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Objective:To discuss the procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved.Methods:A total of 35 patients (63 sides) with primary inverted nipples from January 2006 to March 2019 were reviewed retrospectively. Tiny radial incisions were made on the areola around the base of the inverted nipple which had been pulled out. Without skin removed, shorten fiber bundles which caused nipple inverted were totally cut and released. While the primary breast ducts were preserved, purse-string suture was taken around the base of the nipple. The nipple protector was prepared by ourselves, and the nipple was pulled and suspended for 2-6 months.Results:Sixty-three sides of 35 patients with inverted nipples were successfully corrected by this minimally invasive surgery. There was no nipple necrosis. One patient developed mild swelling 3 weeks after operation, and the swelling subsided after symptomatic anti-inflammatory treatment. The average follow-up period was 39 months. After removing the nipple protector, 2 sides (2/63) had a certain degree of recurrence. The rest of the nipples had ideal shape, no obvious scar, good nipple feeling, and retained the possibility of lactation.Conclusions:The procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved has advantages of minimal invasion, safety, less pain, while retaining the possibility of lactation in the future. The clinical effect is satisfactory. It is especially suitable for the correction of type Ⅰ and type Ⅱ inverted nipples.
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OBJECTIVES@#To study the risk factors for complications after endoscopic therapy for upper gastrointestinal subepithelial lesions (SELs).@*METHODS@#Retrospective analysis was performed on 184 patients in the Department of Gastroenterology in the Third Xiangya Hospital, Central South University after therapeutic endoscopy [endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFR), endoscopic submucosal excavation (ESE), and submucosal tunneling endoscopic resection (STER)] for the upper gastrointestinal SELs from 2014-09-01 to 2019-09-30. The clinic data were collected and risk factors for postoperative complications were analyzed.@*RESULTS@#Among the 184 patients, 22 patients were in the complication group (including 3 cases of delayed bleeding, 2 cases of delayed perforation, and 17 cases of electrocoagulation syndrome) and 162 patients were in the non-complication group. There was no significant difference between the complication group and the non-complication group in gender, age over 70 year, basic diseases, lesion location, lesion invasion layers, pathological results, endoscopic therapy, and preventive closure of wounds (all @*CONCLUSIONS@#For the patients with upper gastrointestinal SELs after endoscopic minimally invasive therapy with the lesion diameter over 40 mm and the operative time over 120 minutes, it needs to highly alert to the occurrence of postoperative complications.
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Humans , Endoscopic Mucosal Resection/adverse effects , Endoscopy , Endoscopy, Gastrointestinal , Gastric Mucosa , Retrospective Studies , Risk Factors , Stomach Neoplasms , Treatment OutcomeABSTRACT
Objective@#To evaluate the efficacy of reinforcement on duodenal stump using single purse-string suture during laparoscopic radical gastrectomy for gastric cancer in preventing duodenal stump leakage.@*Methods@#A descriptive cohort study was conducted to retrospectively collect clinical data of 211 patients with gastric adenocarcinoma who underwent laparoscopic radical gastrectomy with Roux-en-Y or Billroth Ⅱ reconstruction and reinforcement on duodenal stump using laparoscopic single purse-string suture in Zhongshan Hospital of Fudan University between January 2013 and December 2016. Of 211 patients, 136 were male and 75 were female with mean age of (57.5±11.1)(24 to 87) years. Tumors locating at gastric upper 1/3, middle 1/3 and low 1/3 were found in 62, 68 and 81 patients respectively. Eighty-three cases underwent total gastrectomy, 128 underwent distal subtotal gastrectomy, 107 underwent Roux-en-Y reconstruction and 104 underwent Billroth II reconstruction. The procedure of reinforcement on duodenal stump using single purse-string suture during laparoscopic radical gastrectomy was as follows: (1) after cutting the duodenal stump to about 2.0 cm in length, use a 3-0 single-strand absorbable suture to make a muscle layer purse at a distance of 1.0 to 1.5 cm from the duodenal stump; (2) use the purse line to make a slipknot; (3) push the duodenum stump into the purse with a needle holder or grasper; (4) tighten the knot of the purse string, and then make 4 to 5 knots for reinforcement. Postoperative complications were defined and graded according to the Clavien-Dindo grading criteria, and the incidence of early complications was recorded. Clinicopathologic features and postoperative outcomes were analyzed.