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Cannone FG, Cormaci L, Ettore C, Gulino FA, Incognito GG, Benvenuto D, Ettore G. Rate of Vaginal Cuff Dehiscence When Using Vicryl (Poliglactyn 910) Compared to PDS (Polydioxanone) for Vaginal Cuff Closure in Laparoscopic Hysterectomy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:90. [PMID: 38256351 PMCID: PMC10821056 DOI: 10.3390/medicina60010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, between January 2014 and December 2021. Patients underwent hysterectomy for benign gynecologic pathologies (endometriosis, leiomyomas, or benign pelvic pathologies) or malignant gynecologic pathologies (endometrium cancer, complex endometrial hyperplasia, ovarian cancer, cervix cancer, or uterine carcinosarcoma). The Z-score calculation was performed to find eventual statistically significant differences between the two populations regarding VCD rates. Results: Laparoscopic vaginal cuff closure was performed, with Vicryl sutures in 202 patients and PDS sutures in 184 women. Demographic and baseline characteristics were not significantly different in the two groups. VCD occurred in three patients in the Vicryl group and did not occur in the PDS group. The three cases of VCD were precipitated by intercourses that occurred within 90 days of surgery. However, there was not a significant statistical difference between the two groups regarding VCD (p = 0.09). Conclusions: Vicryl and PDS sutures seem to be similar for vaginal cuff closure in laparoscopic hysterectomy. The VCD rate was low, and the observed differences between the Vicryl and PDS groups did not reach statistical significance. Further research through prospective studies is essential.
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Affiliation(s)
- Francesco Giuseppe Cannone
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy; (F.G.C.); (L.C.); (C.E.); (G.G.I.); (G.E.)
| | - Livia Cormaci
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy; (F.G.C.); (L.C.); (C.E.); (G.G.I.); (G.E.)
| | - Carla Ettore
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy; (F.G.C.); (L.C.); (C.E.); (G.G.I.); (G.E.)
| | - Ferdinando Antonio Gulino
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy; (F.G.C.); (L.C.); (C.E.); (G.G.I.); (G.E.)
| | - Giosuè Giordano Incognito
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy; (F.G.C.); (L.C.); (C.E.); (G.G.I.); (G.E.)
| | - Domenico Benvenuto
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 00128 Rome, Italy;
| | - Giuseppe Ettore
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy; (F.G.C.); (L.C.); (C.E.); (G.G.I.); (G.E.)
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Ávila Filho SH, Moura VMBD, Queiroz PJB, Faleiro MBR, Lima BSG, Freitas SLR, Santos AS, Silva LAF. Chitosan thread in the healing of the cecal wall of rabbits (Oryctolagus cuniculus) submitted to cecorrhaphy. J Biomed Mater Res B Appl Biomater 2024; 112:e35314. [PMID: 37565785 DOI: 10.1002/jbm.b.35314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/03/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
The development and evaluation of synthesis materials are crucial to reducing the morbidity and magnitude of post-enterorrhaphy surgical complications. Despite the possibility of production, chitosan thread has not yet been used in enterorrhaphy, and its effects on intestinal healing have not been evaluated. Therefore, this study aimed to evaluate the effects of chitosan thread on the intestinal wall repair of rabbits submitted to cecorrhaphy. For this, 42 rabbits were allocated into two groups with 21 animals. One group was submitted to cecorrhaphy with chitosan suture thread (CG) and the other with poliglecaprone suture thread (PG). The occurrence of postoperative complications, the intensity of edema, cellular response, formation of granulation tissue, as well as the deposition and maturation of collagen fibers, and the intensity of vascular endothelial growth factor (VEGF-α) expression, were evaluated during the intestinal wall repair process. The evaluations occurred on the 5th, 15th, and 25th postoperative (PO) days. The animals did not develop peritonitis, but adherence was observed in six animals from CG and seven from PG, with no difference between groups. The polymorphonuclear infiltrate showed higher intensity and higher amount of type III collagen fibers in CG on the 15th PO day. In contrast, a lower amount of type I collagen fibers was observed in CG samples on the 25th PO day. Therefore, the chitosan thread used for cecorrhaphy in rabbits results in minimal postoperative complications, presents biocompatibility, and bioactively assists the tissue repair process of the cecal wall, inducing minimal tissue reaction, stimulating the deposition of type III collagen fibers in the proliferative phase, with sustained VEGF-α expression, but with reduced deposition of type I fibers, indicating a delay in collagen maturation.
