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PubMed1985

Sutureless intraluminal graft for repair of abdominal aortic aneurysm.

A series of seven patients undergoing elective repair of abdominal aortic aneurysms using sutureless intraluminal aortic prostheses for infrarenal tube grafts was reviewed. Follow-up was five to seven months. There was no morbidity related to the graft and one late mortality. In the uncomplicated cases, the average total operative time was two hours 14 minutes with no bank blood transfusions. The overall average operative time was two hours 41 minutes with an average operative transfusion of 0.28 units and total transfusions of 1.70 units of bank blood per case. Based on this experience and the observation that operative time and blood loss are major determinants of mortality with emergency abdominal aortic aneurysm repairs, we believe that use of sutureless intraluminal prostheses in suitable cases of leaking or ruptured abdominal aortic aneurysms has the potential to markedly improve survival.

Aorta, Abdominal↗
PubMed1988

A method for repair of aortic dissection originating in the transverse arch using two sutureless intraluminal prostheses.

We present a method for repair of ascending aortic dissections that originate in the transverse aortic arch. The technique utilizes two sutureless intraluminal prostheses, which are joined together and inserted during hypothermic circulatory arrest. A diamond-shaped opening between the two grafts is anastomosed about the orifices of the brachiocephalic arteries. This method affords the advantage of excluding the intimal tear, thereby preventing further propagation of the dissection. Additionally, the method offers the time-saving advantage of the sutureless prosthetic rings for the proximal and distal anastomoses.

Aortic Dissection↗
PubMed1990

Pancreatic exocrine function after a sutureless pancreatico-jejunostomy following pancreaticoduodenectomy.

Exocrine pancreatic function was measured in 14 patients after pancreaticoduodenectomy for periampullary neoplasms in order to assess the patency of a sutureless pancreatico-enteric anastomosis. Pancreatic function was examined by the p-aminobenzoic acid/p-aminosalicylic acid (PABA/PAS) test 3-160 months after operation and compared with age- and sex-matched controls. There were no significant differences between mean (s.e.m.) serum PABA concentrations 3 h after ingestion of N-benzoyl-L-tyrosyl-PABA (25.5 (3.6)) mumol/l for patients, 26.1 (2.0) mumol/l for controls). However, the mean (s.e.m.) PABA excretion index was significantly lower in the patients (0.58 (0.08)) than in the controls (0.76 (0.04)). Four patients required pancreatic enzyme supplements for control of diarrhoea. Self-limiting pancreatic leaks occurred in two patients. The results suggests that the sutureless pancreatico-enteric anastomosis has an acceptably low leakage rate but that pancreatic exocrine function is diminished following pancreaticoduodenectomy with this technique. However, the majority of patients require no enzyme supplements and no significant tendency to late stenosis of the anastomosis was demonstrated.

4-Aminobenzoic Acid↗
PubMed1995

Healing process of sutureless choledochojejunostomy in an experimental model.

The healing characteristics and morphological features of sutureless choledochojejunostomy were investigated in a rat experimental model. The common bile duct of 34 conditioned Wistar rats was exposed, divided transversely and a choledochojejunostomy constructed with only a vinyl chloride tube positioned between the common duct and jejunum. The animals were killed 4, 12 and 52 weeks after surgery. Cholangiographic evaluation of the anastomosis in all three groups showed wide openings with dilatation of the extrahepatic bile duct. Microscopic examination of the anastomosis showed hyperplastic changes of the bile duct epithelium. The epithelial defect was completely covered with proliferative epithelium 12 weeks after operation. At long-term follow-up of 52 weeks there were no biliary strictures after the sutureless technique. This surgical approach may be useful for patients in whom sutured anastomosis of the bile duct might lead to stricture, such as those with a normal thin-walled bile duct.

Alanine Transaminase↗
PubMed1985

A biofragmentable ring for sutureless bowel anastomosis. An experimental study.

A biofragmentable bowel anastomosis ring (BAR) for sutureless intestinal anastomosis is described with the laboratory results comparing the BAR to sutured and stapled anastomoses. There was equivalent healing with all three methods of anastomosis. However, "burst" pressure was highest at day zero and overall necrosis was least with the BAR. By virtue of these findings and being sutureless, it is hoped that the limits of safe bowel anastomosis can be extended.

Animals↗
PubMed2006

25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study.