@*Results@#All patients completed operations successfully. The mean time of laparoscopic single purse-string suture was (5.1±1.6) (3.6 to 10.2) minutes. Postoperative early complication occurred in 31 cases (14.7%), of whom 27 cases developed surgery-related complications (12.8%), including 7 cases (3.3%) of peritoneal infection, 6 (2.8%) of pancreatic leakage, 4 (1.9%) of wound infection, 4 (1.9%) of gastroplegia, 2 (0.9%) of peritoneal hemorrhage, 2 (0.9%) of intestinal obstruction, 2 (0.9%) of lymphatic leakage, and no duodenal stump leakage; while 4 cases (1.9%) developed internal non-surgical complication, including 3 cases (1.4%) of pulmonary infection and 1 (0.5%) of cardiovascular event. The patient with peritoneal hemorrhage was healed after re-operation and all other patients were discharged uneventfully after conservative treatment. Four cases (1.9%) developed complications beyond grade III a of Clavien-Dindo criteria.@*Conclusion@#Reinforcement on duodenal stump using laparoscopic single purse-string suture during laparoscopic radical gastrectomy with Roux-en-Y or Billroth II reconstruction is simple and effective, and can prevent the risk of development of duodenal stump leakage.
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Objective To study the clinical efficacy and safety of purse-string suture on the treatment of peptic ulcer bleeding. Methods Data of 42 patients with peptic ulcer bleeding treated by purse-string suture with hexiejia combined with endoloop in Dongguan Tung Wah Hospital from January 2016 to January 2017 were retrospectively analyzed. The immediate hemostasis rate, effective hemostasis rate, additional surgery rate, recurrence rate in two weeks and mortality were analyzed. Results Among 20 cases with active bleeding during operation, 19 were immediately arrested, and 1 case of failure was diagnosed as marginal ulcer after gastric resection. The overall effective hemostasis rate was 97. 6%(41/42), additional surgery rate was only 2. 4%( 1/42). The vital signs of 41 patients with successful endoscopic hemostasis were stable after operation, and no fever, hematemesis, black stool or other symptoms occurred. No recurrence of bleeding or death occurred within two weeks. The ulcers were healed well in follow-up of one month. Conclusion Endoscopic purse-string suture is a safe and feasible method for treatment of patients with peptic ulcer bleeding.
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Objective To evaluate the perforation repair method of purse-string suture with single channel after gastroscopy endoscopic submucosal resection (ESD) in treating gastric submucosalal stromal tumor originating from muscularis propria lay of gastric fundus. Methods 15 patients with GIST from gastric fundus muscularis propria were treated with ESD. The diameters of tumors were from 1.5 ～ 3.5 cm. Purse-string suture with single channel gastroscopy was performed for the gastric wall perforation during ESD. Results All patients underwent repair successfully. The procedure time was 10 ～ 15 min. No severe complications occurred. Conclusion Purse-string suture with single channel gastroscopy is a feasible and effective perforation repair method during ESD of gastric fundus.
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Objective To evaluate the effect of direct-vision and two stiches method and other techno logical improvements on PPH surgical operation by prospective randomized controlled study.Methods A total of 683 patients were randomly assigned.Direct-vision and two stiches method technological improvements were applied in observation group,while standard operation procedures were performed in control group.Operation time,blood loss during operation,specimen size,post-operative complication and other conditions were compared between observation group and control group.Results In 350 cases of the observation group,the average surgical time was (12.2 ± 4.0)minutes,blood loss during operation (4.95 ± 2.82)mL and specimens width (2.61 ± 0.32)cm.2 patients with hemorrhage were performed hemostasis after surgery.5 cases suffered from edema or thrombus in haemorrhoids zones after surgery.In 333 cases of the control group,the average surgical time was (17.2 ± 3.6)minutes,blood loss during operation (7.55 ± 3.94) mL and specimens width (1.18 ± 0.56) cm.5 patients were performed hemostasis after surgery,14 cases suffering from edema or thrombus in haemorrhoids zones after surgery,postoperative infection in 1 case,rectostenosis in 1 case,and 1 case in rectovaginal fistula.In the observation group,operation time was shorter than that in the control group.No significance was found in excision width and depth.The serious complications after surgery are fewer in observation group than that in the control group.Conclusion The direct-vision and two stiches method and other technological improvements are safe and effective,meanwhile operation difficulty can be reduced.
