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PubMed1998

[The use of prosthetic meshes in the surgical treatment of inguinal hernia: the costs and profits for the local health screening unit].

BACKGROUND: Inguinal hernioplasty represents one of the most frequently performed surgical operation. The recent introduction of prosthetic mesh made Bassini operation obsolete, with more space gained by the newly developed "tension-free" and "sutureless" surgical techniques. This new approach, however, results in increased initial costs for the hospital, due to the purchase of mesh materials. On the other hand a reduction of overall expenses for a single hernia repair should be expected. In this work an attempt is made to verify this, by calculating the cost-benefit ratio of different techniques for hernia repair. METHODS: The type and amount of materials used in a standard Bassini hernia repair, Lichtenstein and Trabucco have been examined. The amount of anesthetic drugs required, the average hospital stay and time away from work were recorded too. The costs of the three operations considered, not including routine expenses (operating room, bed sheet, etc.) have been estimated. RESULTS: Lichtenstein and Trabucco repair performed in local anesthesia (L. 1.354.120, L. 1.567.120) were cheaper than Bassini (L. 2.820.950). CONCLUSIONS: Since the system of diagnosis-related group offers a fixed amount of reimbursement for hernia repair (L. 3.247.000), the extensive use of tension free and sutureless methods, offers better profit for the Hospital. Last but not least, tension free hernia repair ensures short hospital stay, less postoperative pain, good compliance and better quality of life for the patient.

Cost-Benefit Analysis↗

PubMed2005

Acute endophthalmitis following cataract surgery: a systematic review of the literature.

OBJECTIVES: To determine the reported incidence of acute endophthalmitis following cataract extraction over time and to explore possible contributing factors, such as type of cataract incision. METHODS: A systematic review of English-language articles was conducted by performing a broad search of PubMed from 1963 through March 2003 using such terms as cataract extraction, endophthalmitis, and postoperative complication. Additional studies were identified from bibliographies of relevant articles and published proceedings. Surgical approach was recorded, when available. Pooled incidence rates and relative risks of developing endophthalmitis using different incision techniques were assessed. RESULTS: From 4916 unique, potentially relevant citations, 215 studies that addressed endophthalmitis and met the selection criteria were analyzed. A total of 3 140 650 cataract extractions were pooled resulting in an overall rate of 0.128% of postcataract endophthalmitis. However, the incidence of acute endophthalmitis changed over time, with a significant increase since 2000 compared with previous decades (relative risk, 2.44 [95% confidence interval, 2.27-2.61]). The rate of endophthalmitis was 0.265% in the 2000-2003 period, 0.087% in the 1990s, 0.158% in the 1980s, and 0.327% during the 1970s. Furthermore, an upward trend in rates after 1992 was noted, compared with 1991 and prior. Incision type appeared to significantly influence risk, as endophthalmitis following clear corneal cataract extraction during the 1992-2003 period was 0.189% compared with 0.074% (relative risk, 2.55 [95% confidence interval, 1.75-3.71]) for scleral incision and 0.062% (relative risk, 3.06 [95% confidence interval, 2.48-3.76]) for limbal incision. CONCLUSIONS: This systematic review indicates that the incidence of endophthalmitis associated with cataract extraction has increased over the last decade. This upward trend in endophthalmitis frequency coincides temporally with the development of sutureless clear corneal incisions.

Acute Disease↗

PubMed1980

Electrocoaptation conjunctival closure in retinal detachment surgery.

This report describes the method of electrocoaptation, a sutureless technique for closure of the conjunctiva, in 75 patients who underwent primary scleral buckling or vitrectomy procedures. The technique is safe, rapid, easily performed, and results in a secure wound that heals well.

Conjunctiva↗

PubMed1987

Heat shrinkage of extraocular muscle tendon.

We have designed and employed a bipolar heating device to shorten extraocular muscles. Treatment involves placing the unidirectional heating device on the sclera with the active surface beneath the tendinous portion of the extraocular-muscle. When power is applied, visible tissue shrinkage occurs. Heat-induced extraocular muscle shrinkage was performed on live rhesus monkeys. Two months later, thermal tendinoplasty-treated extraocular muscles were surgically isolated and evaluated for strength. Biopsies were then performed on these muscles. It was our clinical impression that treated tissues retained their strength, while histologic and electron-microscopic evaluation of heat-treated tendon revealed evidence of shrinkage and compaction of collagen bundles. Thermal tendinoplasty may offer a sutureless method of correcting strabismus by shortening and thereby strengthening extraocular muscles.

Animals↗

PubMed2005

Usefulness of the LigaSure vessel sealing system during superficial lobectomy of the parotid gland.

