Transumbilical single-site laparoscopic parallel mattress suturing prevents bleeding and chronic pelvic pain in myomectomy: a retrospective cohort study of 124 cases with intramural fibroids.

BACKGROUND: The most common complications of myomectomy are intraoperative hemorrhage and postoperative adhesion. The key point to overcome this problem is to improve suture quality. However, to date, there is still no consensus on the optimal method of uterine repair. In this study, we explored the effectiveness and feasibility of single-site laparoscopic parallel mattress sutures to reduce intraoperative bleeding and postoperative adhesion. METHODS: A retrospective cohort analysis was performed, according to the STROBE guidelines, on 124 patients with intramural fibroids admitted between May 2020 and April 2021. The cases were divided into two groups based on the description of the uterine incision suture in the surgical records, including 68 cases in the parallel mattress suture (PMS) group and 56 cases in the simple continuous suture (SCS) group. Operation-related indicators, bleeding indicators, surgical complications, scar reduction index 1 month after surgery, and the incidence of chronic pelvic pain 6 months after the surgery were observed. Independent sample t-tests and Mann-Whitney U tests were performed for the measurement data, and Pearson Chi-square tests were performed for count data. Statistical significance was set at P < 0.05. RESULTS: There was no significant difference in the baseline characteristics between the two groups. All operations were performed under transumbilical single-site laparoscopy without conversion. Compared to the SCS group, the PMS group had earlier postoperative anal exhaust (14.3 ± 6.7 h vs. 19.2 ± 9.6 h, P = 0.002), fewer postoperative hemoglobin drops (7.6 ± 3.7 g/L vs. 11.6 ± 4.3 g/L, P = 0.000), smaller uterine scars (3.7 ± 1.9 cm vs. 5.2 ± 1.8 cm, P = 0.000), and a larger uterine scar reduction index (50.2% vs. 31.0%, P = 0.000) one month after surgery and less chronic pelvic pain 6 months after surgery (2.9% vs. 12.5%, P = 0.016). No difference was found in auxiliary trocar usage, transfusion rate, operation time, hospital stay, or perioperative complications between the two groups. CONCLUSION: Seromuscular parallel mattress sutures during myomectomy can prevent pinhole errhysis of the uterine incision, achieve complete serosal and aesthetic incisions, and reduce postoperative chronic pelvic pain. It is effective and feasible to complete a parallel mattress suture during myomectomy via single-site laparoscopy. Further prospective studies are required to determine its efficacy as well as pregnancy outcomes.

The 1-year outcomes after pancreaticogastrostomy using vertical versus horizontal mattress suturing for gastric wrapping.

PURPOSE: To investigate the differences in nutritional status 1 year after pancreaticogastrostomy (PG) using vertical suturing (VS) vs. twin square horizontal mattress (HMS) suturing in patients undergoing pancreaticoduodenectomy (PD). METHODS: The subjects of this study were 134 patients who underwent PD, followed by PG, which was closed by VS in 52 and by HMS in 82. We evaluated the peri- and postoperative factors, nutritional parameters, diameter of the remnant main pancreatic duct, and glucose intolerance 1 year postoperatively. RESULTS: Forty-five (87%) patients from the VS group and 75 (91%) patients from the HMS group survived for more than 1 year. The incidences of intraabdominal abscess and pancreatic fistula were significantly lower in the HMS group than in the VS group (19.2% vs. 6.6% and19.2% vs. 2.6%, respectively). There were no significant changes in the total protein, serum albumin, and HbA1c levels 1 year postoperatively. The postoperative expansion ratio of the main pancreatic duct diameter was significantly smaller in the HMS group than in the VS group. The strongest risk factor for body weight loss 1 year postoperatively was a non-soft pancreas texture. CONCLUSION: HMS was superior to VS for preventing early postoperative complications and did not affect pancreatic function.

Continuous ab interno repairing of traumatic cyclodialysis cleft using a 30-gauge needle in severe ocular trauma: a clinical observation.

