Search Results (60)

Background and Objectives: Ventilation tube insertion (VTI) is the most commonly performed surgical procedure for otitis media with effusion (OME) in children. While the factors associated with tube extrusion have been investigated, their quantitative impact on the timing of extrusion remains insufficiently characterized. This study aimed to identify independent factors associated with ventilation tube extrusion time and to quantify the magnitude and direction of their effect using survival analysis methodology. Materials and Methods: This retrospective cohort study included 150 patients (262 ears) who underwent VTI with Shepard-type tubes for OME at a tertiary referral center between February 2019 and July 2025. Patient-level variables (age, sex, laterality, allergic rhinitis, secondhand smoke exposure, adenoidectomy, and tonsillectomy) were analyzed per patient (n = 150), while ear-specific variables (effusion type, history of previous VTI, and tube obstruction) were analyzed per ear (n = 262). Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent factors associated with extrusion time. Kaplan–Meier survival curves with log-rank tests were used to compare median extrusion times between groups. Results: The mean ventilation tube extrusion time was 280.38 ± 99.24 days (9.35 ± 3.30 months). Three independent factors significantly associated with shorter extrusion time were identified in multivariate analysis: tube obstruction during follow-up (HR = 2.629, 95% CI: 1.731–3.993, p < 0.001), history of previous VTI (HR = 2.292, 95% CI: 1.678–3.131, p < 0.001), and serous effusion type compared to glue (HR = 1.914, 95% CI: 1.455–2.517, p < 0.001). Age, sex, laterality, allergic rhinitis, secondhand smoke exposure, adenoidectomy, and tonsillectomy were not significantly associated with extrusion time. Conclusions: History of previous VTI, serous effusion type, and tube obstruction during follow-up were independently associated with shorter ventilation tube extrusion time. Notably, tube obstruction during follow-up, which has not been previously evaluated as a factor associated with extrusion time in survival analyses of tube retention, demonstrated the strongest independent effect on extrusion timing. These findings may assist clinicians in anticipating tube behavior and individualizing postoperative follow-up schedules. Full article

Background and Clinical Significance: Left ventricular free-wall rupture (LVFWR) is a rare but devastating mechanical complication of acute myocardial infarction (AMI), with reported in-hospital mortality approaching 90% without surgical intervention. Although its incidence has declined in the contemporary primary percutaneous coronary intervention (PCI) era, LVFWR remains an important cause of early post-infarction death, particularly after delayed reperfusion or fibrinolytic therapy. Subacute or contained “oozing” ruptures pose a unique diagnostic challenge because hemodynamic stability and nonspecific symptoms can mask the underlying catastrophe, and standard transthoracic echocardiography may fail to visualize a sealed defect. Contrast-enhanced cardiac computed tomography (CT) has emerged as a valuable adjunct in this setting, enabling early recognition and surgical planning. Case Presentation: We report a case of a 51-year-old male, a heavy smoker, with acute lateral ST-segment elevation myocardial infarction (STEMI) treated with thrombolysis at a referring hospital, followed by percutaneous coronary intervention (PCI) to the obtuse marginal branch. Despite reperfusion, he developed persistent pleuritic chest pain and a small pericardial effusion. Cardiac computed tomography (CT) demonstrated a contained (sealed) lateral-wall oozing-type left ventricular free-wall rupture (LVFWR) with thrombus sealing the defect. A multidisciplinary heart team initially opted for diligent observation with frequent echocardiography. Within the first 24 h, the pericardial effusion increased, and echocardiography showed circumferential effusion with lateral wall thickening and hematoma, prompting emergent sternotomy. Intraoperatively, a large posterolateral infarct with an oozing-type LV free-wall rupture was identified. Surgical repair was performed using interrupted pledgeted sutures, native pericardial patch, BioGlue, and an overlying Teflon patch, with intra-aortic balloon pump (IABP) support. This case demonstrates the complementary diagnostic value of multimodality imaging—echocardiography for serial monitoring of the pericardial effusion and regional wall changes, and cardiac CT for direct characterization of the contained (sealed) defect—and the timely transition from conservative to surgical management in oozing-type rupture. The patient recovered uneventfully and was discharged in stable condition. Conclusions: This case highlights the diagnostic value of multimodality imaging—particularly cardiac CT—in detecting contained (sealed) LVFWR when echocardiography is inconclusive. Early recognition and prompt surgical intervention enabled a successful outcome in this otherwise frequently fatal complication. Full article

