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A new method of the surgical treatment of Echinococcosis of lungs is analysed consisting in liquidation of the Echinococcosis parasite bed with the help of cyan acrylate glue MK-7. The method was used in 55 patients aged from 9 to 49 years. The application of cyacrine makes the surgical procedure for Echinococcosis of lungs easier. Long-term results of using this sutureless glue method were good.
In 135 femoral vessels of rats (70 arteries, 60 veins) end-to-end anastomoses performed, using 3 different methods (anastomoses with interrupted sutures, two-suture telescopic anastomosis, sutureless telescopic anastomosis with fibrinogen adhesive). The advantages and disadvantages of these methods were investigated and valued by clinical aspects (time of anastomosing, patency rate, complications). The results showed that a combined two-suture-telescopic anastomosis using absorbable suture material and fibrinogen adhesive is very stable and causes minimal lesions of the vessel wall, so that this method will be a nearly ideal anastomosing technique.
A failure of the sensing function of a pacemaker with a sutureless myocardial lead caused by postcardiotomy syndrome, is reported. The pacemaker failure appeared on the sixth postoperative day and disappeared after healing of the syndrome. Attention is called to the possibility of a postcardiotomy syndrome causing a pacemaker failure.
Between March 1974, and November 1979, a total of 244 epicardial electrodes, 29 in the anterior surface and 215 in the right ventricular diaphragmatic surface (RVDS) were implanted using the 212 a left subcostal approach. In 174 consecutive patients (mean age 64 years) a preoperative epicardial electrophysiological study was made (mapping), with measurement of voltage, current, lead impedance and R wave sensing in different zones of right ventricle. A comparative study between two types of sutureless electrodes was realized. In 21 cases, thresholds chronic measurement was made 32 months after implantation. There were one surgical death (0.4%) with a morbidity of 7.4%. The follow-up is 20 months mean. The mapped group has significantly lower thresholds and better sensing than the unmapped group (p 0.001). Chronic thresholds were obtained at pacemaker replacement in 21 cases (average 32 months postimplant) and were much lower in the mapped group. These are in line with the acute studies.
197 myocardial sutureless screw-in electrodes were implanted between the years 1973 and 1978. A subxyphoidal transmediastinal route and general anaesthesia were used. All patients had initially good pacing results. In 93% the electrode was placed into the right, in 7% into the left ventricle. The peroperative mortality rate was 0, peroperative complications were seen in 1%. Of the 19% of the complications which needed some kind of a treatment, 7.6% were confined to the lead and 11.4% were other complications. The lead, placed into the right ventricle, had to be replaced in five patients (2.7%) because of exit block or sensing problems. The postpericardiotomy syndrome was the most frequent complication but it did not impair the function of the pacemaker. 4% of the patients died within 30 days after the implantation. In 46 patients the pacemaker was replaced after a mean time of 32,5 months. The measurement of the threshold rose from a mean of 0.8 mAmp to 3.2 mAmp and the mean resistance was 530 Ohms. In 44 patients the electrode could be reused.
This prospective study was performed to compare the central endothelial cell loss (ECL) after phacoemulsification and 3.5 with 5 mm temporal clear-corneal incision. Moreover, the influence of ultrasound time and power on postoperative endothelial cell density was evaluated. PATIENTS AND METHODS. Sixty-two patients (age 71 +/- 7.7 years) without corneal pathology were operated by phacoemulsification (Storz, Premiere) with a temporal, self-sealing, two-step clear-corneal incision followed by posterior chamber IOL implantation under viscoelastic (1% sodium hyal-uronate). Thirty-one one-piece plate-haptic foldable silicone IOLs (Chiron C10; Staar Surgical AA-4203) were implanted by an injector through a 3.5 mm incision (group A). The other 31 PMMA IOLs (Pharmacia 809P) were implanted through a 5 mm incision (group B). One surgeon performed all operations with the same technique (bimanual phacoemulsification in the capsular bag). Sutureless wound closure was performed in group A, while the wounds in patients of group B were closed with a single radial stitch. The central endothelial cell counts were recorded preoperatively, on days 2-5 and 6 months postoperatively using contact specular microscopy. RESULTS. The collective data revealed a cell loss of 7.9% (+/- 4.1 SD) on days 2-5 postoperatively and 6.7% (+/- 2.9) after 6 months. A direct linear relationship was found to exist between ultrasound time (UT) and ECL. In group A (7 patients) the ECL slightly increased from 3.5% in the first week postoperatively to 3.8% after 6 months, operated under UT < or = 1 min 30 sec. The ECL decreased from 8.2% to 6.4% after 6 months in group A (19 patients), operated under UT of 1 min 30 sec, and from 10.8% to 8.9% under UT of 2 min 31 sec-3 min 30 sec (5 patients). The ECL in group B decreased from 6.3% in the first postoperative week to 5.4% 6 months postoperatively, operated under UT < or = 1 min 30 sec (10 patients), from 8.1% to 7%, operated under UT of 1 min 31 sec-2 min 30 sec (14 patients), and from 11.2% to 10.4% under UT of 2 min 31 sec-3 min 30 sec (7 patients). CONCLUSION. Endothelial cell loss of 6.7% after phacoemulsification through a temporal clear-corneal incision compares favorably with other series in which cell loss was determined following cataract surgery with or without IOL implantation. Phacoemulsification and 3.5 mm clear-corneal incision evoked less ECL of 6.2% compared with phacoemulsification and 5 mm clear-corneal incision with ECL of 7.3% after 6 months.
