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At least 541 records · Page 30Linked to original sources

PubMed2006

Contemporary management of right atrial isomerism: effect of evolving therapeutic strategies.

OBJECTIVES: Infants with right atrial isomerism have poor outcomes because of a complex combination of cardiac anomalies. Aggressive management of total anomalous pulmonary venous drainage might have a positive effect on the prognosis. METHODS: Outcomes of all children with right atrial isomerism from 1994 to the present were reviewed. Management of total anomalous pulmonary venous drainage evolved from no repair or conventional surgical technique to primary sutureless repair on initial palliation. Cox survival models were used to identify variables associated with reduced survival. RESULTS: There were 55 children enrolled in the study. The median age at the initial visit was 2 days. Fifty-one patients had total anomalous pulmonary venous drainage (obstructive in 22 patients). Withdrawal of treatment occurred in 11 (20%) of 55 patients during an interval of institutional bias toward no treatment. Thirteen (24%) of 55 patients had palliations without total anomalous pulmonary venous drainage repair, and 3 (23%) of 13 survived. Thirty-one (56%) of 55 patients had operations that included total anomalous pulmonary venous drainage repair, of whom 13 (42%) of 31 underwent primary sutureless repair for total anomalous pulmonary venous drainage. Sixteen (52%) of 31 survived, and their current status 1 to 10 years (median, 5.8 years) after repair is post-Fontan (7/16 [44%]), postbidirectional Glenn (6/16 [38%]), and others (3 [20%]). In patients who underwent total anomalous pulmonary venous drainage repair (n = 31), 2 risk factors of decreased survival were identified: drainage site obstruction and infracardiac or mixed-type total anomalous pulmonary venous drainage. After adjustment, sutureless repair appeared to be associated with improved survival (hazard ratio, 0.43), but this beneficial effect did not reach significance (P = .19). CONCLUSIONS: Mortality continues to be high; however, aggressive total anomalous pulmonary venous drainage repair for right atrial isomerism has resulted in improved survival. The role of primary sutureless repair for total anomalous pulmonary venous drainage remains to be defined.

Anastomosis, Surgical↗

PubMed1994

Corneal lip tunnel incision.

To evaluate whether the corneal lip tunnel incision or the sutureless closure causes any refractive problems, we performed a retrospective study on 387 cataract surgery patients who were divided into four groups based on type of wound closure and whether the corneal lip was made. The four groups consisted of patients who received an X-stitch closure without the corneal lip, a horizontal mattress stitch without the lip, a horizontal mattress stitch with the lip, and a sutureless closure with the lip. All patients had phacoemulsification in situ; implantation of a foldable silicone lens was performed through a scleral tunnel incision. Clinical evaluations included preoperative characteristics and postoperative Snellen visual acuity, intraocular pressure, and vector analysis of cylinder. In all four groups, a 4.0 mm wide incision was used. Entrance into the clear cornea during the corneal lip tunnel incision did not induce additional cylinder, and the sutureless closure did not decrease induced cylinder or increase the against-the-rule shift. The results of this study indicate that the combination of a 4.0 mm incision with 1.5 mm corneal lip, phacoemulsification in situ, foldable lens implantation, and sutureless closure is a safe and effective procedure for cataract surgery.

Aged↗

PubMed1988

[Early phase of healing of anastomoses with special reference to peritonitis and ischemia].

Experimental sutureless colonic anastomosis was evaluated under various conditions during the first 24 postoperative hours. Adaptation of large bowel segments was achieved by interrupted inverting sutures, which were removed after one hour. This short adaptation period was sufficient for fibrinous contact of bowel segments. Breaking strength of intestinal anastomosis was determined under normal conditions, in peritonitis, complete ischemia and unilateral ischemia of one bowel segment. As control parameter breaking strength of conventional anastomosis was determined under normal conditions. We obtained the following results: 1) Sutureless anastomosis exhibited significantly lower breaking strength than conventional anastomosis. 2) Sutureless anastomosis showed a significant increase in breaking strength under normal conditions after the first 6 h, on the contrary breaking strength remained at lower levels in peritonitis. 3) In complete ischemia anastomotic failure was observed even after 3 h of adaptation. Therefore breaking strength was not measurable. 4) Under unilateral ischemia breaking strength of intestinal anastomosis was significantly lower than under normal conditions.

