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Discussion to: Paraconduit hernia following esophagectomy: Is it safe to watch and wait? J Thorac Cardiovasc Surg 2024; 167:1638-40. [PMID: 38441516 DOI: 10.1016/j.jtcvs.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Indexed: 04/15/2024]
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Cheng L, Lashmanova N, Reddy SB, Yan L, Gattuso P. Histopathological Findings in Hernia Sacs: A Clinical and Pathological Review. Int J Surg Pathol 2024; 32:310-315. [PMID: 37291883 DOI: 10.1177/10668969231177706] [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] [Indexed: 06/10/2023]
Abstract
Routine histopathological examination of hernia sac in adults remains a controversial topic. We undertook a retrospective study to assess possible clinical benefits of pathological examination of hernia sac specimens. Our pathology database between 1992 and 2020 was searched for adult specimens submitted as hernia sac. The clinical and pathological data of patients with abnormal histopathological findings were reviewed. There were 5424 hernia sac specimens (3722 inguinal, 1625 umbilical, and 77 femoral), 32/5424 (0.59%) with malignancies (28 epithelial and 4 lymphoid) and 25/32 were located in the umbilical region. Twelve out of twenty-five malignancies (48%) presented as primary clinical manifestations of the diseases (5 GI tract carcinomas, 5 gynecological tract carcinomas, and 2 lymphoid neoplasms); and 13/25 (52%) specimens were involved by previously known tumors (8 gynecological carcinomas, 3 colon carcinomas, 1 breast carcinoma, and 1 lymphoma). Among the 7 inguinal hernia sacs with malignancies, 3 (42.9%) were primary presentations of the tumors (2 prostatic carcinomas, 1 pancreatic carcinoma), and 4 (57.1%) were previously known tumors (2 ovarian carcinomas, 1 colon carcinoma, 1 lymphoid). Benign lesions were 12/5424 (0.22%), including 7 adrenal rests, 4 endometriosis, and 1 inguinal sarcoidosis. The incidence of hernia sacs with malignancies was 32/5424 (0.59%), most commonly from nearby organs in gynecological tract. However distant metastases from breast were also present. Near half of the hernia sac with malignancies (15/32, 47%) presented as the first clinical manifestation. Routine histopathological examination of hernia sac in adults is recommended, since it may provide important clinical information.
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Affiliation(s)
- Lin Cheng
- Department of Pathology, Rush University Medical Center, Chicago, USA
| | | | - Swathi B Reddy
- Department of Surgery, Rush University Medical Center, Chicago, USA
| | - Lei Yan
- Department of Pathology, Rush University Medical Center, Chicago, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, USA
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Ruli T, Weber F, Baldwin N. Cough With a Pop: A Rare Case of Acquired Abdominal Intercostal Hernia. Am J Gastroenterol 2024; 119:606. [PMID: 38146870 DOI: 10.14309/ajg.0000000000002643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Affiliation(s)
- Thomas Ruli
- Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Frederick Weber
- Division of Gastroenterology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nicholas Baldwin
- Division of Gastroenterology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Schattner A, Dubin I, Glick Y. Cystocele - An Underappreciated Cause of Severe Obstructive Uropathy. Am J Med 2024; 137:e71-e72. [PMID: 38280561 DOI: 10.1016/j.amjmed.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/29/2024]
Affiliation(s)
- Ami Schattner
- Department of Medicine, Laniado University Hospital, Sanz Medical Center, Netanya, Israel; Adelson Medical School, Ariel University, Ariel, Israel; Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
| | - Ina Dubin
- Department of Medicine, Laniado University Hospital, Sanz Medical Center, Netanya, Israel; Adelson Medical School, Ariel University, Ariel, Israel
| | - Yair Glick
- Adelson Medical School, Ariel University, Ariel, Israel; Department of Imaging, Laniado University Hospital, Sanz Medical Center, Netanya, Israel
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Bisciotti GN, Zini R, Aluigi M, Aprato A, Auci A, Bellinzona E, Benelli P, Bigoni M, Bisciotti A, Bisciotti A, Bona S, Brustia M, Bruzzone M, Canata GL, Carulli C, Cassaghi G, Coli M, Corsini A, Costantini A, Dallari D, Danelli G, Danesi G, Della Rocca F, DE Nardo P, DI Benedetto P, DI Marzo F, DI Pietto F, Eirale C, Ferretti A, Fogli M, Foglia A, Guardoli A, Guglielmi A, Lama D, Maffulli N, Manunta AF, Massari L, Mazzoni G, Moretti B, Moretti L, Nanni G, Niccolai R, Occhialini M, Panascì M, Parra MF, Pigalarga G, Randelli F, Sacchini M, Salini V, Santori N, Tenconi P, Tognini G, Vegnuti M, Zanini A, Volpi P. Groin Pain Syndrome Italian Consensus Conference update 2023. J Sports Med Phys Fitness 2024; 64:402-414. [PMID: 38126972 DOI: 10.23736/s0022-4707.23.15517-4] [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] [Indexed: 12/23/2023]
Abstract
Groin pain syndrome (GPS) is a controversial topic in Sports Medicine. The GPS Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athletes was organized by the Italian Society of Arthroscopy in Milan, on 5 February 2016. In this Consensus Conference (CC) GPS etiology was divided into 11 different categories for a total of 63 pathologies. The GPS Italian Consensus Conference update 2023 is an update of the 2016 CC. The CC was based on a sequential, two-round online Delphi survey, followed by a final CC in the presence of all panelists. The panel was composed of 55 experts from different scientific and clinical backgrounds. Each expert discussed 6 different documents, one of which regarded the clinical and imaging definition of sports hernias, and the other 5 dealt with 5 new clinical situations thought to result in GPS. The panelists came to an agreement on the definition of a sports hernia. Furthermore, an agreement was reached, recognizing 4 of the 5 possible proposed pathologies as causes to GPS. On the contrary, the sixth pathology discussed did not find consensus given the insufficient evidence in the available scientific literature. The final document includes a new clinical and imaging definition of sports hernia. Furthermore, the etiology of GPS was updated compared to the previous CC of 2016. The new taxonomic classification includes 12 categories (versus 11 in the previous CC) and 67 pathologies (versus 63 in the previous CC).
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Affiliation(s)
| | - Raul Zini
- Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | | | | | | | | | | | | | | | - Andrea Bisciotti
- Kinemove Rehabilitation Centers, Pontremoli, La Spezia, Italy
- Humanitas Research Hospital, Milan, Italy
| | | | | | - Marco Bruzzone
- University of Brescia, Brescia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
- Unione Sportiva Sassuolo Calcio, Sassuolo, Modena, Italy
| | - Gian L Canata
- Center of Sports Traumatology, Koelliker Hospital, Turin, Italy
| | | | | | | | | | | | - Dante Dallari
- Reconstructive Orthopedic Surgery and Innovative Techniques Musculoskeletal Tissue Bank, Rizzoli IRCCS Orthopedic Institute, Bologna, Italy
| | | | | | | | | | | | | | | | | | - Andrea Ferretti
- Istituto Medicina e Scienza dello Sport Comitato Olimpico Nazionale Italiano, Rome, Italy
| | | | - Andrea Foglia
- Centers of Rehabilitative Phisiotherapy, Civitanova Marche, Macerata, Italy
| | | | | | | | - Nicola Maffulli
- La Sapienza University, Rome, Italy
- Centre for Sport and Exercise Medicine, Queen Mary University of London, London, UK
- Barts and the London School of Medicine, Surgery and Dentistry, London, UK
- Keele University School of Medicine, Stoke on Trent, UK
| | - Andrea F Manunta
- Orthopedic Clinic Sassari, Fondo Ateneo Ricerca 2020, Sassari, Italy
| | | | | | - Biagio Moretti
- Unit of Orthopedics and Traumatology, Polyclinic University Hospital, Bari, Italy
| | - Lorenzo Moretti
- Unit of Orthopedics and Traumatology, Polyclinic University Hospital, Bari, Italy
| | | | | | | | - Manlio Panascì
- Nancy Gvm Care and Research, S. Carlo Hospital, Rome, Italy
| | - Maria F Parra
- Kinemove Rehabilitation Centers, Pontremoli, La Spezia, Italy
| | | | - Filippo Randelli
- Hip Department (CAD), Gaetano Pini-CTO Orthopaedic Institute, University of Milan, Milan, Italy
| | | | | | | | | | | | - Marco Vegnuti
- Kinemove Rehabilitation Centers, Pontremoli, La Spezia, Italy
| | - Antonio Zanini
- San Clemente Nursing Home, S. Anna Clinica Institute, Brescia, Italy
| | - Piero Volpi
- Humanitas Research Hospital, Milan, Italy
- FC Internazionale Milano, Milan, Italy
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Mao Y, Wang Q, Zhang H, Li Y, Wang L. Zwitterion mediated anti-protein adsorption on polypropylene mesh to reduce inflammation for efficient hernia repair. Biomater Adv 2024; 158:213769. [PMID: 38266333 DOI: 10.1016/j.bioadv.2024.213769] [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] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
The effectiveness of polypropylene (PP) mesh is often compromised by severe inflammation. Engineering anti-inflammatory coatings has significant implications for PP mesh to repair unwanted hernias. Here, we presented a facile strategy to develop an anti-fouling coating consisting of zwitterionic poly(carboxybetaine methacrylate) (PCBMA), which could prohibit protein adsorption to endow PP mesh with anti-inflammatory efficacy. The incorporation of PCBMA coating had little impact on the raw features of PP mesh. While the modified mesh PCBMA-PP possessed noticeable hydrophilicity increase and surface charge reduction. The excellent lubricity and surface stability enabled PCBMA-PP to exhibit superior anti-fouling capacity, thus efficiently inhibiting the adsorption of proteins. In vivo experiments showed that incorporating the PCBMA layer could provide PP meshes with outstanding anti-inflammatory effects and tissue compatibility for repairing hernias.
