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PubMed1993

Indications for internal stenting in intestinal obstruction.

Internal stenting (sutureless plication) for intestinal adhesions was performed operatively in 16 patients. Subsequent recurrent obstruction occurred in four patients. Other complications occurred in three patients and included retained tube, jejunostomy-site abscess, and intestinal fistulization. Four patients died for an in-hospital mortality of 25%. Internal stenting for adhesions should be used cautiously. Its use should probably be restricted to the setting of severe adhesive small bowel obstruction particularly when numerous enterotomies are incurred during the course of adhesiolysis.

Humans↗
PubMed1993

[Phacoemulsification without suture. Results of implantation of a large optic PMMA lens].

Sutureless phacoemulsification with implantation of a 7-mm PMMA intraocular lens was performed through a modified scleral tunnel in 100 consecutive patients. This was done to minimize postoperative astigmatism while retaining the advantages of implanting intraocular lenses with large optics. Visual and keratometric results and complications are reported after completion of a follow-up period of 6 months for the first 30 patients. Average uncorrected visual acuity improved from 0.13 preoperatively to 0.30 as early as 1 week postoperatively. Average best-corrected visual acuity improved from 0.23 before surgery to 0.51 as early as 1 week after surgery. No significant changes in visual acuity were recorded thereafter. The absolute value of keratometric astigmatism was not increased significantly at any postoperative examination time. The induced cylinder (Jaffe and Clayman) shifted from -1.27 D x 166 degrees at 1 week to 1.18 D x 91 degrees at 1 month postoperatively without further relevant changes thereafter. Endothelial cell loss did not differ from that reported by other authors after conventional cataract surgery. Corneal thickness was not increased significantly at any postoperative examination time. Implantation of intraocular lenses with large optics through a scleral tunnel allows quick visual rehabilitation as well as early stability of refraction.

Adult↗
PubMed1993

[Calculating the induced, computerized tomography measured corneal astigmatism after cataract surgery with small incision technique and wound closure with single suture technique based on various mathematical models].

Small-incision cataract surgery with scleral tunnel incision and one-stitch horizontal or sutureless wound closure has been found to be an effective way to reduce postoperative astigmatism and to guarantee greater stability of the wound with rapid visual rehabilitation. In some studies surgically induced astigmatism by different wound constructions and wound-closure techniques has been compared to determine the astigmatism induced. Different calculation methods were used leading to different results. Therefore, we evaluated the induced astigmatism in 50 patients operated on by scleral tunnel incision, phacoemulsification with PCL implantation and single-stitch wound closure. We analyzed induced astigmatism on the first postoperative day and 3 months postoperatively by different methods: the simple subtraction method (0.91 and 0.30 D), Naeser's polar value method (-0.74 and -0.75 D), the vector analysis method of Jaffe (2.53 and 1.19 D) and two calculations described by Cravy. Depending on the formula used, different results were obtained. The subtraction method disregards axis change and is less precise. The vector analysis methods obtain the highest values for induced astigmatism and seem to be the most precise for evaluating the real amount of induced postoperative astigmatism.

Aged↗
PubMedDate not supplied

Astigmatic and refractive stabilization after cataract surgery.

We assessed the timing of astigmatic and refractive stabilization following six cataract surgery procedures with intraocular lens implantation in 229 eyes divided into six groups in the following incision sizes and methods of wound closure: 11-mm incision with running suture closure (26 eyes) 6.5-mm incision with running suture closure (29 eyes) 6.5-mm incision with single horizontal suture closure (25 eyes) 6.5-mm incision without suture closure (46 eyes) 5.5-mm incision without suture closure (51 eyes) 3.2-mm incision without suture closure (52 eyes) Analyzed up to 6 months postoperatively were: the mean and standard deviation of axis-based keratometric cylinders the absolute value of the induced-cylinder vector the spherical equivalent of the refractive power. In the 11- and 6.5-mm incision running suture groups, these parameters did not stabilize during the study period. In the 6.5-mm incision horizontal suture and sutureless groups, the values stabilized at 3 months postoperatively; in the 5.5-mm incision group, at 1 month; and in the 3.2-mm incision group, at 2 weeks. These results indicate that the appropriate point at which to prescribe postoperative correction spectacles differs significantly depending on the procedure, and that smaller incisions with wound-closure methods that do not exert vertical force are associated with fewer postoperative refractive changes.

Aged↗
PubMed1996

Management of recurrent and perivascular femoral hernias by giant prosthetic reinforcement of the visceral sac.