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Affiliation(s)
- S H Ávila Filho
- Department of Veterinary Surgery, Federal University Goiás and Goiano Federal Institute, Goiás, Brazil
| | - V M B D Moura
- Department of Veterinary Pathology, Federal University Goiás, Goiás, Brazil
| | - P J B Queiroz
- Department of Veterinary Surgery, Federal University Goiás, Goiás, Brazil
| | - M B R Faleiro
- Department of Veterinary Pathology, Federal University Goiás, Goiás, Brazil
| | - B S G Lima
- Department of Veterinary Pathology, Federal University Goiás, Goiás, Brazil
| | - S L R Freitas
- Department of Veterinary Surgery, Goiano Federal Institute, Goiás, Brazil
| | - A S Santos
- Department of Veterinary Pathology, Goiano Federal Institute, Goiás, Brazil
| | - L A F Silva
- Department of Veterinary Surgery, Federal University Goiás, Goiás, Brazil
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Jaime Moens B, Buonomo A, De Sutter P. Vaginal Cuff Dehiscence: Two Case Reports and a Review of the Literature. J Clin Med 2023; 12:4187. [PMID: 37445221 DOI: 10.3390/jcm12134187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/07/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
Vaginal cuff dehiscence (VCD) is a rare but serious condition associated with high morbidity, especially in the presence of an evisceration. It usually occurs as a complication of hysterectomy, but has also been reported after other pelvic surgeries. In this article, we will present two cases of vaginal cuff dehiscence with evisceration in post-menopausal patients. Both cases occurred post-operatively, the first after a laparoscopic radical hysterectomy and the other after a trachelectomy performed by robotic-assisted laparoscopy (with a prior history of subtotal hysterectomy). Both cases were treated surgically, the first by a combined laparoscopic and vaginal approach, and the second case only by laparoscopic approach. The main risk and protective factors are discussed in a narrative literature review which summarizes the available evidence on this rare condition, discussed by type of study designs and thus evidence level. A laparoscopic vaginal cuff closure is the most protective factor in preventing VCD, compared to a vaginal closure. Clinicians should be aware of this condition and of its risk factors and precipitating events in order to identify high-risk patients. Knowledge of these allows prompt recognition, which is crucial for adequate management, for which multiple approaches have been described.
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Affiliation(s)
- Babette Jaime Moens
- Department of Gynaecology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Antonino Buonomo
- Department of Gynaecology, Centre Hospitalier Universitaire Tivoli, Avenue Max Buset 34, 7100 La Louviere, Belgium
| | - Philippe De Sutter
- Department of Gynaecology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
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Comparison of cesarean delivery outcome after robotic and laparoscopic myomectomy. Taiwan J Obstet Gynecol 2023; 62:12-15. [PMID: 36720523 DOI: 10.1016/j.tjog.2022.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine whether robotic myomectomy (RM) resulted in any measurable clinical improvement over laparoscopic myomectomy (LM) in subsequent cesarean delivery. MATERIALS AND METHODS The medical records of 273 patients who had undergone LM or RM followed by subsequent cesarean delivery for the period of September 2015 to December 2020 were retrospectively reviewed. The patients were divided into LM (n = 222) and RM (n = 51) groups. The cesarean delivery outcomes between the two groups were compared. RESULTS RM had significantly more myomas removed (6.0 ± 4.8 vs. 3.6 ± 3.5, p < 0.001) and a larger size of largest myoma (7.7 ± 2.4 vs. 6.1 ± 2.4, p = 0.002) at myomectomy compared with LM. However, there were no significant differences in the groups' surgical characteristics at cesarean section, in their pregnancy complications, or in adhesion formation. CONCLUSIONS Although more and larger myomas were removed in the RM group, RM showed similar cesarean delivery outcomes and adhesion formation to LM.
