1
|
Manyalich-Blasi M, Domínguez-Garijo P, Saavedra-Pérez D, Sánchez-Izquierdo N, Casanueva Eliceiry S, Perissinotti A, Mora Porta M, de Hollanda A, Hanzu FA, López-Boado Serrat MA, Rull Ortuño AR, Ardid J, Vidal-Sicart S, Vidal Pérez Ò. Comparison of [ 18F]fluorocholine PET/CT with [ 99mTc]sestamibi and ultrasonography to detect parathyroid lesions in primary hyperparathyroidism: a prospective study. Gland Surg 2022; 11:1764-1771. [PMID: 36518798 PMCID: PMC9742049 DOI: 10.21037/gs-22-198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/25/2022] [Accepted: 08/31/2022] [Indexed: 03/07/2024]
Abstract
BACKGROUND Primary hyperparathyroidism is a common endocrine disorder produced by the increase of parathyroid hormone (PTH) due to a benign adenoma of a single parathyroid gland, or as multiple gland hyperplasia, or as a rare malignant tumor. Preoperative imaging scans are frequently necessary for the minimally invasive parathyroidectomies to identify the location of enlarged parathyroid glands and to design the procedure. METHODS The diagnostic reliability of [18F]fluorocholine positron emission tomography/computed tomography (FCH PET/CT), [99mTc]sestamibi [multiplexed ion beam imaging (MIBI)] and cervical ultrasonography was analyzed in 37 patients diagnosed with primary hyperparathyroidism undergoing minimally invasive parathyroidectomy. The three preoperative imaging techniques were correlated with intraoperative and histopathological findings as well as changes in biochemical parameters (serum PTH and calcium levels). Statistical analysis was carried out with SPSS version 24.0. RESULTS In 30 of 37 patients (81.1%), FCH PET/CT correctly localized the pathological gland. In 3 cases of ectopic adenomas, the accuracy of the techniques was 100% (3/3) for FCH PET/CT, 66.7% (2/3) for MIBI, and 33.3% (1/3) for neck ultrasonography. Neither neck ultrasonography nor MIBI were able to locate pathological parathyroid glands in those patients with multiglandular disease, while FCH PET/CT correctly located one patient (1/3, 33.3%) with two adenomas and 3 patients (3/6, 50.0%) with hyperplasia. The three imaging techniques, FCH PET/CT, MIBI and neck ultrasound yielded a sensitivity of 92.1%, 57.9% and 32.4%, a positive predictive value of 94.6%, 84.6% and 78.6%, and a diagnostic accuracy of 96.4%, 85.7% and 79.0%, respectively. CONCLUSIONS In this group of patients diagnosed with primary hyperparathyroidism, FCH PET/CT was superior to MIBI and neck ultrasound in detecting adenomas, particularly in the presence of ectopic glands or multiglandular disease.
Collapse
Affiliation(s)
- Marti Manyalich-Blasi
- Service of General and Digestive Surgery, Institute Clinic of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Paula Domínguez-Garijo
- Service of General and Digestive Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - David Saavedra-Pérez
- Service of General and Digestive Surgery, Consorci Sanitari Alt Penedès-Garraf, Alt Penedès, Spain
| | | | | | - Andrés Perissinotti
- Nuclear Medicine Department, Hospital Clínic Barcelona & Biomedical Research Networking Center of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Mireia Mora Porta
- Department of Endocrinology and Nutrition, Hospital Clinic de Barcelona, Group of Endocrine Disorders, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedad Metabólicas Asociadas (CIBERDEM), Universitat de, Barcelona, Spain
| | - Ana de Hollanda
- Department of Endocrinology and Nutrition, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain
| | - Felicia A. Hanzu
- Department of Endocrinology and Nutrition, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedad Metabólicas Asociadas (CIBERDEM), Universitat de Barcelona, Barcelona, Spain
| | - Miquel A. López-Boado Serrat
- Service of General and Digestive Surgery, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Antonio R. Rull Ortuño
- Service of General and Digestive Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Ardid
- Service of General and Digestive Surgery, Institute Clinic of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Òscar Vidal Pérez
- Service of General and Digestive Surgery, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
