Search Results (28)

Intraocular foreign bodies penetrating the eye can lead to serious complications, including endophthalmitis, and therefore require urgent removal. We present the case of a 9-year-old boy with an intraocular foreign body lodged in the lens with a corneal flap wound. The injury occurred while hammering a bicycle frame. The patient presented with sudden pain, tearing, and decreased visual acuity in the left eye. On admission, the left eye distance best-corrected visual acuity (BCVA) was 0.4 and intraocular pressure (IOP) was 17 mmHg. Slit-lamp examination of the left eye revealed a full-thickness corneal flap wound, a traumatic cataract, and a foreign body located centrally within the lens. B-scan ultrasonography demonstrated an echogenic focus within the lens consistent with an intralenticular metallic foreign body, with a normal posterior segment, a regular appearance of the optic disc, and an attached retina. The patient underwent phacoaspiration of the traumatic cataract with intraocular lens implantation and simultaneous removal of the foreign body. Given the corneal flap wound located in the visual axis and the absence of ocular hypotony, the decision was made not to place a corneal suture. At discharge, BCVA improved to 1.0, with IOP of 17 mmHg and normal fundus appearance. Full article

Per-oral flexible endoscopy has expanded minimally invasive options for the management of gastric subepithelial tumors (G-SETs). This narrative review appraises conventional and advanced endoscopic resections alongside hybrid laparoscopic–endoscopic procedures, within a size- and layer-based clinical framework. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) achieve high en bloc resection rates for small, intraluminal tumors arising from mucosa or submucosa. Traction strategies and dedicated traction devices may improve submucosal exposure, shorten procedure time, and reduce adverse events. Submucosal tunneling endoscopic resection (STER) has been developed to enucleate tumors originating from the muscularis propria while preserving mucosal integrity. However, tunnel creation and specimen retrieval become challenging for large tumors or for those located in the cardia or fundus. Endoscopic full-thickness resection (EFTR) enables controlled transmural excision of G-SETs arising from deeper wall layers. Exposed EFTR, combined with secure endoscopic closure, provides high en bloc and complete (R0) resection rates. Closure options range from through-the-scope clips—for small defects—to over-the-scope clips, endoloop-clip purse-string methods, reopenable-clip over-the-line techniques and endoscopic suturing systems—for larger defects. Non-exposed EFTR and device-assisted systems reduce the risk of peritoneal contamination, although complete resection rates are more variable. Hybrid approaches, including classical laparoscopic–endoscopic cooperative surgery (LECS) and non-exposure variants, combine endoscopic precision with the safety and closure capabilities of laparoscopic surgery, minimizing the amount of resected gastric wall. They are particularly suited to larger, awkwardly located or ulcerated G-SETs. Emerging traction platforms, flexible robotic systems, and AI-based tools may further broaden the role of per-oral flexible endoscopy for the treatment of G-SETs. However, evidence remains preliminary, and surgery continues to play a key role for large, extraluminal or anatomically prohibitive G-SETs. Full article

