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At least 1,117 records · Page 62Linked to original sources
PubMed1978

[The distal rupture of the biceps tendon. Aetiology, clinic and technique (author's transl)].

Compared to the proximal rupture of the Biceps tendon the distal rupture is extremely rare. The numerous published methods of repair show that a reliable method has not yet been found. Considering functional principles we developed a method which combines a safe fixation of the tendon and a good function. An autologous tendon is brought through a burrhole placed obliquely through the mid position of the tuberosity. The Biceps tendon is now placed between the ends of the autologous tendon and fixed with resorbable u-sutures (Sandwich-technic). Thereby the tension on the tendon is adapted as necessary. The achieved results is demonstrated on two cases.

Accidents↗
PubMed2000

Laparoscopic radical prostatectomy: the Montsouris technique.

PURPOSE: Laparoscopic radical prostatectomy has become standard at our institution based on experience with 260 consecutive cases operated on between January 1998 and December 1999. In view of the favorable short-term outcomes we describe our standardized laparoscopic radical prostatectomy technique. MATERIALS AND METHODS: Two urologists trained in open retropubic radical prostatectomy and laparoscopy combined their experience to develop a specific technique of nonincisional radical prostatectomy for localized prostate cancer. Patients presented with clinical stages T1b to T2 prostate cancer and tumor size was approximately 18 to 130 gm. Operations were performed by 1 senior surgeon and 1 assistant, with the help of a voice controlled robot and with the patient under general anesthesia. The 2, 10 mm. ports and 3, 5 mm. ports were placed in the umbilicus and iliac fossa. The laparoscopic procedure was performed transperitoneally, combining anterograde and retrograde approaches in 7 standardized steps. Urethrovesical anastomosis was performed with 3-zero interrupted sutures tied intracorporeally. Technical details were compiled, summarized and illustrated with schematic views. RESULTS: Operating time was approximately 3 hours for the last 120 cases. Estimated average blood loss was 250 ml. with a transfusion rate of less than 1%. The conversion rate was 0%. Postoperative pain was minimal and analgesics were generally not required by postoperative day 2. The accuracy of dissection and sutures allowed patients to be discharged home without urethral catheterization starting on postoperative day 3. CONCLUSIONS: Laparoscopic radical prostatectomy is now not only feasible, but more importantly reproducible. Each step has been checked and validated, and the procedure is standardized and has definitively replaced the retropubic approach in our practice.

Humans↗
PubMed1983

Conservative surgery for bleeding duodenal ulcer--vagotomy and pyloroplasty.

50 unselected cases of bleeding duodenal ulcer were treated by vagotomy and pyloroplasty with suturing of the bleeding vessels. The operative mortality was 8% of which recurrent haemorrhage accounted for 6% of the patients. The operative mortality was related to advanced age, severity of bleed and associated medical illnesses. Vagotomy-pyloroplasty with suture ligation is technically easy to perform for bleeding duodenal ulcer and has a low incidence of recurrent haemorrhage.

Adult↗
PubMed1994

[A single-stage 2-layer suture in cesarean section--the effect of the surgical technic on postoperative febrile conditions].

The aim of the authors is to study the influence of the figure-of-eight suture of the uterine wall on the postoperative febrile complications. 1018 women, delivered with Caesarean were followed. 937 of them with conventional two layer suture of the uterine wall and the rest 81 with a figure-of-eight suture. Postoperative febrile complications were 15.58% in those with two layer suture against 3.5% in the rest 81. Using dispersion analysis the authors point that the on the type of uterine wall suture depends the rate of the postoperative febrile complications. The rate of influence of the figure-of-eight suture is up to 10%. Having in mind that this factor "suture", should be considered as 99% influential with a risk for mistake no more than 1%--F (8.06) > FT (6.64). The results presented show that the figure-of-eight suture is to be preferred to the conventional two layer suture of the uterine wall.

Cesarean Section↗
PubMed1995

Laparoscopic repair of perforated peptic ulcer.