BACKGROUND: Classical hernioplasties have been used to manage primary femoral hernias for over a century. In women, infrainguinal repair of the parietal defect is simple and successful. In men, femoral hernias are frequently associated with inguinal hernias and, therefore, a Cooper's ligament repair is indicated. For recurrent femoral hernias, however, the classical hernioplasties are often inadequate just as they are for the repair of recurrent inguinal hernias and a prosthetic repair is indicated. Giant prosthetic reinforcement of the visceral sac (GPRVS) is the descriptive name of a properitoneal groin hernioplasty with a large piece of Mersilene. The repair focuses on retaining the peritoneum rather than repairing the parietal defect and is efficient, anatomic, sutureless, and tension-free. It is the only repair that reliably eliminates all hernias of the groin, including perivascular femoral hernias. STUDY DESIGN: In this study, GPRVS by way of an abdominal incision was used to treat recurrent and perivascular femoral hernias. Also included are a description of and experiences with a new technique of unilateral GPRVS performed through an infrainguinal approach. RESULTS: The data reveal no recurrences in 69 problem femoral hernias of which 15 were primary (two perivascular) and 54 recurrent (four perivascular). CONCLUSIONS: Giant prosthetic reinforcement of the visceral sac performed transabdominally or by way of the newly described infrainguinal method is a useful and reliable method to treat primary, recurrent and perivascular femoral hernias.

Abdominal Muscles↗
PubMed1977

[Fibrin adhesion (orientating animal experiments) (author's transl)].

For some time fibrin adhesion is successfully used instead of sutures in different branches of surgery. We tested in animal experiments whether this method can be used for a sutureless closure of perforating corneal and corneoscleral wounds. Our results up to now do not show us any such possibility.

Animals↗
PubMedDate not supplied

Effects of wound architecture and suture technique on postoperative astigmatism.

BACKGROUND AND OBJECTIVE: A prospective randomized investigation was performed to evaluate the effects of wound architecture and suture techniques on postoperative astigmatism after phacoemulsification and intraocular lens implantation. PATIENTS AND METHODS: Two hundred eyes with preexisting with-the-rule astigmatism were randomized into four groups: (1) sutureless scleral tunnel frown incision, (2) scleral tunnel frown incision with a horizontal suture, (3) scleral tunnel frown incision with both a horizontal and a running suture, and (4) posterior limbal acute beveled cataract incision with a running suture. All the incisions were placed in the vertical steep meridian. RESULTS: Data were analyzed from 128 cases with 1-year follow-up. The results revealed that at the 2-month postoperative visit, preexisting astigmatism was significantly reduced in group 1 (P = .029) and significantly increased in groups 3 (P = .020) and 4 (P = .005). There was no significant change in group 2 (P = .06). By the 1-year postoperative visit, there was no significant difference in astigmatism from preoperative levels for all four groups. Vector analysis revealed no significant difference in the mean surgically induced cylinder at 1 year in all four groups. The number of eyes with induced against-the-rule astigmatism, however, was significantly higher than the number of eyes with induced with-the-rule astigmatism in all four groups (P <.01). CONCLUSION: The authors found that sutured wounds placed in the vertical steep meridian may initially increase with-the-rule astigmatism, whereas nonsutured wounds placed in the vertical steep meridian may initially reduce with-the-rule astigmatism. By 1 year, however, a mean flattening of the vertical steep meridian was observed in the three groups with sutures as well as in the group without sutures.

Aged↗
PubMed1996

Effect of surgical technique on the increase in intraocular pressure after cataract extraction.

BACKGROUND AND OBJECTIVE: A prospective study was performed to determine the influence of surgical technique on the increase in intraocular pressure (IOP) after cataract surgery. PATIENTS AND METHODS: Three groups of 30 patients each underwent either extracapsular cataract extraction with sclerocorneal suture (ECCE), phacoemulsification with sclerocorneal suture (PS), or phacoemulsification with a sutureless scleral tunnel (PT). RESULTS: Each group experienced a significant increase in IOP 5 to 7 hours after surgery: 20.2 +/- 7.9 mm Hg for ECCE, 11.2 +/- 8.3 mm Hg for PS, and 4.7 +/- 8.7 mm Hg for PT. The differences in the increases among the three groups were significant. CONCLUSION: PT [corrected] produces the lowest postoperative increase in IOP and should be considered for patients with glaucomatous damage.

Aged↗
PubMed1996

Experience with the tension-free hernioplasty for primary inguinal hernias in men.

