Single Layer Versus Double Layer Anastomosis of Small Intestine – A Comparative Study from Karnataka, India

BACKGROUND Intestinal anastomosis is an operative procedure that is of importance in the practice of surgery. It is a very commonly performed technique in today’s surgical era. We wanted to study the postoperative complications like anastomotic leak and abscess formation and duration of hospital stay in single layer and double layer anastomosis and compare the same. METHODS In our prospective observational study, 80 patients were reviewed and were divided into 2 groups. Cases were allotted to either group based on the odd even method requiring single- and double-layer anastomosis, odd being single layer and even being double layer anastomosis. Intestinal anastomosis was carried out in single layer technique with delayed absorbable suture material and double layer technique with inner transmural layer with delayed absorbable suture material and seromuscular layer with non-absorbable suture material. RESULTS Each group had 40 patients, there was significant difference noted between the groups. Mean duration of hospital stay in single layer group was 17.85 ± 7.62 days and in double layer group was 26.20 ± 16.12 days (P = 0.043 *). In single group, mean time taken for anastomosis was 18.50 ± 1.73 and in double group was 29.05 ± 2.19. There was significant difference in time taken between two groups (P < 0.001). In single group, majority of subjects had no anastomotic Leak (95 %) and 5 % had leak. In double group 70 % had no leak and 30 % had leak. P value was statistically significant (P = 0.037). CONCLUSIONS Single layer anastomosis was better in terms of duration of hospital stay, postoperative anastomotic leaks and time taken for anastomosis. KEY WORDS Single Layer, Double Layer, Small Bowel, Duration of Hospital Stay, Anastomotic Leaks

A Case Series : Hymenoplasty Based on The Type of The Tear or Cleft Preoperation Finding For Good Satisfaction Postoperative Result

Purpose: To describe our surgical hymenoplasty technique based on the type of the tear or cleft finding preoperative for satisfaction postoperative. Patient and methods: Hymenoplasty was performed on 4 patient on January 2017 until March 2017, we found three patients with U-type, 1 patient with V-type. And we performed hymenoplasty which is to create a new surface raw, on the right and left cleft to be stiched, we use a rapid absorbable suture material, with horizontal mattress technique. Results: No complications developed in the patients who had undergone hymenoplasty and all patients stated that the sexual intercourse they experienced was similar to the night of the initial experience. Discussion : Our new apporach for hymenoplasty is a technique that has good results, and this is a good approach in doing hymenoplasty.

A Clinical Audit Of Management Of Third And Fourth Degree Perineal Tears

Objective: To perform a clinical audit of the practices of third and fourth degree preineal tears management in our institution. Methods: A review of medical records was performed, of women having singleton term vaginal delivery sustaining obstetric anal sphincter injuries (OASIS) at Aga Khan University Hospital (AKUH), Karachi from January 2008 to December 2018. We compared the change in practices regarding management of OASIS with the results of our previous study done at AKUH in 2008. Results: The frequency of OASIS in our department is 0.56% (142/25370). The documentation of OASIS improved compared to previous study ( 20.7% to 87%). There was also a significant increase in documentation of the method of repair, use of delayed absorbable suture material for the repair of external anal sphincter and follow-up at 06 weeks to see the success of repair and plan next delivery. The use of vaccum vaginal delivery increased to 27(19%) from 5(4%) but there was decrease in the OASIS complicated by instrumental vaginal deliveries, which may be due to the decrease in the use of forceps from 64% to 26%. Conclusions: Despite of increase in the number of deliveries , frequency of OASIS remained similar to the previous study. There was a significant increase in the vaccum vaginal delivery, documentation of degree of tears, use of delayed absorbable suture material and long-term follow-up and decrease in the use of forceps. The compliance to international guideline increased as compared to our previous paper. Continuous...

EFFECT OF ABSORBABLE SUTURES ON POST THORACOTOMY PAIN THE SEQUEL OF NERVE ENTRAPMENT.

Objective: To study the effect of use of absorbable suture material in thoracotomy closure on the chronic post-thoracotomy pain. Keywords: Open thoracotomy, Nerve entrapment, Persistent pain, Absorbable suture

A comparative study of inguinal hernia using monofilament non-absorbable suture versus monofilament absorbable suture in Lichtenstein tension free hernia repair at tertiary care government hospital

Background: The surgical treatment of inguinal hernias has evolved through several stage, history of groin hernia is the history of surgery itself. But, chronic pain is still a major irritating post-operative complain of the patient. The objective of the present study was to compare post-operative outcomes of mesh fixation with monofilament non-absorbable v/s monofilament absorbable suture material in terms of postoperative pain, chronic groin pain, seroma formation, wound infection, scrotal oedema and recurrence in Lichtenstein hernioplasty.Methods: This is a single center, prospective randomized controlled study of 152 cases of inguinal hernia comparing post-operative outcomes of mesh fixation with monofilament non-absorbable v/s monofilament absorbable suture material in Lichtenstein hernioplasty at Baroda Medical College and S.S.G. Hospital, between 1st November 2017 to 30th November 2018.Results: Total 152 patients of unilateral or bilateral inguinal hernia were studied 76 in each group. Chronic groin pain mean visual analogue scale score at 3 months was higher in group with non-absorbable suture compared to monofilament absorbable group (1.3±0.9 v/s 0.95±0.8 p value <0.05).Conclusions: Monofilament absorbable suture is associated with less chronic groin pain and compared to monofilament non-absorbable sutures.

Comparison of Knotless Barbed Suture Versus Monofilament Suture in the Oral Cavity of Cats

The present study compares a knotless, barbed, absorbable suture material against a conventional monofilament absorbable suture material in oral mucosal wound closure. The parameters measured include time of closure and differences in healing at 2 and 4 weeks postoperatively. A prospective study comparing a knotless, barbed suture system with conventional absorbable sutures was undertaken in 19 cats. Nineteen cats had full mouth extractions performed. Following the extraction procedures, the incisions in the arcades (maxillary and mandibular) were apposed with the barbed, knotless suture system in a continuous pattern on one side and with a conventional smooth suture in an interrupted pattern on the other. Suturing times for each arcade were recorded. The material used to close the first side of each cat varied. Healing, dehiscence, and other complications were assessed at 2 and 4 weeks postoperatively. The average closure time (± standard deviation) per quadrant with conventional monofilament suture was 8.7 (±1.3) minutes, while barbed suture required an average of 5.1 (±1.1) minutes per quadrant to complete the suture. This difference (95% confidence interval) of 3.6 (±3.2-4.1) minutes per quadrant was statistically significant ( P < .001). Dehiscence and ranula-like swelling formation were noted as uncommon postoperative complications, but the differences were not significant between the groups. Barbed, knotless sutures resulted in faster closure times than conventional, simple interrupted, monofilament sutures with similar healing and complication rates. To the author’s knowledge, there is no current literature comparing conventional absorbable monofilament sutures to a knotless, barbed, absorbable suture system for closure of oral mucosal incisions in cats.

Absorbable suture material in carotid surgery

Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.