Background: Cuff reconstructions vary due to different technical approaches by suture anchor manufacturers, as well as different suture construct configurations. Objectives: The main aim of this study is to primarily compare clinical outcomes and secondarily observe cost-effectiveness by assessing suture construct configurations in arthroscopic rotator cuff repair (ARCR). Methods: Using a retrospective local registry, we included patients undergoing arthroscopic rotator cuff repair who had been implanted with different anchor configurations and different anchor manufacturers. Data analysis was conducted via multiple linear regression, primarily evaluating the relationship between clinical scores (OSS; SSV) and suture construct configurations, to analyze, monitor, and compare the postoperative clinical development. Total surgical costs were also obtained from the clinical billing department for analysis of various factors, including Adjusted Life Years (ALYs) and Incremental Cost-Effectiveness Ratio (ICER), while controlling for sex, tear severity, and age. Results: A total of 317 patients were included in the final analysis, with a mean age at surgery of 60.1 ± 10.8 years, with 58% of patients being male. According to the Gerber tear severity classification, 23% of patients had a partial tear, 59% had at least one full-thickness tear, and the remaining 18% had a massive tear. Using linear regression models, the analysis of changes in Quality-Adjusted Life Years (QALYs) as the dependent variable did not yield statistically significant results. The postoperative development of the measured clinical scores (SSV; OSS) did not show a significant difference comparing the two manufacturers (p = 0.11, p = 0.85). However, the model evaluating costs identified significant effects related to the type of anchor configuration and manufacturer. Regarding anchor configurations, utilizing anchor configuration 1 or 2 resulted in lower costs by up to CHF 254.51 compared to the reference anchor configuration 4 (p < 0.05), after controlling for age, sex, tear severity, and anchor configuration. Conclusions: The primary findings of this study indicate that although clinical outcomes are generally consistent across various rotator cuff reconstruction scenarios, while secondarily the cost implications can differ significantly and are mainly attributed to the differing numbers of anchors required for each configuration and price setting of the manufacturer. The study underscores the importance of suture construct configuration and manufacturer selection in controlling healthcare costs while maintaining quality patient care. Full article

Background: Necrotizing enterocolitis (NEC) is a life-threatening condition characterized by necrosis of the gastrointestinal tract caused by hypoperfusion and hypoxia-induced inflammation. Surgical treatment often requires resection, with high morbidity and mortality. Intestinal tissue engineering using absorbable biomaterials represents a potential alternative. Small intestinal submucosa (SIS) is a biodegradable extracellular matrix (ECM) scaffold that may facilitate regeneration of the native tissue. Objectives: The aim of our study is to investigate the regenerative potential of SIS in a rat model with multiple gastrointestinal defects. Methods: In rats, after a midline laparotomy, an approximately 1 cm full-thickness incision was performed on the anterior gastric wall, on the antimesenteric side of the small and large intestine, each covered with an SIS patch. After three weeks, the graft sites and adjacent fragments were harvested and fixed in 10% neutral buffered formalin. Cross-sections of the grafted area were processed and stained with hematoxylin and eosin for histologic analysis. Results: Among the fifteen Wistar rats used in the study, the survival rate was 80% (12/15). Macroscopic examination of the abdominal cavity after the second surgery showed no complications. Adhesions were present in 92% (11/12). Histological examination demonstrated complete mucosal coverage in all stomach samples, nine of the small intestine, and ten of the large intestine. Mild fibrosis with minimal inflammatory infiltrates predominated. Ulceration with granulation tissue replacement was observed in three small intestine samples. Foreign body reactions were restricted to suture sites. Conclusions: In this multifocal injury model, SIS integrated effectively and supported early regenerative healing across gastric, small-intestinal, and colonic sites at 3 weeks. These data support further studies with longer follow-up, quantitative histology and functional assessment, and evaluation in neonatal-relevant large animal models to determine translational potential for NEC surgery. Full article

Introduction: Pediatric lower-lip dog bite injuries are challenging due to contamination, tissue loss, and the need to maintain function, appearance, and psychological well-being. This single case describes immediate definitive closure using sharp debridement with adjunct polyhexanide (PHMB), a full-thickness skin graft (FTSG), and a polyurethane (PU) compression foam bolster. Methods: A 10-year-old boy with a severe contaminated lower-lip defect underwent debridement and 0.04% PHMB irrigation. An upper-arm FTSG was inset and compressed with a suture-anchored PU dressing. Topical PHMB gel was used perioperatively and for seven days after bolster removal. Oral antibiotics were given for five days. The patient was discharged eight days after the injury with detailed wound care instructions. Results: Immediate definitive closure was achieved with complete graft survival and no infection, necrosis, unplanned early dressing changes, or reoperations. At 12 months, oral competence, speech, lip mobility, and contour were preserved. However, mild residual esthetic differences remained (dyschromia, shallow border indentation, vellus hairs on the graft). Conclusion: In this single descriptive case, primary closure of a lower-lip injury with the combined intervention was associated with an uncomplicated functional course and manageable esthetic trade-offs at 12 months. These observations are descriptive; comparative studies with standardized functional, esthetic, and psychosocial measures are needed. Full article