Hidalgo NJ, Bachero I, Hoyuela C, Juvany M, Ardid J, Martrat A, Guillaumes S. The transition from open to laparoscopic surgery for bilateral inguinal hernia repair: how we did it. Langenbecks Arch Surg 2022; 407:3701-3710. [PMID: 36070031 DOI: 10.1007/s00423-022-02671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the transition process from open repair (OR) to laparoscopic repair (LR) of bilateral inguinal hernia in a small basic general hospital METHODS: We describe the technical details and training strategy used to facilitate the transition to systematic LR of bilateral inguinal hernia. We conducted a retrospective analysis of prospectively collected data from all patients undergoing bilateral inguinal hernia repair between January 2017 and December 2020. We analysed the evolution of LR and compared the surgical outcomes: complications, acute pain (24 h), chronic pain (> 3 months), and recurrence (1 year) of the patients operated on by OR and LR. RESULTS We performed 132 bilateral inguinal hernia repairs, 55 (41.7%) ORs, and 77 (58.3%) LRs. A significant difference was observed in the choice of LR over time (2017: 9%, 2018: 32%, 2019: 75%, 2020: 91%, p < 0.001). The mean operative time was shorter in the OR group than in the LR group (56 min vs. 108 min, p < 0.001). However, the operative time of the LR decreased over the years. No significant differences were observed in complications or recurrence. LR was associated with lower acute postoperative pain at 24 h (2.2 vs. 3.1 points, p = 0.021) and lower chronic groin pain than OR (1.3% vs. 12.7%, p = 0.009). CONCLUSION A structured and systematized training process made the transition from OR to LR of bilateral inguinal hernias feasible and safe in a small basic general hospital. This transition did not increase complications or recurrence. Additionally, LR was associated with a decrease in postoperative pain and chronic groin pain.
Collapse
Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carlos Hoyuela
- Department of Surgery, Hospital de Mollet, Mollet, Spain
| | - Montserrat Juvany
- Department of Surgery, Hospital General Granollers, Granollers, Spain
| | - Jordi Ardid
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Antoni Martrat
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
| |
Collapse
|
3
|
Hoyuela C, Guillaumes S, Veres A, Hidalgo N, Juvany M, Ardid J, Martrat A, Bachero I, Cano M. O19 5-YEAR OUTCOMES OF A RANDOMIZED CLINICAL TRIAL OF MESH FIXATION WITH CYANOACRYLATE OR SUTURES FOR LICHTENSTEIN HERNIA REPAIR: RECURRENCE, CHRONIC PAIN AND QUALITY OF LIFE. Br J Surg 2021. [DOI: 10.1093/bjs/znab396.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
To assess the 5-year outcomes of mesh fixation with cyanoacrylate or sutures for Lichtenstein hernioplasty (recurrence rate, chronic pain, and patient’s quality of life (QoL).
Methods
370 patients who underwent Lichtenstein hernia repair were randomized to receive either cyanoacrylate or non-absorbable sutures for lightweight polypropylene mesh fixation. Postoperative outcomes were evaluated by an independent blinded observer. QoL was assessed using the EuraHS-QoL questionnaire (European Registry for Abdominal Wall Hernias).
Results
Initially 188 patients received Glue and 182 Suture. Mean follow-up: 72.6±7.8 months. 78.1% patients (Glue:147,Suture:142) completed 5-years follow-up. No significant differences were observed in terms of chronic pain. VAS score≥3: 8.1% vs 9.1%, Glue vs. Suture, respectively (P = 0.836). 8 patients (2.7%) (4 in each group) reported pain at rest, reaching 10.7% when analyzing pain during activity.
QoL was unaffected (EHS-QoL score=0) in the majority of patients: 131 (89.2%) vs. 127 (89.5%) for Glue or Suture respectively (p = 0.930). QoL-score greater than 20/90 points: 2 patients (Glue) vs. 6 (Suture) (p = 0.099). The Suture group QoL-score was higher in all domains but without statistical significance. Foreign body sensation was slightly higher in Suture group (7.5% vs. 9.3%) but without reaching statistical significance (p = 0.534). There were no differences in the recurrence rate (2.6% vs. 3.8% for Glue and Suture respectively) (p = 0533).
Conclusions
Chronic discomfort rate after Lichtenstein hernioplasty is not negligible. Atraumatic mesh fixation with glue was quicker and resulted in less acute postoperative pain than sutures for Lichtenstein hernia repair, but with no statistical differences in terms of chronic pain nor the long-term patients’ QoL.
