Title : Thoracoscopic surgery in children- Rare cases managed successfully
Abstract:
There are different techniques of performing circumcision however in any case requires suturing of wound edges to complete the procedure.Wound closure techniques have evolved from the earliest development of non-absorbable suturing materials to advanced modalities like synthetic absorbable sutures, staples and tissue adhesives. Here we have used iso-amyl cyanoacrylate as adhesive for approximation of wound edges playing a role of sutures and also have done comparative analysis of sutureless circumcision using iso-amyl cyanoacrylate to approximate wound edges with conventional use of absorbale suture material for approximation of wound edges in paediatric patients. We have innovated a newer surgical technique with help of this iso-amyl cyanoacrylate. Use of this adhesive was thought in view of sutureless procedure and to study its safety, efficacy, functional outcome and cosmesis.The two most common complications of circumcision are bleeding and wound infection.The cyanoacrylate tissue glue has been claimed to have the advantages of being hemostatic,bacteriostatic and easy to use.The use of cyanoacrylate as tissue adhesive as an alternative to sutures has invoked curiosity and interest in the field of cosmesis and wound healing.Compared to other cyanoacrylatesIso amyl 2-cyanoacrylate has unique properties having faster tissue bonding capacity and curing, than octyl cyanoacrylate. Iso amyl 2- cyanoacrylate is superior to N-butyl cyanoacrylate since it does not get brittle and fracture on long lacerations.Its fast polymerization,immediate hemostasis,excellent tensile strength, biocompatibility, ease of application, and bacteriostaticproperties make it very effective and useful in closing surgical or wound incisions. Our study shows use of iso-amyl 2 cyanoacrylate as tissue adhesive instead of conventional absorbable interrupted suturing technique for paediatric circumcisions in 364 patients total in which comparative study of Sutureless versus Sutured Circumcision has been done. Our results show that when iso-amyl cyanoacrylate is used for paediatric circumcisions there are less chances of bleeding, infection, lesser degree and incidence of swelling, above all there is less post–operative pain, hence lesser use of analgesics in our paediatric patients. Also wound healing was found to be better and with best final cosmesis in follow-up period as compared to sutured group patients. Our results show that iso-amyl cyanoacrylate is comparatively safe, efficient, has better functional outcome and good cosmesis when used as adhesive for wound edges of paediatric circumcisions.
