O19 5-YEAR OUTCOMES OF A RANDOMIZED CLINICAL TRIAL OF MESH FIXATION WITH CYANOACRYLATE OR SUTURES FOR LICHTENSTEIN HERNIA REPAIR: RECURRENCE, CHRONIC PAIN AND QUALITY OF LIFE

Aim To assess the 5-year outcomes of mesh fixation with cyanoacrylate or sutures for Lichtenstein hernioplasty (recurrence rate, chronic pain, and patient’s quality of life (QoL). Methods 370 patients who underwent Lichtenstein hernia repair were randomized to receive either cyanoacrylate or non-absorbable sutures for lightweight polypropylene mesh fixation. Postoperative outcomes were evaluated by an independent blinded observer. QoL was assessed using the EuraHS-QoL questionnaire (European Registry for Abdominal Wall Hernias). Results Initially 188 patients received Glue and 182 Suture. Mean follow-up: 72.6±7.8 months. 78.1% patients (Glue:147,Suture:142) completed 5-years follow-up. No significant differences were observed in terms of chronic pain. VAS score≥3: 8.1% vs 9.1%, Glue vs. Suture, respectively (P = 0.836). 8 patients (2.7%) (4 in each group) reported pain at rest, reaching 10.7% when analyzing pain during activity. QoL was unaffected (EHS-QoL score=0) in the majority of patients: 131 (89.2%) vs. 127 (89.5%) for Glue or Suture respectively (p = 0.930). QoL-score greater than 20/90 points: 2 patients (Glue) vs. 6 (Suture) (p = 0.099). The Suture group QoL-score was higher in all domains but without statistical significance. Foreign body sensation was slightly higher in Suture group (7.5% vs. 9.3%) but without reaching statistical significance (p = 0.534). There were no differences in the recurrence rate (2.6% vs. 3.8% for Glue and Suture respectively) (p = 0533). Conclusions Chronic discomfort rate after Lichtenstein hernioplasty is not negligible. Atraumatic mesh fixation with glue was quicker and resulted in less acute postoperative pain than sutures for Lichtenstein hernia repair, but with no statistical differences in terms of chronic pain nor the long-term patients’ QoL.

Comparison of 2-octyl cyanoacrylate skin adhesive and interrupted polypropylene sutures for wound closure in total ankle arthroplasty

Background Adhesive skin materials have increasingly been used in orthopedic surgery. We aimed to compare the efficacy and safety of skin adhesive (2-octyl cyanoacrylate and polymer mesh, Dermabond Prineo) and interrupted polypropylene sutures for wound closure in patients undergoing total ankle arthroplasty (TAA). Methods We prospectively enrolled 107 consecutive patients (108 ankles) undergoing TAA and divided them into two groups: skin adhesive group (36 ankles) and suture group (72 ankles). The primary outcome assessment included wound complications and patient satisfaction for wound cosmesis. The secondary outcome assessment included duration of surgery, length of hospital stay, and the Ankle Osteoarthritis Scale (AOS) pain and disability score. Results There was one case of allergic contact dermatitis, three cases of wound dehiscence, and one case of superficial surgical site infection in the skin adhesive group. Among them, one case each with allergic contact dermatitis and wound dehiscence finally progressed to deep surgical site infection. Three cases of wound dehiscence were also reported in the suture group; however, there was no case of surgical site infection. Patient satisfaction for wound cosmesis was significantly higher in the skin adhesive group than in the suture group (p = 0.001). There was no statistically significant difference between the groups in terms of secondary outcomes (p > 0.05). Conclusions Although the use of Dermabond Prineo showed better patient satisfaction for wound cosmesis, it showed significantly high wound complication rates and no other clinical benefits compared to interrupted polypropylene suture in TAA. Our results suggest that awareness of the possibility of wound complications is necessary when Dermabond Prineo is used in TAA.

