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Cesarean Delivery
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
A. Dhanya Mackeen, Meike Schuster
There are several RCTs comparing different sutures for uterine closure. Polyglactin-910 was associated with generally similar outcomes compared to chromic catgut [132]. Knotless barbed sutures as compared to polyglactin-910 braided sutures resulted in shorter uterine closure time (103–119 seconds), less need for hemostatic sutures, and less EBL during incision closure (47 mL) [227, 228]. Monofilament suture resulted in higher residual myometrial thickness (5.5 ± 2.24 versus 4.18 ± 1.76) than multifilament suture [229].
Management of Enterocutaneous Fistula
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
Jonathan C. Epstein, Mattias Soop
Polyglactin or slowly absorbable synthetic mesh can also be used as the closure technique where there is a significant fascial defect too large for tension-free primary repair, when the intestinal phase of the operation is overly prolonged, the patient is becoming less stable or in generally high-risk patients. In these cases, the reconstructive procedure can be staged with a plan to return at an interval for a definitive abdominal wall reconstruction. A fascial defect can be bridged entirely with absorbable mesh or narrowed a little with interrupted near-far slings at the top and bottom of the incision and then bridged accepting that an incisional hernia is the likely result, although 10% of patients with such repairs do not develop a clinically apparent incisional hernia.2
Normal labour
Published in Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves, Clinical Protocols in Labour, 2020
Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves
Polyglactin remains the material of choice for repair of all the tissue layers. Its use is associated with about 40% reduction in short-term pain and the need for analgesia. the continuous subcuticular technique appears preferable to interrupted transcutaneous suturing, causing less in the
Catamenial pneumothorax, a commonly misdiagnosed thoracic condition: case report
Published in Acta Chirurgica Belgica, 2023
Laurie Stiennon, Vincent Tchana Sato, Jean-Paul Lavigne, Jean Olivier Defraigne
There are no clear guidelines for the treatment and prevention of the recurrence of this rare condition. According to Bagan et al. [7], the Video-Assisted Thoracoscopic Surgery (VATS) has to be achieved during the menstruation for an optimal visualization of pleurodiaphragmatic endometriosis. During the procedure, the apical blebs and all accessible lesions have to be excised and diaphragmatic fenestration should be excised or closed [11]. Simple suturing seems to be associated with a higher risk of recurrence. To reduce this, Attaran et al suggest the use of BioGlue surgical adhesive to close the fenestrations combined to the applications of a Gore-Tex mesh affixed on the central part of the diaphragm while Bagan et al as well as Korom et al suggest to us a polyglactin mesh to line the diaphragm in order to reinforce the diaphragmatic surface and to induce fibrotic adhesion with the lung [7,12,13]. In our regular practice, we use a polyglactin mesh due to its ability to be resorbable and its lower costs. A pleural abrasion can be realised to reduce the risk of recurrence, but it seems more controversial for chemical pleurodesis [6,7,10,13]. In our center, we perform only chemical pleurodesis in the case of neoplastic pleural effusion and we promote the pleural abrasion in the first intention for recurrent pneumothoraxes especially for young patients where the potential risks of intrapleural talc exceeds the benefits.
Intraoperative Complications and Conversion to Laparatomy in Gynecologic Robotic Surgery
Published in Journal of Investigative Surgery, 2022
Ayse Filiz Gokmen Karasu, Gürkan Kıran, Fatih Şanlıkan
There was one patient in our cohort that required conversion due to anesthesia and/or hypercapnia complication. In the report by Badawy et al detailing anesthetic complications of robotic surgery, 24 patients (18%) developed hypercapnia defined by the end-tidal Co2 concentration >45 mm H20 [12]. These patients were managed successfully by the anesthesia team and there was no mention of conversion to laparoscopy or laparotomy. In our case series there was one incident of genitofemoral injury and this was encountered during lymphadenectomy. In a report by Nezhat et al, the obturator nerve is described to be inadvertently cut during pelvic lymphadenectomy. The injury was auspiciously repaired with 4-0 polyglactin sutures in 12 minutes [13]. We would also like to underline that besides the aforementioned case of genitofemoral nerve injury, there were no position related upper extremity or lower extremity neuropathies in our study population.
The effect of platelet-rich fibrin on wound healing following strabismus surgery
Published in Cutaneous and Ocular Toxicology, 2022
Betul Tugcu, Havvanur Bayraktar, Cansu Ekinci, Zafer Kucukodaci, Mustafa Tunali, Fadime Nuhoglu
Wound healing after strabismus surgery is critical for the perfect restoration of injured tissues without scar formation. Development of excessive scar formation following strabismus surgery remains to be a challenge due to unsatisfactory surgical outcomes. It is especially common after multiple surgeries, causing restrictive strabismus1. Post-operative tissue scarring involving the conjunctiva, Tenon’s capsule, intermuscular membrane, sclera, and extraocular muscles may result in tissue adhesion causing restriction in ocular motility. These adhesions may occur because of inappropriate tissue handling, extreme bleeding, orbital fat prolapse into the surgical field, and reaction to suture materials1–6. Fine tissue handling with careful dissection which is the principle method of avoiding post-operative adhesions remains to be insufficient in complicated cases. Thus, different methods to reduce adhesion formation have been studied with variable success rates. In literature, experimental studies using various materials (amniotic membrane, silicone sleeve, polyglactin 910 mesh, Seprafilm (Genzyme, Cambridge, MA, USA) and pharmacological agents (5-fluorouracil, mitomycin C, triamcinolone, sodium hyaluronate) have been reported with conflicting results1–8. Nevertheless, none of these methods have been favoured owing to complications, limitations, and contradictory results.