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Effects of Using Barbed Suture in Myomectomy on Adhesion Formation and Adverse Pregnancy Outcome. J Pers Med 2022; 13:jpm13010092. [PMID: 36675753 PMCID: PMC9862078 DOI: 10.3390/jpm13010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/27/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
Background: There is still concern regarding postoperative adhesion formation and adverse effects on pregnancy outcomes caused by barbed suture (BS) after myomectomy. The aim of this study was to compare the postoperative adhesion and pregnancy outcomes between conventional suture (CS) and BS after minimally invasive myomectomy (MIM) by robotic myomectomy (RM) or laparoscopic myomectomy (LM). Methods: The medical records of 94 women who had undergone MIM with CS and 97 who had undergone MIM with BS and achieved pregnancy were reviewed. Postoperative adhesion was evaluated following cesarean section. Results: The number of removed myomas was greater (5.3 ± 4.6 vs. 3.5 ± 3.1, p = 0.001) and the size of the largest myoma was larger (7.0 ± 2.2 vs. 5.8 ± 2.7 cm, p = 0.001) in the BS group relative to the CS group. A total of 98.9% of patients in the CS group and 45.4% in the BS group had undergone LM (p < 0.001), while the others underwent RM. There was no significant difference in the presence of postoperative adhesion at cesarean section between the BS and CS groups (45.5 vs. 43.7%, p = 0.095). Additionally, there were no intergroup differences in pregnancy complications such as preterm labor, placenta previa, accrete or abruption. Note also that in our logistic regression analysis, the suture type (BS or CS) was excluded from the independent risk factors regarding postoperative adhesion formation. Conclusions: Our data indicated that the incidence of postoperative adhesion after MIM with BS was similar when compared with CS. Also it seems that the suture type does not have a significant effect on pregnancy outcomes.
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Qin F, Zeng A, Yu N, Dong R, Long F, Xia Z, Zhang W, Long X, Wang X. The modified inframammary fold suture method and its clinical significance in primary augmentation mammoplasty. J Cosmet Dermatol 2022; 21:6992-7000. [PMID: 36196527 DOI: 10.1111/jocd.15432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/06/2022] [Accepted: 09/29/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The inframammary approach is one of the most commonly used incisions in breast augmentation. There are many suture methods for inframammary incisions; however, no one method has proven optimal. We modified the traditional three-layer suture method according to the inframammary fold (IMF) cadaver dissection results. This study aims to investigate whether using a modified suture method can improve postoperative outcomes. METHODS Cadaver dissections were performed in order to clarify the anatomy of the IMF. From June 2013 to December 2017, a retrospective study of primary breast augmentation patients subjected to the inframammary approach was conducted. Patients were divided into two cohorts: the traditional suture method and the modified suture method. The patient's demographics, specifics of breast augmentation procedures, complications, and scar assessment were analyzed. Univariate and multivariable analyses were used to determine differences between the two cohorts. RESULTS One hundred eighty-four patients were included: 75 patients were subjected to the traditional suture method, and 109 patients were subjected to the modified suture method. Wound-related adverse events (p = 0.026) and IMF-indented scarring (p = 0.014) were significantly different between the two groups. Multivariable analysis showed that the suture method was the most influential factor related to IMF-indented scarring (OR = 16.9), followed by BMI (OR = 2.9). CONCLUSIONS We defined a new suture method for the inframammary incision in primary breast augmentation. This modified suture method reduces the occurrence of wound-related adverse events and IMF-indented scarring.