A total of 100 consecutive patients with perforated duodenal or juxtapyloric ulcers were treated by: laparotomy and omental patch repair (group 1, n = 44); laparoscopic suture patch repair (group 2, n = 35); and laparoscopic fibrin glue repair (group 3, n = 21). The three groups were comparable in Acute Physiology And Chronic Health Evaluation II score and in other known operative risk factors such as shock on admission, delayed presentation and associated underlying medical illness. Operative mortality and morbidity data were identical in all groups. The mean operating time was 52.1, 101.3 and 61.1 min respectively in the three groups (group 1 versus group 2, group 2 versus group 3, and group 1 versus groups 2 and 3 combined, P < 0.001). The median number of doses of analgesia required after operation was 4, 3 and 1 respectively (group 1 versus groups 2 and 3, P < 0.05). Conversion to laparotomy was necessary in six patients in group 2 and in one in group 3 (P not significant). The median hospital stay was 5 days in all three groups. Patients who underwent laparoscopic repair of perforated peptic ulcer required fewer postoperative doses of analgesia than those who had open repair. Laparoscopic glue repair has the additional advantage over laparoscopic suture of being technically simpler; it also takes less time to perform.

Aged↗
PubMed2004

Five years' world experience with nonpenetrating clips for vascular anastomoses.

BACKGROUND: A new sutureless technique has been introduced clinically to facilitate the process of vascular reconstruction and improve patency. The Vessel Closure System (VCS) is nonpenetrating, creates an elastomeric everted anastomosis, and is easily and reproducibly applied. The objective of this report is to review the published world experience that has accrued regarding these clips with attention to the assets, liabilities, and pitfalls associated with the new technology. DATA SOURCES: Medline search and manual cross-referencing were performed, after which 61 original articles were identified on the use of VCS clips for vascular anastomoses. RESULTS: Advantages of the clips compared with sutures include the technical ease of application, the reduced anastomotic time, the superior hemodynamics, and the improved healing pattern of the anastomosis. Disadvantages include the potential problems in atherosclerotic vessels, lack of prospective randomized long-term follow-up, and initial costs. The best clinical results have been achieved in microvascular repair, as well as with vascular access and transplantation surgery. CONCLUSIONS: The VCS clip technology has become an accepted vascular anastomosing technique, which in future could lead to the use of clips as a standard approach and the use of sutures only in case of severe atherosclerosis and other circumstances in which vessel edges are difficult to evert.

Anastomosis, Surgical↗
PubMed1994

[Comparative analysis of sutures and stapling for colorectal anastomosis in resection of the rectum in carcinoma].

In Clinic for general and vascular surgery - Military Medical Academy Belgrade since 1987 to 1993 in treatment of the rectal cancer it was done 326 low anterior resections. In 149 patients anastomosis was done with sutures and in 177 with stapler. Half of them were more then 60 years old, and in 40% of patients carcinoma was staged as Dukes C or D. In group I tumor was localised in the middle or distal third of rectum in 24.8% of patients while in group II this was in 75.7%. Anastomosis related complications where rare in stapler group, clinically evident anastomotic dehiscence was found in 11.4% patients in I group and in 99% in II group. Total mortality was 3.1%; 3.4% in the I group and 2.8% in the II group. In our comparative analysis of early complications after low anterior resection of rectum when colorectal anastomosis was done with suture or stapler technic we have found that stapler technic give opportunity for creating much more low colorectal anastomoses which are safe and with less complications and with the same oncologic control of disease.

Adult↗
PubMed1993

Cardiac stapling in the management of penetrating injuries of the heart: rapid control of hemorrhage and decreased risk of personal contamination.

