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Bellido-Luque J, Scammon-Duran A, Sanchez-Matamoros Martin I, Nogales-Muñoz AL, Morales-Conde S. Easy and reproducible minimally invasive colostomy ischaemia and parastomal hernia prevention after abdominoperineal resection - A video vignette. Colorectal Dis 2024. [PMID: 38503719 DOI: 10.1111/codi.16954] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/25/2024] [Accepted: 02/03/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Juan Bellido-Luque
- Hospital Universitario Virgen Macarena, University of Seville, Sevilla, Spain
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Bellido-Luque J, Bellido-Luque A, Gomez-Rosado JC, Gomez-Menchero J, Suarez-Grau JM, Licardie E, Tejada-Gomez A, Navarro-Morales L, Moreno-Suero F, Sanchez-Matamoros I, Capitán-Morales L, Nogales Muñoz A, Morales-Conde S. Full endoscopic minimally invasive extraperitoneal modified Sugarbaker approach for para-colostomy hernia repair: Technical aspects and 2-year follow-up results of a prospective cohort. Colorectal Dis 2023; 25:2033-2042. [PMID: 37712246 DOI: 10.1111/codi.16734] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/11/2023] [Accepted: 07/09/2023] [Indexed: 09/16/2023]
Abstract
AIM This study aimed to assess technical aspects and clinical results of a new minimally invasive technique in parastomal hernia (PSH) repair, full endoscopic retromuscular access, after 2 years of follow-up. METHODS Data from consecutive patients requiring minimally invasive ventral PSH repair were collected from 2019 to 2022. The inclusion criteria were patients aged between 18 and 80 years old with symptomatic PSH. Demographics and perioperative and postoperative data were collected. Postoperative pain and functional recovery were compared with preoperative data. RESULTS Twelve patients with symptomatic PSH were included. The mean PSH defect area was 16.2 cm2 and the mean midline defect was 8.7 cm2 . No intra-operative complications or conversion to open surgery were detected. One patient (8%) required postoperative readmission due to partial bowel obstruction symptoms that required catheterization of the stoma. Pain significantly worsened after the first postoperative day compared to preoperative data but improved after the first postoperative month compared to the first postoperative week and after the 90th postoperative day compared to the first postoperative month, with significant differences. Significant restriction improvement was identified when 30 days after surgery data were compared to preoperative data and when the 180th postoperative day results were compared to 30 days after surgery. The average follow-up was 29 months. During the follow-up no clinical or radiological recurrence was observed. CONCLUSION This paper shows low rate of intra- and postoperative complications with significant improvement in terms of pain activities restriction compared to preoperatory. After 29 months follow-up, no recurrence was identified, confirming that this approach offers good mid-term results.
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Affiliation(s)
- Juan Bellido-Luque
- Minimally Invasive Surgery, QuironSalud Sagrado Corazón Hospital, Seville, Spain
- Gastrointestinal Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | | | | | - Julio Gomez-Menchero
- Minimally Invasive Surgery, QuironSalud Sagrado Corazón Hospital, Seville, Spain
| | | | - Eugenio Licardie
- Minimally Invasive Surgery, QuironSalud Sagrado Corazón Hospital, Seville, Spain
| | - Antonio Tejada-Gomez
- Minimally Invasive Surgery, QuironSalud Sagrado Corazón Hospital, Seville, Spain
| | | | | | | | | | - Angel Nogales Muñoz
- Gastrointestinal Surgical Department, Virgen Macarena Hospital, Seville, Spain
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Bellido-Luque J, Gomez-Rosado JC, Bellido-Luque A, Matamoros IS, Muñoz AN, Mompeán FO, Conde SM. Severe rectus diastasis with midline hernia associated in males: high recurrence in mid-term follow-up of minimally invasive surgical technique. Hernia 2022; 27:335-345. [PMID: 36454301 DOI: 10.1007/s10029-022-02706-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022]
Abstract
PROPOSE The present study aimed to assess clinical results, in terms of postoperative pain, functional recovery and recurrence rates of FESSA (Full Endoscopic Suprapubic Subcutaneous Access) technique compared to endoscopic anterior rectus sheaths plication and mesh, in male patients with midline ventral or incisional hernias and severe rectus diastasis (SRD) associated. Secondary aims were to identify intra- and postoperative complications associated with each technique. METHODS Male patients with midline ventral or incisional hernia and severe rectus diastasis were included in a prospectively maintained databased and retrospectively analyzed from January 2017 to December 2020. From January 2017 to January 2019, male patients underwent to anterior rectus sheaths plication (ARSP) (Control group). From January 2019 to December 2020, male patients underwent to FESSA technique (FT) (Case group). RESULTS 53 patients were finally included. 