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Affiliation(s)
- Feng Qin
- Department of Plastic Surgery, Pekiong Union Medical College, Pekiong Union Medical College Hospital, Beijing, China.,Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ang Zeng
- Department of Plastic Surgery, Pekiong Union Medical College, Pekiong Union Medical College Hospital, Beijing, China
| | - Nanze Yu
- Department of Plastic Surgery, Pekiong Union Medical College, Pekiong Union Medical College Hospital, Beijing, China
| | - Ruijia Dong
- Department of Plastic Surgery, Pekiong Union Medical College, Pekiong Union Medical College Hospital, Beijing, China
| | - Fei Long
- Department of Plastic Surgery, Pekiong Union Medical College, Pekiong Union Medical College Hospital, Beijing, China
| | - Zenan Xia
- Department of Plastic Surgery, Pekiong Union Medical College, Pekiong Union Medical College Hospital, Beijing, China
| | - Wenchao Zhang
- Department of Plastic Surgery, Pekiong Union Medical College, Pekiong Union Medical College Hospital, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Pekiong Union Medical College, Pekiong Union Medical College Hospital, Beijing, China
| | - Xiaojun Wang
- Department of Plastic Surgery, Pekiong Union Medical College, Pekiong Union Medical College Hospital, Beijing, China
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Reproductive Outcomes after Laparoscopic Myomectomy: Conventional versus Barbed Suture. J Minim Invasive Gynecol 2021; 29:77-84. [PMID: 34182139 DOI: 10.1016/j.jmig.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To study the reproductive outcomes after laparoscopic myomectomy comparing conventional (nonbarbed) suture with barbed suture used for myometrial defect closure. DESIGN Monocentric retrospective cohort study with prospective follow-up survey for reproductive outcomes conducted in April and May 2020. SETTING Tertiary care center (center for advanced gynecologic laparoscopy and infertility). PATIENTS Women who underwent laparoscopic myomectomy for uterine leiomyomas from January 2004 to December 2017. INTERVENTIONS Laparoscopic myomectomy with closure of the myometrium using either conventional (nonbarbed suture) or barbed suture and follow-up survey regarding reproductive outcomes. MEASUREMENTS AND MAIN RESULTS The outcomes measured included the rate of conception, pregnancy complications, mode of delivery, and perioperative complications for both kinds of suture materials used. Of the 399 women who underwent laparoscopic myomectomy, 343 satisfied the inclusion criteria and were followed up; 235 patients responded. A total of 120 patients were included in the nonbarbed group (group A), and 115 patients were included in the barbed group (group B). A total of 182 (group A: 97 vs group B: 85; p = .204) women had actively sought pregnancy postoperatively, of whom 93 (51.09%) in total and 51 (54.8%) in group A vs 42 (45.1%) in group B reported at least 1 pregnancy with no significant difference in the incidence rate ratios between the 2 groups. Of the recorded pregnancies84.9% (group A: 88.2% vs group B: 80.9%) live births, 6.4% (group A: 5.8% vs group B: 7.1%) had first-trimester miscarriages, 2.1% (group A: 1.9% vs group B: 2.3%) had an ectopic pregnancy, and 6 were ongoing pregnancies at the time of the study analysis, which were compared statistically between both study groups. Pregnancy-related complications were noted in 12 of the 93 pregnant women (12.9%), which were comparable in both groups. No case of uterine rupture was reported. CONCLUSION Our study supports good reproductive outcomes in women after laparoscopic myomectomy with barbed sutures. Furthermore, the inclusion of nonbarbed sutures as a control group in our study reinforces that barbed sutures in myomectomy are as safe as, and an easier alternative to, conventional sutures without affecting pregnancy outcomes.