The resuscitation of patients with cardiopulmonary arrest from a penetrating injury of the heart requires emergency thoracotomy and control of hemorrhage. Suture control may be technically difficult in patients with large or multiple lacerations. Emergency cardiac suturing techniques expose the surgeon to the risk of a contaminated needle stick. After we determined that rapid control of hemorrhage from cardiac lacerations could be achieved in anesthetized sheep with the use of a standard skin stapler, the technique was applied in the clinical setting. Twenty-eight patients underwent emergency stapling of 33 cardiac lacerations at our institution from September 1987 to December 1991. Seventy-nine percent (22) of the patients sustained stab wounds, and 21% (6) were injured by gunshots. Fifty-eight percent (19) of the injuries involved the right ventricle, 27% (9) involved the left ventricle, 9% (3) involved the right atrium, and 6% (2) involved the left atrium. In 93% (26) of the patients, control of hemorrhage was achieved within 2 minutes of exposure of the injuries. Both patients in whom control could not be achieved had sustained large-caliber gunshot injuries. Fifteen (54%) of the patients survived, including one patient with two cardiac lacerations and another with three lacerations. Of the surviving patients, two had mild neurologic deficits. No personal contamination occurred related to the use of the stapler. We conclude (1) cardiac stapling is highly effective in the management of hemorrhage from penetrating injury, particularly in the setting of multiple cardiac lacerations; (2) the technique may not be effective with certain types of gunshot wounds; and (3) the use of the stapler for emergency cardiorrhaphy eliminates the risk of personal contamination from a needle stick.

Adult↗
PubMed1984

[Technic of rectum anastomoses in rectum resection. A controlled study: instrumental suture versus hand suture].

Stapler and manual sutures in rectal end-to-end anastomoses were compared in a controlled trial. The following results were obtained: For the analysis the cases naturally separated into three groups, A (manual suture), B (planned stapler suture) and WD ("withdrawn" cases, from both groups, in which continence could be maintained only with a stapler suture). The distribution of the WD cases in dependence on localization and sex varied significantly from groups A and B, while A and B remained comparable, in spite of the WD cases. The analysis of the date showed no, or only slight, clinical differences. In a comparison of the two stapler groups B and WD, significantly more suture dehiscences, colocutaneous fistulae and post-operative disturbances in bladder function were found in group WD. As a general conclusion we can state that: In comparable anastomosis localizations it is possible to achieve almost the same clinical results with both suture techniques. With a circular stapler it is, however, technically possible to perform rectum resections in cases in which this was not previously possible, particularly in men with a narrow pelvis and a stale pelvic floor. To what extent this still is an advantage after the local recurrences are taken into consideration remains to be seen.

Clinical Trials as Topic↗
PubMed2002

Safety and efficacy of a 6 French perclose arterial suturing device following percutaneous coronary interventions: a pilot evaluation.

BACKGROUND: Arterial access site management after percutaneous coronary intervention (PCI) is a matter of increasing importance in this era of potent antiplatelet pharmacotherapy. We evaluated the safety and efficacy of a 6 French (Fr) Perclose suturing device in achieving rapid hemostasis of the access site after PCI and thus improving patient comfort. METHODS: The 6 Fr Perclose (Prostar) device consists of a suture-based closure device delivered via introducer sheath designed for suturing of the arteriotomy puncture site. Over a 3-month period, the device was used in 48 consecutive PCI treated patients (age, 62 13 years; 70% male; 44% post myocardial infarction) and in-hospital groin complication rate was compared to 48 consecutive patients (age, 64 12 years; 64% male; 33% post myocardial infarction) who had manual compression hemostasis. RESULTS: Antiplatelet glycoprotein IIb/IIIa antagonists were used more frequently during and following the procedure in 58% of Perclose-treated patients versus 42% of the manual compression group (p = 0.019). Leg immobilization duration was 3 4 hours in all patients sutured by the device; in patients with manual compression, the sheath was removed at an average of 4.8 2.5 hours after termination of the PCI and an additional 6 hours of leg immobilization were subsequently required. No difference in overall major complication rate was found between groups (6.2% in suture-mediated patients versus 9.3% in manual compression group; p = 0.60). In 3 patients (6.2%) treated using the device, adjunctive manual compression was required in addition to groin suturing due to technical failure or residual oozing from the arteriotomy site. CONCLUSION: The 6 Fr Perclose device can be safely used to achieve rapid hemostasis and the device may hasten bed mobilization of PCI-treated patients despite frequent use of potent antiplatelet pharmacotherapy during coronary interventions.