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Affiliation(s)
- Ying Mao
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang District, Shanghai 201620, China; National Engineering Lab for Textile Fiber Materials & Processing Technology (Zhejiang), Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Qian Wang
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang District, Shanghai 201620, China
| | - Huiru Zhang
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang District, Shanghai 201620, China
| | - Yan Li
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang District, Shanghai 201620, China.
| | - Lu Wang
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang District, Shanghai 201620, China
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Khader R, Whitehead-Clarke T, Mudera V, Kureshi A. Assessment of mesh shrinkage using fibroblast-populated collagen matrices: a proof of concept for in vitro hernia mesh testing. Hernia 2024; 28:495-505. [PMID: 38180627 PMCID: PMC10997730 DOI: 10.1007/s10029-023-02941-6] [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] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This study uses free-floating contractile fibroblast-populated collagen matrices (FPCMs) to test the shrinkage of different hernia mesh products. We hope to present this model as a proof of concept for the development of in vitro hernia mesh testing-a novel technology with interesting potential. METHODS FPCMs were formed by seeding Human Dermal Fibroblasts into collagen gels. FPCMs were seeded with three different cell densities and cast at a volume of 500 μl into 24-well plates. Five different mesh products were embedded within the collagen constructs. Gels were left to float freely within culture media and contract over 5 days. Photographs were taken daily and the area of the collagen gel and mesh were measured. Media samples were taken at days 2 and 4 for the purposes of measuring MMP-9 release. After 5 days, dehydrated FPCMs were also examined under light and fluorescence microscopy to assess cell morphology. RESULTS Two mesh products-the mosquito net and large pore lightweight mesh were found to shrink notably more than others. This pattern persisted across all three cell densities. There were no appreciable differences observed in MMP-9 release between products. CONCLUSIONS This study has successfully demonstrated that commercial mesh products can be successfully integrated into free-floating contractile FPCMs. Not only this, but FPCMs are capable of applying a contractile force upon those mesh products-eliciting different levels of contraction between mesh products. Such findings demonstrate this technique as a useful proof of concept for future development of in vitro hernia mesh testing.
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Affiliation(s)
- R Khader
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK
| | - T Whitehead-Clarke
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK.
| | - V Mudera
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK
| | - A Kureshi
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK
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Lorenz R, Paasch C, Stechemesser B, Reinpold W, Niebuhr H, Fortelny RH, Mayer F, Köckerling F, Mantke R. Long-term evaluation of the Hernia Compact course of the German Hernia School. Hernia 2024; 28:621-628. [PMID: 38393496 DOI: 10.1007/s10029-024-02966-5] [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: 11/10/2023] [Accepted: 01/11/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Since 2011, the German Hernia Society has developed the German Hernia School (GHS) as a standardized hernia surgery training program for younger surgeons, consisting of the Hernia Compact basic module. It is a standardized three day training program (cadaver workshop, ultrasound simulation training, and hands-on training). After 12 years of experience, a survey was conducted to evaluate the long term effect of this training. METHOD Using an anonymous online-questionnaire, we contacted from September 2023 to October 2023 the Hernia Compact course participants via the congress organizer "Weitmeer" and the German Hernia Society. This online questionnaire contains 18 multiple choice questions regarding participants' age, gender, professional experience, participation in other modules of the German Hernia School, the effect of the course on their daily practice and their specific interest in hernia and abdominal wall surgery. RESULTS A total of 146 participants responded to the anonymous online questionnaire. A majority of 132 of 146 participants (90.42%) responded that this course improved the quality of surgical and hernia training (n = 146, no missing data). 141 of 146 individuals (96.58%) recommended the course to surgical colleagues (n = 146, no missing data). There were 89.73% of participants, (n = 146, no missing data) that developed a specific interest in hernia and abdominal wall surgery after the course. For 78.08% (n = 146, no missing data) of participants hernia and abdominal wall surgery was one of the most important activities in their daily surgical practice. CONCLUSION The standardized Hernia Compact basic course of the German Hernia School appears to have a huge impact on the quality of hernia surgery training in Germany and Austria. It might also help generate a specific interest in hernia surgery among participants.
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Affiliation(s)
- R Lorenz
- 3+CHIRURGEN Hernia Center, Klosterstrasse 34/35, 13581, Berlin, Germany.
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.
| | - C Paasch
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
| | - B Stechemesser
- Hernia Center Cologne, PAN-Klinik, Zeppelinstrasse 1, 50667, Cologne, Germany
| | - W Reinpold
- Hamburger Hernien Centrum, Harburg (an der Helios Mariahilf Klinik), Stader Str. 203c, 21075, Hamburg, Germany
| | - H Niebuhr
- Hamburger Hernien Centrum, Eppendorf, Eppendorfer Baum 8, 20249, Hamburg, Germany
| | - R H Fortelny
- Department of General Surgery, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria
- Medical Faculty, Sigmund Freud University, Freudplatz 3, 1020, Vienna, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, University Hospital, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - F Köckerling
- Vivantes Humboldt Hospital Berlin, Academic Teaching Hospital of Charite' University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - R Mantke
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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Paasch C, Meyer J, Hunger R, Krollmann N, Heisler S, Mantke R. Does the angle of trocar insertion affect the fascial defect caused? A porcine model. Hernia 2024; 28:585-592. [PMID: 38319439 PMCID: PMC10997682 DOI: 10.1007/s10029-023-02952-3] [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] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION With an incidence of 0-5.2%, trocar site hernias frequently occur following laparoscopy. It is unclear to what extent the angle of trocar insertion affects the size of the fascial defect caused. Hence, we performed a porcine model. METHODS In October 2022, a total of five female pigs were euthanized. In alternating order, three bladeless and two bladed conical 12-mm trocars were inserted at an angle of 45° on each side for 60 min twice each pig. For this purpose, an epoxy resin handmade cuboid with a central channel that runs at an angle of 45° was used. Subsequently, photo imaging and defect size measurement took place. The results were compared with those of our previously conducted and published porcine model, in which the trocars were inserted at an angle of 90°. Effects of trocar type (bladed vs. bladeless) and angle on defect size were analyzed using a mixed model regression analysis. RESULTS The bladeless trocars caused statistically significant smaller defects at the fascia than the bladed (23.4 (SD = 16.9) mm2 vs. 41.3 (SD = 14.8) mm2, p < 0.001). The bladeless VersaOne trocar caused the smallest defect of 16.0 (SD = 6.1) mm2. The bladed VersaOne trocar caused the largest defect of 47.7 (SD = 10.5) mm2. The defect size of the trocars used at a 45° angle averaged 30.5 (SD = 18.3) mm2. The defect size of trocars used at a 90° angle was significantly larger, averaging 58.3 (SD = 20.2) mm2 (p = 0.007). CONCLUSION When conical 12-mm trocars are inserted at a 45° angle, especially bladeless ones, they appear to cause small fascial defects compared with insertion at a 90° angle. This might lead also to a lower rate of trocar hernias. Bladeless trocars might cause smaller fascial defects than bladed trocars.