BACKGROUND: The aim of the study was to evaluate the safety and functional outcome of a small incision, sutureless vitrectomy in the treatment of idiopathic epiretinal membranes (ERM) compared with a standard 20-gauge vitrectomy system. METHODS: Forty-six consecutive patients with idiopathic ERM were recruited for this study and prospectively evaluated. In group 1 (n=26) we used a transconjunctival sutureless 25-gauge vitrectomy system (TSV), patients in group 2 (n=20) were operated on using a standard 20-gauge vitrectomy system. The ERM was removed and the internal limiting membrane (ILM) was peeled in all eyes. Surgery-related complications, operating time, intraoperative balanced salt solution (BSS) consumption, postoperative discomfort, postoperative intraocular inflammation, lens opacification, and long-term visual outcome are reported and compared. RESULTS: No surgery-related complications were observed in either group. Operating time was shorter in group 1 compared with group 2 (mean 15.6 and 29.6 min respectively). Intraoperative amount of BSS consumption was less in group 1 (mean 28 ml in group 1 and 42 ml in group 2). Postoperative discomfort and intraocular inflammation were significantly reduced in the 25-gauge group. In the 20-gauge group cataract formation requiring surgery was observed in two eyes. Visual acuity improved significantly in both groups. The 25-gauge group improved on average by more lines of vision and the improvement in vision was more rapid. CONCLUSION: The TSV system is a safe and efficient surgical technique for ERM surgery. Operating time is significantly reduced, minimizing surgery-induced trauma, and reducing postoperative intraocular inflammation and the patients' discomfort. The incidence of cataract formation may be less using TSV. Postoperative recovery is accelerated.

Aged↗
PubMed2005

Pitfalls of sutureless repair of a blow-out type left ventricular free wall rupture.

A 55-year-old man was admitted for acute myocardial infarction. Cardiac catheterization revealed total occlusion of the left circumflex artery. During catheterization, he suffered cardiogenic shock. Percutaneous cardiopulmonary support was established, and the patient was transferred to the operating room. A blow-out left ventricular free wall rupture (LVFWR) with an epicardial tear, 1 mm in diameter, was found, and sutureless repair with a collagen hemostat (TachoComb) was performed. However, on postoperative day 7, echocardiography revealed an echo-free space resembling a pseudoaneurysm. A second operation was performed immediately for impending re-rupture. An epicardial tear, 2 x 10 mm in diameter, was found at the previous bleeding point where hemostasis had been achieved with only one sheet of TachoComb. The defect was closed with mattress sutures buttressed with Teflon felt. We conclude that even if the risk of re-rupture is low, sutureless repair with a collagen hemostat alone should be avoided in treating blow-out LVFWR.

Collagen↗
PubMed1975

Jejunal mucosal graft: a sutureless technic for repair of high bile duct strictures.

A simplified sutureless technic for the repair of high bile duct strictures is described. The technic combines the principle of a transhepatic tube together with a mucosal graft formed by removing a seromuscular patch near the end of a Roux-en-Y loop of jejunum creating a mucosal outpouching. The biliary tree is entered at the hilum of the liver and a latex rubber tube is drawn through the liver and anchored to the Roux-en-Y loop through the previously created mucosal diverticulum. The tube is pulled back into the liver carrying with it the sleeve of jejunal mucosa into the duct system in contact with the epithelium of the intrahepatic ducts. The technic is simple, easy, and quick. There is no difficult and tedious duct dissection of hepaticodochojejunal anastomosis to perform. It provides mucosa to mucosa approximation and eliminates the need for sutures through or near the mucosa to compromise the blood supply and prevent primary healing. The stent tube is easily removed without reoperation when desired. Finally, there is access to the biliary tree for daily irrigation, radiography, and cultures. From 1969 to 1972, sixty-one repairs were performed in fifty seriously ill patients utilizing the principles of this sutureless technic. All had had failure of previous attempts at repair with an average of 2.86 previous biliary tract operations per patient. Eight-five per cent of the patients have had an ultimately successful result. The mean postoperative hospital stay was only 19.6 days. Although the follow-up period is still short, these preliminary results are most encouraging.

Adolescent↗
PubMed1989

Replacement of the abdominal aorta with a sutureless intraluminal ringed prosthesis.