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Stabile G, Romano F, De Santo D, Sorrentino F, Nappi L, Cracco F, Ricci G. Case Report: Bowel Occlusion Following the Use of Barbed Sutures in Abdominal Surgery. A Single-Center Experience and Literature Review. Front Surg 2021; 8:626505. [PMID: 33959630 PMCID: PMC8093862 DOI: 10.3389/fsurg.2021.626505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/11/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: A high level of surgical ability is required to perform endoscopic knot tying. Barbed sutures help in avoiding this procedure, thus reducing intraoperative time and lowering blood loss and hospitalization time when compared to traditional sutures. Some cases of bowel occlusion following the use of barbed sutures have been described in literature. All of them are characterized by the entanglement of an intestinal loop in wire barbs with bowel occlusion symptoms. Case Presentation: We report two more cases which occurred in our Institute in 2020 and review those which have been reported in the literature by searching on Pubmed, Scopus, and Embase. We used the search terms: “Barbed,” ”Suture,” “Bowel,” and ”Obstruction.” We examined in the literature the surgical procedures, the type of complications, the time to onset of the complications, and the type of barbed suture. Discussion: Twenty-two cases in total were reported in the literature from 2011 to 2020, and bowel complications were largely subsequent to interventions such as hernia surgical repair and myomectomy. In order to take advantage of barbed sutures while minimizing the risk of adverse events, such as intestinal occlusion, some precautions may be considered, such as the shortening of thread tails and use of antiadhesive barriers. Moreover, performing a few stitches backwards when ending the suture might be a useful suggestion. Further studies in this field may be useful in order to assess whether it might be better avoiding barbed suture application on serosal tissues to prevent bowel damage.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo", Trieste, Italy
| | - Federico Romano
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo", Trieste, Italy
| | - Davide De Santo
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo", Trieste, Italy
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Francesco Cracco
- University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo", Trieste, Italy.,University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Herrmann A, Torres-de la Roche LA, Krentel H, Cezar C, de Wilde MS, Devassy R, De Wilde RL. Adhesions after Laparoscopic Myomectomy: Incidence, Risk Factors, Complications, and Prevention. Gynecol Minim Invasive Ther 2020; 9:190-197. [PMID: 33312861 PMCID: PMC7713662 DOI: 10.4103/gmit.gmit_87_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 12/23/2022] Open
Abstract
Uterine fibroids or uterine myomas are one of the most common benign diseases of the uterus. Symptoms associated with myomas can make surgical removal of myomas necessary. Besides the traditional abdominal route, laparoscopic myomectomy (LM) has gained more acceptances over the last few decades, and it is anticipated that laparoscopy is associated with lower adhesion development. Therefore, we conducted this review to analyze the evidence on adhesions after LM. The PubMed database was searched using the search terms “myomectomy” alone and in combination with “adhesions,” “infertility OR fertility outcome,” and “laparoscopy” among articles published in English and German. Although the well-known advantages of laparoscopy, for example, less pain, less blood loss, or shorter hospital stay, myomectomy belongs to high-risk operations concerning adhesion formation, with at least every fifth patient developing postsurgical adhesions. In laparoscopic surgery, surgeons´ experience as well tissue trauma, due to desiccation and hypoxia, are the underlying mechanisms leading to adhesion formation. Incisions of the posterior uterus may be associated with a higher rate of adhesions compared to anterior or fundal incisions. Adhesions can be associated with severe complications such as small bowel obstruction, chronic pelvic pain, complications in further operations, or impaired fertility. Tissue trauma and the experience of the surgeon in laparoscopic surgery are most of the influencing factors for adhesion formation after myomectomy. Therefore, every surgeon should adopt strategies to reduce adhesion development in daily routine, especially when it conducted to preserve or restore fertility.