OBJECTIVE: To evaluate the usefulness of the LigaSure Precise instrument in superficial lobectomy of the parotid gland. DESIGN: Prospective study of the surgical procedures in the LigaSure Vessel Sealing System and comparison with a conventionally treated control group. SETTING: Secondary care academic referral center. Patients Thirty-five patients with a parotid gland benign tumor were randomly allocated to 2 superficial lobe parotidectomy groups: 17 using the LigaSure procedure (group A) and 18 using the conventional method (group B). MAIN OUTCOME MEASURES: During the past few years, different methods of achieving hemostasis in parotid gland surgery have been tested as means of decreasing operative time and facial nerve injuries by controlling bleeding. With the whole LigaSure Vessel Sealing System, we experienced the usefulness of the LigaSure Precise instrument in superficial lobectomy of the parotid gland. RESULTS: No statistically significant differences were noted between the 2 groups in mean age, tumor diameter, length of hospital stay, time to return to work, or number of adverse events during or after surgery. Operative time was significantly shorter in group A than in group B (P < .001). Total operative time for conservative partial parotidectomy with traditional excision ranged from 115 to 235 minutes (mean, 155.8 minutes). Using the LigaSure system, the mean operative time was 136.4 minutes. Salivary fistulas were more common in group A (3 of 17 patients), with no cases in group B. CONCLUSIONS: The LigaSure method is comparable with but not superior to the conventional method. The main advantages of the LigaSure system are its "sutureless technique" and operative time savings; however, the cost is considerably higher.

Adult↗

PubMed2004

Randomized controlled trial of preservation or elective division of ilioinguinal nerve on open inguinal hernia repair with polypropylene mesh.

HYPOTHESIS: Our study aimed to evaluate the effect of preservation or elective division of the ilioinguinal nerve on pain and postoperative symptoms after open inguinal hernia repair with mesh. DESIGN: Double-blind, randomized trial. SETTING: Four public, government-financed hospitals in Italy. PATIENTS: From January 1, 1997, to June 30, 2002, 813 patients with primary inguinal hernia were randomly allocated to undergo inguinal hernia repair either with ilioinguinal nerve preservation (408 patients, group A) or elective transection (405 patients, group B). INTERVENTION: Hernia repair with sutureless apposition of a polypropylene mesh. MAIN OUTCOME MEASURES: The primary outcome was the evaluation of chronic pain 1 year after operation. Secondary outcomes were postoperative symptoms assessment at 1 week and 1, 6, and 12 months after operation. Telephone interview was performed 35.5 months (range, 12-59 months) after operation to assess the presence of chronic pain. RESULTS: Of the 302 group A and 291 group B patients who made an office visit 1 year postoperatively, pain was absent in 231 (76.5%) and 213 (73%) (difference, 3.30%; 95% confidence interval, -3.68% to 10.28%), mild in 55 (18%) and 60 (21%), moderate in 11 (4%) and 9 (3%), and severe in 5 (2%) and 9 (3%), respectively (P =.55; Pearson chi2(3) test). At 1-month and 6-month follow-up visits, no difference was found between the 2 groups with respect to pain, but loss of pain or touch sensation were significantly greater when the ilioinguinal nerve was divided. One year after operation, the 2 groups were also comparable with respect to loss of pain sensation, but touch sensation remained decreased in group B. At telephone interview, the presence of chronic pain was similar in both groups. CONCLUSIONS: Pain after open hernia repair with polypropylene mesh is not affected by elective division of the ilioinguinal nerve; sensory disturbances in the area of distribution of the transected nerve are significantly increased.

Aged↗

PubMed1981

Agenesis of the common bile duct.

In a case of congenital absence of the common bile duct, the common hepatic duct emptied directly into the gallbladder; the latter drained by a long cystic duct into the second part of the duodenum. To my knowledge, only eight prior cases with this or very similar anomalies have been reported in the literature. This rare arrangement is common in certain lower animals and is explainable by embryologic studies. Cholecystectomy in these cases inevitably produces a complete defect in the biliary tract, which should be recognized and repaired primarily. Reconstruction using a modified Rodney Smith sutureless technique was successful, and apparently this is the first case where it has been used for this purpose.

Adult↗

PubMed2000

Methylene blue based protein solder for vascular anastomoses: an in vitro burst pressure study.

