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Baldan N, Munegato G, Di Leo A, Lauro E, Morpurgo E, Pianigiani S, Briscolini D, Ferrara R, Fiscon V, Brolese A, De Manzoni G, Baldazzi G, Snidero D, Merigliano S, Ricci F, Laterza E, Merenda R, Gianesini R. Lessons learned from 227 biological meshes used for the surgical treatment of ventral abdominal defects. Hernia 2019; 24:57-65. [PMID: 30661179 DOI: 10.1007/s10029-019-01883-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/25/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE The advantages of biological meshes for ventral hernia repair are still under debate. Given the high financial cost, the proper indications for biological meshes should be clarified to restrict their use to properly selected patients. METHODS A retrospective database was instituted to register all cases of abdominal wall defect treated with biological meshes from 1/2010 to 3/2016. RESULTS A total of 227 patients (mean age: 64 years) whose ventral abdominal defects were reconstructed with a biological mesh were included in the study. Patients were divided according to the 2010 four-level surgical-site complication risk grading system proposed by the Ventral Hernia Working Group (VHWG): Grade 1 (G1, 12 cases), Grade 2 (G2, 68 cases), Grade 3 (G3, 112 cases), and Grade 4 (G4, 35 cases). The surgical site complication rate was higher in patients with one or more risk factors (33.6% vs 19% in patients with no risk factors) (P = 0.68). Statistically significant risk factors associated with the onset of one or more postoperative surgical site complications included: diabetes, coronary artery disease, immunosuppression, and obesity. Recurrence was more common in patients with surgical site complications and mainly associated with infection (38.9%) and wound necrosis (44.4%), and in cases of inlay positioning of the mesh (36%). CONCLUSIONS Due to their high costs, biological mesh should not be used in G1 patients. In infected fields (G4), they should only be used if no other surgical solution is feasible. There is a clear need to prospectively evaluate the performance of biological meshes.
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Affiliation(s)
- N Baldan
- Clinica Chirurgica 3, Azienda Ospedaliera Università di Padova, Padua, Italy.
| | - G Munegato
- Ospedale "S. Maria dei Battuti", Conegliano, TV, Italy
| | - A Di Leo
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - E Lauro
- Ospedale "S. Maria del Carmine" di Rovereto, Rovereto, TV, Italy
| | - E Morpurgo
- Ospedale di Camposampiero, Camposampiero, PD, Italy
| | - S Pianigiani
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, Università di Padova, Padua, Italy
| | - D Briscolini
- Clinica Chirurgica 3, Azienda Ospedaliera Università di Padova, Padua, Italy
| | | | - V Fiscon
- Ospedale di Cittadella, Cittadella, PD, Italy
| | - A Brolese
- Ospedale "Santa Chiara", Trento, Italy
| | - G De Manzoni
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - G Baldazzi
- ASST NORD MILANO Presidio Ospedaliero di Sesto San Giovanni, Sesto San Giovanni, MI, Italy
| | - D Snidero
- Ospedale di San Daniele del Friuli, San Daniele del Friuli, UD, Italy
| | - S Merigliano
- Clinica Chirurgica 3, Azienda Ospedaliera Università di Padova, Padua, Italy
| | - F Ricci
- Ospedale "S. Maria del Carmine" di Rovereto, Rovereto, TV, Italy
| | - E Laterza
- Ospedale di Legnago, Legnago, VR, Italy
| | - R Merenda
- Ospedale "SS. Giovanni e Paolo", Venice, Italy
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Gion M, Mione R, Dittadi R, Griggio L, Munegato G, Valsecchi M, Del Maschio O, Bruscagnin G. Carcinoembryonic Antigen, Ferritin, Tissue Polypeptide Antigen, and Ca15/3 in Breast Cancer: Relationship between Carcinoma and Normal Breast Tissue. Int J Biol Markers 2018; 1:33-8. [PMID: 3480322 DOI: 10.1177/172460088600100106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study of tumor markers in breast cancer tissue may supply information on the tumor's biological features and its clinical behaviour. Forty-nine primary breast cancer patients are evaluable to date. CEA, ferritin, TPA and CA15/3 were measured with radioimmu-nometric methods in the cytosol of carcinoma and normal tissue from the same breast. The concentrations of the four markers were higher in the tumor than in normal tissue in 42/49 cases for CEA, 47/49 for ferritin, 42/49 for TPA and in 24/29 for CA15/3. However, an overlap was found between carcinoma and normal tissue levels, particularly for CEA and TPA. We can conclude that the four substances studied may be markers of malignancy in breast carcinoma when nonmalignant breast tissue from the same patient is determined at the same time, whereas assays within a single, unknown breast tissue sample may be useful only in the case of ferritin and, partly, CA15/3.