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Affiliation(s)
- Anja Herrmann
- University Hospital for Gynecology Pius Hospital, University of Oldenburg, Germany
| | | | - Harald Krentel
- University Hospital for Gynecology Pius Hospital, University of Oldenburg, Germany
| | - Cristina Cezar
- University Hospital for Gynecology Pius Hospital, University of Oldenburg, Germany
| | - Maya Sophie de Wilde
- University Hospital for Gynecology Pius Hospital, University of Oldenburg, Germany
| | - Rajesh Devassy
- University Hospital for Gynecology Pius Hospital, University of Oldenburg, Germany
| | - Rudy Leon De Wilde
- University Hospital for Gynecology Pius Hospital, University of Oldenburg, Germany
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Kumakiri J, Kikuchi I, Kitade M, Ozaki R, Kawasaki Y. Incidence of Postoperative Adhesions after Laparoscopic Myomectomy with Barbed Suture. Gynecol Obstet Invest 2020; 85:336-342. [PMID: 32932256 DOI: 10.1159/000510511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/22/2020] [Indexed: 11/19/2022]
Abstract
AIM The aim of the study was to assess the incidence of postoperative adhesion by baseball running suture using barbed suture (BS) in laparoscopic myomectomy in comparison with sutures using an absorbable thread. METHODS Two hundred fifteen patients who underwent second-look laparoscopy (SLL) 6 months after laparoscopic myomectomy at our hospital between 2010 and 2014 were retrospectively reviewed. The incidence, numbers, types, and extent of adhesions were evaluated according to the more comprehensive adhesion scoring method. Propensity score matching (PS) (1:1) between the groups was performed by using the diameter of the largest myoma, the number of enucleated myomas, and the type of adhesion barrier. RESULTS Running baseball sutures and running sutures were applied to 28 and 187 patients with unidirectional BS and absorbable thread, respectively, to close the incised serosal wounds enucleating largest myomas during laparoscopic myomectomy. After PS matching for the patients, surgical findings and the incidence of postoperative wound adhesions were compared between the groups, including 22 patients each. The surgical findings were similar between the groups, except for the total surgical duration and blood loss (medians), which were significantly shorter and lower in the BS group than in the absorbable thread group (70 vs. 100 min; p = 0.01, 50 vs. 100 mL; p = 0.02). Regarding findings of SLL, no significant differences in the incidence of postoperative wound adhesions were found between the groups (BS, 4/22 [18.2%] versus absorbable thread, 8/22 [36.4%]; p = 0.31). CONCLUSION Our data indicated that the incidence of postoperative adhesion following the use of BS for wound closure in laparoscopic myomectomy was similar to that following the use of conventional suture.
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Affiliation(s)
- Jun Kumakiri
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan,
| | - Iwaho Kikuchi
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine Tokyo, Tokyo, Japan
| | - Rie Ozaki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine Tokyo, Tokyo, Japan
| | - Yu Kawasaki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine Tokyo, Tokyo, Japan
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Giusto G, Iussich S, Tursi M, Perona G, Gandini M. Comparison of two different barbed suture materials for end-to-end jejuno-jejunal anastomosis in pigs. Acta Vet Scand 2019; 61:3. [PMID: 30611301 PMCID: PMC6321647 DOI: 10.1186/s13028-018-0437-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hand-sewn intestinal anastomoses are a fundamental procedure in both open and laparoscopic intestinal surgery. Self-retaining barbed suture devices have been tested for a variety of surgical applications. With the exception of clinical reports and various experimental studies on enterotomy, little has been published so far on the use of barbed suture for end-to-end intestinal anastomoses. The aim of the study was to compare two different barbed suture materials for end-to-end jejuno-jejunal anastomosis in pigs. End-to-end jejuno-jejunal anastomosis were performed with unidirectional barbed (A group), bidirectional barbed (B group) or normal (C group) sutures in each animal. A comparison was then made between the groups based on adhesions scoring, suturing time, bursting pressure and histopathology. RESULTS Mean construction times in the A group (518 ± 40 s) and in the B group (487 ± 45 s) were significantly lower than in the C group (587 ± 63 s) but were not different between A and B group (P = 0.10). Mean bursting pressures were significantly higher in the intact intestine (197 ± 13 mmHg) than in any other group (group A 150 ± 16 mmHg, group B 145 ± 22 mmHg, group C 145 ± 24 mmHg). Among anastomotic techniques, the bursting pressures were not significantly different. Histologically no difference could be detected in the grade of inflammation, collagen deposition and neovascularization at the anastomotic sites. CONCLUSIONS Barbed sutures can be effectively used for handsewn end-to-end jejunojejunal anastomosis in pigs. They are comparable to normal suture but could provide a shorter surgical time.
