Gil-Hernández GE, García-Álvarez J

Language: Spanish
References: 9
Page: 7-9
PDF size: 559.47 Kb.

ABSTRACT

Introduction: tying laparoscopic sutures is a great challenge. A knot must ensure the approximation of the tissues, be simple, fast, resistant and safe. There are many knots with a few proof of their resistance. Within the Juarez Hospital in Mexico, Dr. Javier Garcia Alvarez designed a knot that was easier to make, sliding and did not require more knotting, called the H. Juárez knot. Objective: to verify on a pneumatic model that the knot is resistant, does not slip and is easily performable, so it can be used safely in laparoscopic surgery. Material and methods: using a pneumatic pressure device, the H. Juárez knot will be made around the rubber and blow it up to 300 mmHg and observe if the knot slides, breaks or does not change, testing the materials prolene, polyglycolic acid and chromic catgut, in 000 gauge, this 50 times with each material. Results: polyglycolic acid in 96% of cases there is no change at 300 mmHg. In 4% it ran after 250 mmHg. The chromic catgut 000 in 100% of the cases broke above 150 mmHg. Prolene 000, 60% of the tests the knot breaks above 280 mmHg, below 200 mmHg it does not change, 0% ruptures. Conclusion: the H. Juárez knot has a resistance of 100% in structures that do not exceed 150 mmHg, with the appropriate selection of the material this figure can rise to 300 mmHg without undergoing changes, slipping or breaking. We do not recommend the use of chromic catgut to tie this knot.

REFERENCES

1. Akintunde AR, Fasanu A, Chandra MS et al. Comparing extracorporeal knots in laparoscopy using knot and loop. World Journal of laparoscopic Surgery. 2014; 7: 28-32.

2. Shishkina A, Deane A, Lee SK et al. 8509 extracorporeal knots in laparoscopy: modified Roeder's knot. JMIG. 2022; 29: S130.

3. Liceaga A, Fernandes LF, Romeo A. La regla del gladiador romeo nudos, puntos y técnicas de anudamiento. Endo Press. 2015.

4. Sedlack JD, Williams VM, DeSimone J, Page D, Ghosh BC. Laparoscopic knot security. Surg Laparosc Endosc. 1996; 6: 144-146.

5. Drabble E, Spanopoulou S, Sioka E et al. How to tie dangerous surgical knots: easily. Can we avoid this? BMJ Surg Interv Health Technol. 2021; 3: e000091.

6. Burkhart SS, Wirth MA, Simonich M et al. Knot security in simple sliding knots and its relationship to rotator cuff repair: how secure must the knot be? Arthroscopy. 2000; 16: 202-207.

7. Sami Walid M, Heaton RL. Laparoscopy-to-laparotomy quotient in obstetrics and gynecology residency programs. Arch Gynecol Obstet. 2011; 283: 1027-1031.

8. Beltrán SM, Haberle OF. Rodríguez FJ et al. Presiones de la vía biliar en pacientes con y sin colelitiasis. Rev Cir. 2023; 75: 24-30.

9. Rebollar GR, García AJ, Trejo TR. Apendicitis aguda: revisión de la literatura. Rev Hosp Jua Mex. 2009; 76: 210-216.