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Affiliation(s)
- M Gion
- Laboratorio di Oncologia e Endocrinologia, Ospedali Civili Riuniti, Venezia
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Gion M, Mione R, Dittadi R, Griggio L, Munegato G, Valescchi M, Del Maschio O, Fasan S, Bruscagnin G. Estrogen and Progesterone Receptors in Breast Carcinoma and in Nonmalignant Breast Tissue. Tumori 2018; 71:477-81. [PMID: 4060249 DOI: 10.1177/030089168507100511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since 1983 we have studied the relationship, in the same patient, between receptor status in breast carcinoma and in nonmalignant breast tissue. Fifty patients have been evaluated to date. The total unoccupied cytosol estrogen and progesterone receptors were determined by a dextran-coated charcoal method. In nonmalignant breast tissue we found a measurable receptor concentration above the sensitivity of the method in 62 % of cases for estrogen receptors and in 44 % of cases for progesterone receptors. No relationships were found between the receptor level of each tumor and that of the corresponding benign tissue. The data suggest that the levels of the receptors in the tumor and in the nonmalignant tissue are totally independent.
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Schiano di Visconte M, Picciano P, Munegato G. [Acute abdomen due to a right-sided strangulated traumatic diaphragmatic hernia. Case report]. MINERVA CHIR 2006; 61:451-4. [PMID: 17159754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Traumatic rupture of diaphragm is sometimes diagnosed many years after the traumatic event. Due to the silent nature of diaphragmatic injuries, the diagnosis is easily missed or difficult. We describe a rare case of right diaphragmatic hernia, in which the diagnosis was made many years after the trauma. The incidence of right diaphragmatic hernia is about 11-14% of all diaphragmatic hernias. The patient showed acute hernia of the small intestine and was treated with resection of the intestinal loop and repair of breakthrough by suture. The diagnosis was made with a standard X-ray of thorax and abdomen. CT scan and NMR give more accurate information in these cases. The surgical repair is the treatment of choice in all traumatic diaphragmatic hernias.
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MESH Headings
- Abdomen, Acute/diagnosis
- Abdomen, Acute/etiology
- Abdomen, Acute/surgery
- Aged
- Diaphragm/injuries
- Hernia, Diaphragmatic, Traumatic/complications
- Hernia, Diaphragmatic, Traumatic/diagnosis
- Hernia, Diaphragmatic, Traumatic/surgery
- Humans
- Intestinal Obstruction/diagnosis
- Intestinal Obstruction/etiology
- Intestinal Obstruction/surgery
- Intestine, Small/surgery
- Male
- Treatment Outcome
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Affiliation(s)
- M Schiano di Visconte
- Dipartimento di Chirurgia Generale, Ospedale S. Maria dei Battuti, Conegliano, Treviso, Italy.