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Farag S, Padilla PF, Smith KA, Sprague ML, Zimberg SE. Management, Prevention, and Sequelae of Adhesions in Women Undergoing Laparoscopic Gynecologic Surgery: A Systematic Review. J Minim Invasive Gynecol 2018; 25:1194-1216. [DOI: 10.1016/j.jmig.2017.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/11/2017] [Accepted: 12/17/2017] [Indexed: 01/09/2023]
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Yalcin S, Kibar Y, Tokas T, Gezginci E, Günal A, Ölcücü MT, Özgök IY, Gözen AS. In Vivo Comparison of "V-Loc 90 Wound Closure Device" With "Vicryl" and "Monocryl" in Regard to Tissue Reaction in a Rabbit Bladder Model. Urology 2018; 116:231.e1-231.e5. [PMID: 29505856 DOI: 10.1016/j.urology.2018.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 02/15/2018] [Accepted: 02/19/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the barbed polyglyconate suture (BPS) with 2 commonly used conventional sutures, this prospective randomized trial was designed. The sutures applied in the urinary collecting system, in terms of long-term histopathologic and macroscopic suture material features. MATERIALS AND METHODS Eight female and 6 male New Zealand rabbits were included in the study. Each animal served as its own control and was subjected to cystotomy. Watertight running cystorrhaphies were performed using 3 different sutures in a randomized fashion, namely Monocryl, Vicryl, and V-Loc 90. Seven animals were sacrificed after the third and 7 after the sixth week. Macroscopic and histopathologic examinations were performed. Tissue reaction, like inflammation and fibrosis, around the sutures were evaluated. Friedman and Wilcoxon signed ranks test was used for the statistical analysis. RESULTS The BPS demonstrated no adhesion. However, in the six-week group, stone formation was recorded on 4 BPS and 1 Vicryl thread, a difference being statistically significant (P = .039). Additionally, in the third- and in the sixth-week group, 1 (P = .368) and 3 (P = .050) BPS threads migrated, respectively. The histopathologic analysis revealed less inflammation and fibrosis associated with the BPS thread in both the third and the sixth-week groups (P = .010 and P = .002, respectively). CONCLUSION The BPS appears to be superior to conventional sutures in terms of local inflammation and fibrosis. However, suture migration and stone formation following collecting system closure could be potential predicaments.
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Affiliation(s)
- Serdar Yalcin
- Gulhane Training and Research Hospital, Department of Urology, Ankara, Turkey
| | - Yusuf Kibar
- Koru Hospital, Department of Urology, Ankara, Turkey
| | - Theodoros Tokas
- General Hospital Hall i.T., Department of Urology and Andrology, Hall in Tirol, Austria
| | - Elif Gezginci
- Gulhane Training and Research Hospital, Department of Urology, Ankara, Turkey
| | - Armagan Günal
- Gulhane Training and Research Hospital, Department of Pathology, Ankara, Turkey
| | | | | | - Ali Serdar Gözen
- University of Heidelberg, SLK-Kliniken, Department of Urology, Heilbronn, Germany.
