 patients who had sutureless PPV combined with intracameral triamcinolone stain to manage vitreous loss resulting from posterior capsule rupture during phacoemulsification. The charts were analyzed for type of cataract, posterior segment pathology, methods of anesthesia, intraocular lens (IOL) placement, postoperative visual acuity, intraocular pressure, and complications. Additional outcome measurements were duration of the surgical procedures, period of postoperative corneal edema, and time to achieve stable vision. RESULTS: Excluding 2 eyes with preexisting conditions, 18 of 19 eyes (94.7%) had a final best corrected visual acuity (BCVA) of 20/40 or better and 42.1% (8/19) had a final BCVA of 20/20 or better. The mean duration of the surgery was 25.3 minutes (range 16 to 40 minutes). Corneal edema was noted in 12 eyes (57.1%) 3 days postoperatively and 3 eyes (14.3%) at 7 days. Eleven eyes (52.4%) had stable vision at 1 week, and 16 eyes (76.2%) had stable vision within 1 month postoperatively. Four eyes (19.0%) had postoperative complications that included a displaced IOL in 3 eyes (14.3%) and cystoid macular edema in 1 eye (4.8%). CONCLUSIONS: Self-sealing, sutureless PPV combined with intracameral triamcinolone stain was a safe, reliable adjunct to manage vitreous loss during phacoemulsification. The surgery led to rapid visual recovery.

Adult↗

PubMed2002

Sutureless contact lens ring system during vitrectomy.

PURPOSE: To report a new sutureless ring system to fix corneal contact lens in place during vitrectomy. DESIGN: New surgical instrument. METHODS: The sutureless ring system consists of a stainless steel ring that has two upright tabs 180 degrees apart with a hook on the top and two elastic silicone bands 8 mm in diameter to fix the ring to the eyelid speculum. RESULTS: The contact lens fixed in place with the sutureless ring was stable and allowed intraoperative visualization of the fundus. CONCLUSION: This suture-free contact lens system facilitates visualization of the fundus during vitrectomy allowing shorter surgical time. It also enables us to avoid additional trauma associated with the lens ring fixation procedure.

Contact Lenses↗

PubMed1999

Modified sutureless sclerotomies in pars plana vitrectomy.

PURPOSE: To study the effectiveness and safety of a modified sutureless sclerotomy technique in pars plana vitrectomy. METHODS: We rotated the scleral tunnels of the original sutureless sclerotomy technique through 90 degrees, thus rendering them parallel to the corneoscleral limbus. This modified technique was applied to 25 consecutive eyes (25 patients) that had pars plana vitrectomy during a 2-month period. RESULTS: Twenty (80%) of 25 eyes (25 patients) did not require suturing of the sclerotomy sites associated with pars plana vitrectomy. Eight (11%) of 75 sclerotomy sites required suturing to ensure watertight closure. No clinically significant complications were encountered. CONCLUSION: The modified sutureless sclerotomy technique was found to be safe, more convenient, and easier to perform, especially in eyes with small interpalpebral space.

Humans↗

PubMed2003

Combined use of off-pump techniques and a sutureless proximal aortic anastomotic device reduces cerebral microemboli generation during coronary artery bypass grafting.

OBJECTIVE: Intraoperative cerebral microemboli are associated with the development of postoperative stroke and neurocognitive decline in patients undergoing coronary artery bypass grafting. Although cardiopulmonary bypass is responsible for the generation of a significant number of such emboli, the elimination of cardiopulmonary bypass alone has not been conclusively shown to improve neurocognitive outcome. The current study was performed to determine the effects of combined off-pump coronary artery bypass grafting and sutureless proximal aortic anastomotic techniques on the generation of intraoperative cerebral microemboli compared with standard coronary artery bypass grafting techniques of cardiopulmonary bypass and hand-sewn proximal anastomoses. METHODS: Fifty-three patients underwent off-pump coronary artery bypass grafting by using the sutureless Symmetry aortic connector device (St Jude Medical, St Paul, Minn) for all proximal anastomoses. Eighteen of these patients received intraoperative transcranial Doppler ultrasonography to determine right- and left-sided cerebral microembolic counts. These results were compared with those obtained from a similar group of 17 patients undergoing standard coronary artery bypass grafting, in whom cardiopulmonary bypass and hand-sewn proximal anastomoses were used. RESULTS: Our use of the proximal anastomotic device in patients undergoing coronary artery bypass grafting was safe, with no aortic complications, postoperative strokes, or in-hospital deaths. Microembolic counts to both the right and left cerebral circulation were significantly reduced in the patients undergoing off-pump coronary artery bypass grafting (right = 21.9 +/- 20.7 emboli, left = 24.9 +/- 19.2 emboli) compared with those in patients undergoing standard coronary artery bypass grafting (right = 181.6 +/- 85.3, left = 189.9 +/- 60.401, P <.0001). CONCLUSIONS: Our use of a sutureless proximal anastomotic device during off-pump coronary artery bypass grafting is safe and significantly decreases cerebral microembolism when compared with standard coronary artery bypass grafting with cardiopulmonary bypass and hand-sewn anastomoses. Long-term follow-up is needed to determine the effects of this technical strategy on neurocognitive outcome.