BACKGROUND: To investigate the efficacy and safety of continuous ab interno repairing of traumatic cyclodialysis cleft in severe ocular trauma using a 30-gauge (G) needle. METHODS: Fifteen patients (15 eyes) with traumatic cyclodialysis cleft admitted to the ocular trauma department of our hospital from July 2014 to December 2018 were included in this study. After the bulbar conjunctiva corresponding to the ciliary body was incised along the corneal limbus, an incision was made along the corneal limbus on the opposite side. A 30G needle with a 10-0 suture entered the anterior chamber from the incision and passed through the ciliary body with clefts and the sclera to fixate the ciliary body on the sclera wall with continuous mattress suture. The best corrected visual acuity (BCVA) and intraocular pressure (IOP) were observed preoperatively and postoperatively. In vivo ultrasound biomicroscopy (UBM) was performed to observe closure of cyclodialysis cleft before and after surgery. RESULTS: Fifteen patients successfully underwent continuous mattress suture for repair of cyclodialysis cleft. No bleeding and suture breakage were reported during surgery. After surgery, the UBM during follow-up showed satisfactory closure of the cyclodialysis cleft. The BCVA and IOP were improved to different degrees. The difference between the preoperative IOP and the postoperative IOP (1 week) was statistically significant (preoperative: 6.49 ± 0.98 mmHg, postoperative: 16.17 ± 4.65 mmHg, t = - 8.43, P < 0.05), and the difference between the preoperative IOP and the postoperative IOP (1 month) was also statistically significant (preoperative: 6.49 ± 0.98 mmHg, postoperative: 14.63 ± 3.63 mmHg, t = - 8.38, P < 0.05). Duration of outpatient follow-up was 3 to 12 months. No complications, including exposed knots, loose sutures, decompensation of corneal endothelium, sympathetic ophthalmia, endophthalmitis and choroidal detachment, were reported. CONCLUSION: Continuous ab interno repairing of traumatic cyclodialysis cleft in severe ocular trauma using a 30G needle is a safe and effective procedure with simple operation, little tissue damage and few complications.

Double mattress suture lines for valve-sparing aortic root replacement.

Valve sparing aortic root replacement remains a complex procedure despite various improvements that have been made to this operation. Specifically, a hemostatic proximal anastomosis is one of the most important factors for successful completion of the operation without complication. Here we describe a double mattress suture line technique, which facilitates a secure and hemostatic proximal suture line.

The utility of the subcuticular suture in hepatic resection.

AIM OF THE STUDY: Despite recent technical progress and advances in the perioperative management of liver surgery, postoperative surgical site infection (SSI) is still one of the most common complications that extends hospital stays and increases medical expenses following hepatic surgery. MATERIAL AND METHODS: From 2001 to 2017 a total of 1180 patients who underwent hepatic resection for liver tumours were retrospectively analysed with respect to the predictive factor of superficial incisional SSI, using a propensity score matching by procedure (subcuticular or mattress suture). RESULTS: The incidence of superficial and deep incisional SSIs was found to be 7.1% (84/1180). By propensity score matching (PSM), 121 of the 577 subcuticular suture group patients could be matched with 121 of the 603 mattress suture group patients. Multivariate analysis demonstrated wound closure technique as the only independent risk factor that correlated significantly with the occurrence of superficial incisional SSIs (p = 0.038). C-reactive protein (CRP) levels on postoperative day 4 were significantly higher in patients with incisional SSIs than in those without (p < 0.001). CONCLUSIONS: Wound closure technique with subcuticular continuous spiral suture using absorbable suture should be considered to minimise the incidence of incisional SSIs. Moreover, wounds should be carefully checked when CRP levels are high on postoperative day 4.

Cross Vertical Mattress Suturing with Basilar Tightening During the Correction of Inverted Nipple in 30 Cases.

OBJECTIVE: To investigate the efficacy of cross vertical mattress suturing with basilar tightening during the correction of inverted nipple. METHODS: Thirty patients with inverted nipples underwent cross vertical mattress suturing with basilar tightening. The postoperative results were recorded. RESULTS: All the patients were followed up for 6 months to 2 years. The results of 28 cases were satisfactory, and there was no recurrence. Two patients relapsed, and a mild depression was formed. They were satisfied with the results after the second correction. CONCLUSION: The method of cross vertical mattress suturing with basilar tightening has been applied to treat inverted nipple, with minimal trauma, which provides a reliable guarantee for a long-term effect. It is worthy to be widely used in clinical practice. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Pancreatojejunostomy with modified purse-string suture technique.