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Affiliation(s)
- C Paasch
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany.
| | - J Meyer
- Department of General and Visceral Surgery, Ameos Hospital Schönebeck, Schönebeck, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - R Hunger
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - N Krollmann
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany
| | - S Heisler
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany
| | - R Mantke
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
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Alvarez-Lozada LA, Ramos-Morales PE, Elizondo-Omaña RE, Quiroga-Garza A. Comment to: Impact of disclosure of radiographic test results on quality of life among patients with hernias. Hernia 2024; 28:653-654. [PMID: 37682376 DOI: 10.1007/s10029-023-02869-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Affiliation(s)
- L A Alvarez-Lozada
- School of Medicine, Human Anatomy Department, Clinical-Surgical Research Group (GICQx), Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - P E Ramos-Morales
- School of Medicine, Human Anatomy Department, Clinical-Surgical Research Group (GICQx), Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - R E Elizondo-Omaña
- School of Medicine, Human Anatomy Department, Clinical-Surgical Research Group (GICQx), Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - A Quiroga-Garza
- School of Medicine, Human Anatomy Department, Clinical-Surgical Research Group (GICQx), Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.
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Gray M. Context for Practice: Implementing the WOCN Society's Support Surface Algorithm in the Home Care Setting, Parastomal Hernia Following Ostomy, and Determinants of Bladder Care at Night in the Post-Acute Care Setting. J Wound Ostomy Continence Nurs 2024; 51:91-94. [PMID: 38527313 DOI: 10.1097/won.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
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Rezaie N, Ithurburn MP, Powell MT, Mussell EA, Kidwell-Chandler AL, Emblom BA. Outcomes and Proportions of Subsequent Contralateral Sports Hernia Repair Following Primary Unilateral Repair. Am J Sports Med 2024; 52:653-659. [PMID: 38284216 DOI: 10.1177/03635465231221496] [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] [Indexed: 01/30/2024]
Abstract
BACKGROUND In the event that nonoperative treatment for sports hernia fails, surgical repair may be warranted. Bilateral repair can occur in up to 45% of surgically treated patients. PURPOSE To investigate the clinical outcomes of athletes who underwent unilateral sports hernia repair and determine the proportion of patients who required contralateral sports hernia repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS We identified patients at our institution who underwent primary unilateral sports hernia repair (rectus abdominis-adductor longus aponeurotic plate repair and adductor lengthening) with a single surgeon between 2015 and 2020. We assessed patient-reported outcomes using the Hip Outcome Score-Sport (HOS-Sport), the Numeric Pain Rating Scale, and an internally developed return-to-play questionnaire. We further collected data regarding subsequent sports hernia procedures on the ipsilateral or contralateral side. We calculated summary statistics for outcomes and examined the association between preinjury patient characteristics and the HOS-Sport score at follow-up or successful return to preinjury sport using linear and logistic regression, respectively. RESULTS A total of 104 of 128 (81.3%) eligible patients (mean age at surgery, 23.0 ± 6.2 years; 94.2% male; 51.9% American football athletes) completed follow-up at a mean time of 4.4 ± 1.5 years. Overall, 79.8% of athletes (n = 83) were able to return to their preinjury sport/activity, but 90.2% (83/92) who attempted to return were able to do so. When examining reasons for not returning to preinjury sport, only 9 patients reported not returning to preinjury sport because of limitations or persistent symptoms from their original injury. Only 4 patients underwent subsequent sports hernia procedures (3 contralateral, 1 ipsilateral revision) after their index unilateral sports hernia repair. At follow-up, the mean HOS-Sport score was high (94.0 ± 10.8), and the mean Numeric Pain Rating Scale score was low (0.31 ± 1.26). There were no preinjury patient characteristics associated with either the HOS-Sport score at follow-up or the successful return to preinjury sport. CONCLUSION Patients with unilateral sports hernia symptoms can undergo repair and return to sport at the preinjury level with little concern for injuries to the contralateral groin. In our cohort, patient-reported hip function and pain outcomes at follow-up were excellent.
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Affiliation(s)
- Nima Rezaie
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Atlantic Orthopaedic Specialists, Virginia Beach, Virginia, USA
| | - Matthew P Ithurburn
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Eric A Mussell
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | | | - Benton A Emblom
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
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Kuchnowska D, Luterek K, Węgrzyn P, Kosiński P. Review of the Evaluation of Pulmonary Hypoplasia as an Important Determinant of Clinical Outcomes in Infants with Congenital Diaphragmatic Hernia. Med Sci Monit 2024; 30:e943259. [PMID: 38419323 PMCID: PMC10913292 DOI: 10.12659/msm.943259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/29/2023] [Indexed: 03/02/2024] Open
Abstract
Pulmonary hypoplasia is one of main causes of neonatal mortality and morbidity in patients with congenital diaphragmatic hernia. With most cases diagnosed prenatally, the emphasis is put on prediction of the severity of this defect. Several attempts are made to reduce the mortality and provide optimal prenatal and postnatal care. Appropriate estimation of risk of pulmonary hypoplasia also provides an important inclusion criterion for prenatal intervention. The main tool used for the detection and prediction of pulmonary hypoplasia is ultrasound, with an increasing number of available formulas to estimate the risk of occurrence of this phenomenon and complication associated with it. For most of the formulas used in this measurement method, the main limitations are either gestational-age dependency or limited research. Other imaging methods used to assess the risk of pulmonary hypoplasia involve magnetic resonance imaging and vascular assessment of affected lungs. The limitation in these remains the limited accessibility. Currently, the most widely used indexes are observed-to-expected lungs-to-head ratio and presence of liver herniation. These are the 2 most commonly used measurement methods, as they are the basis for patient qualification for fetoscopic endoluminal tracheal occlusion. This article aims to review the evaluation of pulmonary hypoplasia or hypoplastic lung disease as an important determinant of clinical outcomes in infants with congenital diaphragmatic hernia. In this review, we emphasize the importance of early prenatal diagnosis of congenital diaphragmatic hernia and present a summary of different methods of prenatal risk assessment of lung hypoplasia in congenital diaphragmatic hernia.
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Li Q, Wang L, Yu L, Li C, Xie X, Yan H, Zhou W, Wang C, Liu Z, Hou G, Zhao YQ. Polysaccharide-Based Coating with Excellent Antibiofilm and Repeatable Antifouling-Bactericidal Properties for Treating Infected Hernia. Biomacromolecules 2024; 25:1180-1190. [PMID: 38240673 DOI: 10.1021/acs.biomac.3c01175] [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] [Indexed: 02/13/2024]
Abstract
In recent years, the utilization of medical devices has gradually increased and implantation procedures have become common treatments. However, patients are susceptible to the risk of implant infections. This study utilized chemical grafting to immobilize polyethylenimine (QPEI) and hyaluronic acid (HA) on the surface of the mesh to improve biocompatibility while being able to achieve antifouling antimicrobial effects. From the in vitro testing, PP-PDA-Q-HA exhibited a high antibacterial ratio of 93% against S. aureus, 93% against E. coli, and 85% against C. albicans. In addition, after five rounds of antimicrobial testing, the coating continued to exhibit excellent antimicrobial properties; PP-PDA-Q-HA also inhibits the formation of bacterial biofilms. In addition, PP-PDA-Q-HA has good hemocompatibility and cytocompatibility. In vivo studies in animal implantation infection models also demonstrated the excellent antimicrobial properties of PP-PDA-Q-HA. Our study provides a promising strategy for the development of antimicrobial surface medical materials with excellent biocompatibility.
