Echocardiographic and Computed-tomographic Evaluation of the Fate of Bovine Pericardial Patch as a Pericardial Substitute in Bentall’s Procedure: Twenty-year’ Results

Objective: The study was designed to ascertain the influence of usage of bovine pericardial patch in patients undergoing Bentall’s procedure with respect to reexploration for bleeding, mediastinal infection, avoidance of conduit adhesions, late development of pericardial constriction and calcification. Materials and Methods: We reviewed 150 patients (79 males) aged between 22 to 68 years (mean±SD 49.25±12.9 years) receiving a composite aortic conduit between January 1998 to December 2020 for annuloaortic ectasia (n=100), aortic dissection (n=49), and dilated aortic root in repaired tetralogy of Fallot (n=1). Twenty-five patients had Marfan’s syndrome. Modified “button technique” was performed by interposing a glutaraldehyde treated pericardial strip at the graft coronary anastomoses, and proximal aortic conduit suturing using interlocking interrupted, pledgeted mattress suture. On completion, the pericardial cavity was reconstructed using St. Jude Medical Biocor pericardial patch. To detect evidence of pericardial constriction, survivors underwent echocardiography and computed tomography. The Kaplan-Meier curve was drawn to show the probability of survival over a period of follow-up time. Results: Seven (4.7%) patients died of cardiac-related cause, 45% had transient hemodynamic instability, 55% had low cardiac output, and 87.1% had spontaneous return of sinus rhythm. The average 12-hour postoperative drainage was 245±70 ml and there was no mediastinal infection. At a mean follow-up of 172.4 (SD± 58.9) months, the actuarial survival was 94.2±0.04% (95% CI: 88.5-96.8), and there was no pericardial constriction or calcification. Conclusion: Reconstruction of pericardial cavity using Biocor bovine pericardial patch minimizes diffuse oozing of blood, graft infection, and is not associated with later development of pericardial constriction, or calcification.

Cartilage Curvature Reshaping: A Quantitative Assessment

Background Horizontal mattress suture is frequently performed procedure during Rhinoplasty and Otoplasty to control the curvature of the cartilages. Despite the popularity of mattress technique, there are no quantitative methods to determine the suture effects in cartilage reshaping. Objectives The aim of the present experimental study was to quantify the straightening effect of mattress suture on convexity of ear cartilage in rabbit models. Methods Eleven young adult male New Zealand white rabbits were used in this study. Horizontal mattress suture with spacing 3×6 mm was used in rectangle demarcated on left ear in area with maximum convexity. Preoperative and postoperative photographers were done before and immediately after surgery respectively. The Radius of curvature (ROC), first order deviation (FOD) and second order deviation (SOD) were calculated to quantify net cartilage reshaping, each point changes and homogeneity of new shaped cartilage respectively. Results The means for ROC were 1.112 and 2.169 before and after surgery respectively. ROC as indicator of net overall changing increased statistically significant. The means of FOD as each point slope index was statistically lower after surgery. (0.269 before surgery, 0.135 after surgery) The means for SOD also significantly decreased after surgery. (0.007 before surgery, 0.003 after surgery) The values of SOD remained positive after surgery that indicate changes in curve were homogenous. Conclusions A quantitative measurement method was introduced to directly quantify the controlling effect of suture. This quantifying method seems to be mandatory to compare the effect of horizontal mattress suture with other techniques in cartilage reshaping.

Management of canine urolithiasis by cystotomy in a two-year old Lhasa Apso bitch

Canine urolithiasis is a common urinary tract disease requiring a rapid definitive diagnosis for immediate surgical and/or non-surgical therapy. The calculi may be microscopic or macroscopic, and when detected, the condition should be treated, either surgically or conservatively. This paper presents a surgical management of urolithiasis in a two-year old Lhasa apso bitch. The dog was haematuric for two weeks and had been on ceftriaxone and diclofenac for the period. Urolithiasis was confirmed following ultrasonography. The dog was pre-medicated with 0.02 mg/kg atropine sulphate and 2 mg/kg xylazine, while anaesthesia was induced and maintained with 10 mg/kg of 5% ketamine. Following aseptic patient preparation, the peritoneal cavity was accessed via a caudal ventral midline incision. The bladder was incised and the uroliths were evacuated via a cystotomy incision. Retrograde flushing of the urethra was performed to propel uroliths into the bladder for removal. The urinary bladder was closed with polyglycolic acid in Lambert suture pattern. The peritoneum and muscles were sutured using catgut in simple continuous suture. The skin was closed with silk using horizontal mattress suture pattern. The dog recovered uneventfully from the surgery and the wound healed after two weeks, at which time the skin suture was removed Keywords: Bladder, calculi, cystotomy, urolith, urolithiasis.