To evaluate our experience with sutureless intraluminal ringed grafts in the abdominal aorta, we reviewed all patients who were managed with this device from 1980 to 1987. Thirty-one patients were identified with a mean follow-up time of 41 months. Three patients had suprarenal aneurysms and four had ruptured abdominal aneurysms. Average tube graft insertion time was 17 minutes and required 0.9 units of transfused blood. There were two postoperative deaths (6 percent), both secondary to myocardial infarction. None of the patients with ruptured or suprarenal aneurysms died. No patients had permanent renal or neurologic deficits, and no instances of postoperative bleeding, wound infection, pseudoaneurysm formation, or graft migration were encountered. The sutureless intraluminal graft can be implanted easily and quickly and is safe for use in the abdominal aorta. It is particularly helpful in the management of suprarenal or ruptured abdominal aneurysms, in which speed is important, and in effecting technically difficult anastomoses to friable aortic tissue.

Adult↗
PubMed1992

Sutureless repair of inguinal hernia.

Sutureless repair is successful for all but the largest of indirect inguinal hernias. After reduction of the peritoneal sac, the presenting indirect component of the hernia is immediately resolved by placement of a polypropylene mesh through the internal ring. The posterior wall is reinforced with a second swatch of Prolene mesh to prevent herniation, which often results from future degenerative changes. Both swatches of mesh are held in place in separate tissue planes by the body's internal hydrostatic forces. Being sutureless, no tension is placed on any layer; there is no damage to tissues from an errant suturing technique. This procedure has been used in 412 of the 1,091 inguinal hernia repairs over the past 36 months.

Adolescent↗
PubMed2004

Modified sutureless sclerotomies for pars plana vitrectomy.

PURPOSE: To describe a modified technique for performing sutureless sclerotomies for pars plana vitrectomy and to examine its efficacy and safety. DESIGN: Retrospective, interventional case series. METHODS: Self-sealing sclerotomies were created in 35 consecutive cases by oblique penetration of the sclera with a 19G MVR blade. RESULTS: All but two (2.9%) of the sclerotomies were watertight without suturing at the end of surgery. A conjunctival bleb was observed during the first postoperative week in one case, but it resolved without intervention. CONCLUSIONS: Construction of sutureless sclerotomies by this technique is simpler and more rapid compared with previously described techniques. The resulting sclerotomies are more resistant to stretching and tearing of the tunnel's roof, they rarely need suturing, and insertion of instruments is facilitated.

Humans↗
PubMed2005

Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy.

PURPOSE: To report longer-term outcomes in eyes undergoing 25-gauge transconjunctival sutureless vitrectomy. DESIGN: Retrospective, noncomparative, case series. METHODS: Chart review of the initial 45 consecutive patients (45 eyes) that underwent TSV by one surgeon (T.S.H.) for idiopathic epiretinal membrane (n = 15), refractory diabetic macular edema (n = 11), idiopathic macular hole (n = 10), and nonclearing vitreous hemorrhage (n = 9). All patients had at least 6-month follow-up. Main outcome measures included visual acuity (VA), intraocular pressure, intraoperative complications, and postoperative complications. RESULTS: Mean follow-up was 13 months (range 6 to 25 months). Mean overall preoperative VA vs last postoperative VA was 20/229 and 20/65, respectively (P < .0001). Statistically significant VA improvement was seen for each patient subgroup. Mean preoperative intraocular pressure was 16.9 mm Hg (range 10-26 mm Hg). On postoperative day 1, week 1, and week 4, median intraocular pressure was 14.6 mm Hg (range 8-17 mm Hg), 17.6 mm Hg (range 8-38 mm Hg), and 17.7 mm Hg (range 9-33 mm Hg), respectively. No intraoperative complications occurred. Postoperative complications were 1 inferior retinal detachment (2.2%) 4 weeks after macular hole repair, 1 macular hole (2.2%) 6 months after epiretinal membrane peel, and 23 worsening cataracts in 29 phakic eyes (79.3%). CONCLUSIONS: Less surgically complex vitreoretinal pathology may be successfully repaired with TSV. After a mean follow-up of more than 1 year, minimal complications were seen, and none was specifically related to the sutureless nature of the procedure.

Aged↗
PubMed2005

Inflow of ocular surface fluid into the anterior chamber after phacoemulsification through sutureless corneal cataract wounds.

PURPOSE: To report inflow of extraocular fluid after phacoemulsification with use of sutureless corneal incisions. DESIGN: Interventional case series. METHODS: setting: Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland. patients: Eight patients (three women), aged 58 to 91 years, showing minimal bleeding from the limbal capillary bed during phacoemulsification. intervention: Surgery was performed through a 2.8-mm limbal incision. External pressure simulating patient manipulation was applied before and after wound hydrosealing with an irrigation cannula. main outcome measures: Inflow of blood-tinged tear fluid into the anterior chamber through the wound was monitored by using digital video. RESULTS: Inflow of extraocular fluid was observed in all eyes when the cannula was released, even after wound hydrosealing. Two patients showed spontaneous fluid inflow. CONCLUSIONS: Tested sutureless corneal incisions allow inflow of extraocular fluid into the anterior chamber after phacoemulsification. This may permit intraocular contamination leading to endophthalmitis.