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Affiliation(s)
- Qifen Li
- School of Pharmacy, Key Laboratory of Medical Antibacterial Materials of Shandong Province, Binzhou Medical University, Yantai 264003, PR China
| | - Leixiang Wang
- School of Pharmacy, Key Laboratory of Medical Antibacterial Materials of Shandong Province, Binzhou Medical University, Yantai 264003, PR China
| | - Lu Yu
- School of Pharmacy, Key Laboratory of Medical Antibacterial Materials of Shandong Province, Binzhou Medical University, Yantai 264003, PR China
| | - Chengbo Li
- School of Pharmacy, Key Laboratory of Medical Antibacterial Materials of Shandong Province, Binzhou Medical University, Yantai 264003, PR China
| | - Xianrui Xie
- School of Pharmacy, Key Laboratory of Medical Antibacterial Materials of Shandong Province, Binzhou Medical University, Yantai 264003, PR China
| | - Huanhuan Yan
- School of Pharmacy, Key Laboratory of Medical Antibacterial Materials of Shandong Province, Binzhou Medical University, Yantai 264003, PR China
| | - Wenjuan Zhou
- The Affiliated Yantai Stomatological Hospital, Binzhou Medical University, Yantai 264003, PR China
| | - Chunhua Wang
- School of Pharmacy, Key Laboratory of Medical Antibacterial Materials of Shandong Province, Binzhou Medical University, Yantai 264003, PR China
| | - Zhonghao Liu
- The Affiliated Yantai Stomatological Hospital, Binzhou Medical University, Yantai 264003, PR China
| | - Guige Hou
- School of Pharmacy, Key Laboratory of Medical Antibacterial Materials of Shandong Province, Binzhou Medical University, Yantai 264003, PR China
| | - Yu-Qing Zhao
- School of Pharmacy, Key Laboratory of Medical Antibacterial Materials of Shandong Province, Binzhou Medical University, Yantai 264003, PR China
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Betancourt L, Pico S, Rojas E, Gordo MJ, Oliva JC, Almirall J, Ponz E. Relationship between intraperitoneal pressure and the development of hernias in peritoneal dialysis: confirmation for the first time of a widely accepted concept. Int Urol Nephrol 2024; 56:759-765. [PMID: 37566322 DOI: 10.1007/s11255-023-03663-5] [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: 03/24/2023] [Accepted: 06/06/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Intraperitoneal pressure (IPP) in peritoneal dialysis (PD) is an individual characteristic that can be modified by posture and intraperitoneal volume (IPV). It is considered one of the predisposing factors for complications in the abdominal wall, such as the appearance of hernias. No studies to date have confirmed this. The main aim of this study was to assess the relationship between the development of hernia in incident PD patients and IPP measured at PD onset. METHODS A prospective observational study of incident patients in a PD programme between 2010 and 2020. IPP was measured using the Durand's method. RESULTS One hundred and twenty-four incident patients on PD, 68% male, mean age 62.1 ± 15.23 years, body mass index (BMI) 27.7 ± 4.82 kg/m2, 44% were diabetic. IPP in supine was 16.6 ± 4.60 cm H2O for a mean IPV of 2047.1 ± 359.19 mL. Hernias were reported in 18.5% of patients during PD follow-up: 57% were inguinal hernias, 33% umbilical, and a further 10% presented in a combined form. PD hernias correlated positively with IPP in supine position (p = 0.037), patient age (p = 0.008), BMI (p = 0.043), a history of prior hernia (0.016), laparoscopic catheter placement (p = 0.026), and technique failure (p = 0.012). In the multivariate analysis, a higher IPP was independently related to the development of hernias (p = 0.028). CONCLUSIONS The development of hernias in PD was related to a higher IPP at PD onset, older age, higher BMI, history of prior hernia, catheter placement by laparoscopy, and technique failure.
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Affiliation(s)
- Loreley Betancourt
- Department of Nephrology, Parc Tauli Sabadell, University Hospital, Parc Tauli 1, 08208, Sabadell, Barcelona, Spain.
- Department of Medicine UAB, Barcelona, Spain.
| | - Sandy Pico
- Department of Nephrology, Parc Tauli Sabadell, University Hospital, Parc Tauli 1, 08208, Sabadell, Barcelona, Spain
- Department of Medicine UAB, Barcelona, Spain
| | - Estefania Rojas
- Department of Nephrology, Parc Tauli Sabadell, University Hospital, Parc Tauli 1, 08208, Sabadell, Barcelona, Spain
- Department of Medicine UAB, Barcelona, Spain
| | - Maria Jose Gordo
- Department of Nephrology, Parc Tauli Sabadell, University Hospital, Parc Tauli 1, 08208, Sabadell, Barcelona, Spain
- Department of Medicine UAB, Barcelona, Spain
| | - Juan Carlos Oliva
- Department of Medicine UAB, Statistics Unit, Parc Tauli Sabadell, University Hospital, Barcelona, Spain
| | - Jaume Almirall
- Department of Nephrology, Parc Tauli Sabadell, University Hospital, Parc Tauli 1, 08208, Sabadell, Barcelona, Spain
- Department of Medicine UAB, Barcelona, Spain
| | - Esther Ponz
- Department of Nephrology, Parc Tauli Sabadell, University Hospital, Parc Tauli 1, 08208, Sabadell, Barcelona, Spain
- Department of Medicine UAB, Barcelona, Spain
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16
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Estridge P, Stell D, Bowles M, Kanwar A, Aroori S, Briggs C. Telephone assessment of new hernia referrals-is it possible? Hernia 2024; 28:3-7. [PMID: 37597106 DOI: 10.1007/s10029-023-02850-8] [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: 03/15/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE Utilisation of remote clinics is increasing in healthcare settings worldwide. During the height of the COVID pandemic, our UK-based teaching hospital has trialled telephone assessment for new patients presenting with primary hernias. Selected cases are listed for elective repair of primary hernia direct from telephone clinic assessment. In March 2021, after this process had been in place for 13 months, departmental triage criteria were introduced, allocating patients to initial assessment in Face to Face or Telephone Clinics. Here, we evaluate the effectiveness of telephone assessment, with specific attention to 'Day of Surgery' cancellation. We also assess the effect of our triage criteria on rate of 'Day of Surgery' cancellation. METHODS Departmental diaries were studied retrospectively to identify patients listed for hernia repair between February 2020 and February 2022. Data were obtained from clinic letters, discharge paperwork and operating lists, as well as from management teams. Fishers Exact test was used to compare groups seen either face to face or remotely as well and pre- and post-intervention. RESULTS 325 patients were listed for hernia repair, 56 after telephone assessment. 6 (11%) of those listed from telephone clinic were cancelled on the day of surgery, compared with 34 (13%) of those seen face to face. With triage criteria in place, listing from telephone clinic increased significantly from 14 to 27%. Overall day of surgery cancellations reduced from 13 to 9%. Rate of day of surgery cancellation in those assessed in telephone clinic reduced from 12 to 9%. CONCLUSIONS There is no significant difference between day of surgery cancellations after face to face or telephone clinic assessment. Triage criteria for telephone assessment appear to increase the numbers being listed after remote clinics. This did not significantly impact the number of day of surgery cancellations.