Collapse
Affiliation(s)
- Carlos Hoyuela
- Hospital Mollet Barcelona, Universitat Internacional de Catalunya, Dept. of General and Digestive Surgery, Mollet del Vallés - Barcelona, Spain
| | | | | | | | | | | | | | | | - Manuel López Cano
- Hospital Vall D'hebron, Abdominal Wall Surgery Unit, Barcelona, Spain
| |
Collapse
|
4
|
Juvany M, Guillaumes S, Hoyuela C, Bachero I, Trias M, Ardid J, Martrat A. Results of a Prospective Cohort Study on Open Rives Technique of the Midline Incisional Hernia: Midline Closure and Mesh Overlap. Surg Innov 2021; 29:321-328. [PMID: 34275369 DOI: 10.1177/15533506211033137] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/16/2022]
Abstract
Background. Rives repair has been traditionally used for large abdominal wall defects with good results on terms of recurrence. However, it is limited by the lateral border of the posterior rectus sheath. The objective of our study was to evaluate recurrence rate, midline closure and mesh overlap in patients operated on elective midline incisional hernia by open Rives retromuscular repair. Methods. This is a prospective observational study of 83 patients who underwent elective open Rives technique between January 2014 and December 2018. Main inclusion criteria were adults with a midline incisional hernia. Recurrence, midline closure and mesh overlap were determined. Results. At a median postoperative follow-up of 32 (5-59) months, 8 cases of recurrence were reported. Patients with recurrence had wider hernia defects (101 ± 52 mm vs 66 ± 36 mm, P = .014) and were repaired with wider meshes (191 ± 93 mm vs 137 ± 68 mm, P = .042). However, although it was not statistically significant, midline closure was lower (38% vs 59%), as well as the overlapping relationship between mesh area and hernia defect area (2.937:1 vs 3.732:1) on patients that developed a recurrence. Conclusions. Rives technique provides good mid-term results in a midline incisional hernia (10% of recurrence at 36 months), including wider hernias in the recurrent cohort. The authors believe that other techniques which allow midline closure and placement of bigger meshes should be considered, especially in those hernias classified as W3 on EuraHS classification (more than 10 cm on width size).
Collapse
Affiliation(s)
- Montserrat Juvany
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| | - Salvador Guillaumes
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| | - Carlos Hoyuela
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| | - Irene Bachero
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| | - Miguel Trias
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| | - Jordi Ardid
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| | - Antoni Martrat
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| |
Collapse
|
5
|
Guillaumes S, Hoyuela C, Hidalgo NJ, Juvany M, Bachero I, Ardid J, Martrat A, Trias M. Correction to: Inguinal hernia repair in Spain. A population-based study of 263,283 patients: factors associated with the choice of laparoscopic approach. Hernia 2021; 25:1407-1408. [PMID: 33904999 DOI: 10.1007/s10029-021-02421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- S Guillaumes
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain.
| | - C Hoyuela
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - N J Hidalgo
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - M Juvany
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - I Bachero
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - J Ardid
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - A Martrat
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - M Trias
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| |
Collapse
|
6
|
Guillaumes S, Hoyuela C, Hidalgo NJ, Juvany M, Bachero I, Ardid J, Martrat A, Trias M. Inguinal hernia repair in Spain. A population-based study of 263,283 patients: factors associated with the choice of laparoscopic approach. Hernia 2021; 25:1345-1354. [PMID: 33837883 DOI: 10.1007/s10029-021-02402-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of this study is to evaluate the laparoscopic inguinal hernia repair (IHR) rate in Spain and identify the factors associated with the choice of this surgical approach. METHODS A retrospective cohort study of 263,283 patients who underwent IHR from January 2016 to December 2018 was conducted. Data were extracted from the Spanish Minimum Basic Data Set (MBDS) of the Health Ministry database. The primary outcome was laparoscopic (LAP) rate utilization. Univariate analysis and multivariable logistic regression analysis were performed to identify factors associated with LAP-IHR. RESULTS Only 5.7% (15,059) patients underwent LAP-IHR, whereas the remnant 94.3% (248,224 patients) underwent open repair. High variability in the LAP-IHR rate across the country was observed; ranged between provinces from 0 to 19.7%, for a unilateral hernia, and between 0 to 57.4% in the case of bilateral hernias. On multivariate logistic regression analysis, the patient place of residence was the most remarkable factor associated with the likelihood of receiving LAP-IHR (OR 4.96; p < 0.001). There were also significant differences favoring LAP-IHR for bilateral operation (OR 4.596; p < 0.001), insurance coverage (OR 4.439, p < 0.001) and self-pay patients (OR 2.317; p < 0.001), as well as a recurrent hernia (OR 1.780; p < 0.001), age younger than 65 years (OR 1.555; p < 0.001) and male sex (OR 1.162, p < 0.001). CONCLUSION LAP-IHR remains a not frequent choice among surgeons in Spain, even when dealing with recurrent and bilateral hernias. The results suggest that the choice of LAP-IHR could depend on the surgeon's preference rather than on the indication appropriateness.