Background: Post-traumatic corneal wounds that require suturing are quite common; they reduce corneal transparency and cause corneal distortion, leading to corneal astigmatism and higher-order aberrations. Excimer laser treatment can be a potentially beneficial intervention for such wounds. The observation aimed to evaluate the effectiveness of topography-guided custom ablation treatment (TCAT) in patients with corneal injuries. Methods: This observation included three patients with corneal penetrating trauma (full-thickness corneal scar) and one patient with corneal blunt trauma, i.e., a non-penetrating injury with corneal laceration (partial-thickness corneal scar). This cohort study was conducted from July 2021 to August 2023. After first-stage treatment (stabilization of the post-traumatic visual defect confirmed by refraction and topography examination, corneal healing, and improvement of the corneal scar), the patients underwent the second-stage treatment, i.e., TCAT with a 20 to 45 s application of mitomycin C solution to avoid haze induction. After TCAT, the uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (BCVA) were measured. Refractive astigmatism was assessed using autorefractometry. Topographic astigmatism was analyzed using corneal topography and pachymetry. The root mean square (RMS) of the higher-order aberration was calculated using Zernike coefficients. The patients’ corneal healing and refractive changes were monitored. Results: All patients were monitored for corneal healing and refractive changes and underwent the same second-stage treatment, which utilized TCAT to regularize the corneal surface and reduce higher-order aberrations (HOAs). The UDVA of patients 1, 2, 3 and 4 improved by 3, 7.5, 4 and 6 rows (Snellen chart), respectively. The resultant UDVA was 1.0, 0.9, 0.7 and 1.2, while BCVA was 1.0, 1.2, 1.0, and 1.5, respectively. Conclusions: TCAT regularized the patients’ corneal surfaces and reduced HOAs. We, therefore, conclude that TCAT may be a beneficial second-stage treatment for corneal trauma-induced astigmatism. Full article

Objective: Managing flexor tendon injuries surgically remains challenging due to the ongoing debate over the most effective suture technique and materials. An optimal repair must be technically feasible while providing enough strength to allow for early active mobilization during the post-operative phase. This study aimed to assess the biomechanical properties of three modified Kessler repair techniques using two different suture materials: a conventional two-strand and a modified four-strand Kirchmayr–Kessler repair using 3-0 Prolene^® (2s-KK-P and 4s-KK-P respectively), and a four-strand Kessler–Tsuge repair using 4-0 FiberLoop^® (4s-KT-FL). Methods: Human flexor digitorum profundus (FDP) tendons were retrieved from Thiel-embalmed prosections. For each tendon, a full-thickness cross-sectional incision was created, and the ends were reattached using either a 2s-KK-P (n = 30), a 4s-KK-P (n = 30), or a 4s-KT-FL repair (n = 30). The repaired tendons were tested using either a quasi-static (n = 45) or cyclic testing protocol (n = 45). Maximum force (F_max), 2 mm gap force (F_2mm), and primary failure modes were recorded. Results: In both quasi-static and cyclic testing groups, tendons repaired using the 4s-KT-FL approach exhibited higher F_max and F_2mm values compared to the 2s-KK-P or 4s-KK-P repairs. F_max was significantly higher with a 4s-KK-P versus 2s-KK-P repair, but there was no significant difference in F_2mm. Suture pull-out was the main failure mode for the 4s-KT-FL repair, while suture breakage was the primary failure mode in 2s- and 4s-KK-P repairs. Conclusions: FDP tendons repaired using the 4s-KT-FL approach demonstrated superior biomechanical performance compared to 2s- and 4s-KK-P repairs, suggesting that the 4s-KT-FL tendon repair could potentially reduce the risk of gapping or re-rupture during early active mobilization. Full article

