Prevertebral cervical approach: a pure endoscopic surgical technique for posterior mediastinum parathyroid adenomas.

BACKGROUND: Parathyroid gland mediastinal ectopia is an unusual but challenging condition in surgical management of hyperparathyroidism. Posterior mediastinum parathyroid ectopia is rare, and glands need to be removed either with a broad open cervical or thoracic approach. In recent years, several minimally invasive approaches to mediastinal parathyroid glands have been described, but for posterior mediastinum adenomas, proposed techniques are transthoracic. METHODS: The aim of this paper is to describe, to our best knowledge for the first time, a standardized pure endoscopic cervical technique to approach posterior mediastinal parathyroid adenomas which we have used in three patients. RESULTS: The technique was applied in three patients which excellent surgical, postoperative, and cosmetic results. CONCLUSIONS: Endoscopic prevertebral approach is a feasible, sure and inexpensive standardized pure endoscopic cervical approach to posterior mediastinal parathyroid adenomas, which may result in a less aggressive surgical option when compared with thoracic approaches.

[Randomized clinical study of polydioxanone and nylon sutures for laparotomy clousure in high-risk patients]. / Estudio clínico aleatorizado entre sutura de polidioxanona y de naylon en el cierre de laparotomía en pacientes de riesgo.

INTRODUCTION: The complications of surgical wound closure in patients with risk factors significantly increases morbidity and mortality. The aim of the present study was to evaluate differences in abdominal wall closure in patients with risk factors with the same closure technique and slow-absorbable or non-absorbable sutures. MATERIAL AND METHODS: We performed a prospective, multicenter, comparative study of polydioxanone versus nylon sutures. Laparotomies performed for intestinal diseases and hepatobiliopancreatic procedures in patients with at least one risk factor were included. Exclusions criteria were eventrations, interventions for obesity, the need for reinforcement sutures, uncommon incisions, life expectancy of less than 1.5 years and deaths unrelated to the wound. Closure was performed with monoplane, extracutaneous, continuous, en bloc, loop sutures. Infection, evisceration, dehiscence, extrusion, sinus, eventration, intolerance, and pain were evaluated. Postoperative follow-up was performed at 10 and 30 days, 3 and 6 months, and at 1 and 1.5 years. RESULTS: A total of 770 patients were included (451 in the polydioxanone group and 319 in the nylon group). A total of 78.05% were midline incisions, with a mean length of 23.3 cm. Caliber 1 sutures were most frequently used (85.45%), and 1.7 sutures were used per patient. No complications occurred in 94.03% with no differences between groups (94.7% polydioxanone and 93.1% nylon). The results were similar throughout follow-up. The surgical infection rate was 10%. No differences were found in any of the follow-up assessments in any of the variables analyzed. CONCLUSIONS: Abdominal wall closure should be performed with continuous slow-absorption sutures such as polydioxanone since this type of suture has a similar complication rate to reabsorbable sutures and presents greater biocompatibility.

Estudio clínico aleatorizado entre sutura de polidioxanona y de naylon en el cierre de laparotomía en pacientes de riesgo / Randomized clinical study of polydioxanone and nylon sutures for laparotomy clousure in high-risk patients

Introducción. Las complicaciones del cierre de la herida quirúrgica en enfermos con factores de riesgo aumentan significativamente su morbimortalidad. El objeto del estudio es valorar la presencia de diferencias en el cierre de la pared abdominal en pacientes con criterios de riesgo, con la misma técnica de cierre entre sutura de reabsorción lenta y sutura no absorbible. Material y métodos. Estudio prospectivo multicéntrico, comparativo entre polidioxanona y nailon. Se incluyen laparotomías por enfermedad intestinal y hepatobiliopancreática, con un factor de riesgo añadido. Se excluyen eventraciones, intervención por obesidad, cierre con puntos totales, incisiones de escasa incidencia, pronóstico vital menor de 1,5 años o fallecimiento sin relación con la herida. El cierre fue con sutura continua en bloque con lazo, monoplano extracutánea. Se evalúa la infección, la evisceración, la dehiscencia, la extrusión, el sinus, la eventración, la intolerancia y el dolor. Controles: postoperatorio, 10 y 30 días, 3 y 6 meses, 1 año y 1,5 años. Resultados. Se incluyó a 770 pacientes, 451 en el grupo de polidioxanona y 319 en el grupo de nailon El 78,05% eran incisiones medias, con 23,3 cm de longitud media. El calibre de la sutura más utilizado era de 1 (85,45%). Se utilizaron 1,7 suturas por paciente. En el 94,03% no hubo complicaciones, y se obtuvieron los mismos resultados en ambos grupos (94,7% en la polidioxanona y el 93,1% en el nailon). En controles posteriores, los resultados fueron similares a lo largo del tiempo. La tasa de infección quirúrgica fue del 10%. No hay diferencias en ninguno de los controles para ninguna de las variables analizadas. Conclusiones. El cierre de la pared abdominal debería realizarse con sutura continua de material de absorción lenta, como la polidiaxonona, al presentar una incidencia similar de complicaciones y una mayor biocompatibilidad que las suturas irreabsorbibles (AU)

Introduction. The complications of surgical wound closure in patients with risk factors significantly increases morbidity and mortality. The aim of the present study was to evaluate differences in abdominal wall closure in patients with risk factors with the same closure technique and slow-absorbable or non-absorbable sutures. Material and methods. We performed a prospective, multicenter, comparative study of polydioxanone versus nylon sutures. Laparotomies performed for intestinal diseases and hepatobiliopancreatic procedures in patients with at least one risk factor were included. Exclusions criteria were eventrations, interventions for obesity, the need for reinforcement sutures, uncommon incisions, life expectancy of less than 1.5 years and deaths unrelated to the wound. Closure was performed with monoplane, extracutaneous, continuous, en bloc, loop sutures. Infection, evisceration, dehiscence, extrusion, sinus, eventration, intolerance, and pain were evaluated. Postoperative follow-up was performed at 10 and 30 days, 3 and 6 months, and at 1 and 1.5 years. Results. A total of 770 patients were included (451 in the polydioxanone group and 319 in the nylon group). A total of 78.05% were midline incisions, with a mean length of 23.3 cm. Caliber 1 sutures were most frequently used (85.45%), and 1.7 sutures were used per patient. No complications occurred in 94.03% with no differences between groups (94.7% polydioxanone and 93.1% nylon). The results were similar throughout follow-up. The surgical infection rate was 10%. No differences were found in any of the follow-up assessments in any of the variables analyzed. Conclusions. Abdominal wall closure should be performed with continuous slow-absorption sutures such as polydioxanone since this type of suture has a similar complication rate to reabsorbable sutures and presents greater biocompatibility (AU)