Collapse
Affiliation(s)
- S Guillaumes
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain.
| | - C Hoyuela
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - N J Hidalgo
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - M Juvany
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - I Bachero
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - J Ardid
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - A Martrat
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - M Trias
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| |
Collapse
|
7
|
Hoyuela C, Juvany M, Guillaumes S, Ardid J, Trias M, Bachero I, Martrat A. Long-term incisional hernia rate after single-incision laparoscopic cholecystectomy is significantly higher than that after standard three-port laparoscopy: a cohort study. Hernia 2019; 23:1205-1213. [DOI: 10.1007/s10029-019-01969-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/28/2019] [Indexed: 02/06/2023]
|
8
|
Juvany M, Hoyuela C, Trias M, Carvajal F, Ardid J, Martrat A. Impact of Surgical Site Infections on Elective Incisional Hernia Surgery: A Prospective Study. Surg Infect (Larchmt) 2018; 19:339-344. [PMID: 29437528 DOI: 10.1089/sur.2017.233] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Although incisional hernia repair is classified as a clean surgery, it still has a high incidence of surgical site infection (SSI) (0.7%-26.6%). The presence of an SSI could increase early recurrence rates after incisional hernia repair. PATIENTS AND METHODS Patients undergoing elective incisional hernia repair with no bowel contamination between January and December 2015 were assessed prospectively. Demographic and surgical data, local post-operative complications, and one-year recurrence rates in patients with and without SSI were compared. The management of SSI was determined. RESULTS Patients with SSI (16/101) showed more prolonged surgical procedures (91 ± 39 vs. 63 ± 30 min, p = 0.012), more post-operative sero-hematomas (38% vs. 8%, p = 0.001), and a higher one-year recurrence rate (19% vs. 4%, p = 0.047). Multivariable analysis revealed the only identified risk factor for SSI to be post-operative sero-hematomas (p = 0.042; odds ratio [OR] = 4.17 [1.05-16.54]). Patients who developed an SSI required antibiotic agents and daily treatment from one to five months. One of these required the removal of the mesh. CONCLUSIONS Surgical site infection rates are high for incisional hernia surgery (16%), and associated with local complications. Surgical site infection requires long-term treatments and leads to a higher one-year recurrence rate.