Gastroesophageal reflux disease (GERD) is one of the most common diseases that occurs secondary to failure of the antireflux barrier system, resulting in the frequent and abnormal reflux of gastric contents to the esophagus. GERD is diagnosed in routine clinical practice based on the classic symptoms of heartburn and regurgitation. However, a subset of patients with atypical symptoms can pose challenges in diagnosing GERD. An esophagogastroduodenoscopy (EGD) is the most common initial diagnostic test used in the assessment for GERD, although half of these patients will not have any positive endoscopic findings suggestive of GERD. The advanced endoscopic techniques have improved the diagnostic yield of GERD diagnosis and its complications, such as Barrett’s esophagus and early esophageal adenocarcinoma. These newer endoscopic tools can better detect subtle irregularities in the mucosa and vascular structures. The management options for GERD include lifestyle modifications, pharmacological therapy, and endoscopic and surgical interventions. The latest addition to the armamentarium is the minimally invasive endoscopic interventions in carefully selected patients, including the electrical stimulation of the LES, Antireflux mucosectomy, Radiofrequency therapy, Transoral Incisionless Fundoplication, Endoscopic Full-Thickness plication (GERDx™), and suturing devices. With the emergence of these advanced endoscopic techniques, it is crucial to understand their selection criteria, advantages, and disadvantages. Full article

Positional plagiocephaly is a deformational cranial flattening frequently treated in pediatric neurosurgical practice. Positional maneuvers and orthotic helmet therapy are preferred therapeutic options for moderate-to-severe forms. Treatment response seems to be age-dependent. Nevertheless, predictive data are vague, and cost-efficiency might be a limiting factor for treatment. The purpose of this study was to investigate the early predictive value of sonographic parameters on the efficacy of orthotic helmet therapy through the assessment of changes in skull shape and correlation of the parameters with caliper cephalometry values and with age. A consecutive cohort of 49 patients < 10 months of age, undergoing orthotic helmet therapy for positional plagiocephaly, was recruited prospectively. The authors routinely assessed the patency of the lambdoid sutures by ultrasound and the following additional skull parameters were measured: suture width, adjacent full bone thickness, adjacent cortical bone thickness and occipital angle. Caliper cephalometric values, as well as demographic and clinical data were collected. Retrospective data analysis showed an inverse relation between both cortical and full skull bone thickness and early treatment efficacy, defined by a reduction in the occipital angle. The improvement of sonographic parameters correlated with the development of cranial caliper cephalometry values. In conclusion, the sonographic assessment of skull bone thickness is a safe and cost-effective tool to predict the early efficacy of orthotic helmet therapy in positional plagiocephaly and might, therefore, help the clinician to foresee the potential evolution of the deformity. Full article

Objectives: The aim of this review paper is to summarise surgical options available for repairing iris defects at the iris–lens plane, focusing on suturing techniques, iridodialysis repair, and prosthetic iris devices. Methods: A thorough literature search was conducted using multiple databases, including Medline, PubMed, Web of Science Core Collection, and the Cochrane Library, from inception to February 2024. Relevant studies were screened based on predefined criteria, and primary references cited in selected articles were also reviewed. Results: Various surgical techniques were identified for iris defect repair. Suturing methods such as interrupted full-thickness sutures and the McCannel technique offer solutions for smaller defects, while iridodialysis repair techniques address detachment of the iris from the ciliary body. Prosthetic iris devices, including iris–lens diaphragm devices, endocapsular capsular tension ring-based devices, and customizable artificial iris implants, provide options for larger defects, each with its own advantages and limitations. Conclusions: Successful iris reconstruction requires a personalised approach considering factors like defect size, ocular comorbidities, and patient preference. Surgeons must possess a thorough understanding of available techniques and prosthetic devices to achieve optimal outcomes in terms of both visual function and, nonetheless, cosmetic appearance. Full article