Anastomosis, Surgical↗

PubMed2006

[Early single-center experience with the 3F-enable aortic valve bioprosthesis].

BACKGROUND AND PURPOSE: Patients with aortic valve (AV) pathology and severe comorbidities should benefit from reduced myocardial ischemic and extracorporeal circulation (ECC) time. Sutureless implantation of AV prosthesis may reduce myocardial ischemic and ECC time significantly. The authors report on their preliminary results with the first implants of the 3F-Enable sutureless AV prosthesis. MATERIAL AND METHODS: The 3F-Enable prosthesis was implanted in five patients. Prostheses sizes were 27 mm (n = 3), 23 mm (n = 1), and 21 mm (n = 1), respectively. Intraoperatively, at patient's discharge as well as 3 and 6 months postoperatively, the AV prosthesis was evaluated by echocardiography. RESULTS: ECC time was 87 +/- 36 min (range 49-141 min), myocardial ischemic time 55 +/- 27 min (range 32-97 min), and AV implant time 184 +/- 195 s (range 10-420 s). The latest postoperative echo (5.2 +/- 1 months postoperatively) revealed a fully competent AV in three patients, in two patient paravalvular leakage was detected at the severity of an aortic regurgitation (AR) II degrees , and AR II degrees -III degrees , respectively. The mean pressure gradients were 5.8 +/- 1.3 mmHg (range 4.2-7.1 mmHg), valve orifice area was 3.2 +/- 0.4 cm2 (range 2.6-3.6 cm2). CONCLUSION: The first clinical results of the 3F-Enable sutureless AV prosthesis are feasible; however, a paravalvular leakage was detected in two patients (40%). Thus, device and procedural enhancements are required to assure positioning and anchoring of the prosthesis.

Aged↗

PubMed1997

[3 1/2 years experiences with ECCE with tunnel incision].

Since January 1992 planned extracapsular cataract extraction (ECCE) is performed routinely with the no-stitch technique at our clinic. To minimize surgically induced astigmatism further, modified wound constructions for planned ECCE with on 1.1-mm tunnel width were evaluated. The follow-up time was up to 3 years postoperatively. For 250 eyes wound closure was performed prospectively either sutureless (n = 70), with a single perpendicular suture (n = 100) or cross sutures (n = 40) at the 12 o'clock position or sutureless in the temporal position (n = 40). The complication rate was 4% (filtering bleb, iris prolapse or transient hypotonia). There were no wound ruptures, but once endophthalmitis was observed. Late mean astigmatism after up to 3 years follow-up for vertical incision was 2.05 +/- 1.16 D (1.01 +/- 0.96 D preoperatively) for sutureless wound closure, 1.63 +/- 1.08 D (0.86 +/- 0.95 D) for perpendicular and 1.76 +/- 0.88 D (0.73 +/- 0.55 D) for cross-sutures. A temporal incision resulted in 0.78 +/- 0.52 D (1.0 +/- 0.69 D) of astigmatism and was only performed on eyes with against the rule astigmatism preoperatively. Surgically induced astigmatism was stabilized early. For with the rule astigmatism preoperatively, a 12 o'clock incision with a perpendicular single suture is recommended and for against the rule astigmatism, a temporal incision.

Astigmatism↗

PubMed2005

Mesh fixation with human fibrin glue (Tissucol) in open tension-free inguinal hernia repair: a preliminary report.