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Objective To evaluate the efficacy and safety of single forcep endoscopic purse-string suture closing the wound of cardia and gastric fundus after endoscopic full-thickness resection (EFTR) for patients with submucosal tumor (SMT).Methods The clinical data of 32 patients with wound in the cardia and gastric fundus after EFTR for SMT undergoing single forcep endoscopic purse-string suture in Endoscopy Center of Renmin Hospital of Wuhan University from January 2015 to January 2016 were collected.Completion of operation, postoperative complication and follow-up results of these patients were retrospectively analyzed.Results All of the patients successfully received EFTR and purse-string suture.The maximal diameter of tumors was 1-4 cm.The suture time was 10-15 min, and postoperative hospital stay was 5-10 d.Low fever and upper abdominal pain were found in 13 and 20 cases respectively, and all cases were alleviated or restored after conservative treatment.All patients underwent gastroscopy during follow-up of 1 month, and titanium clip and nylon rope were found on the wound surface in 29 cases (90.6%).Three months after operation, 28 patients underwent gastroscopy, and titanium clip but no nylon rope was detected in 15 cases (46.9%).Conclusion Single forcep endoscopic purse-string suture can effectively treat the postoperative wound in the cardia and gastric fundus of patients with submucosal tumors after EFTR.
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Objective To investigate the clinical effect of "pre-purse-string" suture on submucous gastric lesions of external growth type in endoscopic patients. Methods Clinical data of 27 patients with gastric lesions of external growth type admitted to the digestive endoscopy center of Renmin Hospital of Wuhan University from August 2016 to October 2016 for endoscopic submucosal dissection ( ESD ) were analyzed. Patients were randomly divided into two groups, the experiment group receiving the "pre-purse-string" suture, the control group receiving purse-string suture after ESD. Mean size of the lesions, procedure time, withdrawal time of gastric decompression, and hospitalization time were compared. Results In the 15 patients of the experiment group, there were 3 cases whose lesions were located in gastric antrum, 6 in gastric body and 6 in gastric fundus. In the 12 cases of the control group, 3 lesions were located in gastric antrum, 5 in gastric body and 4 in gastric fundus. All procedures were successfully completed in endoscopy. No obvious postoperative complications occurred. The mean size of lesions was 2. 5 cm × 3. 2 cm in the experiment group,and 2. 4 cm×3. 0 cm in the control group (P=0. 63). The operation time was 28. 0-43. 0 min (35. 8±6. 1 min) in the experiment group, and 45. 6-68. 8 min (48. 8±5. 3 min) in control group ( P<0. 01) . Conclusion "Pre-purse-string" technique is of clinical effect on gastric submucosal tumor of external growth.
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Objective To investigate the clinical effect of "pre-purse-string" suture on submucous gastric lesions of external growth type in endoscopic patients. Methods Clinical data of 27 patients with gastric lesions of external growth type admitted to the digestive endoscopy center of Renmin Hospital of Wuhan University from August 2016 to October 2016 for endoscopic submucosal dissection ( ESD ) were analyzed. Patients were randomly divided into two groups, the experiment group receiving the "pre-purse-string" suture, the control group receiving purse-string suture after ESD. Mean size of the lesions, procedure time, withdrawal time of gastric decompression, and hospitalization time were compared. Results In the 15 patients of the experiment group, there were 3 cases whose lesions were located in gastric antrum, 6 in gastric body and 6 in gastric fundus. In the 12 cases of the control group, 3 lesions were located in gastric antrum, 5 in gastric body and 4 in gastric fundus. All procedures were successfully completed in endoscopy. No obvious postoperative complications occurred. The mean size of lesions was 2. 5 cm × 3. 2 cm in the experiment group,and 2. 4 cm×3. 0 cm in the control group (P=0. 63). The operation time was 28. 0-43. 0 min (35. 8±6. 1 min) in the experiment group, and 45. 6-68. 8 min (48. 8±5. 3 min) in control group ( P<0. 01) . Conclusion "Pre-purse-string" technique is of clinical effect on gastric submucosal tumor of external growth.
