http://www.asir-journal.com The most accessed research articles published by Annals of Surgical Innovation and Research 2012-04-27T00:00:00Z Background: A cursory review of the current socket preservation literatures well depicts the necessity of further esthetic considerations through the corrective procedures of the alveolar ridge upon and post extraction. A new technique has been described here is a rotational pedicle combined epithelialized and connective tissue graft (RPC graft) adjunct with immediate guided tissue regeneration (GBR) procedure. Results: We reviewed this technique through a case report and discuss it`s benefit in compare to other socket preservation procedures. Conclusion: The main advantages of RPC graft would be summarized as follows: stable primary closure during bone remodeling, saving or crating sufficient vestibular depth, making adequate keratinized gingiva on the buccal surface, and being esthetically pleasant.Keywordsbone, dental implant, esthetic. http://www.asir-journal.com/content/6/1/3 Gholam Ali Gholami Maryam Aghaloo Farzin Ghanavati Reza Amid Mahdi Kadkhodazadeh Annals of Surgical Innovation and Research 2012, null:3 2012-04-27T00:00:00Z doi:10.1186/1750-1164-6-3 /content/figures/1750-1164-6-3-toc.gif Annals of Surgical Innovation and Research 1750-1164 ${item.volume} 3 2012-04-27T00:00:00Z PDF IntroductionGastro-oesophageal reflux disease (GORD) is a common problem in the Western countries, and the interest in the minimal access surgical approaches to treat GORD is increasing. In this study, we would like to discuss the presentations and management of complications we encountered after Laparoscopic Nissen's fundoplication in our District General NHS Hospital. The aim is to recognise these complications at the earliest stage for effective management to minimise the morbidity and mortality. Methods: 301 patients underwent laparoscopic treatment for GORD by a single consultant surgeon in our NHS Trust from September 1999. The data was prospectively collected and entered into a database. The data was retrospectively analysed for presentations for complications and their management. Results: Surgery was completed laparoscopically in all patients, except in five, where the operation was technically difficult due to pre-existing conditions. The complications we encountered during surgery and follow-up period were major intra-operative bleeding (n = 1, 0.33%), severe post-operative nausea and vomiting (n = 1, 0.33%), wound infection (n = 3, 1%), port-site herniation (n = 1, 0.33%), wrap-migration (n = 2, 0.66%), wrap-ischaemia (n = 1, 0.33%), recurrent regurgitation (n = 4, 1.32%), recurrent heartburn (n = 29, 9.63%), tension pneumothorax (n = 2, 0.66%), surgical emphysema (n = 8, 2.66%), and port-site pain (n = 4, 1.33%). Conclusion: Minimal access approach to treat GORD has presented with some specific and unique complications. It is important to recognise these complications at the earliest possible stage as some of these patients may present in an acute setting requiring emergency surgery. All members of the department, and not just the members of the specialised team, should be aware about these complications to minimise the morbidity and mortality. http://www.asir-journal.com/content/3/1/1 Tarun Singhal Santosh Balakrishnan Abdulzahra Hussain Starlene Grandy-Smith Andrew Paix Shamsi El-Hasani Annals of Surgical Innovation and Research 2009, null:1 2009-02-04T00:00:00Z doi:10.1186/1750-1164-3-1 /content/figures/1750-1164-3-1-toc.gif Annals of Surgical Innovation and Research 1750-1164 ${item.volume} 1 2009-02-04T00:00:00Z XML This article reviews the historical evolution of hepatic vascular clamping and their indications. The anatomic basis for partial and complete vascular clamping will be discussed, as will the rationales of continuous and intermittent vascular clamping.Specific techniques discussed and described include inflow clamping (Pringle maneuver, extra-hepatic selective clamping and intraglissonian clamping) and outflow clamping (total vascular exclusion, hepatic vascular exclusion with preservation of caval flow). The fundamental role of a low Central Venous Pressure during open and laparoscopic hepatectomy is described, as is the difference in their intra-operative measurements. The biological basis for ischemic preconditioning will be elucidated. Although the potential dangers of vascular clamping and the development of modern coagulation devices question the need for systemic clamping; the pre-operative factors and unforseen intra-operative events that mandate the use of hepatic vascular clamping will be highlighted. http://www.asir-journal.com/content/4/1/2 Elie Chouillard Andrew Gumbs Daniel Cherqui Annals of Surgical Innovation and Research 2010, null:2 2010-03-26T00:00:00Z doi:10.1186/1750-1164-4-2 /content/figures/1750-1164-4-2-toc.gif