Predictors of Mortality in Primary Surgical Repair of Postinfarction Ventricular Septal Defects: The Leipzig Experience

Background: A postinfarction ventricular septal defect (pVSD) as a complication of acute myocardial infarction (AMI) is associated with high mortality. This retrospective, single-center study aimed to identify predictors of early and long-term outcomes in patients undergoing primary surgical repair of pVSD managed by various surgical techniques. Methods: We reviewed data from 77 consecutive patients who underwent primary surgical repair after pVSD in our institution. Prospectively collected demographic and perioperative data were analyzed retrospectively. Predictors of 30-day mortality and long-term outcome were assessed. Results: pVSD was anterior in 45 patients (58.4%) and posterior in 32 (41.6%). Buttressed mattress suture (n = 9, 11.7%), simple single septal patch (n = 34, 44.2%), simple double septal patch (n = 2, 2.6%), sandwich double patch (n = 1, 1.3%), and the infarct exclusion technique (n = 31, 40.3%) were performed for surgical closure. Fifty-three patients (68.8%) had preoperative cardiogenic shock. The 30-day mortality was 42.8% (33 patients). Independent risk factors of 30-day mortality were duration between AMI and surgery <7 days (odds ratio [OR] 5.229, P = .011), preoperative absence of diuretics (OR 6.913, P = .005), and preoperative cardiogenic shock (OR 3.558, P = .011). Cumulative survival rates at 1, 5, and 10 years were 57.1%, 57.1%, and 31.2%, respectively. Conclusion: In pVSD, the 30-day mortality remains high, and preoperative cardiogenic shock significantly influenced mortality in our study. None of the surgical techniques or materials used in our investigation influenced the outcome.

Do Techniques for Hill-Sachs Remplissage Matter in Terms of Functional and Radiological Outcomes?

Background: Different techniques are used for the remplissage procedure, including the double-pulley and mattress suture techniques. Both techniques have shown good results; however, it is unclear if one technique is superior. Hypothesis: The remplissage procedure using the double-pulley technique with 2 anchors would have superior functional and radiological outcomes compared with the mattress suture technique with a single anchor. Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients with anterior shoulder instability who were treated using arthroscopic Bankart repair combined with remplissage between 2012 and 2017. A structured questionnaire was used to gather information on the following metrics: Instability Severity Index Score, hyperlaxity, Sugaya index, presence of a Hill-Sachs defect, number of dislocations before surgery, sports participation, radiological measurement of the Hill-Sachs lesion, postoperative range of motion in both shoulders, Rowe score, Walch-Duplay score, American Shoulder and Elbow Surgeons score, and Filling Index Score of Remplissage grade according to magnetic resonance imaging scans at the last follow-up. Results: There were 41 patients included with a mean age of 30 ± 7 years who underwent the Hill-Sachs remplissage procedure using the double-pulley technique with 2 anchors (n = 21; group DA) or the mattress suture technique with a single anchor (n = 20; group SA). At the final follow-up, there were no significant differences between the groups regarding the Instability Severity Index Score ( P = .134), the Sugaya index ( P = .538), sports participation ( P = .41), the radiological measurement of the Hill-Sachs lesion ( P = .803), or the Rowe score ( P = .182). However, there were significant differences between the groups in the Walch-Duplay score ( P = .012), American Shoulder and Elbow Surgeons score ( P = .005), and Filling Index Score of Remplissage grade ( P = .015), favoring group DA, as well as differences in external rotation in a neutral position (external rotation loss: 9° ± 3° [group SA] vs 12° ± 3° [group DA]; P = .003) and at 90° of abduction (external rotation loss: 8° ± 3° [group SA] vs 11° ± 3° [group DA]; P = .006), favoring group SA. Conclusion: In the remplissage procedure, the double-pulley technique provided better filling of the lesion and improvement in functional scores, but external rotation was limited compared with the mattress suture technique.