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Affiliation(s)
- P Estridge
- Royal Devon and Exeter Hospital (Affiliated to University Hospitals Plymouth Hospitals NHS Trust), Exeter, Devon, UK.
| | - D Stell
- Plymouth NHS Hospitals Trust, Plymouth, UK
| | - M Bowles
- Plymouth NHS Hospitals Trust, Plymouth, UK
| | - A Kanwar
- Plymouth NHS Hospitals Trust, Plymouth, UK
| | - S Aroori
- Plymouth NHS Hospitals Trust, Plymouth, UK
| | - C Briggs
- Plymouth NHS Hospitals Trust, Plymouth, UK
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17
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Capoccia Giovannini S, Podda M, Ribas S, Montori G, Botteri E, Agresta F, Sartori A, Chàrvàtova H, Aiolfi A, Antoniou SA, Arvieux C, Berrevoet F, Boermeester MA, Campanelli G, Chintapatla S, Christoffersen MW, Dahlstrand U, De la Croix H, Dietz UA, Ferreira A, Fortenly RH, Gaarder C, Garcia Urena MA, Gok H, Hernández-Granados P, Jisova B, Laver O, Lerchuk O, Lopez-Cano M, Mega M, Mitura K, Muysoms F, Oliva A, Ortenzi M, Petersson U, Piccoli M, Radu VG, Renard Y, Rogmark P, Rosin D, Senent-Boza A, Simons M, Slade D, Smart N, Smith SR, Stabilini C, Theodorou A, Torkington J, Vironen J, Woeste G, De Beaux A, East B. What defines an incisional hernia as 'complex': results from a Delphi consensus endorsed by the European Hernia Society (EHS). Br J Surg 2024; 111:znad346. [PMID: 37897716 DOI: 10.1093/bjs/znad346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Sara Capoccia Giovannini
- Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Sonia Ribas
- Department of General Surgery, Centro Hospitalar Póvoa de Varzim-Vila do Conde, Póvoa de Varzim, Portugal
| | - Giulia Montori
- General Surgery Department, Azienda ULSS2 'Trevigiana', Hospital Vittorio Veneto, Treviso, Italy
| | - Emanuele Botteri
- Department of General Surgery, ASST Spedali Civili Brescia PO, Montichiari, Brescia, Italy
| | - Ferdinando Agresta
- General Surgery Department, Azienda ULSS2 'Trevigiana', Hospital Vittorio Veneto, Treviso, Italy
| | - Alberto Sartori
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Hana Chàrvàtova
- Faculty of Applied Informatics, Tomas Bata University in Zlín, Zlín, Czech Republic
| | - Alberto Aiolfi
- Department of General Surgery, RCCS Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milan, Italy
| | - Stavros A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Frederik Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation Service, University Hospital Medical School, Ghent, Belgium
| | - Marja A Boermeester
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Giampiero Campanelli
- Department of Abdominal Wall Surgery, University of Insubria, Ospedale Galeazzi Sant' Ambrogio, Milan, Italy
| | - Srinivas Chintapatla
- Department of Surgery, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | | | - Ursula Dahlstrand
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Enköping Hospital, Enköping, Sweden
| | - Hanna De la Croix
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten, Olten, Switzerland
| | - Antonio Ferreira
- General Surgery Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Renè H Fortenly
- General Surgery Unit, Medical Faculty Sigmund Freud Private University, Vienna, Austria
| | - Christine Gaarder
- Department of Traumatology, University Hospital, Oslo University Hospital Ullevål, Oslo, Norway
| | - Miguel Angel Garcia Urena
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria Hospital Universitario del Henares Carretera Pozuelo-Majadahonda, Madrid, Spain
| | - Hakan Gok
- Hernia Istanbul®, Comprehensive Hernia Centre, Istanbul, Turkey
| | - Pilar Hernández-Granados
- General Surgery Unit, Hospital Universitario Fundación Alcorcón, Rey Juan Carlos University, Alcorcón, Spain
| | - Barbora Jisova
- Third Department of Surgery, First Medical Faculty of Charles University, Motol University Hospital, Prague, Czech Republic
| | - Orest Laver
- General Surgery Department, Uzhhorod City Central Clinical Hospital, Uzhhorod, National University Uzhhorod, Ukraine
| | - Orest Lerchuk
- Department of General and Endocrine Surgery, Lviv Regional Clinical Hospital, Lviv Danylo Halytsky National Medical University, Lviv, Ukraine
| | - Manuel Lopez-Cano
- Abdominal Wall Surgery Unit, University Hospital Vall d´Hebrón, Barcelona, Spain
- Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Manuel Mega
- Abdominal Wall Unit, Department of General Surgery, Local Health Unit of Castel Branco, Castel Branco, Portugal
| | - Kryspin Mitura
- University of Natural Sciences and Humanities in Siedlce, Siedlce, Masovian Voivodeship, Poland
| | - Filip Muysoms
- Department of Abdominal Wall Surgery, AZ Maria Middelares, Ghent, Belgium
| | - Andrè Oliva
- Department of General Surgery, Coimbra University Hospital, Coimbra, Portugal
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Ulf Petersson
- Department of Surgery, Skane University Hospital, Malmö, Sweden
- Department for Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Micaela Piccoli
- General Surgery Unit, Civil Hospital of Baggiovara Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Victor G Radu
- Department of General Surgery, Life Memorial Hospital-Medlife Bucharest, Romania
| | - Yohann Renard
- University of Reims Champagne Ardenne, France, Unit of Visceral Surgery, Robert Debre University Hospital, Reims, France
| | - Peder Rogmark
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Danny Rosin
- Sheba Medical Centre, University of Tel Aviv, Tel Aviv, Israel
| | - Ana Senent-Boza
- Department of General and Digestive Surgery, Virgen del Rocío University Hospital, Seville, Spain
| | - Maarten Simons
- Department of Surgery, OLVG Hospital Amsterdam, Amsterdam, the Netherlands
| | - Dominic Slade
- Department of General Surgery, Salford Royal Hospital, Salford, UK
| | - Neil Smart
- Department of Gastrointestinal Surgery, Royal Devon and Exeter Hospital, Exeter, UK
| | - Stella R Smith
- General and Colorectal Surgery, Manchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK
| | - Cesare Stabilini
- Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alexis Theodorou
- First Surgical Unit, Hygeia Hospital, Athens, Greece
- Department of Surgery, Aretaieio University Hospital, Athens, Greece
| | - Jared Torkington
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Jaanna Vironen
- Abdominal Centre, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Guido Woeste
- Department of General and Visceral Surgery, Agaplesion Elisabethenstift, Darmstadt, Germany
| | - Andrew De Beaux
- Department of General Surgery, Spire Murrayfield Hospital, Edinburgh, UK
| | - Barbora East
- Third Department of Surgery, First Medical Faculty of Charles University, Motol University Hospital, Prague, Czech Republic
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Kamboj AK, Shen KR, Tapias LF. Gastrointestinal: Progressive dyspnea after motor vehicle accident due to traumatic diaphragmatic rupture with herniation of multiple abdominal organs. J Gastroenterol Hepatol 2024; 39:34. [PMID: 37563774 DOI: 10.1111/jgh.16323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023]
Affiliation(s)
- A K Kamboj
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - K R Shen
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minesota, USA
| | - L F Tapias
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minesota, USA
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Hrebinko KA, Huckaby LV, Silver D, Ratnayake C, Hong Y, Curtis B, Handzel RM, van der Windt DJ, Dadashzadeh ER. Predictors of acute incisional hernia incarceration at initial hernia diagnosis on computed tomography. J Trauma Acute Care Surg 2024; 96:129-136. [PMID: 37335920 DOI: 10.1097/ta.0000000000003994] [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] [Indexed: 06/21/2023]
Abstract
BACKGROUND Acute incisional hernia incarceration is associated with high morbidity and mortality yet there is little evidence to guide which patients will benefit most from prophylactic repair. We explored baseline computed tomography (CT) characteristics associated with incarceration. METHODS A case-control study design was utilized to explore adults (≥18 years) diagnosed with an incisional hernia between 2010 and 2017 at a single institution with a 1-year minimum follow-up. Computed tomography imaging at the time of initial hernia diagnosis was examined. Following propensity score matching for baseline characteristics, multivariable logistic regression was performed to identify independent predictors associated with acute incarceration. RESULTS A total of 532 patients (27.26% male, mean 61.55 years) were examined, of whom 238 experienced an acute incarceration. Between two well-matched cohorts with and without incarceration, the presence of small bowel in the hernia sac (odds ratio [OR], 7.50; 95% confidence interval [CI], 3.35-16.38), increasing sac height (OR, 1.34; 95% CI, 1.10-1.64), more acute hernia angle (OR, 0.98 per degree; 95% CI, 0.97-0.99), decreased fascial defect width (OR, 0.68; 95% CI, 0.58-0.81), and greater outer abdominal fat (OR, 1.28; 95% CI, 1.02-1.60) were associated with acute incarceration. Using threshold analysis, a hernia angle of <91 degrees and a sac height of >3.25 cm were associated with increased incarceration risk. CONCLUSION Computed tomography features present at the time of hernia diagnosis provide insight into later acute incarceration risk. Improved understanding of acute incisional hernia incarceration can guide selection for prophylactic repair and thereby may mitigate the excess morbidity associated with incarceration. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Katherine A Hrebinko
- From the Department of Surgery (K.A.H., L.V.H., D.S., Y.H., R.M.H.), University of Pittsburgh Medical Center; Department of Emergency Medicine, University of Pennsylvania, (C.R.,), Philadelphia, PA; Department of Internal Medicine, University of Michigan (B.C.), Ann Arbor, MI; Department of Surgery (D.J.W.), University of Michigan, Ann Arbor, Michigan; and Section of Vascular Surgery, Department of Surgery (E.R.D.), Washington University School of Medicine in St. Louis, St. Louis, Missouri