The essence of treating scar contractures lies in covering the skin deficit after releasing the contractures, typically using flaps or skin grafts. However, the specific characteristics of scar contractures, such as their location, shape, and size, vary among patients, which makes surgical planning challenging. To achieve excellent outcomes in the treatment of scar contractures, we have developed a dimensional classification system for these contractures. This system categorizes them into four types: type 1 (superficial linear), type 2-d (deep linear), type 2-s (planar scar contractures confined to the superficial layer), and type 3 (planar scar contractures that reach the deep layer, i.e., three-dimensional scar contractures). Additionally, three factors should be considered when determining surgical approaches: the size of the defect, the availability of healthy skin around the defect, and the blood circulation in the defect bed. Type 1 and type 2-d are linear scars; thus, the scar is excised and sutured in a straight line, and the contracture is released using z-plasty or its modified methods. For type 2-s, after releasing the scar contracture band, local flaps are indicated for small defects, pedicled perforator flaps for medium defects, and free flaps and distant flaps for large defects. Type 2-s has good blood circulation in the defect bed, so full-thickness skin grafting is also a suitable option regardless of the defect’s size. In type 3, releasing the deep scar contracture will expose important structures with poor blood circulation, such as tendons, joints, and bones. Thus, a surgical plan using flaps, rather than skin grafts, is recommended. A severity classification and treatment strategy for scar contractures have not yet been established. By objectively classifying and quantifying scar contractures, we believe that better treatment outcomes can be achieved. Full article

Purpose: The goal of this article was to introduce a new root coverage (RC) technique, the mixed-thickness tunnel access (MiTT) technique, which approaches a full-split design and intends to augment soft tissues coronal to the gingival margin. It was shown step-by-step, and the results were presented in a case series. Methods: Healthy individuals (non-diabetics) and non-smokers with gingival recession (GR) type 1 or 2 (RT1 or RT2) were included. After evaluation, prophylaxis was performed 14 days before the surgical procedure. During the surgical appointment, one or two vertical incision(s) on the mucosa (around 1–2 mm apical to the MGJ), lateral to the papilla base, was/were performed after anesthesia. Initially, there was a partial incision to detach the mucosa of the muscles (split design). It was permitted (but not mandatory) to perform intrasulcular incisions. Through the vertical incision, internally, subperiosteal access from the MGJ toward the gingival margin (coronally) was performed to create a full-thickness tunnel. Then, communication from the vertical incision with the gingival sulcus and the papilla base occurred, keeping the papilla tip intact. A connective tissue graft was harvested and inserted through the linear incision or intrasulcularly. There were interrupted sutures. An adjunctive material may be applied (e.g., Endogain). The root coverage was measured using a periodontal probe and considered fully covered when the gingival margin was 1 mm coronal to the cementum–enamel junction (CEJ). Results: Nine healthy individuals (seven females and two males) aged 19 and 43 were enrolled. They were treated following the MiTT steps. Four cases had a single GR; two patients had two teeth involved; and three others had three or four GR. There were seven cases of RT1 and two RT2. All RT1 cases achieved 100% RC, while the mean RC obtained for RT2 was around 80%. Conclusion: The MiTT technique can be considered a more straightforward approach for minimally invasive surgical techniques, which is a feasible option to treat RC with a high success rate, predictability, and esthetic preservation. Therefore, there is a technical sensitivity to performing the full-split design procedure. Full article