Background: Massive pulmonary hemorrhage is a life-threatening complication of pulmonary endarterectomy (PEA) with limited evidence to guide standardized management. Methods: We retrospectively evaluated consecutive PEA procedures performed at a high-volume center and analyzed the incidence, perioperative characteristics, management strategies, and early outcomes of patients who developed massive pulmonary hemorrhage. Results: Among 1123 patients who underwent PEA, massive pulmonary hemorrhage occurred in 51 (4.54%) and developed intraoperatively after completion of PEA and separation from total circulatory arrest. Primary suturing achieved hemostasis in 12 patients (23.5%), and bronchial isolation was applied in 18 (35.3%). Local adjuncts included intraoperative bronchial clamping in 1 patient (2.0%) and biological glue occlusion in 2 (3.9%). Extracorporeal membrane oxygenation (ECMO) was required in 25 patients (49.0%), initiated intraoperatively in 22 and postoperatively in 3. Overall in-hospital mortality was 41.2%, while 30 patients (58.8%) survived to hospital discharge; among survivors, mean hospital length of stay was 16.1 ± 6.8 days. Conclusions: Massive pulmonary hemorrhage after PEA remains associated with substantial early mortality and resource utilization; a stepwise institutional algorithm combining bronchoscopy-guided localization, targeted airway/surgical control, and timely ECMO support may help standardize management in this critical setting. Full article

Background/Objectives: Conjunctival closure may influence early postoperative comfort and wound healing after pediatric strabismus surgery. We compared fibrin glue with absorbable sutures using anterior segment optical coherence tomography (AS-OCT)-based conjunctival thickness, serial clinical scores, ocular-surface screening, and operative time. Methods: We retrospectively reviewed 82 children (5–15 years) who underwent bilateral medial rectus recession. The conjunctiva was closed with 8-0 polyglactin 910 (Vicryl) (suture group, n = 40) or fibrin glue (fibrin group, n = 42) according to routine practice; right eyes were analyzed. Conjunctival thickness was measured by AS-OCT preoperatively and at week 6. The comfort questionnaire (CQ) score and inflammation score (IS) were recorded on postoperative day 1 and weeks 1, 2, and 6. Total operative time and closure time were obtained from surgical video recordings. Ocular Surface Disease Index-6 (OSDI-6) and non-invasive keratographic break-up time (NIKBUT) were assessed preoperatively and at week 6 in cooperative children (n = 62). Results: Conjunctival thickness increased in both groups and was slightly higher at week 6 with sutures (p < 0.001), with a slightly greater percentage increase (p = 0.001). CQ and IS were worse with sutures through week 2 (all p < 0.05) and converged by week 6 (both p > 0.05). Fibrin glue shortened total operative time (32.75 vs. 35.46 min; p < 0.05) and closure time (3.90 vs. 5.35 min; p < 0.001). In the ocular-surface subset, OSDI-6 and NIKBUT did not differ between groups at week 6. No infections or granulomas occurred; two early conjunctival wound gaps occurred in the fibrin group and one resolved with topical management, while the other met the dehiscence definition (≥2 mm) and required re-suturing, and both healed without sequelae. Conclusions: In pediatric strabismus surgery, fibrin glue demonstrated better early comfort with a modest difference in conjunctival thickness at week 6 along with slightly shorter operative time while clinical scores converged by week 6, and ocular-surface screening outcomes were similar. Full article