Adult↗
PubMed1987

[Mechanical circular colorectal anastomosis using a transanal approach. Apropos of a series of 51 cases].

Automatic circular suture forceps offer new technical possibilities for the confection of colorectal anastomosis. A retrospective study was conducted in 51 patients, representing a homogeneous group of anastomoses performed by the same surgeon using the same operative technique and with routine review by barium enema examination on the 8 th postoperative day. Technical difficulties during operation were encountered in 10 patients (19.6%) requiring supplementary sutures in 3 cases and protective colostomies in 3 others. Review examinations revealed anastomotic dehiscence in 7 cases (13.7%), only 3 (5.9%) of these radiologic fistulae provoking clinical manifestations, and only one of these (1.9%) necessitating recovery operation. Perfect compliance with conditions of use of the mechanical forceps and a minute technique identical to those of manual sutures produced excellent early result with circular mechanical suturing using EEA forceps when compared with manual suturing methods. This was particularly true in Goligher's series in which there were 51% of radiologic fistulae. Under certain difficult conditions, the use of EEA forceps simplifies performance of a colorectal anastomosis, mechanical anastomosis using the circular forceps constituting an undeniable technical progress in colorectal surgery with conservation of anal sphincter.

Adolescent↗
PubMed1998

[Risks of 360 degree suture trabeculotomy].

BACKGROUND: In 1995, Beck and Lynch reported a method to perform a 360 degrees trabeculotomy by prolene suture introduced into Schlemm's canal. Because this type of surgery has proved to have perils and can lead to extreme hypotony, even a small series of cases must be reported. PATIENTS: Suture trabeculotomy was planned in five eyes of four patients, 5 and 7 months old and 6 and 51 years old, with primary congenital glaucoma, but completed in only two eyes. RESULTS: In one child, suture trabeculotomy could be accomplished easily in both eyes. In the first eye a 360 degrees-tomy was performed, in the second eye only a 180 degrees-tomy was done. Both eyes remained extremely hypotonic (4 mm Hg). In one eye Schlemm's canal could not be disrupted by the suture; in another eye, Schlemm's canal could be probed only for a short distance, and in one eye the suture went the wrong way. CONCLUSIONS: Because a suture trabeculotomy can be transformed into a normal trabeculotomy any time, the main problems of the 360 degrees-suture trabeculotomy are not the possible technical difficulties, but that a successful suture trabeculotomy is followed by extreme hypotony.

Child↗
PubMed1990

Sutureless ring graft replacement of ascending aorta and aortic arch.

Complications after aortic replacement that result from prolonged graft insertion time and technical difficulties with suturing through friable, diseased aortic tissue can be addressed with use of the sutureless intraluminal ring graft. Between 1978 and 1989, we replaced the ascending aorta or aortic arch with this device in 49 patients. At no time were we unable to use a sutureless graft during a procedure. Twenty-eight cases of aneurysmal disease and 21 cases of acute or chronic dissection were treated. Twenty-six patients required replacement of the aortic valve, with annuloartic ectasia being the most common indication (71%). Ten patients underwent concomitant coronary artery bypass grafting. The operative mortality rate for ascending aortic aneurysm repairs was 4%, and that for dissections was 18%. Five of 8 patients requiring aortic arch replacement survived. Most patients were studied angiographically before discharge. No complications were related to anastomotic hemorrhage, pseudoaneurysm formation, graft migration, or thromboemboli. Individual cases of phrenic nerve palsy, acute tubular necrosis, and transient ischemic attack, all of which resolved completely, were identified. The actuarial 5-year survival rate is 64%. We conclude that modification of the sutureless intraluminal ring graft to suit the pathology encountered at operation allows the quickest repair with the least chance of anastomotic complication.

Adolescent↗