BACKGROUND: The Lichtenstein technique for inguinal hernia repair is easy to learn and associated with few complications. However, recent studies have suggested that this technique is inferior to some 'sutureless' repair systems in terms of perceived difficulty, operating time, surgeon satisfaction, etc. METHODS: We employed a sutureless Lichtenstein technique in 80 consecutive patients with primary unilateral inguinal hernia, to assess patient and trainee surgeon outcomes. Human fibrin glue was used in place of conventional sutures. RESULTS: The mean operating time was 36 min and all patients were discharged 5-6 h after the operation. On a 100-point visual analogue scale, the surgeons rated the difficulty of the operation as low (mean score, 31), and perceived satisfaction as high (mean score, 84). No complications were observed at 12-month follow-up. CONCLUSION: This study confirms the efficacy of mesh fixation with human fibrin glue, and supports the viability of a sutureless Lichtenstein procedure.

Adult↗

PubMed2006

Management of congenital and acquired pulmonary vein stenosis.

BACKGROUND: Pulmonary vein (PV) stenosis, whether congenital or after repair of total anomalous pulmonary venous connection (TAPVC), continues to carry a poor prognosis. METHODS: A retrospective review identified 36 patients who underwent repair of PV stenosis between December 1989 and June 2003. Fourteen with congenital PV stenosis underwent scar excision and primary repair (n = 2), intraoperative stent placement (n = 4), or sutureless pericardial marsupialization (n = 8). Twenty-two with acquired PV stenosis after TAPVC repair underwent anastomotic revision and/or vein repair (n = 11) or sutureless pericardial marsupialization (n = 11). Follow-up ranged from 1 month to 14 years (median, 30 months). RESULTS: Among the 14 patients with congenital PV stenosis, 8 died (3 early deaths, 4 late deaths with restenosis, and 1 late noncardiac death). Among the six survivors, five (4 after marsupialization) have not developed restenosis. Among 11 of 22 patients with acquired PV stenosis undergoing anastomotic revision or vein repair, there were 5 deaths (2 early, 2 late with restenosis, and 1 late noncardiac death) and 1 of the six survivors has developed restenosis. Of the remaining 11 undergoing marsupialization, there was one late death (with restenosis) and 10 survivors have no restenosis. Congenital etiology, use of marsupialization technique, presence of associated defect, and extent of disease were identified as risk factors for poor outcome. CONCLUSIONS: Patients with pulmonary vein stenosis continue to have a guarded prognosis. Sutureless pericardial marsupialization was associated with satisfactory midterm results and appears superior to other conventional techniques.

Heart Defects, Congenital↗

PubMed2005

Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients.

PURPOSE: To evaluate long-term IOP control after sutureless clear corneal phacoemulsification in eyes with preoperatively controlled glaucoma. SETTING: Institutional study. METHODS: The charts of 345 patients who had uneventful sutureless clear corneal phacoemulsification with acrylic foldable lens (IOL) implantation were retrospectively reviewed. Included were 58 patients with medically controlled open-angle glaucoma and 287 normal controls. Follow-up was 1 to 2 years. Outcome measures were postoperative IOP and number of glaucoma medications. RESULTS: Postoperatively, there was an insignificant decrease in IOP in the glaucoma group; the mean decrease was 1.5 mm Hg +/- 4.4 (SD) at 12 months and 1.9 +/- 4.9 mm Hg at 24 months. The mean number of medications decreased significantly at 12 months (0.53 +/- 0.86) and at 24 months (0.38 +/- 0.9) (P=.04). The control group also had a significant decrease in IOP, with a mean decrease of 0.72 +/- 3.7 mm Hg at 12 months (P=.01) and 1.33 +/- 3.2 mm Hg at 24 months (P<.0001). The decrease in IOP was more pronounced in eyes with a higher preoperative IOP in both the glaucoma and control groups. CONCLUSIONS: These findings suggest that sutureless clear corneal phacoemulsification with foldable acrylic IOL implantation is a relatively simple and efficient surgical option in patients with cataract and well-controlled glaucoma. The approach combines long-term IOP control with fewer medications and leads to rapid visual rehabilitation.