BACKGROUND: Tension-free inguinal hernioplasties have been highly touted and aggressively promoted by the initiators of the procedures and manufacturers of the prosthesis. Beginning in 1990, these procedures were adopted for the treatment of primary groin hernias in men. STUDY DESIGN: This experience involved 1,252 tension-free hernioplasties that were performed in 1,076 men who were then followed up for one to six years. Lichtenstein's tension-free hernioplasty and Gilbert's sutureless hernioplasty were the techniques used, usually in combination and tailored to the problem at hand. The mesh was polypropylene. Anesthesia was local in 97 percent of the operations. Antibiotics were not used as prophylaxis for wound infections. RESULTS: Fifteen complications occurred for a rate of 1.2 percent. They were one wound infection, one seroma, 12 hematomas, and one ilioinguinal neuralgia. In none was it necessary to remove the mesh. Six recurrences occurred for a rate of 0.5 percent. Of these, four were indirect, one was direct, and one was femoral. The indirect recurrence followed repair of primary indirect hernias. No indirect recurrences have occurred since the procedure has included placing Gilbert's cone-shaped plug in the deep ring when an indirect hernia was present. CONCLUSIONS: Tension-free hernioplasties consisting of a patch of polypropylene mesh partially fixed to the perimeter of the floor of the inguinal canal, plus a cone-shaped plug of the same material placed in the deep ring when an indirect hernia is present, produce excellent results however they are measured and are the preferred methods to manage most primary inguinal hernias in men.

Aged↗
PubMed1996

Effect of scleral buckling on unsutured cataract wound strength.

BACKGROUND AND OBJECTIVE: Modern cataract surgery has evolved to include small, unsutured wounds with rapid visual rehabilitation and fewer complications. Properly constructed, these unsutured wounds can withstand increased intraocular pressures without leakage, rupture, or incarceration of intraocular contents. However, scleral buckling surgery may alter the architecture of these wounds and thus their strength. The authors wanted to study the effect of scleral buckling on the integrity of these unsutured cataract wounds. MATERIALS AND METHODS: Eighteen fresh human globes underwent creation of scleral and limbal corneal incisions so as to create self-sealing wounds. Scleral buckles were then placed. Intraocular pressures were elevated to 400 mm Hg before and after placement of the scleral buckles and evidence for wound leakage was sought. RESULTS: Two globes with clear corneal incisions and no scleral buckles leaked slightly at 300 mm Hg, but no globe with a scleral buckle, regardless of incision type or silicone element style, leaked at pressures to 400 mm Hg. CONCLUSION: Sutureless cataract incisions, if properly constructed, provide a strong, pressure-resistant wound. Scleral buckling does not appear to affect the strength of these wounds.

Cataract Extraction↗
PubMed1996

[Treatment of recurrent and prevascularized femoral hernias by reinforcement of the visceral sac using a giant prosthesis].

Giant prosthetic reinforcement of the visceral sac (GPRVS) is the descriptive name of a preperitoneal groin hernioplasty with a large piece of Mersilene. The repair focuses on retaining the peritoneum rather than repairing the parietal defect and is efficient, anatomic, sutureless, and tension-free. Herein, is a discussion of its use to manage recurrent and perivascular femoral hernias and a description of a new technique of unilateral GPRVS done through an infrainguinal approach. The data presented reveal no recurrences in 69 problem femoral hernias of which 13 were primary, 50 recurrent and 6 perivascular.

Female↗
PubMed1996

Colorectal surgery using a biofragmentable anastomotic ring.

To compare the efficacy of the biofragmentable anastomotic ring (Valtrac-BAR, Davis and Geck, Medical Device Division, Danbury, CT, USA) with conventional anastomotic techniques, 30 patients who underwent colorectal surgery from August 1993 to March 1995 were retrospectively studied. The use of the BAR was also compared with conventional techniques including hand-sewn sutures in 30 patients and an end-to-end anastomosis (EEA) stapler in 24 patients. There were 17 men and 13 women in the BAR group with ages ranging from 37 to 80 years, 18 men and 12 women in the hand-sewn group with ages ranging from 41 to 82 years and 14 men and 10 women in the EEA group with ages ranging from 38 to 72 years. Surgical indications included: 25 colon cancers and five rectal cancers in the BAR group; 27 colon cancers and three rectal cancers in the hand-sewn group; and six colon cancers and 18 rectal cancers in the EEA group. There was no conversion to other anastomotic methods. Most of the patients tolerated a low-residual diet from the fifth post-operative day. No clinical leakage or stricture was noted. Only seven patients were aware of the passage of BAR fragments. The mean hospital stay was 14.1 days. There were no significant differences among these techniques in the return of bowel function, the incidence of surgical complications, including anastomotic leakage, or the length of hospitalization. BAR anastomosis was more time efficient than conventional techniques. Our results confirmed that BAR was an ideal sutureless alternative for anastomosis in colorectal surgery.

Adult↗
PubMed1996

[Intestinal anastomosis with biodegradable ring].

