Results of the early and mid-term postoperative period after correction of total anomalous pulmonary venous connection

<p><strong>Aim.</strong> To compare complications and outcomes in the postoperative period with two different methods for correcting total anomalous pulmonary venous connection.</p><p><strong>Methods. </strong>In this pilot, two-centre, simple, blind, prospective randomised study, the patients’ quality of life after correction of total anomalous pulmonary venous connection in infancy was evaluated using the sutureless (n = 20) and conventional repair methods (n = 20) in 40 patients. The overall mortality and complications in the mid-term were evaluated.</p><p><strong>Results.</strong> The average follow-up was 15 (13; 16) months. Mortality was noted only in the conventional repair group, amounting to 5 (25%) patients (p = 0.018). Severe obstruction of the pulmonary veins anastomosis was also noted only in the conventional repair group (n = 8, 40%; p = 0.0013). Infectious endocarditis was observed in one (6.6%) patient in the conventional repair group (p = 0.42). Arrhythmias were present in 4 (26.6%) patients in the conventional repair group (p = 0.02).</p><p><strong>Conclusion.</strong> The rates of obstruction of the pulmonary vein anastomosis, arrhythmias and death depend on the method of total anomalous pulmonary venous connection correction. The sutureless repair reduces the incidence of early and mid-term postoperative complications compared to conventional repair.</p><p>Received 16 March 2021. Revised 8 June 2021. Accepted 11 June 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Conception and study design: Yu.N. Gorbatykh, A.V. Bogachev-Prokophiev, M.V. Plotnikov<br /> Data collection and analysis: M.V. Plotnikov, M.G. Galstyan, D.G. Tarasov<br /> Statistical analysis: M.V. Plotnikov<br /> Drafting the article: M.V. Plotnikov, Yu.N. Gorbatykh<br /> Critical revision of the article: I.A. Soynov<br /> Final approval of the version to be published: M.V. Plotnikov, Yu.N. Gorbatykh, A.N. Аrkhipov, M.G. Galstyan, A.V. Bogachev-Prokophiev, D.G. Tarasov, I.A. Soynov</p>

Early-term surgical outcomes after correction of total anomalous pulmonary venous connection

Highlights. The geometry of the left atrium and the growth of the left heart after correction of total anomalous pulmonary venous connection are evaluated for the first time.Aim. To assess the morphological and functional characteristics of the left heart after correction of total anomalous pulmonary venous connection.Methods. 40 patients referred to the correction of total anomalous pulmonary venous connection were enrolled in a pilot, two-center, simple, blind, prospective randomized study. Patients were assigned to the sutureless repair group (n = 20) and conventional repair group (n = 20).Results. In the early postoperative period, the indexed left atrial volume in the group of sutureless repair was 15 (13.65; 17.25) versus 12.85 (10.95; 15.15) in the group of conventional repair, p = 0.057. The end diastolic volume index in the sutureless repair group was 38 (28.5; 45), while in the conventional repair group - 37.1 (31; 47.75), p = 0.48. At the follow-up, the indexed left atrial volume in the group of sutureless repair was 37 (34.5; 38.9) versus 31 (23.6; 35) in the group of conventional repair, p = 0.01. The end diastolic volume index (EDVI) in the group of sutureless repair was 50 (43; 57), while in the group of conventional repair - 50.2 (28.8; 60.9), p = 0.49.Conclusion. The growth of the left atrium depended on the chosen technique for correcting total anomalous pulmonary venous connection and was higher in the group of sutureless repair (37) compared to the group of conventional repair (31). The proportionality of the growth of the left ventricle did not depend on the surgical technique and was equivalent in both groups.

Sutureless repair and deep sedation for a blow-out type post-infarction left ventricular free wall rupture

A 71-year-old woman who was resuscitated from cardiac arrest after pericardial drainage, was admitted to our hospital. Enhanced computed tomography demonstrated pericardial effusion due to rupture of posterior ventricular myocardium. She underwent emergent surgical repair. A 20-mm tear in the extensively necrotic left ventricular posterior wall and active hemorrhage were identified. Sutureless repair using three sheets of TachoSil (CSL Behring, Tokyo, Japan) and fibrin glue was performed. To reduce ventricular pressure to avoid re-rupture and formation of ventricular aneurysm, deep sedation was followed in the intensive care unit for 2 weeks. The patient returned to her normal daily life and is progressing well for more than 5 months after the surgery.

An Off-the-Shelf Bioadhesive Patch for Sutureless Repair of Gastrointestinal Defects

ABSTRACTSurgical sealing and repair of injured and resected gastrointestinal (GI) organs are critical requirements for successful treatment and tissue healing. Despite being the standard of care, hand-sewn closure of GI defects using sutures faces various limitations and challenges. The process remains technically complicated and time-consuming. The needle-piercing and pointwise closure also inflict tissue damage and stress concentration, raising the risk of local failure and subsequent anastomotic leaks. To address these limitations and challenges, we introduce an off-the-shelf bioadhesive GI patch capable of atraumatic, rapid, robust, and sutureless repair of GI defects. The GI patch synergistically integrates a non-adhesive top layer and a dry bioadhesive bottom layer, resulting in a thin, flexible, transparent, and ready to use dressing with tissue-matching mechanical properties. Rapid, robust, and sutureless sealing capability of the GI patch is systematically characterized based on various standard tests in ex vivo porcine GI organ models. In vitro and in vivo rat models are utilized to validate biocompatibility and biodegradability of the GI patch including comprehensive cytotoxicity, histopathology, immunofluorescence, and blood analyses. To validate the GI patch’s efficacy in a clinically relevant setting, we demonstrate successful sutureless in vivo sealing and healing of GI defects; namely in rat stomach and colon, and porcine colon injury models. The proposed GI patch not only provides a promising alternative to suture for repair of GI defects but also offers potential clinical opportunities in the treatment and repair of other organs.One Sentence SummaryAn off-the-shelf bioadhesive patch is introduced for facile sutureless repair of gastrointestinal defects, addressing various limitations of conventional suture-based treatments.

Comparison of Surgical Treatment of Postoperative Abdominal Wall Hernias with and without Fixation of a Synthetic Mesh: Literature Review

Objective. Review articles with postoperative abdominal wall repair without mesh suturing (sutureless hernioplasty). Methods. A systematic search of the literature published from 01/01/2004 to 31/12/2018 was performed using Medline, PubMed and the Cochrane Library databases. The search was performed using the keywords: postoperative hernia, incisional hernia, mesh hernioplasty, sutureless repair, sutureless hernioplasty, sutureless herniotomy. Results. For the present analysis 5 publications were identified. The quality of each study was assessed. The information about operative methods, main results, conclusions and recommendations was collected. Conclusions. According to the results and conclusions of reviewed articles, it can be stated that postoperative abdominal wall hernia repair without mesh suturing is a safe and can improve postoperative results, but there is insufficient evidence to determine if it is associated with better outcomes than hernioplasty with mesh fixation. Further clinical studies are needed to clarify whether this method is clinically important.