Acrylic Resins↗

PubMed2004

Clinical and angiographic results after mechanical connection for distal anastomosis in coronary surgery.

BACKGROUND: Sutureless anastomotic devices are of increasing interest in cardiovascular surgery. We investigated the stainless steel clip system of St Jude Medical/Anastomotic Technology Group (Maple Grove, Minn) to connect saphenous vein grafts with coronary arteries. METHODS: Forty-five patients were enrolled in this feasibility study performed on patients who had on-pump coronary artery bypass grafting, but 32 patients only received 1 distal anastomosis with this investigational device (2.5 mm [n = 14] and 2.0 mm [n = 18]). Thirteen were excluded because target vessels were too small, calcified, or tortuous. The system consists of an expandable clip mounted on a balloon catheter; delivery is obtained during balloon inflation. The main differences between the 2.5-mm and 2.0-mm devices are different loading and deployment in smaller coronary arteries for the 2.0-mm device. RESULTS: A connecting device was deployed on the right coronary artery in 14 patients, the posterior descending branch in 12 patients, the obtuse marginal in 5 patients, and the posterolateral branch in 1 patient. Perfect hemostasis of the sutureless connector anastomosis was obtained in 28 patients. Three connectors were removed because of minor leakage at the connection site, and 1 connector was removed because of mismanipulation after successful deployment. Hand-sewn anastomosis was performed at the same arteriotomy site. Intraoperative flow was assessed by the transit time method and averaged 71 +/- 24 mL/min. One patient died of neurologic injury; the connector was patent at autopsy. One patient had a perioperative myocardial infarction. There was no adverse cardiac event in the remaining patients. All patients underwent clinical follow-up after 6 and 12 months and 35 angiograms were available in 21 patients: after 3 and 6 months, 17 anastomoses were patent and the saphenous vein graft was occluded in 4 patients. CONCLUSIONS: The coronary connector system from St Jude Medical/Anastomotic Technology Group allows consistently uniform sutureless connection between the saphenous vein graft and coronary artery. Loading and deployment require careful training. This technology is under constant development and may give a significant boost to less invasive coronary revascularization techniques.

Aged↗

PubMed1999

Surgical management of progressive pulmonary venous obstruction after repair of total anomalous pulmonary venous connection.

BACKGROUND: The occurrence of a progressive pulmonary venous obstruction after the repair of the total anomalous pulmonary venous connection is a severe complication. OBJECTIVES: The objectives of this study were to retrospectively review the patients with this condition and to report our experience with a new surgical technique with a sutureless in situ pericardium repair. METHODS: Of 178 patients who underwent correction of total anomalous pulmonary venous connection, 16 patients (9%) experienced the development of a progressive pulmonary venous obstruction in a median interval of 4 months (5 weeks-12 years). Three patients had isolated anastomotic stenosis, 4 patients had isolated pulmonary venous ostial stenosis, and 9 patients had both. Pulmonary venous obstruction was bilateral in 7 patients. The surgical procedures used at reoperation included 8 patch enlargements, 5 ostial endarterectomies, 1 intraoperative stenting, and 7 sutureless in situ pericardium repairs. RESULTS: There were 4 deaths after reoperation (4 of 15 patients; 27%). The only significant mortality risk factor was the bilateral location of the pulmonary venous obstruction (P =.045). In patients with isolated anastomotic stenosis or with only 1 pulmonary venous ostial stenosis (n = 5), there was no death, except the patient presenting with a single ventricle. In patients with 2 or more pulmonary venous ostial stenoses (n = 10), there were 3 deaths; 5 of the 7 survivors were successfully treated with the in situ pericardial technique, with normalized pulmonary artery pressure at a mean follow-up of 26 months. CONCLUSION: Progressive pulmonary venous stenosis after repair of total anomalous pulmonary venous connection remains a severe complication when bilateral. The sutureless in situ pericardial repair offers a satisfactory solution, particularly on the right side.