28 patients (52%) underwent to FT and 25 patients (48%) to ARSP. Regarding intraoperative complications, no significant differences were identified between the groups. Hospital stay was significantly improved in FT group when compared to ARSP group. No significant differences in terms of postoperative seroma or hematomas, were shown. FT group showed significantly less pain on 1st, 7th and 30th postoperative days than ARSP group. Functional recovery was significantly improved in FT group compared to ARSP group on the 30th day and no differences were observed on the 180th day after surgery. The mean follow-up was 17.3 ± 2.6 months in FT group and 24 ± 3 months in ARSP group. During the follow-up, 1(3%) and 9 (36%) diastasis recurrences were identified respectively, with significant differences in favor of FT group. CONCLUSION In males with SRD and symptomatic midlines hernias, ARSP with onlay mesh placement shows high diastasis recurrence rate in mid-term follow-up. We propose FESSA technique in those patients, which decreases the excessive midline tension, improving the postoperative pain, functional recovery and recurrence rate, without increasing postoperative complications.
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Affiliation(s)
- J Bellido-Luque
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain.
- Gastrointestinal Surgical Department, QuirónSalud Sagrado Corazón Hospital, Seville, Spain.
| | - J C Gomez-Rosado
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | - A Bellido-Luque
- Gastrointestinal Surgical Department, QuirónSalud Sagrado Corazón Hospital, Seville, Spain
| | - I Sanchez Matamoros
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | - A Nogales Muñoz
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | - F Oliva Mompeán
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | - S Morales Conde
- Gastrointestinal Surgical Department, QuirónSalud Sagrado Corazón Hospital, Seville, Spain
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Sánchez-Velázquez P, Pueyo-Périz E, Álamo JM, Suarez Artacho G, Gómez Bravo MÁ, Marcello M, Vicente E, Quijano Y, Ferri V, Caruso R, Dorcaratto D, Sabater L, González Chávez P, Noguera J, Navarro Gonzalo A, Bellido-Luque J, Téllez-Marques C, Ielpo B, Burdio F. Radiofrequency-assisted transection of the pancreas versus stapler in distal pancreatectomy: study protocol for a multicentric randomised clinical trial (TRANSPAIRE). BMJ Open 2022; 12:e062873. [PMID: 36332946 PMCID: PMC9639090 DOI: 10.1136/bmjopen-2022-062873] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION To date, no pancreatic stump closure technique has been shown to be superior to any other in distal pancreatectomy. Although several studies have shown a trend towards better results in transection using a radiofrequency device (radiofrequency-assisted transection (RFT)), no randomised trial for this purpose has been performed to date. Therefore, we designed a randomised clinical trial, with the hypothesis that this technique used in distal pancreatectomies is superior in reducing clinically relevant postoperative pancreatic fistula (CR-POPF) than mechanical closures. METHODS AND ANALYSIS TRANSPAIRE is a multicentre randomised controlled trial conducted in seven Spanish pancreatic centres that includes 112 patients undergoing elective distal pancreatectomy for any indication who will be randomly assigned to RFT or classic stapler transections (control group) in a ratio of 1:1. The primary outcome is the CR-POPF percentage. Sample size is calculated with the following assumptions: 5% one-sided significance level (α), 80% power (1-β), expected POPF in control group of 32%, expected POPF in RFT group of 10% and a clinically relevant difference of 22%. Secondary outcomes include postoperative results, complications, radiological evaluation of the pancreatic stump, metabolomic profile of postoperative peritoneal fluid, survival and quality of life. Follow-ups will be carried out in the external consultation at 1, 6 and 12 months postoperatively. ETHICS AND DISSEMINATION TRANSPAIRE has been approved by the CEIM-PSMAR Ethics Committee. This project is being carried out in accordance with national and international guidelines, the basic principles of protection of human rights and dignity established in the Declaration of Helsinki (64th General Assembly, Fortaleza, Brazil, October 2013), and in accordance with regulations in studies with biological samples, Law 14/2007 on Biomedical Research will be followed. We have defined a dissemination strategy, whose main objective is the participation of stakeholders and the transfer of knowledge to support the exploitation of activities. REGISTRATION DETAILS ClinicalTrials.gov Registry (NCT04402346).