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Objective To evaluate an improved technique of vertical mammaplasty with purse string suture for correction of breast ptosis and its clinical application.Methods The adjustable markings of vertical mammaplasty was improved with an upper pedicle for the areola,and breast reduction was adapted with the lower part.The breast tissue was lifted and fixed on the second rib level to reshape the breast,which did not rely on the skin,with purse string suture for the lower half of vertical incision.32 patients with breast ptosis had been operated from May 2009 to February 2014.Results 32 cases were treated with vertical mammaplasty with short scar.The shape of the breasts was strengthen,without obvious scar,and follow-up results of patients were satisfied.Conclusions The vertical mammaplasty with short scar design is simple,operation is convenient,breast shape is plump,and postoperative long-term effect is great.This procedure can be used as one of the feasible operation for breast ptosis correction.
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PURPOSE: Although laparoscopic surgery in children has expanded in recent years. laparoscopic hernia repair in children is still debatable. We aimed to summarize and describe our results of laparoscopic inguinal hernia repair and techniques among children. METHODS: Between March 2011 and August 2013, 117 children (81 male, 36 female) underwent laparoscopic inguinal hernia repair at the department of surgery. The clinical outcomes were collected retrospectively. RESULTS: The mean follow-up period was 26.2 months. Thirteen patients were ex-premature infants and a contralateral patent processus vaginalis (PPV) was present in 44 of the 110 unilateral inguinal hernia patients. There were two postoperative complications (transient hydrocele, umbilical port site infection). The mean operative time was 47 minutes. Recurrence, metachronous hernia, and testicular atrophy were not observed during the follow-up period. CONCLUSION: Our preliminary experiences suggest that the laparoscopic purse-string suture of internal inguinal opening of the hernia sac could be an effective and reliable alternative for management of pediatric inguinal hernia.
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Child , Humans , Infant , Male , Atrophy , Follow-Up Studies , Hernia , Hernia, Inguinal , Herniorrhaphy , Laparoscopy , Ligation , Operative Time , Postoperative Complications , Recurrence , Retrospective Studies , SuturesABSTRACT
Objective To explore the effect of intraoperative tension adjustment and postoperative scar formation in the treatment of circular skin defects using modified purse-string suture.Methods Twenty-eight cases of circular lesions in the face region were selected and resected along the edge.We first used purse-string suture technique to reduce the circular defect area,and then closed the wound with linear suture in random direction.After 7 days,the stitches were removed and longterm follow-up effects were observed.Results All patients had no facial organ deformation and displacement,the length of the linear scar lesions was shorter than the preoperative length.In 28 cases,one patient's surgical wound was dehisced after removal of stitches in 24 h,and the rest of the skin defects healed after operation in stage Ⅰ.All cases were followed up for 3 months to 1 year,and had a satisfactory therapeutic effect.Conclusions Modified purse-string suture can linearly close the dicision in stage Ⅰ,reduce the scar area and maintain the normal morphology and relative position of the nearby organs.