Comparison of laparoscopic continuous inverting mattress suture + suction curettage and laparoscopic hysterotomy for exogenous cesarean scar pregnancy(CSP-Ⅱ)

Background:Type II CSP is usually treated by surgery, such as transabdominal, transvaginal, hysteroscopic and laparoscopic resection, It takes a long time for contraception,For patients with urgent fertility requirements, the above methods lack advantages,We are trying to find a safe and effective treatment to shorten the time of contraception.Methods: A total of 41 cases of CSP-Ⅱ were selected from January 1, 2019 to June 30, 2020 in the first people's Hospital of Kunshan City, Jiangsu Province,The patients were divided into two groups, group A(20 cases) was laparoscopic continuous inverting mattress suture + suction curettage,Group B(21 cases) was laparoscopic hysterotomy.Group A was compared with group B:serum β-hCG levels on the first day after operation;Inpatient time;time for serum β-hCG levels to return to normal;HGB on the first day after operation;menstruation recovery time;The differences in the intraoperative blood loss;operation time;The decrease rate of serum β - hCG level on the first day after operation.Results: Group A was compared with group B,serum β-hCG levels on the first day after operation,Inpatient time were not statistically significant (p > 0.05);time for serum β-hCG levels to return to normal,HGB on the first day after operation,menstruation recovery time were statistically significant (p < 0.05),Group A was significantly higher than group B;The differences in the intraoperative blood loss,operation time were significant difference between the two groups (P < 0.05),Group A was significantly lower than group B;The level of serum β - hCG on the first day after operation decreased by 50% in both groups.In group B, the pathology of the excised scar muscle layer showed that there was a little villus tissue in the muscle layer, and a large number of trophoblast cells were seen between the fibrous smooth muscle tissues.Conclusions: In group A,the method is more simple, less bleeding, shorter operation time and less trauma;it also can remove the diverticulum and increase the thickness of the lower uterine segment;the contraception time was shortened,but the decrease of serum β - hCG was slow and the recovery time of menstruation was long.

Trans-urethral bladder suture in female patients: Not a tour de force but a quick and realistic answer to complex situations

Introduction: Trans-urethral bladder surgery has gained popularity in the fields of electro-resection and laser lithotripsy, with endoscopic suturing being overlooked. Bladder defect closure using a pure trans-urethral suturing technique can provide a quick and effective solution in situations where conventional management options are not feasible. Methods: Here we describe this innovative novel technique developed by our group that was used to treat two different cases with bladder perforation at two different institutions. We used a 5 mm laparoscopic port with gas insufflation and a laparoscopic needle holder trans-urethrally to achieve defect closure with a monofilament 2/0 monocryl mattress suture on a small 22 mm needle. Results: The defects were successfully closed without any intraoperative complications. Average operative time for the technique was 18 min with minimal blood loss. Bladder closure was sustained at a median follow-up of 2 years for one of these cases. Conclusions: We claim that transurethral bladder suturing is quick, safe in expert hands and provides an effective option where the clinical condition/situation of the patient warrants a minimally invasive surgery approach.

A Modified Approach to Transconjuntival Levator Advancement Offering Intraoperative Options

Background The transconjunctival technique is a preferable and beneficial approach in mild to moderate blepharoptosis repair as without skin incision. However, accurate surgical manipulation of this method is greatly restricted by the poor intraoperative evaluation. Objectives To introduce a modified transconjunctival approach with flexible intraoperative adjustments in order to achieve more accurate ptosis correction. Methods By transconjunctival approach, the levator aponeurosis and the Müller’s muscle were folded using a square-like mattress suture for flexible adjustment and accurate correction. Results In 18 mild ptosis eyelids, 94.5% (17 eyelids) achieved adequate or normal correction. In 9 eyelids with moderate ptosis, 88.9% (8 eyelids) achieved adequate or normal correction. Amongst 24 ptosis patients, 23 (95.8%) achieved good or fair symmetry result. Conclusion We presented a modified transconjunctival technique for repair of mild to moderate ptosis, which is characterized by flexible intraoperative adjustments achieving both satisfying functional and aesthetic outcomes.