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Affiliation(s)
- Patricia Sánchez-Velázquez
- Department of Surgery, Hospital del Mar, Barcelona, Spain
- Department of Surgery, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Eva Pueyo-Périz
- Department of Surgery, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - J M Álamo
- Department of Surgery, University Hospital Virgen del Rocío, Sevilla, Spain
| | | | | | - Manuel Marcello
- Department of Surgery, Alcorcon Hospital Foundation, Alcorcon, Spain
| | - Emilio Vicente
- Department of Surgery, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Yolanda Quijano
- Department of Surgery, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Valentina Ferri
- Department of Surgery, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Riccardo Caruso
- Department of Surgery, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Dimitri Dorcaratto
- Liver, Biliary and Pancreatic Unit, Department of General Surgery. Biomedical Research Institute INCLIVA, Hospital Clínico Valencia, Valencia, Spain
| | - Luis Sabater
- Liver, Biliary and Pancreatic Unit, Department of General Surgery. Biomedical Research Institute INCLIVA, Hospital Clínico Valencia, Valencia, Spain
| | | | - Jose Noguera
- Hospital Juan Canalejo de La Coruña, A Coruña, Spain
| | | | | | | | - Benedetto Ielpo
- Department of Surgery, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Parc Salut Mar Hospital, Barcelona, Spain
| | - Fernando Burdio
- Department of Surgery, Hospital del Mar Medical Research Institute, Barcelona, Spain
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Bellido-Luque J, Licardie E, Sanchez-Matamoros I, García Reyes A, Bellido Luque A, Nogales Muñoz A, Tejada Gomez A, Morales S. V-017 TOTALLY ENDOSCOPIC APPROACH TO MODIFIED SUGARBAKER PARASTOMAL HERNIA REPAIR BY TRANSVERSUS ABDOMINIS RELEASE (ETEP-PAULí). ADVANTAGES OF RETROMUSCULAR/PREPERITONEAL MESH PLACEMENT. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.269] [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: 11/12/2022]
Abstract
Abstract
Several studies published have shown that TAR is an effective technique for reconstructing midline hernias and lateral hernias. In 2016, Pauli et al. described a novel technique for parastomal hernioplasty using open TAR combined with a modified Sugarbaker repair.A 56-year-old woman operated on 5 years earlier due to rectum adenocarcinoma by laparoscopic resection. A parastomal hernia was diagnosed. CT revealed a 5 cm wide parastomal hernia associated with an umbilical hernia.Patient is placed in the supine position. Identification by ultrasound of the lateral junction of right rectus sheaths. incision on subcostal region 1 cm medial to said juntion. An incision is made on the anterior lamina and retromuscular space is created with a dissection balloon. With the placement of two 11–5 trocars, the medial aspect of the posterior rectus sheath muscle is incised at the epigastric level and the Crossover is carried out. Left retromuscular dissection is performed. The hernia content is reduced. the left arcuate ligament is identified and the transverse abdominis muscle is released.
Anterior defect closure with barded suture. An horizontal peritoneal incision is performed with the aim of lateralizing the colonic stump, the peritoneum and posterior aspect of the rectum sheath are closed.Placement of PPL mesh of 25×30 cms covering the dissected space.Patient was discharged on postoperative day 2. No complications or hernia recurrence were identified.
Conclusions
This technique offers some advantages; Coated mesh is unnecessary,The retromuscular positioning permits the integration on both sides.However several drawbacks; lack of long-term outcomes and technically challenge.