PURPOSE: Despite many efforts, pancreatic fistula remains the most troublesome complication following pancreatic resections, especially in case of anastomosis made with soft pancreatic tissue. The purpose of the authors was to show their modification of purse-string pancreatodigestive anastomosis and the results obtained. METHODS: Between January 2013 and June 2015, the technique was applied in 49 patients; one purse-string suture and two U-shaped mattress sutures were used to create the pancreatojejunal anastomosis. In case of soft pancreatic parenchyma, an external stent was temporarily left in the main pancreatic duct. The most frequent pathology was pancreatic cancer, and a pylorus-preserving Whipple procedure was mostly done. RESULTS: Postoperative early morbidity rate was 35 %. There were two fistulas, one grade A fistula from a fibrotic pancreas (4.2 %) and one grade B in case of a soft pancreas (4 %). However, there was no reoperation and mortality. CONCLUSIONS: According to favorable results, the modification of the purse-string suture technique makes this method even safer.

Does wound eversion improve cosmetic outcome?: Results of a randomized, split-scar, comparative trial.

BACKGROUND: Wound edge eversion has been hypothesized to improve aesthetic outcomes after cutaneous wound closure. Data supporting this assertion are sparse. OBJECTIVE: We sought to determine if wound eversion, achieved with interrupted subcuticular sutures, improves aesthetic outcome compared with planar closures. METHODS: We undertook a prospective, randomized, split-scar intervention in patients who underwent cutaneous surgery. Half of the wound was randomized to an everted or planar repair; the other side received the opposite one. At 3- and 6-month follow-up, both the patient and 2 blinded observers evaluated the wound using the Patient Observer Self-Assessment Scale (POSAS). RESULTS: The total observer POSAS score for the everted (13.59, 12.26) and planar (12.91, 12.98) sides did not differ significantly at 3 or 6 months, respectively. Similarly, there was not a significant difference in patient assessment between the everted (16.23, 12.84) and planar (15.07, 12.79) sides at 3 or 6 months, respectively. Finally, there was no significant difference between the 2 closure methods in terms of scar height or width at follow-up. LIMITATIONS: This was a single-center trial, which used a validated but still subjective scar assessment instrument. CONCLUSION: Wound eversion was not significantly associated with improved overall scar assessments by blinded observers or patient assessment.

Set-back versus buried vertical mattress suturing: results of a randomized blinded trial.

BACKGROUND: The set-back suture, an absorbable dermal suturing technique, purportedly improves wound eversion and cosmetic outcomes. OBJECTIVE: We sought to conduct a split-wound, prospective, randomized study to compare the cosmetic outcome and wound eversion achieved with the set-back suture and the buried vertical mattress suture (BVMS). METHODS: A total of 46 surgical elliptical wounds were randomized to subcuticular closure with the set-back suture on half and the BVMS on the other. Maximum eversion height and width were measured immediately postoperatively. At 3 months, 2 blinded observers evaluated each scar using a 7-point Likert physician global scar assessment scale. Subjects and observers also completed the validated Patient and Observer Scar Assessment Scale, where a score of 6 represents normal-appearing skin and 60 represents worst imaginable scar. RESULTS: In all, 42 subjects completed the study. The set-back suture provided statistically significant wound eversion. On the Likert scale, observers rated the set-back suture side 1 point better than the BVMS side. Both patient and observer total Patient and Observer Scar Assessment Scale scores were significantly lower for the set-back suture side (subject mean 13.0 ± 8.7 vs 16.2 ± 12.0 [P = .039]; observer mean 24.5 ± 10.4 vs 27.7 ± 13.6 [P = .028], respectively). LIMITATIONS: Single institution experience and relatively short follow-up are limitations. CONCLUSION: The set-back suture provides superior wound eversion and better cosmetic outcomes than the BVMS.

[Application of Allgöwer-Donati suture in internal fixation of Schatzker type â ¤and â ¥ tibial plateau closed fractures].