An Evaluation of Muscle Repair Techniques: Implications in Musculoskeletal Healing and Corollaries in Oral-Facial Clefting

We performed an animal study to identify the techniques associated with the best muscle healing outcomes in cleft lip/palate surgery. The right triceps of thirty adult male Sprague–Dawley rats were cut and repaired by three different suture techniques: simple (n = 10), overlapping (n = 10), and splitting sutures (n = 10). Muscle tissues were isolated from 5 rats per group 1 and 8 weeks postoperation. The inflammatory response and muscle fiber healing were evaluated by hematoxylin and eosin (H&E) staining, Western blotting, immunohistochemistry for TNF-α and IL-1β, and immunofluorescence for laminin and MyoD. Grip strength (N/100 g) and spatial gait symmetry were evaluated before surgery and 1, 2, 4 and 8 weeks postoperation. Eight weeks postoperation, grip force per weight was significantly higher in the simple suture (median, 3.49; IQR, 3.28–3.66) and overlapping groups (median, 3.3; IQR, 3.17–3.47) than the splitting group (median, 2.91; IQR, 2.76–3.05). There was no significant difference in range of motion between groups. The simple group exhibited significant remission of inflammation by H&E staining and lower expression of TNF-α and IL-1β than the other groups by Western blotting and immunohistochemistry. Immunofluorescence revealed stronger expression of MyoD and weaker expression of laminin in the splitting group than in the other groups at week 8, indicating prolonged inflammation and healing followed by poor muscle fiber remodeling. Simple and overlapping sutures demonstrated similar functional healing, although greater inflammation and failure to maintain a thicker muscle belly were observed in the overlapping suture group compared with the simple suture group. Therefore, reconstruction of the philtral column with overlapping sutures alone may result in limited long-term fullness, and additional procedures may be needed.

Staples Versus Sutures For Skin Closure In Hip Arthroplasty: A Meta-Analysis And Systematic Review

Objective: The purpose of this present study was to estimate complication and other outcomes associated with staples and sutures closure after hip arthroplasty through meta- analysis techniques and system review. Methods: We searched for articles on EMBASE, PubMed, Medline, Web of Science and Cochrane Library. Eligibility of the searched trials. Cochrane Collaboration's Review Manager software is used to perform meta-analysis.Results: Four randomized controlled trials and one retrospective cohort trial chosen into our study. Our study indicated that the risk of infection and prolonged discharge higher with staples than with sutures for skin closure after hip arthroplasty. Meanwhile, there was no significant difference in allergic reaction, dehiscence, inflammation, abscess formation, Hollander Wound Evaluation Score and patient's satisfaction with skin closure methods between the two groups after hip arthroplasty. However, the suture group may require additional operating time.Conclusions: Closure with suture have a lower risk of infection and prolonged discharge when compared with staples skin closure in hip arthroplasty, while it may take more time.

Feasibility Analysis and Advantages of Wedge Resection Plus Transverse Suture Applied to Closure of Loop Ileostomy

Objectives: To evaluate the feasibility and advantages of wedge resection plus transverse suture applied to loop ileostomy closure by analyzing the surgical data and the incidence of postoperative complications of patients undergoing this procedure.Methods: We performed a retrospective analysis of the hospitalization data of patients who underwent ileostomy closure surgery and met the research standards from January 2017 to April 2021 in the Guangxi Medical University Cancer Hospital; all surgeries were performed by the same surgeon. The perioperative data were statistically analyzed by grouping.Results: In total, 65 patients were enrolled in this study, with 12 in the wedge resection group, 35 in the stapler group, and 18 in the hand suture group. There was no significant difference in operation time between the wedge resection group and stapler group (P > 0.05), but both groups had shorter operation time than that in the hand suture group (P< 0.05). The postoperative exhaustion time of wedge resection group was earlier than that of the others, and cost of surgical consumables in the wedge resection group was significantly lower than that in the stapler group, all with statistically significant differences (P< 0.05). By contrast, there was no statistically significant difference in postoperative complication incidences among the three groups.Conclusions: The wedge resection plus transverse suture is safe and easy for closure of loop ileostomy, and the intestinal motility recovers rapidly postoperatively. It has less surgical consumables, and is particularly suitable for the currently implemented Diagnosis-Related Groups payment method.

Comparing methods to secure a tracheal tube placed via a surgical cricothyroidotomy: a randomised controlled study in cadavers

Objective In the ‘can’t intubate can’t oxygenate’ scenario, techniques to achieve front of neck access to the airway have been described in the literature but there is a lack of guidance on the optimal method for securing the tracheal tube (TT) placed during this procedure. The aim of this study was to compare three different methods of securing a TT to prevent extubation following a surgical cricothyroidotomy. Methods A randomised controlled trial was undertaken. The population studied were emergency physicians (EPs) attending a cadaveric airway course. The intervention was securing a TT placed via a surgical cricothyroidotomy by suture. The comparison was securing the TT using fabric tape with two different tying techniques. The primary outcome was the force required to extubate the trachea. The trial was registered with ANZCTR.org.au (ACTRN12621000320853). Results 17 emergency physicians completed intubations using all three of the securing methods on 12 cadavers for a total of 51 experiments. The mean extubation force was 6.54 KG (95 % CI 5.54–7.55) in the suture group compared with 2.28 KG (95 % CI 1.91–2.64) in the ‘Wilko tie’ group and 2.12 KG (95 % CI 1.63–2.60) in the ‘Lark’s foot tie’ group; The mean difference between the suture and fabric tie techniques was significant (p < 0.001). Conclusions Following a surgical cricothyroidotomy in cadavers, EPs were able to effectively secure a TT using a suture technique, and this method was superior to tying the TT using fabric tape.