The present work explores the effects of dental splints from a mechanical standpoint, aiming to provide a practical tool for the surgical decision-making process regarding splint cross-section dimensions. Our investigation centers on the anatomical structure of a pentamorphic dental arch encompassing central and lateral incisors and one canine on each side. Using parametric in silico models built up by means of an ad-hoc procedure, geometry, material properties, and boundary conditions are defined on a parametric anatomical model that can be tailored using RX-derived geometrical information. Two general cases have been considered, one with the splint and the other splintless, and a sensitivity analysis has been performed by varying the splint section height and thickness. The results show the diminishing mobility at the apex and basis of the diseased incisors, demonstrating the effectiveness of the periodontal treatment. Moreover, the stress due to physiological loads moves away from diseased teeth toward the healthy ones due to the splint effects, focusing on the splint–glue–canine contact zone and highlighting the crucial role played by the canine in fixing the entire dental structure. To establish a preliminary mechanical assessment of the dental structure’s safety and to confine its actual value within a mechanically reasonable range, a synthetic “traffic-light” indicator of stress-based failure risk is proposed. It is felt that the tool proposed in this study can help surgeons assess the pre-operative patient-specific mechanical effects of the splint treatment, driving the design and choice of periodontal splints. By linking splint geometry to mechanical safety via a stress-based indicator, the method supports the optimized design and selection of splints, improving treatment reliability while preserving comfort and clinical effectiveness. Full article

Background/Objectives: Female tubal factor infertility is a major clinical challenge. While surgical repair of the fallopian tubes remains the traditional standard, biological fibrin sealants have been proposed to reduce tissue trauma and improve reproductive outcomes. Methods: We conducted database searches of PubMed/MEDLINE, EMBASE and Google Scholar until 31 August 2025, using the keywords “tubal anastomosis”, “tubal reanastomosis,” “tubal reanastomosis”, “uterine horn anastomosis”, “fibrin glue”, “fibrin sealant”, “biological sealant”, “tissue adhesive”, “rabbit”, “rat” and “sterilization reversal.” Reference lists of retrieved articles have been examined to find studies which tested end-to-end tubal (or small-animal uterine horn) anastomosis through biological adhesives with or without additional components to evaluate patency success, fertility results and adhesion formation. Results: Thirteen studies met the inclusion criteria (eleven animal; two human). Rat and rabbit models demonstrated that fibrin sealants with intraluminal splints and one-to-two anchoring sutures produced results comparable to microsutures for patency (tubal patency rates of 75–100%) and pregnancy success (pregnancy rates of 60–83%) while reducing surgical time and decreasing peritubal adhesions. The success rates of the procedures depended on the anastomosis locations. Isthmic–isthmic anastomosis produced better results than ampullary repairs which tended to fail or develop stenosis. Fibrin sealant-only repairs without splinting were associated with lower patency (almost 60%) despite acceptable histologic healing. Human data showed similar pregnancy rates (intrauterine pregnancy in about 40–50% of women) and tubal patency but no consistent decrease in adhesions. Ectopic pregnancy rates ranged from 9 to 11%. Conclusions: Fibrin sealants are useful adjuncts to microsurgical tubal repair, but they should not replace the basic repair procedures. The effectiveness of this procedure is dependent on three critical factors: precise segment alignment, proper use of splints and stents, and selection of segments with comparable caliber. In a personalized-medicine framework, fibrin-assisted reanastomosis may offer a tailored option for selected women who desire natural pregnancy. Modern standardized research is required to define indications and analyze how the adaptation of fibrin sealants in minimally invasive procedures affect reproductive outcomes, ectopic pregnancy rates, and adhesion development. Full article