Collapse
Affiliation(s)
- Montserrat Juvany
- General and Digestive Surgery Department, Hospital Plató , Barcelona, Spain
| | - Carlos Hoyuela
- General and Digestive Surgery Department, Hospital Plató , Barcelona, Spain
| | - Miguel Trias
- General and Digestive Surgery Department, Hospital Plató , Barcelona, Spain
| | - Fernando Carvajal
- General and Digestive Surgery Department, Hospital Plató , Barcelona, Spain
| | - Jordi Ardid
- General and Digestive Surgery Department, Hospital Plató , Barcelona, Spain
| | - Antoni Martrat
- General and Digestive Surgery Department, Hospital Plató , Barcelona, Spain
| |
Collapse
|
9
|
Juvany M, Hoyuela C, Carvajal F, Trias M, Martrat A, Ardid J. Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life. Hernia 2018; 22:319-324. [DOI: 10.1007/s10029-018-1730-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/04/2018] [Indexed: 12/21/2022]
|
10
|
Hoyuela C, Juvany M, Trias M, Ardid J, Martrat A. Incisional hernia prevention using a cyanoacrilate-fixed retrofascial mesh. Cir Esp 2017; 96:35-40. [PMID: 29249278 DOI: 10.1016/j.ciresp.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 05/03/2017] [Revised: 10/24/2017] [Accepted: 10/28/2017] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The rate of incisional hernia in high-risk patients (obesity, cancer, etc.) is high, even in laparoscopic surgery. The aim of this study is to evaluate the safety of the use of cyanoacrylate fixed prophylactic meshes in the assistance incision in overweight or obese patients undergoing laparoscopic colorectal surgery. METHODS A prospective, non-randomized cohort study of patients undergoing elective laparoscopic resection for colorectal cancer between January 2013 and March 2016 was performed. Those with a body mass index greater than 25kg / m2 were evaluated to implant a prophylactic meshes fixed with cyanoacrylate (Histoacryl®) as reinforcement of the assistance incision. RESULTS 52 patients were analyzed (mean body mass index: 28.4±2kg / m 2). Prophylactic meshes was implanted in 15 patients. The time to put the mesh in place was always less than 5minutes. There was no significant difference in wound infection rate (12% vs. 10%). No mesh had to be explanted. Although the mean follow-up was shorter (14.1±4 vs. 22.3±9 months), there were no incisional hernia in the mesh group. On the other hand, in the non-mesh group, 1 acute evisceration (2.7%) and 4 incisional hernia of the assistance incision were observed (10.8%). There were no significant differences between groups regarding trocar incisional hernia (6.6 vs. 5.4%). CONCLUSIONS The implantation of a reinforcement prophylactic mesh in overweight or obese patients undergoing laparoscopic colorectal surgery is safe and seems to reduce the short-term rate of incisional hernia. Fixation with cyanoacrylate is a rapid method that facilitates the procedure without additional complications.
Collapse
Affiliation(s)
- Carlos Hoyuela
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Montserrat Juvany
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Trias
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jordi Ardid
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Antoni Martrat
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| |
Collapse
|
11
|
Hoyuela C, Juvany M, Carvajal F, Veres A, Troyano D, Trias M, Martrat A, Ardid J, Obiols J, López-Cano M. Randomized clinical trial of mesh fixation with glue or sutures for Lichtenstein hernia repair. Br J Surg 2017; 104:688-694. [PMID: 28218406 DOI: 10.1002/bjs.10488] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 09/20/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pain is the most likely reason for delay in resuming normal activities after groin hernia repair. The primary aim of this study was to determine whether the use of glue to fix the mesh instead of sutures reduced acute postoperative pain after inguinal hernia repair. Secondary objectives were to compare postoperative complications, chronic pain and early recurrence rates during 1-year follow-up. METHODS Some 370 patients who underwent Lichtenstein hernia repair were randomized to receive either glue (Histoacryl®) or non-absorbable polypropylene sutures for fixation of lightweight polypropylene mesh. Postoperative complications, pain and recurrence were evaluated by an independent blinded observer. RESULTS Postoperative pain at 8 h, 24 h, 7 days and 30 days was less when glue was used instead of sutures for all measures (P < 0·001). The operation was significantly quicker using glue (mean(s.d.) 35·3(8·7) min versus 39·9(11·1) min for sutures; P < 0·001). There were no significant differences between the groups in terms of postoperative complications, chronic pain and early recurrence at 1-year follow-up. CONCLUSION Atraumatic mesh fixation with glue was quicker and resulted in less acute postoperative pain than sutures for Lichtenstein hernia repair. Registration number: NCT02632097 (http://www.clinicaltrials.gov).