Aged↗

PubMed1995

Is the sutureless cataract incision a valve for bacterial inoculation?

Many cataract surgeons perform sutureless surgery to decrease operating time, postoperative astigmatism, and healing time. Anecdotal case reports of postoperative endophthalmitis after sutureless surgery prompted our investigation of this type of wound closure and its possible relationship to an increased incidence of infection. This in vitro study addressed the question: Is sutureless more likely than sutured cataract surgery to provide a route for inoculation of microbial organisms into the eye? Twenty-eight human eyes obtained postmortem were randomly divided into 14 pairs and successively incubated for 90, 150, 210, and 270 minutes each in a suspension of Staphylococcus epidermidis in physiologic media. Cultured aqueous aspirates yielded no significant differences between sutured and unsutured eyes in colony counts at any time interval. This suggests that both sutured and unsutured wounds resist bacterial ingrowth equally and that a properly constructed unsutured wound is not a significant valve for bacterial inoculation in an eye pressurized to physiological conditions.

Adult↗

PubMed1998

Two year follow-up of astigmatism after phacoemulsification with adjusted and unadjusted sutured versus sutureless 5.2 mm superior scleral incisions.

PURPOSE: To evaluate changes in astigmatism 6 months to 2 years after 5.2 mm superior scleral incision phacoemulsification using 3 closures. SETTING: Department of Ophthalmology, Vejle Hospital, Vejle, Denmark. METHODS: This long-term follow-up study included 75 consecutive phacoemulsification patients who were randomly allocated to 1 of 3 incision closures: 1 intraoperatively adjusted cross suture, 1 unadjusted cross suture, no suture. Postoperative astigmatism after 1 and 2 years was evaluated by keratometric cylinder, induced astigmatism (Naeser's polar values), induced cylinder (Jaffe's vector analysis), and vector decomposition (Olsen). The data were compared with 1 week values. RESULTS: In the previous study, median astigmatism after 6 months was similar in all 3 groups, but only the sutureless group showed early stability. Significant against-the-rule (ATR) changes were seen in the sutured cases (P < .01). The 1 and 2 year follow-up showed continued stability in the sutureless cases. The adjusted-suture group exhibited stability after 6 months, while the unadjusted-suture group showed a further tendency to change ATR. At 2 years, median ranges of astigmatism were -0.49 to -0.90 diopter (D) (Naeser), 0.77 to 1.02 D (Jaffe), and 96% to 98% ATR (Olsen). The intergroup differences were not statistically significant. CONCLUSION: Two year follow-up confirmed that sutureless closure led to early astigmatism stability. Using a suture prolonged the postoperative period of astigmatism instability, and if used without intraoperative adjustment, a tendency toward a less predictable outcome persisted after 2 years.

Aged↗

PubMed2002

Sutureless securement device reduces complications of peripherally inserted central venous catheters.

PURPOSE: This study was conducted to evaluate the performance of a sutureless adhesive-backed device, StatLock, for securement of peripherally inserted central venous catheters (PICCs). Earlier studies have demonstrated that StatLock significantly reduces catheter-related complications when compared to tape. The purpose of this study was to determine whether a sutureless securement device offers an advantage over suture in preventing catheter-related complications. MATERIALS AND METHODS: 170 patients requiring PICCs, which were randomized to suture (n = 85) or StatLock (n = 85) securement were prospectively studied. Patients were followed throughout their entire catheter course, and PICC-related complications including dislodgment, infection, occlusion, leakage, and central venous thrombosis were documented. Catheter outcome data were compared to determine if statistically significant differences existed between the suture and StatLock groups. RESULTS: The groups had equivalent demographic characteristics and catheter indications. Average securement time with StatLock was significantly shorter (4.7 minutes vs 2.7 minutes;P <.001). Although StatLock was associated with fewer total complications (42 vs 61), this difference did not achieve significance. However, there were significantly fewer PICC-related bloodstream infections in the StatLock group (2 vs 10; P =.032). One securement-related needle-stick injury was documented during suturing of a PICC. CONCLUSION: The sutureless anchor pad was beneficial for both patients and health care providers. Further investigation to determine how StatLock helps reduce catheter-related blood stream infections is necessary.

Adult↗

PubMed2006

Sutureless amniotic membrane fixation using fibrin glue for ocular surface reconstruction in a rabbit model.

