Experiences with polyglactin 910 (Vicryl) in general surgery.

The physical properties of polyglactin 910 (Vicryl) have been studied experimentally and clinically and compared with other synthetic and natural suture materials. Polyglactin 910 has a relatively high fluid absorption capacity but a low capillary capacity. The tensile strength is high and well comparable with, or superior, to other synthetic non-absorbable suture materials commonly used. The elongation at break is moderate. No unfavourable wound reaction to the suture material has been registered. The material has not increased the expected frequency of wound infections. The follow up of laparotomized patients 12-18 months after the operation showed a very low frequency of wound hernia. Neither was any recurrence noticed after repair of inguinal hernia. No clinical signs of leakage in the anastomoses of the gastrointestinal region was registrated. It is concluded that polyglactin 910 in a wide extent seems to be able to replace catgut and also non-absorbable suture materials when normal wound healing is to be expected.

Hiatal hernia. Follow-up of a ten-year material.

A clinical study of 70 patients with hernia hiatus oesophagi (59 sliding hernias, 11 paraoesophageal), of whom 22 had received primary surgery, 33 medical treatment and 15 with no discomfort from the hernia had no primary treatment at all. None of the patients in any of these groups had undergone an operation later. A follow-up examination in 1972-73 was achieved in 43 of the 70 patients (16 of those with surgery, 18 with medical treatment and 9 with no treatment); 6 of the others did not attend the follow-up and 21 had died. Of the 16 operated patients, 8 stated they were free from discomfort and 8 that they had improved (7 of the latter only after additional medical treatment). Of the 18 patients who had received only medical treatment, 8 stated that they were free from discomfort (2 of them not until the medication had been changed), 6 that they had improved, 2 had noted no improvement, and 2 a deterioration even though their medication had been changed. Of the 9 untreated patients, 4 stated that they still had no discomfort and 5 that discomfort had materialised later; subsequent medical treatment had eliminated the discomfort in 2 of the later and produced an improvement in 2 more; the 5th patient had not reacted to medical treatment - the follow-up disclosed an inoperable gastric carcinoma.

Bilateral chylothorax - complication in malignancy.

Bilateral chylothorax is a rare condition caused by traumas and disorders with perforation or destruction of main lymphatics in the thorax leading to lymph leakage. Two patients with bilateral chylothorax are presented one of whom was successfully operated on. Etiology, diagnostics and therapy of this condition are discussed.

Dexon for sutures and ligatures.

Dexon has been used in 375 operations of various types on 360 patients. No wound infection was observed in the group of 'clean' cases. As Dexon is absorbed completely but relatively slowly and at an even rate, it can even be used in most instances instead of non-absorbable suture and ligature materials. When used for sutures and ligatures in operations of various types, Dexon costs about the same as catgut.