Female↗

PubMed2002

Vesicourethral anastomosis with 2-octyl cyanoacrylate adhesive in an in vivo canine model.

OBJECTIVES: To evaluate the effectiveness of 2-octyl cyanoacrylate adhesive (OCA) in the formation of vesicourethral anastomoses. METHODS: Open total prostatectomy was performed on 12 mongrel hounds. Of these, 8 had a vesicourethral anastomosis formed using OCA (4 with suture support and 4 sutureless). The remaining four anastomoses were conventionally formed using eight interrupted sutures. Acute leakage was tested intraoperatively. Before killing the hounds, the anastomosis of 1 animal in each group was assessed on postoperative days 3, 5, 7, and 14 by radiography. Each anastomotic specimen was then tested for leak pressure and examined histologically. RESULTS: At intraoperative testing, one small leak was found in the sutureless OCA group. All other anastomoses were watertight intraoperatively. Radiographically, two leaks occurred in the OCA group with suture support, three leaks in the sutureless OCA group, and only one small localized leak in the control group. Only one of the eight anastomoses using OCA achieved a physiologic leak pressure greater than 70 mm Hg (one of these, however, could not be tested because of injury at the time the specimen was retrieved). The leak pressures of all four control-group anastomoses were 70 mm Hg or greater. Histologically, no significant differences were found in healing between the control and OCA anastomoses. CONCLUSIONS: With or without suture support, OCA appears to be unsuitable for use in forming the large-diameter vesicourethral anastomosis required in radical prostatectomy.

Anastomosis, Surgical↗

PubMed1996

Hypospadias repair by laser tissue soldering: intraoperative results and follow-up in 30 children.

OBJECTIVES: We examined the use of laser tissue soldering (LTS) as an adjunct to suturing of, as well as a primary means of, tissue closure in urethral reconstruction. METHODS: Since June 1994, 26 boys ranging in age from 3 months to 14 years (mean 3.0 years) underwent hypospadias repair using LTS techniques. The classification of hypospadias was subcoronal in 13, midpenile in 5, penoscrotal in 7, and scrotal in 1. Laser tissue soldering was used in an additional 4 patients: tunica vaginalis patch graft corporoplasty in 2 (scrotal hypospadias), epispadias fistulae in 1, and urethral diverticulum in 1. Of these cases, 3 hypospadias repairs were completely sutureless. An intraoperative comparision was made between suturing and LTS with respect to operative time and degree of difficulty in performing LTS. Postoperatively, patients were examined to determine complications, including stricture, fistula, or impaired wound healing. An unselected group of 25 consecutive boys undergoing hypospadias repair between 1991 and 1992 served as a historical control group. RESULTS: No intraoperative complications resulted from laser activation. In 5 of the 30 procedures (16.6%), suture disruption was noted to occur, with a higher incidence seen with finer, dyed suture material. For hypospadias repair, the average time to suture was 6.7 min/cm (n = 23), whereas it was 3.1 min/cm for adjunctive LTS (n = 23) and 1.4 min/cm for sutureless urethroplasty (n = 3). Follow-up ranged from 3 to 22 months (average 9.6). Four fistulae were noted (1 onlay, 2 skin tube grafts, 1 Thiersch tube) each following penoscrotal or scrotal hypospadias repair; a fifth fistula developed following a traumatic catheterization in a sutureless repair. The overall complication rate in the LTS group was 19% (5 of 26) versus 24% (6 of 25) for controls, whereas that for the distal forms of hypospadias was 11% (2 of 18) and 13.6% (3 of 22), respectively. CONCLUSIONS: Tissue soldering with laser and chromophore-doped solder is feasible, safe, and easy to perform. Laser tissue soldering may be an alternative to standard microsuture technique for hypospadias repair.

Adolescent↗

PubMed1996

Phacoemulsification with intraocular lens implantation in high myopia.