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Zayed MA, Fouda UM, Elsetohy KA, Zayed SM, Hashem AT, Youssef MA. Barbed sutures versus conventional sutures for uterine closure at cesarean section; a randomized controlled trial. J Matern Fetal Neonatal Med 2017; 32:710-717. [DOI: 10.1080/14767058.2017.1388368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mohamed A. Zayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Usama M. Fouda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khaled A. Elsetohy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shereef M. Zayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed T. Hashem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A. Youssef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Fouda UM, Elsetohy KA, Elshaer HS. Barbed Versus Conventional Suture: A Randomized Trial for Suturing the Endometrioma Bed After Laparoscopic Excision of Ovarian Endometrioma. J Minim Invasive Gynecol 2016; 23:962-8. [DOI: 10.1016/j.jmig.2016.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
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16
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Giampaolino P, De Rosa N, Tommaselli GA, Santangelo F, Nappi C, Sansone A, Bifulco G. Comparison of bidirectional barbed suture Stratafix and conventional suture with intracorporeal knots in laparoscopic myomectomy by office transvaginal hydrolaparoscopic follow-up: a preliminary report. Eur J Obstet Gynecol Reprod Biol 2015; 195:146-150. [PMID: 26540594 DOI: 10.1016/j.ejogrb.2015.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/27/2015] [Accepted: 10/15/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare surgical outcomes of different types of intracorporeal sutures for laparoscopic posterior myomectomy, by a prospective randomized study. STUDY DESIGN Prospective randomized study on 47 patients with single posterior intramural myoma (4-7cm in diameter) undergoing laparoscopic myomectomy. The patients enrolled were divided into two groups, one operated using conventional suture in double strand, and the other with bidirectional barbed suture Stratafix. The main outcome measures were suturing time, peri-operative variables, and post-operative adhesions in both groups. RESULTS The mean operative time was shorter with the Stratafix™ than with the conventional suture (66.3±8.2 vs. 73±8min; p=0.005). Suturing time was significantly shorter in the Stratafix™ than in the control group (8.8±2.4 vs. 15.5±2.8min; p=0.001). Intraoperative bleeding was significantly less in the Stratafix group (p=0.0012). Conversely, there was no statistically significant difference for postoperative adhesions between the two groups (26.7% vs. 21.4% p=0.5). CONCLUSIONS The use of barbed suture may reduce operative time, suturing time, and blood loss. No difference in post operative adhesions was found.
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Affiliation(s)
| | - Nicoletta De Rosa
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
| | | | - Fabrizia Santangelo
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
| | - Carmine Nappi
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
| | - Anna Sansone
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
| | - Giuseppe Bifulco
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
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Peritoneal closure over barbed suture to prevent adhesions: a randomized controlled trial in an animal model. J Minim Invasive Gynecol 2015; 22:619-25. [PMID: 25620215 DOI: 10.1016/j.jmig.2015.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/15/2015] [Accepted: 01/17/2015] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To compare adhesion formation and histological features of peritoneal closure and nonclosure over an intra-abdominally placed barbed suture. DESIGN Single-blind randomized controlled trial (Canadian Task Force Classification I). SETTING Certified animal research facility. SUBJECTS Eight nonpregnant rats. INTERVENTIONS Abdominal cavities were entered via midline incision. Left and right parietal peritoneal surfaces were incised 1.5 cm long separately and stitched with unidirectional barbed suture material (3/0 V-Loc). The parietal peritoneum was approximated over the barbed suture using polypropylene suture material (7/0 Prolene) to embed the barbed suture (peritonization) on one side, and left open on the other side. The side of the barbed suture to be peritonized was allocated at random. On the postoperative day 32, all rats were sacrificed, adhesion formations on each side were macroscopically scored, and histological features were evaluated microscopically. MEASUREMENT AND MAIN RESULTS The median adhesion score was 2.00 (range, 1-4) on operative fields. There was no statistically significant difference in median adhesion score between the peritonized and nonperitonized sides (1.5 vs 2, respectively; p = .13). Microscopically, there were no statistically significant differences in median acute and chronic inflammation scores between the peritonized and nonperitonized sides (p = .58 and p = .45, respectively), but a significantly higher median fibrosis score on the peritonized side (3 vs 1.5, respectively; p = .02). CONCLUSION Based on the results of the present study in a rat model, barbed suture material might be associated with adhesion formation when used intra-abdominally, and these adhesions could not be prevented by peritonization.
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