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20
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Bokhari N, Ali A, Yasmeen A, Khalid H, Safi SZ, Sharif F. Fabrication of green composite hand knitted silk mesh reinforced with silk hydrogel. Int J Biol Macromol 2023; 253:127284. [PMID: 37806415 DOI: 10.1016/j.ijbiomac.2023.127284] [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: 07/18/2023] [Revised: 09/17/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
Soft tissue defects like hernia and post-surgical fistula formation can be resolved with modern biomaterials in the form of meshes without post-operative complications. In the present study hand knitted silk meshes were surface coated with regenerated silk fibroin hydrogel and pure natural extracts. Two phytochemicals (Licorice extract (LE) and Bearberry extract (BE)) and the two honeybee products (royal jelly (RJ) and honey (HE)) were incorporated separately to induce antibacterial, anti-inflammatory, and wound healing ability to the silk hydrogel coated knitted silk meshes. Meshes were dip coated with a blend of 4 % silk hydrogel (w/v) and 5 % extracts. Dried modified meshes were characterized using SEM, DMA, GC-MS and FTIR. Antimicrobial testing, in-vitro cytotoxicity, in-vitro wound healing and Q-RT-PCR were also performed. SEM analysis concluded that presence of coating reduced the pore size up to 47.7 % whereas, fiber diameter was increased up to 17.9 % as compared to the control. The presence of coating on the mesh improved the mechanical strength/Young's modulus by 1602.8 %, UTS by 451.7 % and reduced the % strain by 51.12 %. Sustained release of extracts from MHRJ (62.9 % up to 72 h) confirmed that it can induce antibacterial activity against surgical infections. Cytocompatibility testing and gene expression results suggest that out of four variables MHRJ presented best cell viability, % wound closure and expression of wound healing marker genes. In-vivo analyses in rat hernia model were carried out using only MHRJ variant, which also confirmed the non- toxic nature and wound healing characteristics of the modified mesh. The improved cell proliferation and activated wound healing in vitro and in vivo suggested that MHRJ could be a valuable candidate to promote cell infiltration and activate soft tissue and hernia repair as a biomedical implant.
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Affiliation(s)
- Natasha Bokhari
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, Lahore 54000, Pakistan; Department of Chemistry, Lahore College for Women University, Lahore 54000, Pakistan
| | - Asif Ali
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, Lahore 54000, Pakistan; Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Ghent 9000, Belgium
| | - Abida Yasmeen
- Department of Chemistry, Lahore College for Women University, Lahore 54000, Pakistan
| | - Hamad Khalid
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, Lahore 54000, Pakistan
| | - Sher Zaman Safi
- Faculty of Medicine, Bioscience & Nursing MAHSA University, Jenjarom 42610, Selangor, Malaysia
| | - Faiza Sharif
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, Lahore 54000, Pakistan.
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Alonso Grandes M, Herranz Yagüe JA, Roldán Testillano R, Márquez Negro AM, Cernuda Pereira C, Ripalda Ferretti EAR, Páez Borda Á. Parastomal hernia after radical cystectomy. Incidence, natural history and predictive factors - A single center study. Arch Ital Urol Androl 2023; 95:12108. [PMID: 38193222 DOI: 10.4081/aiua.2023.12108] [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: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
PURPOSE Parastomal hernia (PH) is one of the most frequent complications after stoma creation. Our objective was to analyze the incidence, evolution and predictive factors of PH in Bricker-type urinary diversion. PATIENTS AND METHODS Case series analysis of 125 patients submitted to radical cystectomy and ileal conduit diversion for cancer in a single center during 2006-2021. Patient's record and imaging tests were reviewed to identify those suffering PH. Moreno-Matías classification was used to define radiological PH (rPH). Demographic and preoperative characteristics of the patients, surgical details and postoperative complications were recorded. Univariate and multivariate analyses were conducted to determine the effect of each predictive variable on the development and progression of PH. RESULTS 21.6% of patients developed PH (median follow-up 37 months). Incidence increased with follow-up time (15.2% at 1 year, 20.8% at 2 years). BMI ≥ 25 (Expβ 8.31, 95% CI 1.06- 65.18, p = 0.04), previous midline laparotomy (Expβ 6.74, 95% CI 1.14-39.66, p = 0.04) and wound infection (Expβ 3.87, 95% CI 1.21-12.33, p = 0.02) were significantly associated with PH. Half of the patients with hernia had symptoms, 25.9% requiring surgical correction. 46% of type 1 hernias and 40% of type 2 hernias progressed to grade 3 with a median of 11 months. No variable was associated with radiological progression. CONCLUSIONS This study proved 3 independent factors (overweight, laparotomy and wound infection) that increase the risk of developing PH.
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Affiliation(s)
| | | | | | | | | | | | - Álvaro Páez Borda
- University Hospital of Fuenlabrada, Department of Urology, Fuenlabrada, Madrid.
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Başkiran Y, Uçkan K, Çeleğen İ, Tanoğlu FB. Maternal and neonatal consequences of cystocele and rectocele in the delivery process. Medicine (Baltimore) 2023; 102:e36720. [PMID: 38134086 PMCID: PMC10735123 DOI: 10.1097/md.0000000000036720] [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: 09/22/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
The study aimed to investigate the effects of cystocele and rectocele on the stages of vaginal birth and maternal and newborn outcomes. A total of 672 multiparous pregnant women between the ages of 18 to 40 who underwent normal vaginal delivery in our tertiary center between November 2022 and February 2023, were included in this prospective study. Among the participants, 348 (51.8%) had no abnormalities, 78 (11.6%) had rectocele only, 112 (16.7%) had cystocele only, and 134 (19.9) had both cystocele and rectocele. Patients with the coexistence of cystocele and rectocele experienced a notably extended duration for both the first stage and second stage of labor, although the extension in the second stage was not statistically significant. Among the maternal complications, the development of maternal laceration and chorioamnionitis was significantly more common in the patient group with cystocele and rectocele compared to the other groups. When the groups were assessed for postpartum bleeding, while the bleeding risk increased from the normal group to the rectocele + cystocele group, this increase was not statistically significant. There was no difference between the groups in terms of neonatal outcomes. The delivery time of pregnant women with cystocele and rectocele, in the absence of additional risk factors, was determined to be significantly longer than that of the control group. We think that these patients should receive more vigilant monitoring, and this criterion should be kept in mind when assessing the indication for a cesarean section.
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Affiliation(s)
- Yusuf Başkiran
- Yuzuncu Yil University, Faculty of Medicine, Gynecology and Obstetrics Clinic Van, Van, Turkey
| | - Kazim Uçkan
- Yuzuncu Yil University, Faculty of Medicine, Gynecology and Obstetrics Clinic Van, Van, Turkey
| | - İzzet Çeleğen
- Yuzuncu Yil University, Faculty of Medicine, Public Health Van, Van, Turkey
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23
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Taylor C, Munro J, Goodman W, Russell S, Oliphant R, Beeken RJ, Hubbard G. Hernia Active Living Trial (HALT): an exercise intervention in people with a parastomal hernia or bulge. Br J Nurs 2023; 32:S4-S11. [PMID: 38060393 DOI: 10.12968/bjon.2023.32.22.s4] [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] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Parastomal hernias are a common consequence of stoma surgery and can occur in up to 50% of patients. They are mangaged either conservatively, through support hosiery, or surgically. A patient feasibility study called the Hernia Active Living Trial (HALT) was designed to examine if a clinical pilates-based exercise programme offers an alternative approach to managing a parastomal hernia or bulge. METHOD Adults with an ileostomy or colostomy who perceived they had a bulge around their stoma were included in the study. The intervention included up to 12 online sessions of an exercise booklet and videos with an exercise specialist. Interviews were conducted to explore participants' experiences of the intervention. The interview data were analysed systematically and thematically. Participants were also asked to complete patient diaries every week. RESULTS Twelve of the 13 participants who completed the intervention agreed to be interviewed. Following analysis, three main themes emerged including managing a hernia/bulge, benefits and barriers. Participants talked about the benefits of this programme including: reduction of the size of their hernia, increased abdominal control, body confidence and posture, as well as increased physical activity levels. The barriers described were generally overcome allowing participants to engage in what was perceived to be a positive and potentially life-changing experience. CONCLUSIONS A clinical pilates-based exercise programme for people with a parastomal hernia can bring both direct and indirect improvements to a patient's hernia management, sense of wellbeing and day-to-day life. Individuals with a hernia should be informed about the need for, and value of, exercise to strengthen core muscles, as part of their non-surgical options for self-management.