This research paper is concerned with fibrin glues, used as effective tools to stop bleeding in the case of wounds and surgical interventions. The paper provides data on the various fibrin glues—both currently used in practice and being developed, their sources, mechanisms of action, and properties. Such glues are biocompatible and are characterized by good adhesive and hemostatic properties. These characteristics mean that fibrin glues are currently widely used across a range of surgical applications. Such glues can be used independently or in combination with mechanical techniques, being particularly suitable for difficult-to-access parts of the body. The combined use of fibrin glues with various biologically active substances (BASs)—such as antibiotics and growth factors—and with cell therapy is a promising approach. Such adjuncts enhance the effectiveness of the glues and help to optimize the therapies. This research paper presents the latest data from studies using various experimental models demonstrating the increased efficacy of fibrin glues used in combination with BASs. We also report on the ongoing development of new fibrin glues for long-term use and with optimized formulations. Studies on the interactions of these glues with cells and tissues are supporting the creation of a new generation of fibrin glues with adjustable properties. Full article

Background/Objectives: Vertical ridge augmentation remains a challenging procedure in alveolar bone reconstruction, with existing techniques often limited by surgical complexity, graft instability, and high resorption rates. This study evaluates the clinical and histological outcomes of a novel vertical ridge augmentation technique using a wide-head tenting pole screw (WHTPS) combined with sticky bone graft material. Methods: Five patients with vertical bone deficiencies (6–10 mm) in the maxilla or mandible underwent augmentation using a single WHTPS (rectangular or round wide-head type). Sticky bone was prepared using autologous tooth bone, allografts, or xenografts, combined with fibrin glue and covered with concentrated growth factor (CGF) membranes and/or resorbable collagen membranes. After 5–6 months of healing, the WHTPS was removed, and bone biopsies were taken for histological analysis. Results: Radiographic and histological evaluations confirmed successful ridge augmentation in all cases. Newly formed bone ranged from 21.2% to 57.5%. All patients proceeded to implant placement without complications. Radiographic, clinical, and histological assessments consistently showed that new bone formation extended up to the level of the screw head, indicating complete vertical fill of the augmented space. Histology showed well-integrated, mineralized bone with no signs of inflammation. The wide-head tenting pole screw was observed to support stable space maintenance and facilitate surgical handling and favorable outcomes in vertical ridge augmentation. Conclusions: In this case series, a single wide-head tenting pole screw appeared sufficient to maintain space and resist soft tissue pressure in wide alveolar bone defects during healing. This case series suggests that the wide-head tenting pole screw technique may be a feasible option for managing severe alveolar bone deficiencies. Full article

Surgical dead spaces are challenging to handle with current preventive methods. Tissue adhesives show promise in obliterating ‘dead spaces’, but the drawbacks of currently available adhesives prevent them from being used for dead space elimination. An adhesive powder based on N-Hydroxysuccinimide-poly(2-oxazoline), NHS-POx, combines robust adhesive strength in moist environments with favorable biocompatibility and biodegradability, which makes this an interesting candidate for eliminating spaces that remain between tissues after surgery. The current study evaluates the swelling, crosslinking speed, and degradation properties of this novel tissue adhesive. These results were then used to design multiple adhesive variants differing in pH, surfactant addition, and particle size, which were subsequently examined based on their wetting rates, adhesive strength, and durability. The powder displayed minimal swelling and rapid crosslinking properties, by which the latter could be increased by a basic buffer or surfactant addition and reduced by increasing particle size. The wetting rate of the powder increased when a surfactant (Pluronic F68) was added to the mix. The adhesive strength, as measured by tensile and shear strength measurements of different prototypes of the adhesive powder, was significantly better than that of a commercially available fibrin glue. The addition of both buffer and Pluronic F68 led to a breakdown of adhesive force after 14 days of incubation, while the prototype containing neither buffer nor Pluronic F68 still had measurable adhesive force after 14 days of incubation. The current study results display several characteristics of the NHS-POx-based tissue adhesive that are favorable for tissue approximation, preventing the occurrence of dead spaces. The most effective and usable adhesive prototype will be identified in further ex vivo and in vivo animal model studies. Full article

Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide, with over 20 million cases annually. The evolution of hernia surgery has transitioned from tension-based techniques to tension-free approaches, significantly reducing recurrence rates. This review explores the history, advancements, and current trends in minimally invasive inguinal hernia repair, focusing on laparoscopic techniques such as transabdominal preperitoneal (TAPP), totally extraperitoneal (TEP), single-incision laparoscopic surgery (SILS), and robotic-assisted repair. The importance of prosthetic meshes is emphasized, detailing their mechanical properties, pore size, weight classifications, and biocompatibility. Additionally, various mesh fixation methods—including tacks, sutures, and glues—are analyzed, with a discussion on their impact on postoperative complications such as chronic pain, adhesions, and infection risk. The debate between TAPP and TEP techniques is examined, highlighting the ongoing quest to determine the most effective approach. Emerging advancements, including drug-loaded meshes and dual-layered prosthetics, aim to improve integration and reduce complications. Despite significant progress, no universally superior technique or mesh exists, underscoring the need for individualized surgical approaches. Future research should focus on optimizing materials, refining fixation strategies, and enhancing patient outcomes in minimally invasive hernia repair. Full article

Surgical adhesives and glues have gained significant attention in the medical field due to their potential to replace traditional sutures and staples in various surgical applications. This review explores the evolution of biocompatible adhesives, focusing on their chemical composition, mechanical properties, and biocompatibility. We discuss the key challenges in developing these materials, including their adhesive strength, degradation rate, and tissue compatibility. The article also delves into regulatory frameworks governing their use in clinical settings and highlights the ongoing innovations aimed at enhancing their performance and safety. Finally, the review examines the current trends in the development of next-generation surgical adhesives, with an emphasis on environmentally friendly and bioresorbable options. The importance of multidisciplinary collaboration in advancing these materials for clinical use is also underscored. Full article

Perineal injuries are a common complication of vaginal delivery, affecting 75–85% of women. This review examines current knowledge on risk factors, classification, treatment, and quality of life impacts. Risk factors are divided into maternal, foetal, and labour-related categories. Treatment depends on injury severity. First-degree tears can be managed conservatively, with skin glue or suturing—preferably with synthetic absorbable sutures to reduce pain and infection risk. Second-degree tears and episiotomies respond best to continuous non-locking sutures, improving healing, and minimizing postpartum pain. Severe third- and fourth-degree tears require specialised surgical techniques, such as the overlay method for anal sphincter repair, which improves faecal continence. Proper preoperative care, including antibiotics and anaesthesia, enhances outcomes. Episiotomy is controversial; selective use based on clinical indications is recommended over routine practice. Research shows no significant long-term benefits compared to spontaneous tears, and links episiotomy to psychological distress and negative body image. Preventative strategies, like perineal massage and warm compresses during labour, may reduce the risk of severe trauma, particularly in first-time mothers. Perineal trauma can have lasting physical and psychological effects, impacting sexual function, continence, and mental health. Proper diagnosis, treatment, and postpartum care are essential. Future studies should aim to standardise care protocols and explore long-term outcomes to enhance patient quality of life. Full article

Background/Objectives: Healing of colonic anastomoses is critical to surgical recovery, particularly under obstructive ileus conditions. Adhesive biological materials such as albumin/glutaraldehyde glue (Bioglue) show potential in enhancing anastomotic healing and minimizing complications. This study investigates the effect of Bioglue on colonic anastomoses healing under obstructive ileus conditions in rats. Methods: Eighty albino Wistar rats were divided into control, ileus, Bioglue, and ileus + Bioglue groups (n = 20 each). Subgroups (n = 10) were sacrificed on the 4th or 8th postoperative day. In the control and Bioglue groups, end-to-end anastomoses were performed after colonic resection. In the ileus and ileus + Bioglue groups, obstructive ileus was induced by colonic ligation, followed by resection and primary anastomosis. Bioglue was applied in the Bioglue and ileus + Bioglue groups. Assessments included bursting pressure, peritoneal adhesion and inflammation scores, and biochemical markers (fibroblast activity, neoangiogenesis, collagen deposition, hydroxyproline, and collagenase concentrations). Results: Bursting pressure and fibroblast activity were significantly higher in the ileus + Bioglue group compared to the ileus group on both postoperative days. Although anastomotic rupture occurred in the ileus and ileus + Bioglue groups, the incidence was not significantly different from the control and Bioglue groups. Ileus + Bioglue showed significantly higher adhesion scores, inflammatory infiltration, neoangiogenesis, and collagen deposition compared to the control and ileus groups. Hydroxyproline was significantly elevated in the ileus + Bioglue group on the 8th day. Collagenase I concentrations were higher in ileus + Bioglue but not significant. Conclusions: Bioglue application enhances colonic anastomotic healing under obstructive ileus conditions, improving mechanical strength and promoting tissue repair by the 4th and 8th postoperative days. These findings support its potential clinical application. Full article

