Absorbable cyanoacrylate surgical sealant in kidney transplantation.

As the proportion of older recipients increases, the vascular anastomoses can be challenging with significant atherosclerosis, and patients with comorbidities may be on an anticoagulation therapy, potentially increasing the risk of hemorrhagic complications. We report a case of kidney transplantation in which an absorbable cyanoacrylate surgical sealant was used. A 32-year-old white male received a kidney transplant from his wife. Two renal arteries of the donor's left kidney were reconstructed on the back table and anastomosed to the right iliac artery of the recipient. After the sealant was applied to the suture lines, the vascular clamps were released without significant bleeding from the anastomoses. The recipient demonstrated a stable graft function without an immediate complication. This case illustrates the potential benefits of the cyanoacrylate sealant in selected kidney transplant recipients.

Fade or fate. Seroma in laparoscopic inguinal hernia repair.

BACKGROUND: Postoperative fluid collection in the space left behind the dissected hernia sac in laparoscopic herniorraphy puts the surgeon in a dilemma as to whether it is a recurrence or a seroma, and it is not always easily judged only by physical examination (PE). Another important issue is what kind of seroma can be accepted as a complication of surgery. METHODS: Thirty patients with unilateral inguinal hernia who had a hernia sac of >4 cm were operated on with transabdominal preperitoneal hernia repair (TAPP) technique and the collection at the hernia site was followed by PE and superficial ultrasonography (USG) postoperatively on the first day, first week, first month, and third month. RESULTS: USG detected seroma in 20 patients, while 17 could be noticed by PE on the first postoperative day. At the end of the third month, seromas resolved by 90%, and could only be detected by USG in two patients. Pain or complication rates attributable to seroma in patients were not determined (p > 0.05) in the statistical analyses between the groups. CONCLUSIONS: Superficial USG is a beneficial tool in differentiating early recurrence or seroma in patients. It should not be intervened with as a complication until the patient has complaints attributable to seroma.

Comparison of early postoperative enteral nutrients versus chow on colonic anastomotic healing in normal animals.

We aimed to clarify the effects of different enteral nutrients (normal chow, complete balanced nutrition, elemental nutrition enriched with glutamine, immune-enhancing diet and fiber) on colonic anastomotic healing in the stress-free metabolic state. The study was carried out with 50 male Balb-C mice in five groups of 10 animals each. After transverse colon anastomosis, animals were fed with early enteral nutrients using normal chow (group 1), Ensure((R)) (group 2), Alitraq((R)) (group 3), Impact((R)) (group 4), and Benefiber Resource((R)) orange juice drink (group 5) for 7 days. There were no significant differences among the groups in bursting pressure (p > 0.05). There was no statistical difference in terms of hydroxyproline level among groups 1-3. The hydroxyproline levels of groups 4 and 5 were statistically higher than that of the control group (p < 0.05 for both comparisons). Under normal conditions without stress, we could not demonstrate the superior effects of early enteral feeding with specialized enteral preparations over normal diets on colonic anastomoses when the bursting pressures were compared.