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Affiliation(s)
- Claire Taylor
- Macmillan Nurse Consultant in Colorectal Cancer, London North West University Healthcare NHS Trust and Visiting Lecturer, King's College, London
| | - Julie Munro
- Researcher, Department of Nursing & Midwifery, University of the Highlands and Islands, Centre for Health Sciences, Inverness
| | - William Goodman
- Research Fellow, Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Sarah Russell
- Clinical Exercise Specialist, The Ostomy Studio, Wadhurst, East Sussex
| | - Raymond Oliphant
- Colorectal Consultant Surgeon, NHS Highland, Raigmore Hospital, Inverness
| | - Rebecca J Beeken
- Associate Professor of Behavioural Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Gill Hubbard
- Professor of Health Services Research, Department of Nursing & Midwifery, University of the Highlands and Islands, Centre for Health Sciences, Inverness
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24
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Ding J. Effect of retrieval bags in preventing surgical site wound infection during elective laparoscopic cholecystectomy in liver cancer patients: A meta-analysis. Int Wound J 2023; 20:4031-4039. [PMID: 37424304 PMCID: PMC10681484 DOI: 10.1111/iwj.14292] [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] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/11/2023] Open
Abstract
A meta-analysis research was implemented to appraise the effect of retrieval bags (RBs) in preventing surgical site wound infection (SSWI) in elective laparoscopic cholecystectomy (ELC) in liver cancer (LC) patients. Inclusive literature research until April 2023 was done, and 1273 interconnected researches were reviewed. From a total of 11 researches that were chosen, 2559 ELC procedures in LC patients were at the starting point of the researches: 1273 of them were utilising RBs and 1286 were controls. Odds ratio (OR) and 95% confidence intervals (CIs) were utilised to appraise the consequence of RBs in preventing SSWI in ELC in LC patients by the dichotomous approach and a fixed or random model. RBs had significantly lower SSWI (OR, 0.54; 95% CI, 0.38-0.76, p < 0.001) compared with controls in ELC in LC patients. However, no significant difference was found between RBs and controls in ELC in LC patients in bile spillage (OR, 0.51; 95% CI, 0.21-1.24, p = 0.14), fascial extension (OR, 0.54; 95% CI, 0.07-4.11, p = 0.55), postoperative collection (OR, 0.66; 95% CI, 0.24-1.76, p = 0.40) and port site hernia (OR, 0.72; 95% CI, 0.25-2.06, p = 0.54). RBs had significantly lower SSWI, and no significant difference was found in bile spillage, fascial extension, postoperative collection and port site hernia compared with controls in ELC in LC patients. However, caution needs to be taken when interacting with its values because there was a low sample size in some of the chosen researches and a low number of researches were found for some of the comparisons in the meta-analysis.
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Affiliation(s)
- Jing Ding
- Department of General Surgery, Beijing You'an HospitalCapital Medical UniversityBeijingChina
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25
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Grillo A, Hyder Z, Mudera V, Kureshi A. Evaluation of hernia surgical meshes sterilised with ethylene oxide for adoption under UK regulations. Surg Endosc 2023; 37:9556-9562. [PMID: 37730855 PMCID: PMC10709235 DOI: 10.1007/s00464-023-10460-9] [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: 03/31/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Low-cost meshes (LCM) have been successfully used in low-income countries (LIC) over the past decades, demonstrating comparable surgical outcomes to commercial meshes at a fraction of the cost. However, LIC sterilisation standards (autoclave sterilisation at 121 °C) do not meet UK regulations for medical devices, which require either ethylene oxide (EO) sterilisation or steam sterilisation at 134 °C. Therefore, the aim of this study was to sterilise UK LCM and characterise their mechanical properties and in vitro biocompatibility to verify whether EO sterilisation causes changes in the mechanical properties and biocompatibility of LCM. METHODS EO sterilised LCM were used. Uniaxial tensile tests were performed to measure mechanical properties. Biocompatibility was measured through viability and morphology of Human Dermal Fibroblasts (HDFs) cultured in mesh-conditioned media, and by calculating the metabolic activity and proliferation of HDFs attached on the meshes, with alamarBlue assay. RESULTS Break stress of LCM1 was significantly higher than LCM2 (p < 0.0001), while Young's modulus of LCM1 was significantly lower than LCM2 (p < 0.05) and there was no significant difference in break strain. Viability and morphology showed no significant difference between LCM and control. Attachment and proliferation of HDFs on LCM showed a better proliferation on LCM2 than LCM1, with values similar to the control at the final time point. CONCLUSIONS We demonstrated that EO sterilisation affects LCM mechanical properties, but they still have values closer to the native tissues than the commercially available ones. We also showed that in vitro biocompatibility of LCM2 is not affected by EO sterilisation, as HDFs attached and proliferated on the mesh, while EO affected attachment on LCM1. A more detailed cost analysis of the potential savings for healthcare systems around the world needs to be performed to strengthen the cost-effectiveness of this frugal innovation.
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Affiliation(s)
- Alessandra Grillo
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, UCL, London, UK.
| | - Zargham Hyder
- Hydermed Limited, Woodford Green, UK
- Homerton University Hospital, NHS Trust, London, UK
| | - Vivek Mudera
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, UCL, London, UK
| | - Alvena Kureshi
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, UCL, London, UK
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26
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Kreisel SI, Sharabiany S, Rothbarth J, Hompes R, Musters GD, Tanis PJ. Quality of life in patients with a perineal hernia. Eur J Surg Oncol 2023; 49:107114. [PMID: 37839295 DOI: 10.1016/j.ejso.2023.107114] [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: 07/05/2023] [Revised: 09/13/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Patients who develop a perineal hernia after abdominoperineal resection may experience discomfort during daily activities and urogenital dysfunction, but the impact on quality of life has never been formally assessed. MATERIALS AND METHODS Patients who underwent abdominoperineal resection for rectal cancer between 2014 and 2022 in two prospective multicenter trials were included. Primary outcome was defined as median overall scores or scores on functional and symptom scales of the following quality of life questionnaires: 5-level version of the 5-dimensional EuroQol, Short Form-36, and European Organization for Research and Treatment of Cancer QoL Questionnaire Colorectal cancer 29 and 30, Urogenital Distress Inventory-6, Incontinence Impact Questionnaire-7. RESULTS Questionnaires were available in 27 patients with a perineal hernia and 62 patients without a perineal hernia. The 5-dimensional EuroQol score was significantly lower in patients with a perineal hernia (83 vs 87, p = 0.048), which implies a reduced level of functioning. The median scores of pain-specific domains were significantly worse in patients with a perineal hernia as measured by the SF-36 (78 vs. 90, p = 0.006), the EORTC-CR29 (17 vs. 11, p=<0.001) and EORTC-C30 (17 vs. 0, p = 0.019). Also, significantly worse physical (73 vs. 100, p = 0.049) and emotional (83 vs. 100, p = 0.048) functioning based on EORTC-C30 was observed among those patients. Minimally important differences were found for role, physical and social functioning of the SF-36 and EORTC-C30. The urological function did not differ between the groups. CONCLUSION A symptomatic perineal hernia can significantly worsen quality of life on several domains, indicating the severity of this complication.