Background and Objectives: To report the outcomes of cyanoacrylate tissue adhesive (CTA) in patients with corneal perforations and thinning. Materials and Methods: A retrospective interventional study of 83 eyes treated with CTA for corneal thinning or perforation at a single institution between 2010 and 2020. Primary endpoints leading to CTA failure, visual acuity, and surgical outcomes were evaluated. Results: At presentation, 55 (66%) had frank perforations and 28 (34%) had thinning or desmetocele. Univariate analysis showed that only multiple CTA applications were associated with CTA failure (p = 0.047). Multivariate analysis did not show any statistically significant variables associated with CTA failure. No variables were associated with the need for future surgery at 30 days or any further point. Older patients (p = 0.005), use of topical steroids before gluing (p = 0.03), corneal thinning (vs. perforation) (p = 0.02), location of pathology (p = 0.048), and multiple CTA applications (p = 0.046) were associated with worse visual outcomes in univariate analysis. Multivariate logistic regression analysis showed that older age (OR 1.05) and use of topical steroids before gluing (OR 3.84) showed higher odds, and systemic immunosuppression (OR 0.08) and single (versus multiple) CTA application (OR 0.11) showed lower odds of worse visual acuity (BCVA ≥ 20/200). The presence of an anterior chamber prior to gluing was associated with spontaneous dislocation of CTA (p = 0.015). Spontaneous dislocation versus manual removal of glue was not associated with final visual acuity (p = 0.7), nor was duration of glue on the cornea (p = 0.2). Conclusions: CTA remains a mainstay of management in patients with corneal thinning or perforation. Only multiple CTA applications were associated with CTA failure, and duration of glue on the cornea was not associated with final visual acuity. Full article

Background/Objectives: To report the cosmetic, clinical, and visual outcomes of a combined surgical approach for treating a corneal/limbal dermoid using excision and a three-layered amniotic membrane graft with fibrin glue. Methods: An 18-year-old female presented with impaired vision and ocular discomfort caused by a prominent dome-shaped limbal congenital dermoid on the inferotemporal cornea, resulting in a significant aesthetic concern. A full assessment, including refraction, best-corrected visual acuity (BCVA), corneal topography, aberrometry and anterior segment OCT (AS-OCT) was conducted to plan the surgical approach. The dermoid was excised under peribulbar anaesthesia using manual lamellar dissection, followed by the application of 0.02% Mitomycin C and a multilayered amniotic membrane graft with fibrin glue. A bandage contact lens was applied and removed after three weeks, with postoperative treatment including topical antibiotics and steroids. Follow-ups were conducted on day 1, at 1 week, 3 weeks, 2 months, 6 months, 1 year, and 2 years. Results: Histopathological examination confirmed the mesoblastic nature of the lesion. Significant improvements in BCVA and ocular symptoms were observed. Corneal topography showed ocular surface regularization with reduction of high order aberrations and point spread function. AS-OCT showed complete integration of the amniotic membrane, with full epithelial coverage of the defect. The healing process was uneventful and the ocular surface remained stable throughout the entire follow-up, without complications or recurrence. Conclusions: This approach of dermoid excision, multilayered amniotic membrane and fibrin glue restored vision effectively, with notable improvements in ocular surface and cosmetic outcomes, without recurrence over two years. Full article