PURPOSE: Amniotic membrane transplantation has become an important treatment option for corneal surface reconstruction. However, suture fixation of the transplant has various disadvantages like corneal irritation, scarring, graft loss due to membrane shrinkage, and the need for subsequent suture removal. Replacement of sutures by bioadhesives might be an advantageous alternative. This controlled study was designed to evaluate a new sutureless technique for amniotic membrane fixation onto the corneal surface by using fibrin glue. METHODS: Standardized disks of cryopreserved amniotic membranes were transplanted onto the deepithelialized cornea of 12 rabbits using either conventional suture fixation or a new fibrin glue technique. The rabbits were followed-up with slit-lamp examination and fluorescein staining until epithelialization was completed. Consecutively, the rabbits were killed and the eyes processed for histology and immunohistochemistry for cytokeratin-3. RESULTS: All membranes of both groups stayed in place throughout the follow-up time and showed a progressive graft epithelialization that was completed after 12 days. Whereas suture-fixated membranes showed progressive tissue shrinkage, fibrin-glued sheets remained unaltered. In the bioadhesive group, histology revealed a smooth fibrin layer in the graft-host interface and a continuous, stratified layer of cytokeratin-3 expressing corneal epithelial cells on the membrane surface. In contrast, suture-fixated membranes showed contracted and prominent membrane edges with epithelial ingrowth into the submembrane interface. CONCLUSION: Our results demonstrate the general feasibility of reproducible and reliable sutureless amniotic membrane fixation onto the corneal surface in rabbits. Stable adherence is maintained until epithelialization is completed. The sutureless technique gives sufficient manipulation time for the sheet before the final cross-linking process is completed. Furthermore, several advantageous characteristics could be demonstrated as increased biocompatibility, better epithelialization pattern and the lack of membrane shrinkage.

Amnion↗

PubMed2004

Sutureless transconjunctival repair of orbital blowout fractures.

PURPOSE: To evaluate early postoperative results and complications in patients who underwent repair of isolated orbital floor blowout fractures with placement of nonfixed implants through a transconjunctival and sutureless incision. METHODS: We retrospectively reviewed 26 cases of isolated floor fractures repaired by this technique. Criteria for inclusion in this study were transconjunctival approach, nonfixed orbital implants, and sutureless closure. Early postoperative complications were evaluated. RESULTS: Twenty-six patients (16 male, 10 female) underwent repair of an isolated floor fracture and were followed after surgery for 1 to 26 months. No eyelid malposition, infection, or implant extrusion occurred. However, 1 patient (3.8%) had early migration of the orbital implant that did not require further intervention. CONCLUSIONS: Repair of orbital floor blowout fractures with a nonfixed implant through the transconjunctival approach and sutureless closure provides an excellent functional and cosmetic result.

Adolescent↗

PubMedDate not supplied

Sutureless cholecystojejunostomy in pigs using an absorbable intraluminal stent and fibrin glue.

The absence of foreign bodies in sutureless anastomoses provides faster healing. The first sutureless cholecystojejunostomies were reported by Murphy in 1892. The common bile duct was tied and 11 cholecystojejunostomies plus 12 jejunojejunostomies were performed in 12 Landrace pigs employing sliding absorbable intraluminal nontoxic stents (SAINTs) and fibrin glue. One cholecystojejunostomy was not performed owing to a gallbladder morphologic anomaly. Three animals died of problems unrelated to the SAINT-glue anastomoses. Of the 18 anastomoses in the 9 remaining animals, all were patent at the verification times of 14, 30, 120, and 480 days. Morphologically,there was greater edema and reduced height of the glandular epithelium in the 30-day CJs when compared to the jejunojejunal anastomoses. Results indicate that the sutureless SAINT-fibrin glue procedure is quite versatile and may be utilized for cholecystoenteric anastomoses.

Anastomosis, Surgical↗

PubMedDate not supplied

Gastrointestinal sutureless anastomosis using fibrin glue: reinforcement of the sliding absorbable intraluminal nontoxic stent and development of a stent placement device.

Sutureless anastomosis of the gastrointestinal tract using fibrin glue and sliding absorbable intraluminal nontoxic stents (SAINTs) has two shortcomings, stent shaft breakage and the lack of a transanal insertion device (TID) for low anterior resection. Reinforcement of the sucrose base SAINT (R-SAINT) is described. Sutureless anastomosis is attempted using a stapleless mechanical stapler (SS) and used as preprototype to screen histologically and mechanically for TID anastomoses in the small intestine. Finally, a prototype absorbable head SAINT placement device (SAINT-PD) intended for TID, similar to the SS, is utilized on the small intestine. Fifty-seven Landrace pigs weighing 25-35 kg were used to perform 58 anastomoses, including the small intestine (15 manual, 19 SAINT, 11 SS, 5 R-SAINT, 6 SAINT-PD) and large intestine (2 R-SAINT). All anastomoses performed with the R-SAINT succeeded on the first attempt even if the shaft cracked. The SS technique proved impractical, but the histological screen results from 7 to 60 days did approximate those of corresponding SAINT anastomoses. The SAINT-PD demonstrated operational improvement over the SS, but the histological results were similar to both the SS and SAINT. The advantages of the R-SAINT and SAINT-PD are that they leave no foreign bodies or pressure clamping devices at the anastomostic site. Larger studies may show the R-SAINT and the SAINT-PD to be practical, new surgical tools in sutureless fibrin glue anastomosis.

Absorption↗