Collapse
Affiliation(s)
- C Hoyuela
- Department of General and Digestive Surgery, Hospital Platón, Barcelona, Spain
| | - M Juvany
- Department of General and Digestive Surgery, Hospital Platón, Barcelona, Spain
| | - F Carvajal
- Department of General and Digestive Surgery, Hospital Platón, Barcelona, Spain
| | - A Veres
- Department of Surgery, Hospital de la Cerdanya, Puigcerdà, Spain
| | - D Troyano
- Department of General and Digestive Surgery, Hospital Platón, Barcelona, Spain
| | - M Trias
- Department of General and Digestive Surgery, Hospital Platón, Barcelona, Spain
| | - A Martrat
- Department of General and Digestive Surgery, Hospital Platón, Barcelona, Spain
| | - J Ardid
- Department of General and Digestive Surgery, Hospital Platón, Barcelona, Spain
| | - J Obiols
- Department of General and Digestive Surgery, Hospital Platón, Barcelona, Spain
| | - M López-Cano
- Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
12
|
Hoyuela C, Ardid J, Martrat A, Obiols J, Guillaumes S. Hemicolectomía derecha laparoscópica por incisión única por carcinoma de colon: técnica quirúrgica y resultados preliminares. Cir Esp 2011; 89:551-3. [DOI: 10.1016/j.ciresp.2010.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 08/18/2010] [Accepted: 08/26/2010] [Indexed: 11/17/2022]
|
13
|
Fernández-Cruz L, Olvera C, Lozano-Salazar RR, Bollo J, Ardid J, López-Boado MA. Neuroendocrine pancreatic tumors: the laparoscopic approach. Eur Surg 2006. [DOI: 10.1007/s10353-006-0290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
14
|
Abstract
Laparoscopic adrenalectomy has recently been shown to be a safe and effective procedure for treating a variety of benign adrenal tumors. Advanced age, with its concomitant comorbid conditions, has been believed to be associated with more postoperative complications in laparoscopic procedures. The purpose of this study was to evaluate the outcome of laparoscopic adrenalectomy in patients age 65 and older. From June 1992 to February 1998, 14 patients (4 men and 10 women) with a mean age of 69 years underwent 17 laparoscopic adrenalectomies. In 12 procedures, a transperitoneal lateral decubitus flank approach was used. The lesion was a nonfunctioning adenoma in three patients, aldosterone adenoma in four, Cushing's syndrome in four, and pheochromocytoma in one. A retroperitoneal lateral decubitus approach was used in five procedures. The lesion was a nonfunctioning adenoma in one patient, aldosterone adenoma in one, Cushing's adenoma in one, and pheochromocytoma in two. Seventy-eight percent of these patients had comorbid conditions, including hypertension, diabetes, chronic obstructive airway disease, coronary artery disease, and cardiac dysrhythmia. The preoperative physical status was as ASA Class II in 11 patients and ASA III in 3. Two of the 17 laparoscopies were converted to open surgery (11%), in one because of difficulties in dissecting extraperitoneally a mass >8 cm, and in the other because of difficulties in localization of a 3-cm mass. The median surgical time was 95 +/- 33 minutes. The mean analgesia requirements were 3 doses of (range 2-7) ketorolac. There were no deaths. Postoperative morbidity consisted of pulmonary atelectasis in one patient and urinary tract infection in two patients. The median hospital stay was 3 days (range 2-4 days). We conclude that laparoscopic adrenalectomy in the elderly population is safe and offers low morbidity, fast recovery, and a short hospital stay. Age alone should not be a contraindication to treating adrenal tumors laparoscopically.
Collapse
Affiliation(s)
- J Kuriansky
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel.
| | | | | | | | | | | |
Collapse
|
15
|
Abstract
BACKGROUND Mirizzi's syndrome (MS) is an unusual cause of obstructive jaundice. It can mimic bile duct cancer, and the role of laparoscopic surgery is not well defined. The aim of this paper is to report five cases and describe the pitfalls encountered in its diagnosis and treatment with a laparoscopic approach. METHODS From January 1992 to January 1996, five cases of MS out of 560 patients with gallstones prospectively treated and recorded were found (0.9%). RESULTS There were two men and three women, (mean age: 54 years [30-93]). In one case diagnosis of bile duct carcinoma was established but surgery revealed MS. Four cases were approached by laparoscopy, but all of them were converted: in two, due to a distorted anatomy, in a third due in the difficulty of visualizing the distal end of the bile duct, and in the last case due to the impossibility of retrieving the stones. All were treated with a cholecochorrhaphy over a T tube, except one, in which a hepaticojejunostomy was performed. Morbidity and mortality were nil, and they remain asymptomatic after a mean follow-up of 19 months (3-36). CONCLUSIONS MS constitutes an important laparoscopic challenge, both to clearance of duct stones and to the proper reconstruction of the biliary duct. A prudent policy is to perform a dissection trial and convert if local conditions are not clear for an experienced laparoscopic surgeon.
Collapse
Affiliation(s)
- E M Targarona
- Service of General and Digestive Surgery, University of Barcelona, Spain
| | | | | | | | | |
Collapse
|