Objective: To investigate the effectiveness of Allgöwer-Donati suture in open reduction and internal fixation of Schatzker type Ⅴ and Ⅵ tibial plateau closed fractures. Methods: A clinical data of 60 patients with Schatzker type type Ⅴ and Ⅵ tibial plateau closed fractures, who met the selection criteria and admitted between May 2022 and May 2023, was retrospectively analyzed. After open reduction and internal fixation via double incisions, the incisions were closed with conventional mattress suture in 30 cases (control group) and Allgöwer-Donati suture in 30 cases (observation group). There was no significant difference in gender, age, fracture side and type, time from injury to operation, body mass index, and other baseline data between the two groups ( P>0.05). The incidence of incision-related complications after operation, visual analogue scale (VAS) score of incision at 3 days and 1 and 2 weeks after operation, and the short-form 36 health survey scale (SF-36) [physical functioning (PF), role physical (RP), bodily pain (BP), and general health (GH)] at 12 weeks after operation were compared between the two groups. Results: All operations of the two groups successfully completed. All patients were followed up 6-14 months (mean, 12 months). Incision fluid leakage occurred in 1 case of observation group and 7 cases of control group within 1 week after operation, and the incisions healed after symptomatic treatment. The incisions of other patients healed by first intention. The incidence of early incision complications in observation group was significantly lower than that in control group ( P<0.05). No late incision complications was found in the two groups. There was no significant difference in VAS scores at each time point between the two groups ( P>0.05). The VAS score significantly decreased with the increase of time in the two groups, showing significant differences between the different time points ( P<0.05). There was no significant difference in SF-36 scores (PF, RP, BP, and GH) between the two groups at 12 weeks after operation ( P>0.05). Conclusion: Compared with conventional mattress suture, Allgöwer-Donati suture is effective in open reduction and internal fixation via double incisions for Schatzker type Ⅴand Ⅵ tibial plateau closed fractures, which can reduce the incidence of early incision complications.

[Pancreatojejunostomy--with purse-string suture]. / Pancreatojejunostomia - dohányzacskóöltéssel.

INTRODUCTION: Pancreatic fistula is one of the most relevant complications following pancreatoduodenectomies. Significant effort has been made to decrease it. The aim of the authors was to show a pancreatojejunal anastomosis combined with purse-string suture, and report the first experiences, as well. MATERIAL AND METHODS: The implantation pancreatojejunostomy - which has been applied by the authors since 2003 - was modified, that the remnant of the pancreas was fixed in the jejunum with one purse-string and two mattress sutures. In case of a soft pancreas the Wirsungian duct was stented, then the vein canule was pulled out to the outside throught the afferent jejunal limb. The method was applied in seven patients during pylorus-preserving pancreatoduodenectomy performed for neoplasm. RESULTS: In the postoperative period there were two complications in two patients noted (a bleeding ulcer developed in the region of the duodenojejunostomy and a transient confusion). However there was no pancreatic fistula, reoperation or early mortality detected. CONCLUSIONS: While major conclusions can not be drawn due to the relatively small number of cases, this method seems promising and it is worth to carry out further trials.

Metal-free laparoscopic distal pancreatectomy using transpancreatic mattress suture with polyglycolic acid sheet and fibrin glue: A case report.

Laparoscopic distal pancreatectomy (LDP) is the standard surgery for malignant and premalignant tumors of the pancreatic body and tail. A stapler is commonly used to close the pancreatic stump due to its simplicity; however, the use of a stapler is associated with the risk of metal allergy and postoperative pancreatic fistula, especially in thick pancreases. Here, we present a case of LDP without metal instruments, including staplers and clips, in a 54-year-old woman with a metal allergy and a thick pancreas. The pancreatic stump was closed using the transpancreatic mattress suture method with a polyglycolic acid sheet (PGA) and fibrin glue. The postoperative course was uneventful. Metal-free LDP is useful and can be adopted regardless of the patient's background, such as a metal allergy or pancreatic thickness.

Two mattress suture: A useful technique to prevent bleeding in tunneled catheter insertion.

INTRODUCTION: The implant of tunneled catheters, may be associated with some complications such as bleeding after insertion. We aimed this study to present a modified method for catheter insertion to prevent bleeding after the procedure. METHOD: The study included the analysis of retrospective results of 5339 tunneled catheter insertion procedures in our center, 5005 of which were performed using the standard method, and in 334 cases, the modified technique was applied. RESULTS: Applying a two-mattress suture was a safe and easy to apply and useful method for tunneled catheter insertion in our center. We reported only one bleeding around the catheter entry site with this modified technique of tunneled catheter removal. While the standard and routine technique was associated with 39 cases of bleeding. DISCUSSION AND CONCLUSION: In our practice, the two-mattress suture procedure is the simplest and best method of central venous catheter insertion in hemodialysis patients and it is associated with less bleeding around the catheter entry site, so, it can be applied over the world.

Vertical mattress suture applied as "tension band fixation" for the antihelix creation and prominent ear treatment: 104 case reports.