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Affiliation(s)
- J Bellido-Luque
- Gastrointestinal Surgical Department , Quironsalud Sagrado Corazón, Seville , Spain
| | - E Licardie
- Gastrointestinal Surgical Department , Quironsalud Sagrado Corazón, Seville , Spain
| | - I Sanchez-Matamoros
- Gastrointestinal Surgical Department, virgen Macarena universitary Hospital , Seville , Spain
| | - A García Reyes
- Gastrointestinal Surgical Department, virgen Macarena universitary Hospital , Seville , Spain
| | - A Bellido Luque
- Gastrointestinal Surgical Department , Quironsalud Sagrado Corazón, Seville , Spain
| | - A Nogales Muñoz
- Gastrointestinal Surgical Department, virgen Macarena universitary Hospital , Seville , Spain
| | - A Tejada Gomez
- Gastrointestinal Surgical Department , Quironsalud Sagrado Corazón, Seville , Spain
| | - S Morales
- Gastrointestinal Surgical Department , Quironsalud Sagrado Corazón, Seville , Spain
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Bellido-Luque J, Licardie E, Gomez Rosado JC, Sanchez-Matamoros I, Nogales Muñoz A, Tejada Gomez A, Bellido Luque A, Morales S. P-097 MINIMALLY INVASIVE REPAIR IN SEVERE RECTUS DIASTASIS WITH MIDLINE HERNIA ASSOCIATED IN MALES SHOWS HIGH RECURRENCE IN MID-TERM FOLLOW-UP. CASE-CONTROL STUDY. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.195] [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
Endoscopic plication could develop excessive midline tension that could increase recurrence rate in patients with severe rectus diastasis (SRD). New minimally invasive endoscopic repair (FESSA technique)(FT) was proposed to corrects both pathologies. Aim: assess clinical results, postoperative pain, functional recovery and recurrence of FT compared to endoscopic anterior rectus sheaths plication and mesh (ARSP).
Patients and Methods
male patients with ventral/incisional hernia and SRD were included. 2017–2019 patient underwent to ARSP. 2019–2020 patients underwent to FT. data: Defect and diastasis width and length. Surgical results: Operation time, Intraoperative complications, Hospital stay,Postoperative complications,Pain on 1th/7th/30th days, Functional recovery, Hernia recurrence. Statistic variables were compared using nonparametric tests.
Results
53 patients were included. 28 patients underwent FT and 25 to ARSP. operative time: 70 +/-9 min in FT, 55+/- 7 min in ARSP with significant differences.Hospital stay:1.4+/- 0,5 days for FT and 2,08+/-0,5 for ARSP with significant differences. one postoperative subcutaneous hematoma, requiring surgical removal (2%) in ARSP. Pain at postoperative day 1:21+/2 in FT and 25 +/-2 in ARSP without differences. Pain after 7 and 30 days,significant improvement were shown in favor of FT. functional recovery at 1 month: 17,8 +/-2,4 in FT and 27,8 +/-3,3 in ARSP with significant improvement in FT. recurrence after 24 months: 1 patient in FT (3.6%) and 9 patient in ARSP(36.0%) with significant differences.
Conclusions
Minimally invasive endoscopic Anterior rectus sheaths plication with mesh in SRD and midline hernias, shows higher recurrence rate, postoperative pain and worse functional recovery due to probably excessive midline tension.
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Affiliation(s)
- J Bellido-Luque
- Gastrointestinal Surgical Department , Quironsalud Sagrado Corazón, Seville , Spain
| | - E Licardie
- Gastrointestinal Surgical Department , Quironsalud Sagrado Corazón, Seville , Spain
| | - J C Gomez Rosado
- Gastrointestinal Surgical Department, virgen Macarena universitary Hospital , Seville , Spain
| | - I Sanchez-Matamoros
- Gastrointestinal Surgical Department, virgen Macarena universitary Hospital , Seville , Spain
| | - A Nogales Muñoz
- Gastrointestinal Surgical Department, virgen Macarena universitary Hospital , Seville , Spain
| | - A Tejada Gomez
- Gastrointestinal Surgical Department , Quironsalud Sagrado Corazón, Seville , Spain
| | - A Bellido Luque
- Gastrointestinal Surgical Department , Quironsalud Sagrado Corazón, Seville , Spain
| | - S Morales
- Gastrointestinal Surgical Department , Quironsalud Sagrado Corazón, Seville , Spain
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