BACKGROUND AND OBJECTIVE: Attempts at sutureless anastomoses have used protein-based solders containing chromophores [Oz et al., J Vasc Surg 1990;11:718; Poppas et al., J Urol 1998150:1052] to enhance the strength of laser anastomoses. Reports have described the use of indocyanine green [Oz et al., Surg Forum 1989;316.], fuschin, and fluorescein isothiocyanate as chromophores [Chuck et al. , Lasers Surg Med 1989;9:471; Vance et al., Lasers Med Sci 1988;3:219]. Methylene blue (MB) is a chromophore with absorption peaks in the 600-700 nm region whose use has not been reported in laser-assisted vascular anastomoses. Therefore, we set out to produce and characterise a MB-containing protein solder. The absorption and burst pressure characteristics have been investigated and described as well as a brief review of the chemical and biological properties of MB. STUDY DESIGN/MATERIALS AND METHODS: The MB and porcine serum albumin (PSA)-based solder was produced and used to form end-to-end anastomoses in porcine splenic arteries. The solder was activated using a laser diode emitting at 670 nm. The burst pressures of the anastomoses were tested, and the results analysed as a function of MB concentration and absorption. In addition, the relationship between MB concentration and absorption was examined. RESULTS: A dose-response relationship was found between the measured absorption of the solder and the burst pressure of the anastomoses formed. Burst pressures exceeding physiological levels were found. Changes in MB concentration revealed a marked negative deviation from Beer's law at 670 nm, owing to the monomer-dimer-trimer equilibria. CONCLUSION: PSA with MB solder is able to form high-quality end-to-end anastomoses, with immediate burst pressure profiles similar to those previously described for sutured [Quigley et al., Microsurgery 1985;6:229], lasered [Quigley et al., Microsurgery 1985;6:229], and soldered anastomoses [Small et al., J Clin Laser Med Surg 1997;15:205]. The relationship between burst pressure strength and chromophore absorption is discussed.

Absorption↗

PubMed1998

Laser welding of vas deferens in rodents: initial experience with fluid solders.

This study evaluates the use of sutureless laser welding for vasovasostomy. In 14 rodents, the left vas deferens underwent vasovasostomy using an albumin-based solder applied to the adventitia of the vas deferens. The solder contained the dye, indocyanine green, to allow selective absorption and denaturation by a fiber-coupled 800-nm diode laser. The right vas deferens served as a control, receiving conventional layered microsurgical repair. We used a removable 4/0 nylon stent and microclamps to appose the vas deferens during repair, with no need for stay sutures. The mean time to perform laser solder repair (23.5 min) and conventional repair (23.3 min) were not significantly different (P=0.91). However, examination after 8 weeks showed that granuloma formation (G) and patency (P) rates for the conventional suture technique (G, 14%; P, 93%) were significantly better than observed for the laser solder technique (G, 57%; P, 50%).

Albumins↗

PubMed1986

Fibrin adhesive versus sutured anastomosis: a comparative intraindividual study in the small intestine of pigs.

The small intestine in each of ten pigs was subjected to three anastomoses: one sutured anastomosis and two non-suture fibrin adhesive anastomoses in an intra-individual controlled comparison. There was no significant difference in the in vivo bursting strength after 7 days. Thus, the two types of anastomoses were of equal strength. It is concluded that it appears possible to achieve a safe sutureless anastomosis in the small intestine, with fibrin adhesive alone.

Animals↗

PubMed1996

Experimental oesophagogastric anastomosis: preliminary report of a new compression device that also fragments.

Fifteen Beagle dogs underwent oesophagogastric anastomosis with a new device which enables a 'sutureless' compression anastomosis. The device fragmented and was passed in bits anally without causing obstruction. Immediate bursting pressure, tested in five dogs, was between 175 and 190 mmHg. The anastomoses of the remaining dogs were examined macroscopically and microscopically from day 6 to day 30. Healing was excellent with good muscular apposition and minimal residual inflammation.

Anastomosis, Surgical↗

PubMed2004

Closure of skin incisions in rabbits by laser soldering: I: Wound healing pattern.

BACKGROUND AND OBJECTIVES: Temperature-controlled tissue laser soldering is an innovative sutureless technique awaiting only solid experimental data to become the gold-standard surgical procedure for incision closure. The goals of the current study were: (1) to define the optimal laser soldering conditions, (2) to explore the immediate skin reparative healing events after sealing the wound, and (3) to determine the long-term trajectory of skin wound healing. STUDY DESIGN/MATERIALS AND METHODS: Skin incisions were generated over rabbit dorsa and were closed using different wound-closure interventions, in three groups: (a) closure, using a temperature-controlled infrared fiberoptic CO2 laser system, employing 47% bovine serum albumin as a solder; (b) wound closure by cyanoacrylate glues; and (c) wound closure by sutures. The reparative outcomes were evaluated macroscopically and microscopically, employing semi-quantitative grading indices. RESULTS: Laser soldering of incisions at T = 65 degrees C emerged as the optimal method achieving immediate wound sealing. This in turn induced accelerated reparative events characterized by a reduced inflammatory reaction, followed by minimal scarring and leading to a fine quality healing. CONCLUSIONS: Temperature-controlled laser soldering offers an accelerated wound reparative process with numerous advantages over the conventional methods. Further investigations may reveal additional benefits in the spectrum of advantages that this innovative surgical technology has to offer. This can introduce new scientific insight that will pave the way for clinical use.