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Abstract
BACKGROUND The computerized noninvasive measurement of respiratory mechanics enables new prospects in the study of respiratory physiopathology in surgical repair of large incisional hernias. STUDY DESIGN We studied 10 patients with COPD ventilated with a Servo Ventilator 900C. We measured inspiratory flow by means ofa pneumotacograph, the volume by integrating the flow signal, and esophageal and airway opening pressure by means of two differential pressure transducers (an esophageal balloon measures, separately, chest wall and lung mechanical properties). The signals were sent by an analogic-digital converter to a personal portable computer to be analyzed. We calculated compliance of total respiratory system (Crs), chest wall (Ccw), and lung (CI); maximum resistance of the total respiratory system (Rmax, Rs), chest wall (Rmax, w), and lung (Rmax, L); and work of breathing (Wob). Statistics were performed using one-way analysis of variance and p = 0.05 was considered significant. RESULTS At the closure of the peritoneum a reduction of Crs and Wob was recorded in seven patients in whom a PTFE prosthesis widening the abdominal cavity was used to restore the baseline value. Variations in respiratory compliance are from variations in Ccw with unaffected CI (Ccw varied from 0.180 to 0.130 L/cmH2O at peritoneal closure and from 0.130 to 0.170 L/cmH2O by prosthetic peritoneal widening). Respiratory resistances remained unchanged (11.3 cmH2O/ L/s) at any time of measurement. CONCLUSIONS The intraoperative assessment of respiratory mechanics is useful to evaluate and eventually to decrease the mechanical workload (prosthesis widening peritoneum or fascia incisions). The passive mechanical work performed by the ventilator needs to be kept constant or no higher than 10% basic data: if these conditions are maintained, mostly in patients with COPD, there is no risk of respiratory muscular fatigue during the postoperative period.
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MESH Headings
- Aged
- Airway Resistance
- Analysis of Variance
- Female
- Forced Expiratory Volume
- Functional Residual Capacity
- Hernia, Ventral/complications
- Hernia, Ventral/surgery
- Humans
- Lung Compliance
- Lung Diseases, Obstructive/complications
- Lung Diseases, Obstructive/physiopathology
- Lung Diseases, Obstructive/prevention & control
- Male
- Middle Aged
- Monitoring, Intraoperative/instrumentation
- Monitoring, Intraoperative/methods
- Monitoring, Intraoperative/standards
- Peritoneum/surgery
- Polytetrafluoroethylene
- Predictive Value of Tests
- Respiration, Artificial/methods
- Signal Processing, Computer-Assisted
- Spirometry
- Surgical Mesh
- Surgical Wound Dehiscence/complications
- Surgical Wound Dehiscence/surgery
- Tidal Volume
- Vital Capacity
- Work of Breathing
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Affiliation(s)
- G Munegato
- First Surgical Department, General Hospital, Padova, Italy
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Munegato G, Basso A, De Min V, Ferraro B, Reschiglian E, Segalina P, Zotti EF. [Combined surgical treatment with prosthesis of recurrent ventral and inguinal hernias]. MINERVA CHIR 1997; 52:1401-4. [PMID: 9489343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The presence of associated incisional and groin hernias is relatively rare and it represents an important problem in surgical treatment. The authors here report their experience of three patients treated with no reabsorbable prostheses placed according to Rives' technique for incisional hernias, and according to Stoppa's for inguinal hernias.
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Affiliation(s)
- G Munegato
- I Divisione Chirurgica, Ospedale Civile di Padova
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Pierri A, Munegato G, Carraro L, Zaccaria F, Tiso E, Zotti EF. Hemodynamic alterations during massive incisional hernioplasty. J Am Coll Surg 1995; 181:299-302. [PMID: 7551322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The operative treatment of a large abdominal incisional hernia increases intra-abdominal pressure (IAP). This study was done to verify if this IAP elevation acts on the cardiocirculatory function. STUDY DESIGN Hemodynamic measurements were performed in five patients who underwent massive incisional hernioplasty before and after abdominal wall closure. RESULTS Reduction of a large abdominal hernia increases (+226 percent) IAP, which can produce serious hemodynamic alterations, manifested in two patients by a fall of cardiac output (-30 percent), without significant variations of heart rate and arterial pressure. Cardiac output is decreased secondary to decreased venous return, despite the increase in measured central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP). CONCLUSIONS During massive incisional hernioplasty, CVP cannot be used as an indicator of venous return to the heart as it reflects a composite of venous filling pressure, pleural pressure, and transmitted IAP. Transmural CVP and PCWP, and not directly measured CVP and PCWP, should be used as clinical indicators of venous return to the heart in this situation.