Annals of Surgical Innovation and Research 1750-1164 ${item.volume} 2 2010-03-26T00:00:00Z XML Background: New sphincter-saving approaches have been applied in the treatment of perianal fistula in order to avoid the risk of fecal incontinence. Among them, the fibrin glue technique is popular because of its simplicity and repeatability. The aim of this review is to compare the fibrin glue application to surgery alone, considering the healing and complication rates. Methods: We performed a systematic review searching for published randomized and controlled clinical trials without any language restriction by using electronic databases. All these studies were assessed as to whether they compared conventional surgical treatment versus fibrin glue treatment in patients with anal fistulas, in order to establish both the efficacy and safety of each treatment. We used Review Manager 5 to conduct the review. Results: The healing rate is higher in those patients who underwent the conventional surgical treatment (P = 0,68), although the treatment with fibrin glue gives no evidence of anal incontinence (P = 0,08). Furthermore two subgroup analyses were performed: fibrin glue in combination with intra-adhesive antibiotics versus fibrin glue alone and anal fistula plug versus fibrin glue. In the first subgroup there were not differences in healing (P = 0,65). Whereas in the second subgroup analysis the healing rate is statistically significant for the patients who underwent the anal fistula plug treatment instead of the fibrin glue treatment (P = 0,02). Conclusion: In literature there are only two randomized controlled trials comparing the conventional surgical management versus the fibrin glue treatment in patients with anal fistulas. Although from our statistical analysis we cannot find any statistically significant result, the healing rate remains higher in patients who underwent the conventional surgical treatment (P = 0,68), and the anal incontinence rate is very low in the fibrin glue treatment group (P = 0,08). Anyway the limited collected data do not support the use of fibrin glue. Moreover, in our subgroup analysis the use of fibrin glue in combination with intra-adhesive antibiotics does not improve the healing rate (P = 0.65), whereas the anal fistula plug treatment compared to the fibrin glue treatment shows good results (P = 0,02), although the poor number of patients treated does not lead to any statistically evident conclusion. This systematic review underlines the need of new RCTs upon this issue. http://www.asir-journal.com/content/3/1/12 Roberto Cirocchi Eriberto Farinella Francesco La Mura Lorenzo Cattorini Barbara Rossetti Diego Milani Patrizia Ricci Piero Covarelli Marco Coccetta Giuseppe Noya Francesco Sciannameo Annals of Surgical Innovation and Research 2009, null:12 2009-11-14T00:00:00Z doi:10.1186/1750-1164-3-12 /content/figures/1750-1164-3-12-toc.gif Annals of Surgical Innovation and Research 1750-1164 ${item.volume} 12 2009-11-14T00:00:00Z XML ObjectiveThe aim of this study is to clinically test the efficacy of author's approach of suture ligation and mucopexy for patients having symptomatic and prolapsing hemorrhoids.Materials and methods616 patients (255 females) complaining of symptoms of hemorrhoids were included in the study. The hemorrhoids were suture ligated with an absorbable suture material under vision. Operating time, postoperative complications, time to return to work, and outcome of the procedure were analyzed. Follow-up was planned following discharge after 1 month, 6 months and after at least 1 year. Patient satisfaction was also assessed. Results: The mean procedure time was 8 ± 0 minutes (range, 6–15 minutes), and the total admission period was 12 ± 4 Hours. Perianal thrombosis and skin tags were the commonest post-operative complications. The mean total analgesic dose and duration of pain control using analgesics was 19 ± 4 tablets, and 9 ± 3 days respectively.The postoperative follow up after 4 weeks revealed therapeutic success in 589 patients (95.6%), who presented with hemorrhoidal bleeding. Prolapse was no longer observed in 98% of patients and 96% patients experienced no pain after defecation. 