Efficacy of a Novel Medical Adhesive for Sealing Lung Parenchyma: An in vitro Study in Rabbit Lungs

<b><i>Introduction:</i></b> During thoracic resection procedures, complete hemostasis and aerostasis are priorities. A persistent alveolar air leak is associated with increased morbidity and mortality rates. This study aimed to evaluate whether the novel medical adhesive VIVO (Adhesys Medical GmbH Aachen, Germany) is a reliable alternative sealing technique to routine surgical procedures. <b><i>Methods:</i></b> We conducted an in vitro animal study by analyzing 21 lungs of New Zealand (<i>n</i> = 19) and Chinchilla Bastard (<i>n</i> = 2) rabbits (age, 11–18 weeks; weight, 2,400–3,600 g). Three groups, each comprising 7 animals, were evaluated. VIVO (VIVO-group) was compared with standard surgical lung parenchymal lesion closure with a polypropylene suture (Suture-group) and TachoSil® (TachoSil-group). We adopted a stable, pressure-controlled ventilation protocol. After explantation, a surgical incision 0.5-cm deep and 1.5-cm wide was made in the lungs using a customized template. Air leak was measured quantitatively (mL/min) using a respirator and visualized qualitatively by 2 observers who made independent judgments. Next, the leak was closed using VIVO, suture, or TachoSil® as specified by the manufacturer. Subsequently, positive end-expiratory pressure (PEEP) and inspiratory pressure were gradually increased until a maximum of 15 and 30 mbar were attained, respectively. <b><i>Results:</i></b> At PEEPs of 8, 10, and 15 mbar, VIVO achieved complete sealing of the profound parenchymal defect in all (<i>n</i> = 7) lungs. After closure of the incision, we observed an air leak variation of 127 ± 114 mL/min (Suture-group), 31 ± 49 mL/min (VIVO-group), and 114 ± 134 mL/min (TachoSil-group). VIVO showed a significantly lower air leak than surgical sutures (<i>p</i> = 0.031) and TachoSil® (<i>p</i> = 0.046). <b><i>Conclusion:</i></b> VIVO offers sufficient closure of the lung parenchymal lesions. The novel adhesive enabled significantly better sealing with lower persistent air leakage than TachoSil® or surgical sutures. Further investigation using in vivo models is strongly encouraged to confirm our findings.

Clinical Outcome of Fibrin Glue versus Sutures in Conjunctival Autografts in Patients Undergoing Pterygium Excision - A Prospective Study from Kalaburagi, Karnataka

BACKGROUND Pterygium removal is prone for recurrence. Use of conjunctival autografting is considered the most suitable approach that can lower the recurrence. Traditionally, the conjunctival autograft (CAG) is attached to the sclera by suturing. Recently fibrin glue has been used as an alternative to suturing. Advantages being shortened operating time, improved postoperative comfort and absence of suture related complications. Fibrin glue (Baxter TISSEEL kit) is a biological tissue which has a fibrinogen component and a thrombin component prepared by processing plasma. On activation of human fibrinogen by thrombin it imitates the final stage of the coagulation cascade and acts as a tissue adhesive. Fibrin glue is absorbable, relatively easy to use and can be kept at room temperature or in a refrigerator. We wanted to compare the postoperative outcomes in patients undergoing pterygium surgery with conjunctival autografting using fibrin glue (fibrin glue group) in comparison to suturing with 10 - 0 nylon (suture group). METHODS This was a prospective study carried out at M.R. Medical College, Kalaburgi, in the Department of Ophthalmology. Patients with pterygium were enrolled into the study after taking informed and written consent. Clinical grading of pterygium was done as Grade 1 - < 2 mm onto cornea, Grade 2 – 2 to 4 mm onto the cornea, Grade 3 - > 4 mm onto the cornea. 100 subjects were randomly divided into 2 groups of 50 patients each undergoing pterygium surgery between Nov 2018 and Oct 2019. Group 1: Conjunctival autograft with 10 0 nylon suture. Group 2: Conjunctival autograft with fibrin glue. A post-operative comfort scale was used to assess pain, foreign body sensation and lacrimation. These patients were followed up on postoperative day 1, one week, 1 month for postoperative signs and symptoms and 6 months for any recurrence of pterygium. RESULTS Patients in the fibrin glue group experienced significantly less pain, foreign body sensation and lacrimation on day-one, 1 week and at 1 month after surgery, compared to those in the suture group. Other complications like graft oedema, graft retraction, corneal scarring, sub graft haemorrhage were noted in both the groups. At the end of 6 months follow up, no recurrence was noticed in both the groups. CONCLUSIONS The use of fibrin glue for attaching autografts in pterygium surgery is an effective method with global autograft success, less post-operative discomfort like pain, foreign body sensation, lacrimation and less chance of recurrence. KEYWORDS Pterygium, Conjunctival Autograft, Suture, Fibrin Glue