Animals↗

PubMed1984

A microsurgical technique for simultaneous pancreas and renal transplantation in the rat.

A successful technique of simultaneous pancreatico-renal transplantation into the streptozotocin-induced diabetic rat is described employing a sutureless cuff technique for three of four vascular anastomoses. Reversal of the diabetic state was uniformly observed within 24 hours postoperatively and near-normal renal function was evidenced by 50 days postoperatively. The technique is reliable and reproducible and represents the first report of successful combined transplantation into the diabetic rat.

Animals↗

PubMed1984

Histological findings in sutured and fibrin-glued microvascular anastomosis.

A new method of microvascular anastomosis is presented. A sufficient sutureless telescoping anastomosis was achieved using fibrin adhesive (Tissucol, Immuno GmbH, Heidelberg, FRG) and a Fogarty embolectomy catheter (American Hospital Supply, Deutschland GmbH, Munich, FRG) as an internal splint in the abdominal aorta of Sprague-Dawley rats. The main advantage of this technique is its short application time. Histological examinations mostly showed accelerated healing compared with sutured anastomosis.

Animals↗

PubMed1991

Intestinal anastomotic healing in the absence of suture material: an experimental study in rats.

In order to investigate the influence of sutures on intestinal anastomotic healing, 48 rats underwent both ileal and colonic resection. In 24 rats all intestinal sutures were removed 30 min after anastomotic construction (group 1), while in the remaining animals (group 2) the sutures were left in place. Bursting pressures and collagen (hydroxyproline) levels in anastomotic segments were measured 1, 3, and 7 days after operation. Two lethal ileal dehiscences and 9 anastomotic abscesses (5 ileal and 4 colonic) occurred in group 1, while in group 2 there were 3 ileal anastomotic abscesses. On the first day after operation, bursting pressures were significantly lower in sutureless ileal and colonic than in sutured anastomoses. During the post-operative course, changes in collagen concentrations in ileal and colonic segments did not differ between the groups. Thus, sutures are only essential in providing anastomotic strength during the immediate post-operative period, but do not seem to affect post-operative collagen metabolism.

Anastomosis, Surgical↗

PubMed1994

No-stitch combined glaucoma cataract-surgery.

A new method of small incision cataract surgery is presented which allows sutureless wound closure with a fistulating aperature for regulating IOP. After in-the-bag pcIOL implantation, a triangular opening is made into the posterior scleral valve and combined with a peripheral iridectomy. Sufficient regularization of the IOP and good visual results could be observed in the majority of all 61 eyes operated on using this method.

Aged↗

PubMedDate not supplied

Preperitoneal herniorrhaphy: a historical review.

From ancient times, both the transabdominal (posterior) and the groin (anterior) approach have been used either singly or in combination in the management of inguinofemoral herniation. Development accelerated in the nineteenth century after Lister introduced antisepsis. Although Bassini and Halsted conducted their classic procedures in the preperitoneal plane, it was Cheatle, in 1920, who first performed transabdominal preperitoneal herniorrhaphy. In 1950, McEvedy described the lateral approach, which was made popular by Nyhus and Condon in the 1960's. The problem of relaxing incisions and the importance of prosthetic repair through this exposure are substantiated along with the anatomy of the preperitoneal fatty layer and the results of sutureless bilateral herniorrhaphy.

General Surgery↗

PubMed1988

Evaluation of the biofragmentable anastomotic ring following preoperative irradiation to the rectosigmoid in dogs.

An animal study was done to evaluate the safety of a sutureless colorectal anastomosis in irradiated bowel. Forty mongrel dogs received preoperative radiation with 5000 rads and then underwent a low anterior resection and anastomosis using either the EEA-31TM stapling device, a two-layer handsewn technique, or the biofragmentable anastomotic ring (BAR) 31-1.5 mm and BAR 31-2.0 mm devices. The anastomoses were then evaluated for early and late anastomotic healing and leaks. The results show four radiographic (three clinical) leaks (P less than .05) in the BAR 31-1.5 mm group and one radiographic leak in the handsewn group. No leaks were detected in the EEA or BAR 31-2.0 mm groups. Results indicate that all three techniques can be done safely with this dose of radiation, and gap size (1.5 mm vs. 2.0 mm) is of critical importance when performing a BAR anastomosis in irradiated bowel.

Anastomosis, Surgical↗