We present of modified technique for sutureless ECCE with a trapezoidal tunnel incision of 11 mm. The operation can be performed in a closed system because of the self-sealing wound construction. Compared to the sutured corneoscleral ECCE the new procedure has important advantages: the procedure is safe even during the critical phase following nucleus extraction. The procedure is therefore safer, faster, more economical and suture-induced astigmatism is avoided. Clinical experience after 2 years showed that postoperative complications were reduced significantly. Iris prolapse, wound dehiscens and hyphema occurred at a rate of 2%. The astigmatism (Jaffe analysis) was at a rate of 2 D, stable within 4 weeks after surgery, and did not change up to 2 years postoperatively. The astigmatism induced was then reduced about 0.5 D by a radical suture.
Self-sealing intrascleral wound construction with a trapezoidal 12-mm incision for extracapsular cataract extraction and implantation of a standard PMMA IOL with a 6.5-mm optical diameter using the no-stitch technique has been well established at our clinic since 1991. This technique allows cataract surgery in a nearly closed system. In consideration of our earlier results, the no-stitch technique was modified by a single perpendicular suture in the middle of the 12-mm incision to reduce postoperative induced astigmatism further. We examined 200 consecutive patients 6 months after surgery (no-stitch vs one-stitch wound closure). The preoperative average astigmatism was 0.86 +/- 0.68 D (1.01 +/- 0.95 D). Preoperatively 37% (47%) of the eyes had With the Rule Astigmatism and 47% (39%) Against the Rule Astigmatism. Six months after surgery 10% (8%) of the cases showed With the Rule Astigmatism and 72% (65%) Against the Rule Astigmatism. Induced astigmatism was stabilized to 1.43 +/- 0.87 D (2.11 +/- 1.43 D). Compared with sutureless wound closure, the one-stitch technique had no long-term effect on the axes of astigmatism but significantly diminished induced astigmatism about 0.5 D.
Small-incision surgery has contributed considerably to accelerated wound healing and minimization of surgically induced astigmatism. A variation of this surgical technique is sutureless cornea small-incision surgery with preparation of a corneal tunnel of 4.5 mm or less. To date, 195 patients have been operated on with this technique. In 130 cases the incision was made in the upper temporal area, in 65 cases laterally. Visual outcome and development of induced astigmatism over a period of 2 years were compared with the results achieved with corneoscleral small-incision surgery. Four weeks postoperatively, the vision in all three groups was > 0.5 in 67% of the patients. Also in the further course no significant changes were found. Regarding the average astigmatism, more severe fluctuations during the whole follow-up period and approximately 0.4 D higher values were observed with clear corneal incision via an oblique meridian at the same initial value. After 2 years, the value found in this group was 1.5 +/- 0.7 D. The development of surgically induced astigmatism, determined according to Jaffe and Clayman, indicates the same relationship. Following clear corneal incision in the upper temporal area, the value decreased within 1 year postoperatively to an average of 0.85 +/- 0.55 D, followed by an increase after 2 years to 1.26 +/- 0.44 D, in contrast to a temporal or corneoscleral approach, where no severe fluctuations were found. Based on our experience, we only apply clear corneal incisions via the oblique or vertical meridian when try to correct preexisting astigmatism. Corneoscleral small-incision surgery remains our standard operation technique. If corneoscleral tunneling is not possible or is unfavorable, a clear corneal incision is placed laterally.