93% patients completed the one-year follow-up and 89 percent of them were asymptomatic. The patient satisfaction scoring was 8.2% on visual analogue scale. Conclusion: Suture ligation and mucopexy of hemorrhoids is an easy-to-perform technique that is well accepted by patients and has good results for prolapsing hemorrhoids. http://www.asir-journal.com/content/2/1/5 Pravin Gupta Surekha Kalaskar Annals of Surgical Innovation and Research 2008, null:5 2008-11-28T00:00:00Z doi:10.1186/1750-1164-2-5 /content/figures/1750-1164-2-5-toc.gif Annals of Surgical Innovation and Research 1750-1164 ${item.volume} 5 2008-11-28T00:00:00Z XML Background: The history of surgical reconstruction of the left ventricle after an anterior myocardial infarction shows an evolution of techniques which tend to a more and more physiologic restoration of ventricular shape and volume, with increasing attention to the orientation of myocardial fibers. Methods: We set a new surgical procedure for endoventricular patch reconstruction technique with the aim to rebuild a physiologic shape and volume of the left ventricle caring about realignment of myocardial fibers orientation. Peculiarities of this reconstruction are the shape of the patch (reduction of minor axis compared with currently used oval-shaped patch) and the asymmetrical way of suturing it inside the ventricle. Results: We present a detailed description of operative steps of this procedure, and we add some relevant surgical hints to clarify its peculiarities. Most of the patients operated on with this technique showed the original renewal of apical rotation and left ventricular torsion as specific index of the restoration of physiologic fiber orientation: we report an exemplary case of at-sight recovery of apical rotation in the operating room. Conclusion: This technique can represent a reproducible new way to realign myocardial fibers in a near-normal setting, improving the physiological restoration of ischemically injured left ventricle. It could be also the basis to reconsider surgical treatment for heart failure. http://www.asir-journal.com/content/3/1/6 Marco Cirillo Annals of Surgical Innovation and Research 2009, null:6 2009-06-23T00:00:00Z doi:10.1186/1750-1164-3-6 /content/figures/1750-1164-3-6-toc.gif Annals of Surgical Innovation and Research 1750-1164 ${item.volume} 6 2009-06-23T00:00:00Z XML Background: Emergency repair of incarcerated incisional hernia with associated bowel obstruction in potentially or contaminated field is technically challenging due to edematous, inflamed and friable tissues with occasional need for concurrent bowel resection and carries high rates of post-operative infectious complications. The aim of this study was to retrospectively assess the wound related morbidity of use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. We also describe a new technique of leaving the mesh exposed to heal by secondary intention with granulation tissue. Methods: Between 2000 and 2010 a total of 60 patients underwent emergency surgery for incarcerated incisional hernia with associated bowel obstruction with placement of permanent prosthetic mesh. The wound was closed after hernia repair in 55 patients while it was left open to granulate in 5 patients. Results: In the group of patients with primary wound closure, 11 patients developed superficial surgical site infection, 5 developed deep wound infection and one patient had cellulitis. These patients were treated with wound debridement and antibiotics. Mesh removal was required in one patient. There were no infections in the group of patients who had their surgical wounds left open. One patient in this group died on the fifth postoperative day from septicemia. Conclusion: Use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. in contaminated field is associated with high risk of wound infection. http://www.asir-journal.com/content/6/1/1 Hasnain Zafar Masooma Zaidi Irfan Qadir Ayaz Memon Annals of Surgical Innovation and Research 2012, null:1 2012-01-04T00:00:00Z doi:10.1186/1750-1164-6-1 /content/figures/1750-1164-6-1-toc.gif Annals of Surgical Innovation and Research 1750-1164 ${item.volume} 1 2012-01-04T00:00:00Z XML Background: Epidural fibrosis is regarded as a cause of failed back surgery syndrome (FBSS) when excessive adhesional/fibrotic scar tissue causes compression, pain or discomfort by tethering of nerve tissue to the surrounding muscle or bone. Fibrosis inhibitors could therefore increase the success rate of spinal surgery and decrease the need for reoperations. In recent years, bio-resorbable gels or films for the prevention of peridural fibrosis and post-operative adhesions have been developed that look clinically promising. This included a 100% synthetic, sterile, absorbable gel combinations of carboxymethylcellulose (CMC) and polyethylene oxide (PEO) used to coat the dura to reduce scarring after discectomy which became available in Europe in 2002. However, given the burden of the problem and unfavorable experience with other types of adhesion-reduction agents, our unit decided to evaluate the safety of CMC/PEO in a large population of patients undergoing spinal microdiscectomy for herniation. Methods: To determine the safety and assess efficacy of carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel as an anti-adhesion gel, a consecutive series of 396 patients undergoing lumbar discectomy performed by one surgeon had CMC/PEO gel administered at the end of surgery. The patients were followed up in accordance