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PURPOSE: In cases of breast reconstruction with a free transverse rectus abdominis musculocutaneous(TRAM) flap after skin-sparing mastectomy with nipple-areolar complex(NAC) removal, the flat contour of the flap's skin paddle can easily look unnatural and dissatisfying. Reconstructed NAC on the flap surface lacks the elevated contour that the normal areola possesses, resulting in an unnatural final result. Therefore, we would like to introduce a novel method to improve this problem and report the satisfactory results we obtained. METHODS: Operations were conducted on 19 patients who underwent immediate breast reconstruction with a free TRAM flap and skin-sparing mastectomy from January 2009 to January 2010, with a mean follow-up of nine months. While the TRAM free flap was being inset, a purse-string suture was carried out on the dermal layer of skin flap to create a slight protrusion with Gore-Tex(R) sutures. RESULTS: The elevated mound surrounding the NAC was well maintained for an average follow-up period of nine months. Nipple projection was also well maintained. There was no complaint about breast contour or nipple height reduction. In addition, there was no reported incidence of other complications. CONCLUSION: The purse-string suture technique presents a more natural breast silhouette around the NAC and helps to maintain nipple projection. Furthermore, it does not require any supplementary incisions or complicated skills. There has been no report of additional complications using this technique.
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Female , Humans , Breast , Follow-Up Studies , Free Tissue Flaps , Incidence , Mammaplasty , Mastectomy , Nipples , Rectus Abdominis , Skin , Suture Techniques , SuturesABSTRACT
Objective Extrapolate the relationships between the width of circumferential rectal mucosa re-sected and the method of either performing single purse-string or performing double purse-string during per-forming the procedure for prolapse and hemorrhoids (PPH), and to assess the impact of both the level of sta-ple line and the width of rectal mucosa resected on clinical outcomes after stapled hemorrhoidpexy. Meth-ods Twenty-eight adult patients with Ⅲ-Ⅳ hemorrhoids were assigned to two groups: 15 patients using sin-gle pursestring and the remaining 13 patients using double purse-string. The mucosal width of doughtnuts of both groups were measured and the data recorded. The doughtnuts resected were sent to pathology examina-tion after stapled hemorrhoids pexy to identify whether or not the specimens involved the smoth muscles. The demographic complications (bleeding, postoperative pain, urinary retention, fecal urgency) were compared and statistically analysed between the two groups, respectively. Results There were no statistical differ-ences between the two groups in terms of postoperative short-term results and complication rates, as well as the proportion of involving smooth muscle in specimens(P >0.05). However, when compared the width of doughtnuts resected in single-pursestring group was smaller than that in double-parse-string group (P < 0. 01). Conclusion The single or double-purse-string suture in PPH can control the width of resected rectal mucosa.
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PURPOSE: Severe type of inverted nipple (cannot be pulled out above the areola plane by manipulation, grade III) usually cannot be corrected by a relatively simple pursestring suture technique. Most patients want to avoid visible scars. To treat the severe case and avoid visible stigma, we introduce this invisible dermal flap method. METHODS: This new surgical procedure makes bilateral incisions on the sidewall of nipple and dissections vertically to free the ducts from the contracted tissues. After dissection, the tunnel is formed. We insert "dermal flaps" into the tunnel underneath nipple base. Then through-and-through sutures are performed vertically (6 o'clock and 12 o'clock positions) and the purse-string suture is added with 4-0 nylon. RESULTS: We had treated 35 primary inverted nipples (grade III) in 27 patients and 13 recurrent nipples in 7 cases. The results were excellent in 45 nipples (93.7%). All but 3 recurred cases was fully or very satisfied with the results. CONCLUSION: This technique is effective for the correction of severe inverted nipples and recurrent cases. We can avoid the visible scars on the areola surface
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Humans , Cicatrix , Contracts , Nipples , Nylons , Skin , Suture Techniques , SuturesABSTRACT
PURPOSE: An inverted nipple presents both cosmetic and functional problems. It is a source of repeated irritation and inflammation, and interferes with nursing. In addition, its abnormal appearance may cause psychological distress. With consideration of its underlying pathophysiologic components and severity, a number of techniques have been introduced for correction of this anomaly. The diversity of techniques indicates the lack of a good, sustainable, and durable solution for this quite common problem. We report our method as an alternative solution for correcting of the inverted nipple. METHODS: From August 2003 to November 2007, 273 nipples in 147 patients were treated. 126 patients had bilateral inverted nipples. Patient age at the operation ranged from 21 to 63 years(mean age, 34 years). All nipples were congenital anomaly. 45 nipples were graded as grade I, 179 nipples as II, and 49 nipples as III. In the our study, we made some modification to the classic purse-string suture: (1) twice purse-string suture: (2) excision of diamond-shaped skin at the nipple neck: (3) buried suture of the breast parenchyma at the nipple base: (4) some timely release of retraction using Bovie's electrocautery dissection at inner surface of the nipple neck. RESULTS: The operation time averaged 15 minutes. The mean follow-up period ranged from 3 to 48 months, with an average of 8.4 months. There were no complications associated with the surgery, such as infection, hematoma, permanent sensory disturbance, or total nipple necrosis except temporary sensory loss in 9 cases, partial nipple necrosis in 7 cases, and recurred inversion in 15 cases. All patients except recurred inversion were satisfied with their results. CONCLUSION: We believe that our modified purse- string suture is a reliable, simple, safe, and effective method for correcting the inverted nipple.
