STRABO care less traumatic strabismus surgery technique in the rehabilitation of patients with strabismus

Purpose. Comparative evaluation of patients' rehabilitation using less traumatic STRABO care technique and traditional methods of strabismus surgery. Material and methods. Sixty-two patients with esotropia were included in the study. All participants underwent medial rectus muscle recession and lateral rectus muscle plication. Patients were divided into two groups. In the main group (38 patients), the surgery was performed with less traumatic technique. Radio-wave knife was used for dissecting the connective tissues. Vicryl 7-0 was used as suture material. Traditional surgical technique was used in control group (24 patients). Scissors were used as a cutting tool and Vicryl 6-0 as a suture material. In the postoperative period conjunctival hyperemia, and width of the palpebral fissure were assessed after the surgery. Conjunctival flap edema (thickness) was measured one day after surgery by the anterior segment optical coherence tomography (AS-OCT). Results. The 1st day after surgery the median thickness of the conjunctival flap above the recession site according to AS-OCT was on average 1.5 times thinner in the main group than in the control group: 405 (351–555) µm vs. 618 (513–732) µm; p<0.001. During the entire observation period in the eyes operated with less traumatic technique, hyperemia was less expressed and palpebral fissure was wider as compared to the control group, where the standard surgical technique was used. Conclusion. Less traumatic STRABO care surgical technique allows to reduce the inflammatory response of tissues in response to surgical intervention and to facilitate the course of the early postoperative period. Key words: strabismus surgery, low-traumatic technique, radio-wave knife, oculomotor muscles, rehabilitation, STRABO care, anterior segment optical coherence tomography

Lipogranulema of the hernia sac. Clinical case

Lipogranulomas in surgical practice, are the most often encountered in the mammary glands, penis and facial area associated with subcutaneous injections for cosmetic purposes of various types of fillers that cause chronic granulomatous inflammation. Atypical localization occurs due to the development of reactions to foreign bodies after traumatic injuries and reactions to suture material used in surgical interventions. The article presents a clinical case of revealing a large peritoneal lipogranuloma localized in the area of the hernial sac in a patient who 7 years ago suffered from endometrial cancer and underwent extirpation of the uterus using median incision access. Subsequently, the patient was treated for a long time in an outpatient care because of the ligature abscesses with the formation of fistulas; several rough ligatures were removed from the subcutaneous tissue. Lipogranuloma, found in the wall of the hernial sac measuring 15 × 6 × 5 cm, covered from all sides with an unaltered peritoneum, contained a cystic cavity with a light fluid, thick synthetic ligatures of a braided structure were present in the cyst wall. The use of large-diameter braided non-absorbable sutures for suturing the peritoneum does not meet modern requirements for the use of suture material and can cause complications.

The role of scar massage in cleft lip surgery

Introduction: Despite advances in surgical technique for cleft lip, minimal evidence exists for methods of scar management, particularly scar massage. Some parents express concern that lip massage creates pain and distress to their children. This study aims to determine whether scar massage has enough cosmetic advantage to justify its use. Method: We reviewed 33 unilateral complete cleft lip repairs performed at our institution. Information on repair technique, suture material and scar management were recorded. Parent questionnaires and clinical photography were used with a panel of eight trained blinded observers asked to assess photos taken 24 months postoperatively. Scars were graded using a scale of 1 (very poor) to 5 (excellent). Twenty patients were included. Ethics approval was obtained from The Royal Children’s Hospital Melbourne Research Ethics and Governance office with HREC reference number QA/60562/RCHM-2019. Results: Frequency of scar massage was not associated with a better scar score (p= 0.36). Both the technique of repair and type of suture material used had greater effect on scar grading than massage therapy. Discussion: Problematic scarring following cleft lip surgery is a challenging outcome. This is the first study aiming to explore the effect of scar massage following cleft lip surgery. Conclusion: We found no conclusive evidence to support the use of scar massage in the postoperative care of cleft lip patients. Limitations include the retrospective nature of the study, low patient numbers and heterogeneity of surgical techniques. Nevertheless, there was no correlation seen between the frequency of massage and scar quality. Lip scar massage can cause significant pain to patients and distress to their family, warranting further studies to justify its use.

Laparoscopic-assisted percutaneous herniorrhaphy as an alternative to open surgery technique in farm swines

Background Despite numerous experimental studies presenting laparoscopic treatment of inguinal hernia in a pig model so far no described technique has been used in clinical patients of this species. Minimal invasiveness and the simplicity of closure of the inguinal canal using the Percutaneous Internal Ring Suturing (PIRS) technique makes it the world’s first technique for laparoscopic treatment of inguinal hernia in pigs as clinical patients. Aim This study aims to assess the applicability and effectiveness of the laparoscopic PIRS technique in the treatment of inguinal hernia in pigs as clinical patients and to compare the PIRS technique with the open surgery technique, which is currently being used. Methods The study was conducted on 22 non-castrated male pigs with inguinal hernia (clinical patients), divided into two equal groups: PIRS and open surgery (OS). In the PIRS group, the inner inguinal ring was closed with an optical trocar inserted at the umbilicus level and an injection needle with a suture material inserted percutaneously over the inguinal canal. The suture material was threaded through the inner inguinal ring and then tied, leaving the knot under the skin. As a result to this the inguinal canal was closed. In the OS group the procedure was performed with open access above the inguinal canal where, after dissection of the vaginal processus and reducing the contents of the hernia to the abdominal cavity, it was ligated as close to the inguinal canal as possible, and the wound was then closed in layers. Results All operated pigs returned to full fitness immediately after recovery from anesthesia. There was one case of hernia recurrence in the PIRS group. In the OS group all the operated pigs had a temporary swelling of the postoperative wound and the scrotum on the side of the operated inguinal hernia, which was not found in the PIRS group. Conclusions The effectiveness of the PIRS technique is comparable to that of open surgery. Considering the simplicity of the PIRS procedure and its minimal invasiveness, this technique may be used as an alternative to the open technique in the treatment of inguinal hernias in pigs not subjected to surgical castration.