Appendectomy in the surgical treatment of benign ovarian mucinous cystadenomas — is it necessary?

Objectives: To determine if appendectomy as an adjunctive procedure is necessary in the surgical treatment of benign ovarian mucinous cystadenomas. Material and methods: Retrospective analysis of clinical data: in a research hospital, obstetrics and gynecology depart­ment setting, 63 cases of benign ovarian mucinous cystadenomas confirmed in the pathological evaluation were revised. 59 had the complete clinical, final pathological and follow-up data available and were included. Results: 20.6% (13/59) went through an appendectomy. Basic characteristics of patients with different appendiceal pathologies did not show any significant differences. In the study group the mean age, parity, adnexial mass size were (40.1 ± 12.4); (1.3 ± 1.1) and (9.1 ± 5.3 cm), respectively. Patients were either operated laparoscopically (20), laparotomically (39) to perform a unilateral salpingoopherectomy/cystectomy. In 7 patients, oopherectomy was an additional procedure with: 2 abdominal hysterectomies, 4 cesarean sections and 1 total laparoscopic hysterectomy. 2 synchronous appendiceal pathologies (mucinous cystadenomas of the appendix) were defined in appendectomies performed. In these cases, the ovarian tumour sizes were: 7 cm and 4 cm. Conclusions: In the presence of a benign or borderline unilateral ovarian mucinous tumour as defined during the operation and especially if it is larger than 10–12 cm and with normal peritoneal and appendiceal gross morphology, appendectomy is not a necessary adjunctive procedure

Comparison of barbed unidirectional suture with figure-of-eight standard sutures in vaginal cuff closure in total laparoscopic hysterectomy

The aim of the study was to compare postoperative vaginal cuff complications due to the use of barbed sutures (V-Loc™ 180 unidirectional suture; Covidien, Mansfield, MA) and standard braided sutures (Vicryl®; Ethicon Inc., Somerville, MA) during vaginal cuff closure of patients undergoing a total laparoscopic hysterectomy (TLH) due to benign diseases. Eighty-nine patients were in the standard suture group and 208 patients were included in the barbed suture group. Vaginal cuff dehiscence was identified in only three (3.3%) patients within the standard suture group and none in the barbed suture group. Five (5.6%) patients in the standard suture group and two (0.9%) patients in the barbed suture group developed postoperative cuff infection/cellulitis. Duration of the surgery was significantly shorter in the barbed suture group than in the standard suture group (p < .05). V-Loc™ 180 unidirectional barbed suture, which is used during TLH for vaginal cuff closure, is an applicable, safe and tolerable alternative to a standard suture.IMPACT STATEMENT What is already known on this subject: Barbed sutures are a relatively new type of suture that include sharp barbs inserted on monofilament material in various configurations, and are used for approximating tissues without any need for surgical knotting. They have increasingly been used in obstetrics and gynaecology in recent years, particularly in total laparoscopic hysterectomy and laparoscopic myomectomy. At present, there are a limited number of studies of V-Loc™ suture in the literature. What the results of this study add: We demonstrated that barbed sutures used for enabling vaginal cuff integrity did not cause major morbidity and mortality for the patient. We suggest that V-Loc™ 180 barbed sutures offer a practical, safe and tolerable alternative for surgeons because they are easy to use, do not cause a significant increase in vaginal cuff complications, and shorten the operating time. Our study with V-Loc™ 180 unidirectional barbed suture is the second largest series after the study of Cong et al. What the implications are of these findings for clinical practice and/or further research: We believe that the barbed suture, the surgery results of which are openly discussed in our study, will be more prominent in clinical practice owing to the shortened operating time, and that the use of these sutures does not cause a significant increase in vaginal cuff complications