BACKGROUND: Prominent ears were the most common auricular deformity. Different surgical techniques, such as cartilage-cutting techniques and suturing techniques, are available for treatment. The horizontal mattress suture technique, represented by the Mustard technique, is widely accepted, while the vertical mattress suture technique is rarely discussed in otoplasty. METHOD: A total of 104 cases of prominent ear deformities were treated from January 2017 to December 2020. Several hypothetical "tension bands" perpendicular to the natural curvature of the antihelix were introduced for the surgical design and determination of the position of the antihelix fixation, and vertical mattress sutures were placed accordingly for the auricular cartilage fixation. RESULT: Follow-up ranged from 3 months to 2 years. No complications, such as hematoma, infection, or poor wound healing, were observed. Three patients had recurrence within two months post operation, and one complained about the overfolded antihelix. Three cases had suture exposure, but the shape of the auricle was not affected after suture removal. The surgical result was evaluated according to the overall shape of the auricle, including the shape of the antihelix, the improvement of the prominent, the surgical marks, and the bilateral symmetry. A total of 98 patients (94.23%) rated the results as "very satisfactory" or "satisfactory". CONCLUSION: The vertical mattress suture applied as "tension band fixation" could provide stable cartilage fixation with the natural appearance of the antihelix formation. In addition, the technique could fit a wide range of indications with a low risk of complication and reoccurrence.

Rectovaginal fistula surgery with horizontal mattress and running suture after unsuccessful first repair: a report of two cases.

Rectovaginal fistula (RVF) repair after failed primary repair is uncommon. Patients with RVF experience physiological and sexual dysfunction with a significantly high risk of intravaginal infection and sepsis. There are many surgical procedures available for RVF repair. We performed an improvised transvaginal repair technique. Methods: We report two cases of recurring RVF after failed primary repair. Patient 1 developed RVF because of a failed vaginoplasty due to cosmetic reasons, while patient 2 developed RVF because of a fourth-degree perineal rupture repair post-delivery. We used a combination of horizontal mattress and running suture with the addition of diverting colostomy. Both surgeries went successfully and there were no complications. Outcomes: RVF repair using a combination of horizontal mattress and running suture went successfully and there were no complications. Both patients were able to be discharged after a short stay. Long-term evaluation was done by physical and supporting examinations for 2-3 months. Both patients showed excellent wound healing and physiological function. Conclusions: The combination of a transvaginal horizontal mattress and running suture in the posterior to anterior fashion with diverting colostomy is a safe and effective procedure for recurring RVF repair.

Lateral abdominal hernia associated with thin abdominal musculature in a calf.

This study aimed to evaluate the clinical utility of ultrasonography in the diagnosis of a newborn calf presenting with extended swelling within its right flank, in addition to its therapeutic planning. Ultrasonograms of the bilateral flanks identified thinning of the external and internal oblique abdominal muscles in whole areas of the abdominal walls. A right lateral abdominal hernia associated with thin abdominal muscular structures was diagnosed ultrasonographically. The right flank abdominal hernia was successfully reconstructed through a modified Mayo mattress suture. This allowed the overlapping of the two very thin structures of the abdominal walls, resulting in the creation of a thicker structure of the right lateral abdominal walls. Reconstruction of the abdominal walls using this method could prevent re-protrusion of the viscera during calf growth.

A novel bidirectional side exiting pledgetted suture for valve replacement surgery.

The pledgetted mattress suture is one of the most widely used suture techniques for valve replacement surgery. However, the traditional pledgetted suture has several defects including intertwining of the sutures and the pledget flipping over. Here we present a novel side exiting pledgetted suture that can overcome these defects. It offers cardiac surgeons a new alternative for valve replacement surgeries.

Modified membrane fixation technique in a severe continuous horizontal bone defect: A case report.

BACKGROUND: Continuous severe horizontal bone defect is common in the aesthetic maxillary anterior area, and presents a major challenge in implant dentistry and requires predictable bone augmentation to increase the width of the alveolar bone. CASE SUMMARY: A 24-year-old man, with a history of well-controlled IgA nephropathy, presented to the Dentistry Department of our hospital complaining of missing his right maxillary anterior teeth 1 mo ago. Severe horizontal alveolar bone defects at sites of teeth 12, 13 and 14 were diagnosed. A modified guided bone regeneration surgical approach stabilizing the absorbable collagen membrane and particulate graft materials by periosteal diagonal mattress suture (PDMS) combined with four corner pins was used for this severe continuous horizontal bone defect. The outcome revealed that the newly formed alveolar ridge dimension increased from 0.72 mm to 11.55 mm horizontally 10 mo postoperatively, with no adverse events. The implant surgery was successfully performed. CONCLUSION: This case highlights that PDMS combined with four corner pins is feasible to maintain the space and stabilize the graft and membranes in severe continuous horizontal bone defect.