Historical developments of groin herniorrhaphy date from Bassini's contributions through many present-day simplified tension-free techniques. Availability of sterile-packaged prosthetic mesh has currently given every surgeon an inexhaustible "tissue bank" for hernia repair surgery. The value of using a local anesthetic is unequaled in verifying the completeness of a repair. Same-day surgery has many advantages including lowered rates of infection, quicker ambulation, and more rapid return to regular activities. The sutureless umbrella plug technique is discussed. It is the simplest technique to permanently repair indirect inguinal hernias. Taking advantage of Nature' window through the internal inguinal ring, the properitoneal space can be reached. By dissecting the peritoneal sac high on its neck and shoulders, the retromuscular properitoneal space can be actualized. It allows a permanent repair to be done by simply protecting the internal ring with a swatch of polypropylene mesh shaped as an umbrella. The body's natural forces that created the hernia work to repair it by transversalis fascia. The procedure is easy to perform, done with local anesthesia, inexpensive, safe, and has minimal recurrence and complication rates.
The Biofragmentable Anastomosis Ring (BAR) is a device, which originally has been designed for sutureless large bowel anastomoses. In this study, the method is evaluated in comparison with sutured and stapled anastomoses through experimental surgery. Clinical results of colonic BAR anastomoses are compared to those gained by sutured anastomoses. New applications of the anastomosis ring: small bowel anastomoses and cholecystojejunostomies are introduced in clinical trials. Fourteen dogs had a laparotomy with three consequent colonic transections. These were anastomosed; one by manual suture, one with a circular stapler and one with the BAR. On day 1, 3, 5, 7, or 40, postoperatively, the animals were sacrificed, and each operated colonic segment was removed for examination. In four animals dilation of the bowel was seen proximal to the BAR anastomosis. No clinical obstruction had been noted in them, however. Up to the seventh postoperative day, edematous and inflamed mucosa was observed with the BAR, and the least reaction was connected to the stapled anastomoses. Forty days after the operation all the three types of anastomoses had healed equally well both macroscopically and histologically. One hundred and fifty patients undergoing colonic surgery were randomized into two groups: 71 underwent hand-suture and 79 were fitted with the BAR. Five patients, two treated using the BAR and three by suturing, developed anastomotic leakage. During follow up, one patient in each group underwent reoperation for anastomotic stricture. Recovery of the gastrointestinal tract and the hospital stay were similar in the two groups. The late results after colonic anastomoses performed with the BAR were evaluated in 26 patients who had undergone a left sided colonic or rectosigmoid anastomosis. One had been operated on for an anastomotic stricture 22 months after the initial operation, which was a sigmoid resection. One had been operated during the study for reasons not related to the anastomosis. 24 patients underwent the study scheme. In 16 of the patients, the anastomosis could not be radiologically identified, and in seven not even during endoscopy. Histologically there was mild to moderate fibrosis and scarring in 17 anastomoses and in the seven that could not be identified, only normal colonic mucosa was found. Of one hundred and seventy patients undergoing upper gastrointestinal surgery, 81 had the jejunojejunal enteroanastomosis done with the BAR and 89 patients received sutures. Both end-to-side (101 patients) and side-to-side reconstructions (69 patients) were done. Neither ruptures nor obstructions of the enteroanastomosis occurred.(ABSTRACT TRUNCATED AT 400 WORDS)
The cosmetic effect of operative interventions for the anterior abdominal wall hernia, vaginal process of peritoneum anomalies in 558 patients aged from 7 to 27 years was studied. The 15-year follow-up was available. Poor cosmetic results appropriateness were determined, the advantages of the sutureless abdominal wound closure were examined, an operative accesses for the umbilical hernia and the hernia of linea alba treatment were proposed.
