Suspension sutures facilitate single-incision laparoscopic-assisted rectal pull-through for Hirschsprung disease

Background To present a surgical technique of single-incision laparoscopic-assisted endorectal pull-through (SILEP) with suspension sutures using conventional instruments for Hirschsprung disease (HD) and its long-term follow-up outcomes. Methods The procedure began with a 1 cm transumbilical skin incision. Three separate punctures were made in the fascia with a 5 mm scope in the middle and 5 mm and 3 mm ports for working instruments on the left and right, respectively. The first suspension suture was placed to secure the sigmoid colon to the abdominal wall. A window was created through the rectal mesentery, and dissection around the rectum was carried out. The second suspension suture was performed to suspend the rectovesical peritoneal fold or the rectovaginal peritoneal fold to the abdominal wall. Dissection around the rectum was continued downward to approximately 1 cm below the peritoneal fold. Then, the operation was completed by a transanal approach. Results Forty patients underwent SILEP from March 2013 to April 2015. The median age was 2.7 months (ranging from 1 to 17 months). The mean operative time was 96 ± 23 min. No conversion to an open operation was required. The average hospitalization time was 4.5 ± 2 days. There were no intraoperative or perioperative complications. Long-term follow-up results were obtained from 38 patients. A frequency of defecation from every other day to twice a day was noted for 33 patients (86.8%) and more often for 5 patients (13.2%). Two patients had enterocolitis (5.2%). Conclusion Single-incision laparoscopic rectal pull-through with suspension sutures using conventional instruments is feasible and safe for HD with good long-term outcomes.

An Update on the Posterior Earlobe/Concha Mastoid Suspension Suture to Correct "Pixie Ear" Following Facelift: Review of 40 Cases

Background Auricular displacement and earlobe distortion, such as “pixie ear”, are commonly seen deformities after rhytidectomies. In 2018, the authors of this article published a prophylactic technique (posterior earlobe rotation flap (PERF) and concha-mastoid suspension suture (CMSS)) to prevent such cosmetic-related complications in primary facelift surgery. Here, the authors review the use of this technique to correct such deformities in patients receiving revision facelift surgeries. Objectives To demonstrate the usefulness of this technique in reconstructive cases suffering from such aesthetic deformities. Methods A total of 25 secondary and 15 tertiary rhytidectomies were operated between 2015 and 2018. A combination PERF/CMSS technique was performed bilaterally during each revision facelift surgery (n = 80). A retrospective data analysis (preoperatively; one year postoperatively) was conducted to detect any deformities. Results No “pixie ear” deformities could be seen in any of our patients postoperatively. Auricular displacement was detected twice and unilateral hypertrophic scarring once. The postoperative photometric analysis showed a natural ptosis grade I/II in all of our patients. The total rate of aesthetic-related complications in our patient cohort was 3.75% (auricular displacement: 2.5%; hypertrophic scarring: 1.25%). Conclusions After demonstrating the effectiveness of the PERF and CMSS techniques in primary facelifts, the authors reviewed the technique’s effectiveness for restoring earlobe distortion and auricular displacement in secondary or tertiary rhytidectomy cases. In addition to its prophylactic use, this method also possesses strong reconstructive power to change tension vectors applied on the face (CMSS) and/or to correct pre-existing aesthetic complications, such as “pixie ear” formation (PERF).

Suspension Sutures Facilitate Single Incision Laparoscopic-Assisted Rectal Pull-Through for Hirschsprung Disease

BackgroundTo present the surgical technique and long-term follow-up outcomes of single incision laparoscopic-assisted endorectal pull-through (SILEP) with suspension sutures using conventional instruments for Hirschsprung disease. MethodsThe procedure began with a 1cm transumbilical skin incision. Three separate punctures were made onto the fascia for a 5mm scope in the middle, a 5mm and 3mm ports for working instruments on the left and right, respectively. The first suspension suture was performed to secure the sigmoid colon to the abdominal wall. A window was created through the rectal mesentery, and dissection around the rectum was carried out. The second suspension suture was performed to suspense the rectovesical peritoneal fold or the rectovaginal peritoneal fold to the abdominal wall. Dissection around the rectum was continued downward to approximately 1cm below the peritoneal fold. The operation was completed by a transanal approach. Results40 patients underwent SILEP from March 2013 to April 2015. The median age was 2.7 months (ranged from 14 days to17 months). The mean operative time was 94.7 ± 20 minutes. No conversion to open operation was required. Mean hospital stay was 4.1±1.3 days. There were no intraoperative or perioperative complications. Long term follow-up results were obtained in 38 patients. The number of defecation from 1-2 times per day was noted in 36 patients (94.7%) and from 3-4 times per day in 2 patients (5.2%). Two patients had enterocolitis (5.2%).ConclusionSingle site laparoscopic rectal pull-through with suspension sutures using conventional instruments is feasible and safe for Hirschsprung disease with good long-term outcomes.

External Nasal Valve Repair in Children: Alar Batten Graft Reinforced by External Temporary Suspensory Suture

Background: The nasal valve area is the narrowest point in the nasal airway. External nasal valve (ENV) collapse during inspiration occurs if external valve area is too narrow or its lateral component is too floppy. Patients and Method: Twelve patients (7 males, 5 females) aged 8 to 12 years complaining of nasal obstruction due to ENV dysfunction underwent surgical intervention using alar batten graft assisted by temporary external suspensory suture. Results: All patients showed subjective and objective improvement of the nasal airway. The mean Nasal Obstructive Symptom Evaluation (NOSE) was 14 ± 1.71 before surgery and 7.83 ± 1.47 1 year after surgery (significant improvement, p ≤ .0001). The mean Peak Inspiratory Flow Rate was 29.92 ± 4.46 before surgery and 42.58 ± 4.93 1 year after surgery (significant improvement, P ≤ .0001). Conclusion: External nasal valve collapse in children can be managed surgically by using alar batten graft. Temporary suspension suture can be helpful for supporting of the graft until complete healing occurs.