Background and Objectives: Women with a history of cesarean section are a high-risk group because they are likely to develop uterine rupture during their next pregnancy. Current evidence suggests that a vaginal birth after cesarean section (VBAC) is associated with lower maternal mortality and morbidity than elective repeat cesarean delivery (ERCD). Additionally, research suggests that uterine rupture can occur in 0.47% of cases of trial of labor after cesarean section (TOLAC). Case Description: A healthy 32-year-old woman at 41 weeks of gestation, in her fourth pregnancy, was admitted to the hospital due to a dubious CTG record. Following this, the patient gave birth vaginally, underwent a cesarean section, and successfully underwent a VBAC. Due to her advanced gestational age and favorable cervix, the patient qualified for a trial of vaginal labor (TOL). During labor induction, she displayed a pathological CTG pattern and presented symptoms such as abdominal pain and heavy vaginal bleeding. Suspecting a violent uterine rupture, an emergency cesarean section was performed. The presumed diagnosis was confirmed during the procedure—a full-thickness rupture of the pregnant uterus was found. The fetus was delivered without signs of life and successfully resuscitated after 3 min. The newborn girl of weight 3150 g had an Apgar score of 0/6/8/8 at 1, 3, 5, and 10 min. The uterine wall rupture was closed with two layers of sutures. The patient was discharged 4 days after the cesarean section without significant complications, with a healthy newborn girl. Conclusions: Uterine rupture is a rare but severe obstetric emergency and can be associated with maternal and neonatal fatal outcomes. The risk of uterine rupture during a TOLAC attempt should always be considered, even if it is a subsequent TOLAC. Full article

Background: Obesity is a chronic disease that impairs quality of life and leads to several comorbidities. When conservative therapies fail, bariatric surgical options such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most effective therapies to induce persistent weight loss. Over the last two decades, bariatric endoscopy has become a valid alternative to surgery in specific settings. Primary bariatric endoscopic therapies: Restrictive gastric procedures, such as intragastric balloons (IGBs) and endoscopic gastroplasty, have been shown to be effective in inducing weight loss compared to diet modifications alone. Endoscopic gastroplasty is usually superior to IGBs in maintaining weight loss in the long-term period, whereas IGBs have an established role as a bridge-to-surgery approach in severely obese patients. IGBs in a minority of patients could be poorly tolerated and require early removal. More recently, novel endoscopic systems have been developed with the combined purpose of inducing weight loss and improving metabolic conditions. Duodenal mucosal resurfacing demonstrated efficacy in this field in its early trials: significant reduction from baseline of HbA1c values and a modest reduction of body weight were observed. Other endoscopic malabsorptive have been developed but need more evidence. For example, a pivotal trial on duodenojejunal bypasses was stopped due to the high rate of severe adverse events (hepatic abscesses). Optimization of these more recent malabsorptive endoscopic procedures could expand the plethora of bariatric patients that could be treated with the intention of improving their metabolic conditions. Revisional bariatric therapies: Weight regain may occur in up to one third of patients after bariatric surgery. Different endoscopic procedures are currently performed after both RYGB and SG in order to modulate post-surgical anatomy. The application of argon plasma coagulation associated with endoscopic full-thickness suturing systems (APC-TORe) and Re-EndoSleeve have shown to be the most effective endoscopic treatments after RYGB and SG, respectively. Both procedures are usually well tolerated and have a very low risk of stricture. However, APC-TORe may sometimes require more than one session to obtain adequate final results. The aim of this review is to explore all the currently available primary and revisional endoscopic bariatric therapies focusing on their efficacy and safety and their potential application in clinical practice. Full article

Acute hydrops is a rare complication of corneal ectatic disease, which occurs secondary to Descemet membrane break. Spontaneous resolution of this condition is associated with longstanding ocular discomfort and corneal scar. Intracameral gas/air injection with or without corneal suturing, anterior segment ocular coherence tomography (ASOCT)-guided drainage of intrastromal fluid, and penetrating keratoplasty are some of the described surgical interventions to manage this condition. The purpose of our study was to assess the effect of full-thickness corneal suturing as a solo treatment in the management of acute hydrops. A total of five patients with acute hydrops received full-thickness corneal sutures perpendicular to their Descemet break. A complete resolution of symptoms and corneal oedema was observed between 8 to 14 days post-operation with no complications. This technique is simple, safe, and effective in the management of acute hydrops and saves patients from a corneal transplant in an inflamed eye. Full article