The authors report their experience using biofragmentable anastomosis ring (BAR) in bowel anastomosis. Starting January 1993 to February 1994, 46 intestinal anastomoses were performed using BAR, and particularly 39 end-to-end colo-colostomies, 2 end-to-side colo-colostomies and 5 end-to-side ileo-colostomies. 35 patients were affected by colonic neoplasm, 5 patients by diverticular colonic complications- and 5 patients by several unusual bowel diseases. Four emergency operations were performed, while 42 patients had an accurate bowel preparation before surgery. In this series of patients one case of preoperative mortality is reported, due to massive pulmonary embolism. Instead several minor complications occurred in other patients, such as paroxysmal atrial fibrillation (one case), basal pleuritis (one case), hyperpyrexia (three cases), temporary subocclusion or delayed canalization (five cases). Only one patient suffered from intestinal occlusion induced by adhesions and a second laparotomy was required. Delayed canalization seems to be caused by the small size of the BAR employed (25 mm) or by inadequate intestinal preparation, that usually occurs in emergency operations. After surgery all patients were followed up and 18 of them were examined by coloscopy six months after surgery. No clinical problem connected with bowel anastomosis was reported and all anastomosis looked quite previous and resilient. No anastomotic stenosis was found. In our experience and from recent reviewed reports, BAR seems to be a rapid, effective and safe device for sutureless bowel anastomosis.

Adult↗
PubMed1997

Thoracoscopic implantation of a pacemaker lead: experimental study.

We have performed five thoracoscopic pacemaker lead implantations into the porcine myocardium. A small opening, approximately 2 cm in diameter, was made thoracoscopically in the pericardium overlying the apex of the left ventricle, avoiding phrenic nerve injury. Three screw-in type or two stab-in type standard sutureless unipolar epicardial electrodes were introduced through a trocar, and then screwed or stabbed into the myocardium near the apex of the left ventricle, avoiding the coronary vessels. Hemorrhage and arrhythmia were negligible during the procedures. Electrical tests of the pacing threshold and lead impedance after implantation of the leads revealed acceptable values in each lead. We conclude that thoracoscopic implantation of pacemaker leads is feasible, and may be used as a minimally invasive option when conventional transvenous techniques are unavailable or contraindicated.

Animals↗
PubMed1996

[Repair of inguinal hernias without tension and without suture using a large dacron mesh prosthesis and by pre-peritoneal approach. A method of reference for selective indication].

This original and now classical method was the first tensionless and sutureless repair of groin hernias proposed almost 30 years ago. Its authors recall its principles, technique and results. The discussion justifies the choice of the particular prosthetic material, demythifies the sepsis risk which is balanced by the recurrence risk, the potentially raising problems related to retroparictal sclerosis at reoperation on the bladder or external iliac vessels, and defines the indications and contraindications of the procedure.

Bacteremia↗
PubMed1997

[My experience in repairing, without tension, primary inguinal hernia in men].

Beginning in 1990, the tension-free inguinal hernioplasties were adopted for the treatment of primary groin hernias in men. 1252 tension-free hernioplasties were performed in 1,076 men and followed for one to six years. Lichenstein's tension-free hernioplasty and Gilbert's sutureless hernioplasty were used, usually in combination. Anesthesia was local in 97% of the operations. 15 complications occurred (1.2%): one wound infection, one seroma, 12 hematomas, and one ilioinguinal neuralgia, 6 recurrences occurred (0.5%): 4 indirect, one direct and one femoral. No indirect recurrences have occurred since placing Gilbert's cone shaped plug in the deep ring. Tension-free hernioplasties consisting of a patch of polypropylene mesh plus a cone plug of the same material, placed in the deep ring when an indirect hernia is present, produce excellent results and are the preferred methods to manage the majority of primary inguinal hernias in men.

Adult↗
PubMed1996

[Results of the intraocular lens SI-30 implantation].

PURPOSE: clinical evaluation of the flexible silicone intraocular lens SI-30 (Allergan). METHOD: retrospective study over 3 years of 2000 implantations of the SI-30 IOL. The lenses were inserted through a 3.2 mm scleral tunnel and placed in the capsular bag after continuous circular capsulorhexis and phacoemulsification. RESULTS: visual outcome was excellent. Without other causes of impaired vision, 99% of patients regained a visual acuity of 20/30 or better after 1 month. Induced astigmatism was unsignificant: 0.4 D; preop., 0.9 D. at day 7, 0.4 at 1 month, 0.5 D. at 1 year. A disinsertion of the inferior haptic occurred in 2 cases during the insertion manoeuver. More specific postoperative complications consisted of pigmented deposits (less than 1%), pupillary capture (4 cases), and capsule contraction associated with small size capsulorhexis. Aspecific complications were: cystoid macular oedema (3% at 1 month, less than 1% afterwards), chronic uveitis (0.6%), acute uveitis (1 patient). CONCLUSION: implantation of the SI-30 silicone lens is safe and gives the patient the benefits of a small, non enlarged, and sutureless cataract incision. The postoperative follow-up must take in account the properties of the lens.

Capsulorhexis↗