PURPOSE: To assess phacoemulsification and posterior chamber intraocular lens (IOL) implantation in highly myopic eyes and to compare the results of sutureless scleral tunnel incision and sutured scleral incision techniques. SETTING: The Eye Institute of Utah, Salt Lake City. METHODS: A series of 109 highly myopic eyes (axial length over 26.00 mm) were reviewed at a mean postoperative follow-up of 27 months. RESULTS: Postoperative corrected visual acuity was 20/40 or better in 94% of eyes, and uncorrected visual acuity was 20/40 or better in 77% of eyes. Posterior capsule opacification developed in 50% of eyes; 95% of these had neodymium:YAG (Nd:YAG) laser capsulotomy. Cystoid macular edema occurred in two eyes, and one eye developed retinal detachment following Nd:YAG capsulotomy. Eyes that had sutureless scleral tunnel incisions attained earlier postoperative rehabilitation of visual acuity and stabilization of astigmatism than did patients who had sutured scleral incisions. CONCLUSIONS: The results of this study of highly myopic eyes indicate that treating retinal pathology preoperatively and using the sutureless procedure, phacoemulsification, and in-the-bag IOL placement lead to good visual outcome, a lower rate of retinal complications, and a more stable wound.

Adult↗

PubMed1998

Long-term course of surgically induced astigmatism after a 5.0 mm sclerocorneal valve incision.

PURPOSE: To study surgically induced astigmatism (SIA) after a sutureless 5.0 mm sclerocorneal valve incision. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This study evaluated SIA in 34 cases of sutureless cataract surgery with a 5.0 mm superior sclerocorneal valve incision and implantation of a poly(methyl methacrylate) intraocular lens. Keratometry was measured with a Zeiss keratometer in all cases preoperatively, and 1 day, 1 week, 1 and 3 months, and 1 and 5 years postoperatively. RESULTS: Surgically induced astigmatism, calculated by Cravy's vector analysis, showed an initial mean with-the-rule shift of 0.35 diopter (D), followed by an against-the-rule shift to a mean of -0.30 D after 1 month. One year postoperatively, mean SIA was -0.46 D. Between 1 and 5 years postoperatively, there was a statistically significant increase in mean SIA calculated by Cravy's vector analysis; SIA increased from -0.46 D after 1 year to -0.76 D after 5 years postoperatively. CONCLUSIONS: A small, although statistically significant, amount of postoperatively induced astigmatism occurred 5 years after a sutureless 5.0 mm sclerocorneal valve incision.

Aged↗

PubMed2004

Corneal topographic changes after phacoemulsification through steep axis incision.

PURPOSE: To evaluate the effect of 5.5 mm sutured and 4.0 mm sutureless corneal incisions after phacoemulsification on corneal topograpy. MATERIAL AND METHODS: Twenty eyes of 20 patients that underwent phacoemulsification with IOL implantation were randomly divided into two. The first group received a PMMA IOL through a sutured 5.5 mm corneal incision. The second group received a foldable hydrophilic acrylic IOL through a sutureless 4.0 mm incision. Complete ocular examination and computerized corneal topography (Keratron Corneal Analyzer, Software version 3.2, Optikon 2000, Italy) were performed preoperatively, at 1 week, and 1 month postoperatively. The Maloney indices [best fit sphere (BFS), best fit cylinder (BFC) and topographic irregularity (TI)] were provided by the Keratron Corneal Analyzer. RESULTS: There was no statistically significant difference in the mean BFS between the groups preoperatively (p = 0.305), at postoperative week 1 (p = 0.362), and at postoperative month 1 (p = 0.160). The BFC was significantly higher in the 5.5 mm incision group than in the 4.0 mm incision group preoperatively (p = 0.025), however, there was no statistically significant difference between the groups at postoperative week 1 (p = 0.909), and at postoperative month 1 (p = 0.382). There was no statistically significant difference in the mean TI between the groups preoperatively (p = 0.494) and at postoperative week 1 (p = 0.271). However the mean TI at postoperative month 1 was significantly higher in the 5.5 mm incision group than the 4.0 mm incision group (p = 0.05). CONCLUSION: The 5.5 mm sutured incisions caused an increase in TI at 1 week and 1 month postoperatively. For a more rapid visual rehabilitation, 4.0 mm sutureless incisions are recommended.