We use the trapezoidal lamellar incision as standard construction for sutureless self-sealing wound closure in our clinic: a 7 mm incision for phacoemulsification and implantation of a 6.5 mm optic diameter PMMA posterior chamber less (PCL) and an incision up to 11 mm for ECCE with standard PCL. The operation can be performed in a nearly closed system because of the self-sealing wound construction. Experiments in cadaver eyes showed that the wound closure of a 7 mm incision with the no-stitch technique ruptured at a pressure five times greater than the cross-stitch-sutured corneoscleral incision and in an 11 mm incision four times greater (602 +/- 149 mmHg and 150 +/- 29 mmHg). Due to the high stability of the wound closure, no sutures are necessary. Complications arising in connection with sutures are therefore avoided. Clinically, two typical postoperative complications were observed: hypotony occurred in 1% and anterior chamber hemorrhage in 5%. These complications are exclusively caused by imperfection of the internal corneal opening.
The number of patients undergoing anticoagulation therapy is increasing. Interruption of the treatment can potentially result in complications endangering the patient's life. A new surgical technique with corneal incision, phacoemulsification and sutureless wound closure under maintained anticoagulation therapy is presented. Preliminary results after 36 cases seem to show that this technique is superior to those usually employed in cataract surgery, with corneal incision and suture.
OBJECTIVE: To assess the effectiveness of tuboplasty procedures employing fibrin glue. METHODS: Experimental tuboplasty operations were performed on 63 rats using biological glues (fibrin glue--"Beriplast" Behring; "FK-1", Russia) and microsuture materials. Uterine horn patency, adhesion formation, and other changes at the site of anastomosis, as well as pregnancy rate and embryonal characteristics, were assessed. CONCLUSIONS: We confirmed the effectiveness of fibrin glue application in reconstructive surgery on uterine horns, and documented no significant differences between microsuture and sutureless anastomoses with regard to pregnancy rates (80 and 83.3%, respectively).
Endocardial placement of electrodes for myocardial electrostimulation is a standard procedure. In the past, myocardial electrode placement was not performed routinely mainly because of the trauma of surgical access to the heart. We have developed for the first time an endoscopic approach. It is based on the use of a rigid endoscope with a diameter of 20 mm, which is introduced via a subxyphoideal skin incision into the pericardium. A sutureless, screw-in electrode is positioned via the endoscope. 129 patients were treated successfully without method-related lethality. An advantage especially for our large country is the possibility of performing this procedure in distant hospitals without the need of X-ray facilities. The equipment can be carried in an attaché case. Further developments could include two-chamber ECS using disposable kits ready for on-the-spot use.
A single center, single surgeon, nonrandomized, prospective clinical trial was performed comparing the keratometric induced astigmatism by different types of incisions and closures, one day, one week, one month and three months after 255 cataract surgeries. After phacoemulsification, or in rare cases after extracapsular cataract extraction, through a scleral pocket or limbal incision, patients received either a 5 x 6 mm, 5.5 mm, or 6 mm diameter polymethylmethacrylate optic posterior chamber intraocular lens. Incision was closed with either none, one horizontal or radial, or running 10-0 nylon suture. Vector analysis calculations of prism diopters of mean postoperative-induced keratometric astigmatism showed a trend to lesser values at each interval in scleral pocket incisions but statistically significant difference only at 1 day and 1 week between 9-mm and 6-mm limbal, and 5-mm and 6-mm scleral pocket incisions. Other subgroup analyses, including incision shape and distance from limbus, and type of suture, did not reach statistical significance. Horizontal, 5-mm, sutureless scleral tunnel incision showed less induced astigmatism with more rapid stable refraction.
A review of 375 cases of aortic valve replacement with the Magovern-Cromie sutureless prosthesis demonstrated a 43 per cent survival rate 10 to 13 years following the operation. Of the 308 patients surviving zero to 30 days, 238 patients are alive after one to 14 years. A total of 70 patients (22 per cent died during the 14 year follow-up period. The actuarial survival rate of all patients at risk was 64 per cent at the fifth year and 51 per cent at the tenth year. For those patients who lived at least one year after surgery, the probability of survival was 84 per cent and 70 per cent at 5 and 10 years, respectively. These results compare favorably with reports of up to only 8 years with the Smeloff-Cutter and Starr-Edwards prostheses. There was only a 1.5 per cent incidence of perivalvular leak with this method of fixation, and no valve has migrated. Ball variance has not occurred with any valve inserted since 1964, and the incidence of thromboembolism with the Model A4 prosthesis is 2.4 per cent. Improvement in results depend on reduction of thromboembolism, lessening of late and operative morality rates, and by earlier operative intervention to reduce the late deaths from cardiogenic factors.