Lars Aanning

Questions and Answers (9) View all

• Answer added in Appendicitis
  21 What is your current practice about the use of intraperitoneal drains for perforated appendicitis following an open appendicectomy?
  By Gianpiero Gravante · Kettering General Hospital
  Lars Aanning ·

  I agree with these authors. If the rind that enclosed the abscess can be completely removed/peeled from the surfaces of bowel, omentum, and peritoneu... [more]

  I agree with these authors. If the rind that enclosed the abscess can be completely removed/peeled from the surfaces of bowel, omentum, and peritoneum (such as in the pelvis or gutter) then a drain is superfluous and thorough irrigation will suffice. Removing this rind is probably more difficult using the laparoscopic approach. I have used simple round silastic perforated drains in recesses (as in the pelvis or gutter) where removal of the rind was incomplete, dissection was difficult, and there was oozing of raw surfaces - a situation inviting a postoperative abscess to form. It is imperative to completely remove any fecalith(s) that may have escaped from a perforated appendix!
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• Answer added in Surgical Techniques
  22 Which traditional surgical myths have the greatest conflict with the modern trends of general surgery ?
  By Igor Gerych · Danylo Halytsky Lviv National Medical University
  Lars Aanning ·

  To be able to deal with these myths means we need to be able to recognize them in our daily routines. Dr. Dionigi aptly focuses on surgical education... [more]

  To be able to deal with these myths means we need to be able to recognize them in our daily routines. Dr. Dionigi aptly focuses on surgical education, role of mentors, and EBM as playing crucial roles - and Dr. Borodach rightly challenges their inflexibility and thus propagating such myths. This is a never ending struggle. But knowing our own personal results also helps. Keeping track of our own operations and their results should be a life-long endeavor to improve the quality of our surgical performance. When we ask a patient for consent to operate we should also be able to give an up-to-date summary of complications - recurrences, reoperations, wound infections, etc. - as part of the consent process. Unusual or unexpected outcomes or trends become flags for further investigation - and possibly myth debunking.
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• Answer added in Surgical Techniques
  22 Which traditional surgical myths have the greatest conflict with the modern trends of general surgery ?
  By Igor Gerych · Danylo Halytsky Lviv National Medical University
  Lars Aanning ·

  I recommend that all running suture closures be anchored with a final series of half hitches to avoid tumbling of the final knot(s). Alternately, use... [more]

  I recommend that all running suture closures be anchored with a final series of half hitches to avoid tumbling of the final knot(s). Alternately, use a loop suture or another type of self-tightening knot. The initial knot can be a square knot if you like that - but I have probably always used half hitches - on fascia, bowel, vascular, and other tissues. Eric Rawdon, a mathematician, studied knot tying by experienced surgeons and concluded that "Knot mechanics are poorly understood and that most surgeons neither tie nor recognize the knots they intend to tie." More at: http://george.math.stthomas.edu/rawdon/Preprints/monofilamentknots.pdf William Halsted said [JAMA 1913;601:1119-1126], "A granny knot [half hitches] is adequate when fine silk is used. In some instances the granny is better than the reef knot [square knot], for in the tying of the former in the presence of tension the traction on the first turn of the knot can easily be maintained, and should the first turn loosen, in the taking of the second the slack can usually be taken up in the drawing home of the latter." So Halstead was OK with half hitches for ligatures!! I will be glad to email copies of our two papers on the unreliability of square knots in anchoring running sutures - send inquiry to laanning@gmail.com. Again, I am only really illuminating what others have already made known.
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• Answer added in Surgical Techniques
  22 Which traditional surgical myths have the greatest conflict with the modern trends of general surgery ?
  By Igor Gerych · Danylo Halytsky Lviv National Medical University
  Lars Aanning ·

  One can also start a running anchor knot with a square knot as long as the successive throws are half hitches - since it is the final square knot(s) t... [more]

  One can also start a running anchor knot with a square knot as long as the successive throws are half hitches - since it is the final square knot(s) that tumble and weaken the suture when tension is placed on the needle-bearing end. Try this: fasten a suture to each of the two loops of a needle driver - using square knots to one loop and half hitches to the other loop. Now pull on the middle of the suture (using a pen works well) until it breaks. The suture will ALWAYS break at the square knots! All your comments are very helpful and really allow me to more fully understand conceptual barriers to myth changing.
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• Answer added in Surgical Techniques
  22 Which traditional surgical myths have the greatest conflict with the modern trends of general surgery ?
  By Igor Gerych · Danylo Halytsky Lviv National Medical University
  Lars Aanning ·

  Dr. Borodach: Your comment indicates that 1) I was unsuccessful in getting my point across, and 2) This myth will persist! 

  Dr. Borodach: Your comment indicates that 1) I was unsuccessful in getting my point across, and 2) This myth will persist!
  Following