How to tie dangerous surgical knots: easily. Can we avoid this?

ObjectiveSecure knots are essential in all areas of surgical, medical and veterinary practice. Our hypothesis was that technique of formation of each layer of a surgical knot was important to its security.DesignEqual numbers of knots were tied, by each of three groups, using three techniques, for each of four suture materials; a standard flat reef knot (FRK), knots tied under tension (TK) and knots laid without appropriate hand crossing (NHCK). Each knot technique was performed reproducibly, and tested by distraction with increasing force, till each material broke or the knot separated completely.SettingTemporary knot tying laboratory.MaterialsThe suture materials were, 2/0 polyglactin 910 (Vicryl), 3/0 polydioxanone, 4/0 poliglecaprone 25 (Monocryl) and 1 nylon (Ethilon).ParticipantsThree groups comprised, a senior surgeon, a resident surgeon and three medical students.Outcome measuresProportion of each knot type that slipped, degree of slippage and length of suture held in loop secured by each knot type.Results20% of FRK tied with all suture materials slipped; all knots tied with the other two techniques, with all materials, slipped, TK (100%) and NHCK (100%). The quantitative degree of slip was significantly less for FRK (mean 6.3%–, 95% CI 2.2% to 10.4%) than for TK (mean 312%, 95% CI 280.0% to 344.0%) and NHCK (mean 113.0%, –95% CI 94.3% to 131.0%).The mean length of suture in loops held within (FRK mean 25.1 mm 95% CI 24.2 to 26.0 mm) was significantly greater than mean lengths held by the other techniques (TK mean 17.0 mm, 95% CI 16.3 to 17.7 mm), (NHCK mean 16.3 mm, 95% CI 15.9 to 16.7 mm). The latter two types of knot may have tightened more than anticipated, in comparison to FRK, with potential undue tissue tension.ConclusionMeticulous technique of knot tying is essential for secure knots, appropriate tissue tension and the security of anastomoses and haemostasis effected.</jats:sec

Myocardial perfusion imaging with 99 mTc - tetrofosmin SPECT in breast cancer patients that received postoperative radiotherapy: a case-control study

<p>Abstract</p> <p>Purpose</p> <p>To evaluate the cardiac toxicity of radiotherapy (RT) in breast cancer (BC) patients employing myocardial perfusion imaging (MPI) with Tc-99 m Tetrofosmin - single photon emission computer tomography (T-SPECT).</p> <p>Materials and methods</p> <p>We studied 46 BC female patients (28 patients with left and 18 patients with right BC) treated with postoperative RT compared to a control group of 85 age-matched females. The median time of RT to SPECT was 40 months (6-263).</p> <p>Results</p> <p>Abnormalities in the summed stress score (SSS) were found in 54% of left BC patients, 44.4% of right BC patients, and 32.9% of controls. In left BC patients there were significantly more SSS abnormalities compared to controls (4.0 ± 3.5 vs 2.6 ± 2.0, p = 0.05) and possible trend of increased abnormalities of right BC patients (3.7 ± 3.0 vs 2.6 ± 2.0, p = 0.14). Multiple regression analysis showed more abnormalities in the MPI of left BC patients compared to controls (SSS, p = 0.0001); Marginal toxicity was also noted in right BC patients (SSS, p = 0.045). No additional toxicity was found in patients that received adjuvant cardiotoxic chemotherapy. All T-SPECT abnormalities were clinically silent.</p> <p>Conclusion</p> <p>The study suggests that radiation therapy to BC patients result in MPI abnormalities but without apparent clinical consequences.</p

Laparoscopic Spigelian Hernia Repair: Intraperitoneal Onlay Mesh-Plus Technique - Video Presentation