Aged↗
PubMed2004

Sutureless anastomoses of small and medium sized vessels by medical adhesive.

PURPOSE: Using an animal model we have assessed sutureless anastomoses. METHODS: The two cut ends of the rabbit common carotid artery were sutured by three stitches with a 120 degrees interval circumferentially, then two optional threads were pulled horizontally and 0.1 ml adhesive was smeared on the attached surface of the two ends. The three stitches were removed after completion of anastomosis. The burst pressure of the anastomosis was measured and compared with that of a traditional sutured artery. RESULTS: The glued anastomosis was associated with: a shorter completion time (8.25+/-6.34 min vs. 20.67+/-14.24 min, P<0.01), less bleeding (3.17+/-9.04 ml vs. 11.04+/-16.28 ml, P<0.01), and equivalent patency (93.8 vs. 87.5%, P>0.05). The sutureless anastomosis was associated with less intimal thickening (decreased by 31.4, 24.5, 23.9 and 31.9%, P<0.01 compared with the traditional suture group at 1, 2, 4 and 12 weeks, respectively). CONCLUSION: Glued anastomoses provides an effective, simple and feasible way for anastomosing small or medium caliber vessels. This technique may reduce intimal injury.

Anastomosis, Surgical↗
PubMed2004

Dynamic morphology of sutureless cataract wounds--effect of incision angle and location.

OBJECTIVE: Sutureless cataract surgery has been growing in popularity over the last decade. These clear corneal incisions allow for rapid visual recovery after phacoemulsification, but may be associated with an increased risk of endophthalmitis. The purpose of this study was to evaluate the effect of intraocular pressure (IOP), location, and angle of cataract incisions on wound apposition and sealing in postmortem globes. METHODS: This was an ex vivo laboratory investigation of 20 rabbit eyes and 14 human eyes. Self-sealing clear corneal, limbal, and scleral incisions were created and IOP was controlled with an infusion cannula. Incisions were made at a variety of angles. Optical coherence tomography was used to image the incisions in real time as the IOP was varied by raising and lowering the infusion bottle, so as to simulate the variation in IOP occurring with blinking or squeezing of the eye. RESULTS: With each type of incision, optical coherence tomography demonstrated the dynamic nature of cataract wound morphology as IOP was varied. Higher IOPs, in general, were associated with more tightly sealed wounds than lower IOPs, but this varied according to the location and angle of the incisions. More perpendicular incisions, relative to the surface tangent, sealed less well than incisions created at smaller angles at higher levels of IOP; At lower IOPs, the reverse relationship was observed such that more perpendicular incisions sealed less well than smaller incision angles. CONCLUSION: Changes in IOP may result in variable and sometime poor wound apposition in sutureless cataract incisions. The type of incision and angle of the incision may affect the likelihood of inoculation of the aqueous humor with potentially pathogenic bacteria. For each type of incision, there may be a critical angle at which the incision is better able to withstand fluctuations in IOP.

Animals↗
PubMed1995

Aspergillus endophthalmitis after sutureless cataract surgery.

PURPOSE: We studied a case of Aspergillus endophthalmitis after sutureless cataract surgery. METHODS: A patient underwent sutureless phacoemulsification complicated by a posterior capsular tear. She subsequently developed Aspergillus endophthalmitis. Amphotericin B was injected intravitreally at the time of repeat pars plana vitrectomy. RESULTS: The eye was enucleated because of pain and poor response to treatment. CONCLUSIONS: We recommend suturing the wound in any eye that has experienced a complication of surgery.

Aged↗
PubMed2002

Angiographic results after the use of a sutureless aortic connector for proximal vein graft anastomoses.

The sutureless aortic connector system was recently developed to create anastomoses between the aorta and saphenous vein grafts for coronary artery bypass grafting. Ten consecutive patients scheduled for coronary artery bypass grafting were studied; in each patient one proximal anastomosis was performed using the aortic connector and another was sutured in the conventional manner to serve as the patient's own control. One graft in the sutured group had a significant stenosis and one of the grafts in which the aortic connector was used, was occluded. In this limited study the use of the sutureless connector system for proximal anastomosis shows satisfactory early graft patency (90%).

Aged↗