with standard clinical practice and records reviewed for side effects, such as skin reactions, general reactions or local fluid collections. Reoperations for recurrent herniation included an evaluation of fibrosis reduction. Results: No product related complications were observed. Five patients needed reoperations for recurrent herniation. Significant but subjective reduction in fibrosis was observed in these patients. Conclusion: The findings provide confidence that CMC/PEO gel is well tolerated as an agent to achieve reduction of fibrosis in lumbar disc surgery. Further formal prospective study is recommended in this area of unmet need. http://www.asir-journal.com/content/2/1/2 Patrick Fransen Annals of Surgical Innovation and Research 2008, null:2 2008-05-30T00:00:00Z doi:10.1186/1750-1164-2-2 /content/figures/1750-1164-2-2-toc.gif Annals of Surgical Innovation and Research 1750-1164 ${item.volume} 2 2008-05-30T00:00:00Z XML Background: There have been numerous studies on reduction mammaplasty and its modifications in the literature. The multitude of modifications of reduction mammaplasty indicates that the ideal technique has yet to be found. There are four reasons for seeking the ideal technique. One reason is to preserve functional features of the breast: breastfeeding and arousal. Other reasons are to achieve the real geometric and aesthetic shape of the breast with the least scar and are to minimize complications of prior surgical techniques without causing an additional complication. Last reason is the limitation of the techniques described before. To these aims, we developed a new versatile reduction mammaplasty technique, which we called conical plicated central U shaped (COPCUs) mammaplasty. Methods: We performed central plication to achieve a juvenile look in the superior pole of the breast and to prevent postoperative pseudoptosis and used central U shaped flap to achieve maximum NAC safety and to preserve lactation and nipple sensation. The central U flap was 6 cm in width and the superior conical plication was performed with 2/0 PDS. Preoperative and postoperative standard measures of the breast including the superior pole fullness were compared. Results: Forty six patients were operated with the above mentioned technique. All of the patients were satisfied with functional and aesthetic results and none of them had major complications. There were no changes in the nipple innervation. Six patients becoming pregnant after surgery did not experience any problems with lactation. None of the patients required scar revision. Conclusion: Our technique is a versatile, safe, reliable technique which creates the least scar, avoids previously described disadvantages, provides maximum preservation of functions, can be employed in all breasts regardless of their sizes. http://www.asir-journal.com/content/3/1/7 Eray Copcu Annals of Surgical Innovation and Research 2009, null:7 2009-07-03T00:00:00Z doi:10.1186/1750-1164-3-7 /content/figures/1750-1164-3-7-toc.gif Annals of Surgical Innovation and Research 1750-1164 ${item.volume} 7 2009-07-03T00:00:00Z XML Post-operatory wound infections are a very uncommon finding after thyroidectomy. For these reasons international guidelines do not routinely recommend systemic antibiotic prophylaxis.The benefits of this antibiotic prophylaxis is not supported by clinical evidence in the literature. We have conducted a multicentric randomized double-blind trial on 500 patients who had undergone thyroidectomy for goitre or thyroid carcinoma. The 500 patients enrolled in the study (mean age 47 years) were randomized in two subgroups of 250 patients. 250 patients were treated with standard antibiotic prophylaxis with sulbactam/ampicillin 1 fl (3 gr.) 30 min before surgery. No antibiotic prophylaxis was instituted in the remainder 250 patients. Our RCT showed that prophylactic antibiotic treatment is not beneficial in patients younger than eighty years old, with no concomitant metabolic, infective and hematologic disease, with no cardiac valvulopathies, not under steroidal or immunosuppressive treatment, and not severely obese. Our study should be regarded only as a preliminary RCT, and should be followed by a study in which a larger number of patients should be enrolled so that statistically significant data can be obtained. http://www.asir-journal.com/content/3/1/10 Nicola Avenia Alessandro Sanguinetti Roberto Cirocchi Giovanni Docimo Mark Ragusa Roberto Ruggiero Eugenio Procaccini Carlo Boselli Fabio D'Ajello Francesco Barberini Domenico Parmeggiani Lodovico Rosato Francesco Sciannameo Giorgio De Toma Giuseppe Noya Annals of Surgical Innovation and Research 2009, null:10 2009-08-05T00:00:00Z doi:10.1186/1750-1164-3-10 /content/figures/1750-1164-3-10-toc.gif Annals of Surgical Innovation and Research 1750-1164 ${item.volume} 10 2009-08-05T00:00:00Z XML