Aged↗

PubMed2003

Use of adhesive surgical tape with the absorbable continuous subcuticular suture.

BACKGROUND: The absorbable continuous subcuticular suture is frequently used to close surgical incisions where the aim is healing by primary intention. A form of adhesive surgical tape is commonly also placed over the wound but this combination closure seems to have its development based on anecdotal, rather than experimental evidence. The present study reviews the scientific literature on the development of sutureless wound closure and presents the current evidence for the use of combination wound closure. METHODS: Review was undertaken of the medical literature using the PubMed Internet database and cross-referencing major -articles on the subject. The following combinations of key words were searched: skin closure, wound closure, suture technique, sutureless, adhesive tape, op-site, staples, subcuticular suture, complication, infection and scars. RESULTS: Taped closure alone has advantages of lower wound infection rates and greater wound tensile strength, but disadvantages of epidermal reaction, skin edge inversion, doubtful safety and time required for meticulous surgical technique. The use of the continuous absorbable subcuticular suture allows accurate skin edge approximation, which increases the safety margin. The combination closure has a slightly superior cosmetic result to sutureless techniques but no study has been performed to compare the results of combination subcuticular suture and tape, with tape or subcuticular suture alone. CONCLUSIONS: There is no evidence in the scientific literature to justify or support the practice of closing a surgical wound with both subcuticular suture and adhesive surgical tape.

Adhesives↗

PubMed1995

[Induced astigmatism in extracapsular cataract extraction with tunnel incision and various wound closures].

BACKGROUND: For planned extracapsular cataract extraction the no-stitch technique with 11-mm tunnel width has been well established. Four modifications of wound closure were performed to further reduce surgically induced astigmatism. PATIENTS AND METHODS: In this prospective study we controlled 250 eyes of 250 consecutive patients 4 months after surgery with four different wound constructions: sutureless wound closure (n = 70), singular perpendicular suture (n = 100), cross suture (n = 40) in 12 o'clock position or sutureless wound closure in temporal position (n = 40). RESULTS: Surgically 'Induced Astigmatism' was for eyes with preoperative 'With the Rule Astigmatism' (vs Against the Rule astigmatism), operation in 12 o'clock position and sutureless wound closure 2.22 +/- 0.77 D (1.66 +/- 0.94 D), with perpendicular suture 1.66 +/- 0.93 D (1.24 +/- 0.82 D), and with cross suture 1.47 +/- 0.96 D (0.9 +/- 1.13 D). Temporal incision was only performed in preoperative 'Against-the-Rule-Astigmatism' eyes and resulted in 0.6 D of 'Induced Astigmatism'. Preoperative average astigmatism was 0.86 +/- 0.68 D (1.01 +/- 0.95 D). CONCLUSIONS: For preoperative 'With the Rule Astigmatism', operation in 12 o'clock position and singular perpendicular suture and for 'Against the Rule Astigmatism' (especially > 1.5 D) temporal incision is recommended.

Astigmatism↗

PubMed2002

First clinical experience with an anastomotic device to facilitate aortomesenteric saphenous vein bypass.

The use of a sutureless anastomotic device recently has been reported for the construction of the proximal anastomoses during aortocoronary bypass surgery. In this report, we describe the first reported application of this device for the sutureless aortic anastomosis of an aortosuperior mesenteric artery saphenous vein graft. Sutureless anastomoses reduce the need for extensive dissection of the inflow vessel and may be performed rapidly and without blood loss.

Anastomosis, Surgical↗