Whether sutures reduce the graft laceration caused by interference screw in anterior cruciate ligament reconstruction? A biomechanical study in vitro

Background Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction. However, previous studies had reported that the insertion of interference screws significantly caused graft laceration. The purposes of this study were to (1) quantitatively evaluate the graft laceration from one single insertion of PEEK interference screws; and (2) determine whether different types of sutures reduced the graft laceration after one single insertion of interference screws in ACL reconstruction. Methods The in-vitro ACL reconstruction model was created using porcine tibias and bovine extensor digitorum tendons of bovine hind limbs. The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra-high molecular weight polyethylene (UHMWPE) sutures. Poly-ether-ether-ketone (PEEK) interference screws were used for tibial fixation. This study was divided into five groups (n = 10 in each group): the non-fixed group, the non-sutured group, the absorbable suture group, the Ethibond suture group and the UHMWPE suture group. Biomechanical tests were performed using the mode of pull-to-failure loading tests at 10 mm/min. Tensile stiffness (newtons per millimeter), energy absorbed to failure (in joules) and ultimate load (newtons) were recorded for analysis. Results All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre-tension of the tendons, tibial bone mineral density) among all groups (P > 0.05). The biomechanical tests demonstrated that PEEK interference screws significantly caused the graft laceration (P < 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction (P > 0.05). Conclusions Our biomechanical study suggested that the ultimate failure load of grafts was reduced of approximately 25 % after one single insertion of a PEEK interference screw in ACL reconstruction. Suturing the ends of the grafts using different sutures (absorbable, Ethibond and UHMWPE sutures) did not decrease the graft laceration caused by interference screws.

The Effect of TISSEELTM on Confined Bowel Perforation: An Experimental Study

<b><i>Objective:</i></b> During the last decades, surgeons of several specialties presenting different levels of expertise in colon handling have been involved in laparoscopic procedures. The aim of the present experimental study was to investigate the feasibility of TISSEEL^TM versus the conventional suture placement technique on confined bowel lesions in rats. <b><i>Methods:</i></b> Twenty-four Sprague-Dawley rats underwent confined bowel perforation and were divided into three groups: the SUTURE group (sutures were used), the SUTURE + TISSEEL^TM group (sutures and TISSEEL^TM were utilized), and the TISSEEL^TM group (only TISSEEL^TM was used). Blinded histopathologic analysis followed animal sacrifice. <b><i>Results:</i></b> The median weight of the rats was 526 ± 50 g. A single animal had hematochezia on the first postoperative day. Cessation of bleeding at the perforation margin was indicated intraoperatively after TISSEEL^TM application. Animals in the TISSEEL^TM group presented less intraperitoneal adhesions and lower hemorrhagic infiltration compared to animals of the two other groups. In addition, animals in the TISSEEL^TM group showed thrombus formation at the bowel perforation site compared to animals of the two other groups (<i>p</i> = 0.042). Histopathologic analysis demonstrated reduced inflammatory reaction (<i>p</i> = 0.003), diminished fibrosis (<i>p</i> = 0.001), and better tissue regeneration (<i>p</i> = 0.000) in the TISSEEL^TM group compared to the other two groups. <b><i>Conclusion:</i></b> Application of TISSEEL^TM at the perforation site was associated with increased regeneration of the intestinal wall and less inflammatory and fibrotic reaction compared to suture placement. However, more experimental and clinical studies should be conducted before implementation in humans.