Background: Spigelian hernia represents a rare entity. Traditionally, it was repaired by the open technique. Various laparoscopic techniques have emerged periodically. Most laparoscopic repairs use the technique of placing an intraperitoneal onlay mesh (IPOM). There is currently a tendency to close the hernia defect. Methods: A 68-year-old man was admitted to our hospital complaining of vague abdominal pain and discomfort. Physical examination revealed a bulky palpable mass on the left side of the patient. Computed tomography of abdomen revealed a left-sided incarcerated spigelian hernia containing bowel. The aim of this study was to report an educational video providing a successful laparoscopic IPOM-plus technique with muscles approximation of spigelian hernia repair step by step. Results: Total operative time was 120 minutes. The postoperative period was uneventful. The patient reported no pain and the cosmetic result was excellent. No bulging or seroma was noted. The patient was discharged on postoperative day 1. Conclusion: The IPOM-plus technique may improve the outcome of spigelian hernia repair. © Copyright 2018, Mary Ann Liebert, Inc. 2018

Gallbladder

Malignant hepato-pancreatico-biliary (HPB) tumors attack more often the sixth to eighth decades of life. The aging of the world population is the reason that the number of elderly patients considered for resection of malignant HPB tumors has highly increased. Since elderly patients are more likely to have more co-morbidities, cognitive impairment, and decreased life expectancy, the benefit and appropriateness of these procedures must be scrutinized for geriatric patients. However, many surgeons have compared the perioperative and long-term outcome of hepatic and pancreatic resections for elderly and younger patients. In most cases the elderly population was above 70 years of age. The results demonstrate that hepatic resection for hepatocellular carcinoma and colorectal liver metastases can be safely performed in well-selected elderly patients with long-term outcome comparable to younger patients. Similar findings are also reported for pancreatic resection in elderly patients with either ampullary or pancreatic cancer. Even though the survival benefit of pancreatico-duodenectomy is limited in all age groups, the absence of competitive therapy justifies this procedure as the sole curative option in younger as well as older patients. Data on resection of gallbladder cancer and hilar bile duct cancer in the elderly are sparse, but there is proof from large series on resection of these types of tumors that advanced age per se is not a risk factor for reduced outcome. Therefore, surgical options should not be denied to elderly patients with a malignant HPB tumor, and the evaluation should include surgeons expert in HPB surgery. © 2011 Nova Science Publishers, Inc. All Rights Reserved

Robotic versus Laparoscopic Sleeve Gastrectomy for Morbid Obesity: a Systematic Review and Meta-analysis

We aim to review the available literature on obese patients treated with robotic or laparoscopic sleeve gastrectomy, in order to compare the clinical outcomes and intraoperative parameters of the two methods. A systematic literature search was performed in PubMed, Cochrane Library and EBSCOhost databases, in accordance with the PRISMA guidelines. Sixteen studies met the inclusion criteria incorporating 29,787 patients. Robotic sleeve gastrectomy (RSG) technique showed significantly higher mean operative time and increased length of hospital stay. Post-operative incidence of leakage, wound infection and bleeding, along with weight reduction, were comparable. The majority of the studies assessing charges found increased cost in RSG population. Well-designed, randomized controlled studies, comparing RSG to laparoscopic sleeve gastrectomy (LSG), are necessary to assess further their clinical outcomes and cost-effectiveness. © 2016, Springer Science+Business Media New York

Validation of the suter questionnaire after laparoscopic sleeve gastrectomy in the Greek population

Background &amp; aims: The purpose of this study was to validate the Greek version of Suter questionnaire in order to be used for the evaluation of patients after Laparoscopic Sleeve Gastrectomy (LSG). Methods: A total of 170 patients were enrolled in the study. Results: The correlation coefficients for criterion validity had range between 0.202 (Food Tolerance) and 0.252 (Suter Total Score) (p &lt; 0.05).There was moderate correlation between the questionnaire&apos;s subscales and the Hematocrit which satisfied the criterion validity marginally. The internal consistency measured with Cronbach&apos;s alpha yielded a value of 0.866 for the factor tolerance and 0.78 for the factor symptoms, which indicate excellent internal consistency. Excellent test-retest reliability with ICC of 0.997 for food tolerance and 0.990 for symptoms were also observed. The Suter questionnaire demonstrated a high sensitivity to detect clinical changes. Conclusion: The Greek version of Suter questionnaire seemed to be valid and reliable to assess morbidly obese patients after LSG. © 201