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Affiliation(s)
- A Pierri
- Servizio di Anestesia e Rianimazione, Azienda Ospedaliera di Padova, Italy
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Zotti EF, Munegato G, Nicoletto O. [Peritonectomy in the treatment of ovarian carcinoma at an advanced stage]. G Chir 1993; 14:75-8. [PMID: 8489897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Munegato G, Da Dalt GF, Godina M, Pluchinotta A, Ferraro B, Zangrande P, Zotti EF. [The surgical treatment of preperitoneal inguinal hernia: a comparison between the methods of Rives and Stoppa]. MINERVA CHIR 1992; 47:919-23. [PMID: 1385858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In groin hernia surgery pre-peritoneal prosthetic repair is a valid alternative to traditional inguinal repair in patients with a large area of transversalis fascia weakness: direct, inguinoscrotal, recurrent, bilateral hernias. Pre-peritoneal prosthetic surgical approach by Rives' technique (little unilateral prosthesis) has been used in 121 cases (24% bilateral and 67% recurrent hernias) and by Stoppa's technique (great bilateral prosthesis) in 95 cases (26% bilateral and 55% recurrent hernias). The results demonstrated 9.9% morbidity and 5.7% recurrences by Rives' technique vs 3.1 morbidity and complete absence of recurrences by Stoppa's technique. These results confirm the validity of large prosthetic pre-peritoneal repair in groin surgery.
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Affiliation(s)
- G Munegato
- Complesso Conv. Ospedale-Università, USSL n. 21, Regione Veneto, Padova
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Zotti EF, Gracco L, Munegato G, Della Dora R, Pagan V. [Diagnostic and therapeutic surgery of pulmonary mycoses]. MINERVA CHIR 1989; 44:387-90. [PMID: 2654712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Gion M, Dittadi R, Munegato G, Mione R, Gurnari G, Zotti EF, Bruscagnin G. Tumor marker radioimmunoassays in gastric juice. Methodologic drawbacks due to pH variations. Gastroenterology 1988; 94:1271-5. [PMID: 3162887 DOI: 10.1016/0016-5085(88)90663-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Conflicting data have been reported on tumor marker determination in gastric juice. In the present study the effect of pH variations on both antibody-antigen binding and the immunologic stability of the antigen were evaluated for the radioimmunoassay of carcinoembryonic antigen, CA19-9, tissue polypeptide antigen, and ferritin. A significant inhibition of antibody-antigen binding was constantly found in acidic conditions. Antigen concentration was lower in acidified than in untreated samples, possibly due to the carryover of acidity in the incubation mixture. Neutralization of acidified samples partly improved recovery of carcinoembryonic antigen and CA19-9. Tissue polypeptide antigen and ferritin were not recovered by neutralization in samples with pH less than 4.5, suggesting an irreversible damage of the immunologic characteristics of the two antigens. From the present data we conclude that an accurate validation of methods and a rigorous standardization of sample collection are mandatory for tumor marker determination by radioimmunoassay in gastric juice.
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Affiliation(s)
- M Gion
- Division of Radiotherapy and Nuclear Medicine, Regional General Hospital, Venezia, Italy
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Milano F, Munegato G, Fasolo F, Gracco L, Bortoletto A, Zotti EF. Psychoanalytic evaluation of a case study: does the colostomy reproduce the problems of childhood "anal phase"? J Enterostomal Ther 1987; 14:240-2. [PMID: 3693673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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