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Humans , Breast , Cosmetics , Electrocoagulation , Follow-Up Studies , Hematoma , Inflammation , Necrosis , Nipples , Skin , SuturesABSTRACT
A nipple can be reconstructed either by nipple sharing or local flap. But donor site scar is inevitable when nipple is reconstructed with local flap method. The scar which remains inside the nipple areolar complex can be hidden by medical tattooing, but elongated scar, which cross over the areolar border leads to poor esthetic result. So as to solve this problem, we used purse string suture method. We reconstructed nipple with C-V flap for 9 patients who previously reconstructed breast with extended latissimus dorsi flap. Purse string suture with 3-0 nylon was used for donor site closure. We minimize 10.7% of the scar length with this method. Enhancement of nipple projection due to the flattening of V limb was attained in addition. We expect the reduction of V-limb of C-V flap and amount of absorption of the reconstructed nipple with purse string suture method.
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Humans , Absorption , Breast , Cicatrix , Extremities , Nipples , Nylons , Superficial Back Muscles , Sutures , Tattooing , Tissue DonorsABSTRACT
Reconstruction of the umbilicus is not a frequent event. Umbilical restoring should always be aimed at creating an umbilicus of sufficient depth and good morphology(circular and cylinder shape) with less scarring. A wide range of techniques has been described to reconstruct neoumbilicus; nevertheless, a perfect result is difficult to obtain. I provide another alternative to reconstruct the umbilicus using defatting, anchoring and purse-string suture. The important steps are the following; the first step is defatting of 2.0cm umbilicus' circle. The second step is to umbilical fixation to the fascia wall using anchoring suture. The third step is purse-string suture to decrease new formative umbilicus and to make the circular and cylinder shape umbilicus. The author's method is a simple, easy and useful technique and renders better aesthetic result. So, I reviewed two cases and discussed the literatures.
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Cicatrix , Fascia , Sutures , UmbilicusABSTRACT
Inversion of nipple is a common condition occurring with an incidence of 2% in women. It not only causes irritation and inflammation, but also causes aesthetic problems, affecting sexual relationships and psychological well-being of the patients. Several methods have been introduced to treat this condition in the past century, but the major principle of correction is based on the concept suggested by Schwager, that inverted nipple develops because of the lack of connective tissue located directly beneath the nipple. Based on this concept, many surgeons including Broadbent, Teimourian, and Elshy etc. have proposed that adding bulk of connective tissue and scarifing the ductal system is the principle of the treatment. Author`s method is also based on such a concept, and we have modified the Teimourian method. First, an intraglandular section in the shape of an inverted cone was performed. The crator-like glandular section was closed using horizontal mattress suture, leading to circumglandular V-Y advancement. Second, the donor sites on the areolar area were closed with V-Y advancement. Third, purse-string suture was performed to achieve neck tightening and to compensate for the lack of connective tissue beneath the nipple. Dermal flap suture was done by Foot-plate manner. We operated on 52 cases using this method, 28 patients during past 2 years. After 1 year following the operation, there were just two cases of relapse and virtually no complications. We obtained satisfactory projection of the nipples in all patients except in 2 cases. The resulting shapes and scars were acceptable to all patients.