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Affiliation(s)
- Saskia I Kreisel
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands.
| | - Sarah Sharabiany
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands.
| | - Joost Rothbarth
- Erasmus Medical Center, Department of Surgical Oncology and Gastrointestinal Surgery, Rotterdam, the Netherlands.
| | - Roel Hompes
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands.
| | - Gijsbert D Musters
- Erasmus Medical Center, Department of Surgical Oncology and Gastrointestinal Surgery, Rotterdam, the Netherlands.
| | - Pieter J Tanis
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands; Erasmus Medical Center, Department of Surgical Oncology and Gastrointestinal Surgery, Rotterdam, the Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.
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27
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Haywood N, Scott J, Zhang A, Hallowell P, Schirmer B. Characterization of the robotic surgery experience in minimally invasive surgery fellowships from 2010 to 2021. Surg Endosc 2023; 37:9393-9398. [PMID: 37658200 DOI: 10.1007/s00464-023-10402-5] [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: 03/30/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Robotic surgery has experienced exponential growth in the past decade. Few studies have evaluated the impact of robotics within minimally invasive surgery (MIS) fellowship training programs. The purpose of our study was to examine and characterize recent trends in robotic surgery within MIS fellowship training programs. METHODS De-identified case log data from the Fellowship Council from 2010 to 2021 were evaluated. Percentage of operations performed with robot assistance over time was assessed and compared to the laparoscopic and open experience. Case logs were further stratified by operative category (e.g., bariatric, hernia, foregut), and robotic experience over time was evaluated for each category. Programs were stratified by percent robot use and the experience over time within each quartile was evaluated. RESULTS MIS fellowship training programs with a robotic platform increased from 45.1% (51/113) to 90.4% (123/136) over the study period. The percentage of robotic cases increased from 2.0% (1127/56,033) to 23.2% (16,139/69,496) while laparoscopic cases decreased from 80.2% (44,954/56,033) to 65.3% (45,356/69,496). Hernia and colorectal case categories had the largest increase in robot usage [hernia: 0.7% (62/8614) to 38.4% (4661/12,135); colorectal 4.2% (116/2747) to 31.8% (666/2094)]. When stratified by percentage of robot utilization, current (2020-2021) programs in the > 95th percentile performed 21.8% (3523/16,139) of robotic operations and programs in the > 50th percentile performed 90.0% (14,533/16,139) of all robotic cases. The median number of robotic cases performed per MIS fellow significantly increased from 2010 to 2021 [0 (0-6) to 72.5 (17.8-171.5), p < 0.01]. CONCLUSIONS Robotic use in MIS fellowship training programs has grown substantially in the past decade, but the laparoscopic and open experience remains robust. There remains an imbalance with the top 50% of busiest robotic programs performing over 90% of robot trainee cases. The experience in MIS programs varies widely and trainees should examine program case logs closely to confirm parallel interests.
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Affiliation(s)
- Nathan Haywood
- Division of General Surgery, Department of Surgery, University of Virginia Health, 1215 Lee St., Charlottesville, VA, 22903, USA.
| | - Joshua Scott
- Department of General Surgery, Sheridan Memorial Hospital, Sheridan, WY, USA
| | - Aimee Zhang
- Division of General Surgery, Department of Surgery, University of Virginia Health, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Peter Hallowell
- Division of General Surgery, Department of Surgery, University of Virginia Health, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Bruce Schirmer
- Division of General Surgery, Department of Surgery, University of Virginia Health, 1215 Lee St., Charlottesville, VA, 22903, USA.
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28
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Petrovic S, Le Forestier N, Pradat PF, Pascal-Moussellard H, Chougar L. Spinal cord ischemia revealed by a Brown-Sequard syndrome and caused by a calcified thoracic disc extrusion with spontaneous regression: a case report and review of the literature. J Med Case Rep 2023; 17:510. [PMID: 38017566 PMCID: PMC10685598 DOI: 10.1186/s13256-023-04208-1] [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: 02/09/2023] [Accepted: 10/10/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Thoracic disc herniation is relatively uncommon, accounting for less than 1% of all spinal herniations. Although most often asymptomatic, they may represent a rare cause of spinal cord ischemia. CASE REPORT We report the case of a healthy 43-year-old North African male who presented with a Brown-Sequard syndrome revealing a spinal cord ischemia caused by a thoracic disc extrusion. The initial MRI revealed a calcified disc extrusion at the level of T5-T6 without significant spinal cord compression or signal abnormality. A pattern consistent with a medullary ischemia only appeared 48 h later. The patient was treated conservatively with Aspirin and Heparin, which were discontinued later because of a negative cardiovascular work-up. The calcified disc extrusion, which was later recognized as the cause of the ischemia, decreased spontaneously over time and the patient recovered within a few months. CONCLUSIONS Our case highlights the challenge in diagnosing and managing this uncommon condition. We propose a literature review showing the different therapeutic strategies and their corresponding clinical outcomes.
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Affiliation(s)
- Sonja Petrovic
- Diagnostic Imaging Center, Oncology Institute of Vojvodina, Put Dr Goldmana 4, 21204, Sremska Kamenica, Serbia
| | - Nadine Le Forestier
- Département de Neurologie et Centre SLA IdF. Sorbonne, Département.de Recherche : Études des Sciences et Techniques, Hôpital de La Pitié Salpêtrière, Université, AP-HP. Espaces Régional IdF et National de Réflexion Éthique-Maladies Neuro Évolutives, Université Paris Sud/Paris Saclay, Paris, France
| | - Pierre-François Pradat
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France
- Département de Neurologie, APHP, Hôpital Pitié-Salpêtrière, Centre Référent SLA, Paris, France
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute Ulster University, Altnagelvin Hospital, Derry/Londonderry, C-TRIC, UK
| | - Hugues Pascal-Moussellard
- Sorbonne Université, AP-HP, Hôpital de La Pitié Salpêtrière, Département de Chirurgie Orthopédique, 75013, Paris, France
| | - Lydia Chougar
- DMU DIAMENT, Department of Neuroradiology, Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de La Pitié Salpêtrière, 75013, Paris, France.
- Centre de NeuroImagerie de Recherche-CENIR, Institut du Cerveau-ICM, Hôpital Pitié-Salpêtrière, 47 Boulevard de L'Hôpital, 75651, Paris Cedex 13, France.
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29
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Drapal V, Mosier S, Norman A, Berbel G, Robinson JL, Friis EA. A preliminary In Vitro viability study of an electrically active hernia mesh on mouse fibroblasts. J Biomater Appl 2023; 38:662-669. [PMID: 37862784 DOI: 10.1177/08853282231209312] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Hernias occur when part of an organ, typically the intestines, protrudes through a disruption of the fascia in the abdominal wall, leading to patient pain, discomfort, and surgical intervention. Over one million hernia repair surgeries occur annually in the USA, but globally, hernia surgeries can exceed 20 million. Standard practice includes hernia repair mesh to help hold the compromised tissue together, depending on where the fascial disruption is located and the patient's condition. However, the recurrence rate for hernias after using the most common type of hernia mesh, synthetic, is currently high. Physiological-level electrical stimulation (ES) has shown beneficial effects in improving healing in soft tissue regeneration. Piezoelectric materials can produce low-level electrical signals from mechanical loading to help speed healing. Combining the novelty of piezo elements to create an electrically active hernia repair mesh for faster healing prospects is explored in this study through simulated transcutaneous mechanical loading of the piezo element with therapeutic ultrasound. A tissue phantom was developed using Gelatin #0 and Metamucil® to better simulate a clinical application of the therapeutic ultrasound loading modality. The cellular viability of varying ultrasound intensities and temporal effects was analyzed. Overall, minimal cytotoxicity was observed across all experimental groups during the ultrasound intensity and temporal viability studies.
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Affiliation(s)
- Victoria Drapal
- Bioengineering Graduate Program, School of Engineering, University of Kansas, Lawrence, KS, USA
| | - Savannah Mosier
- Bioengineering Graduate Program, School of Engineering, University of Kansas, Lawrence, KS, USA
| | - Anna Norman
- Bioengineering Graduate Program, School of Engineering, University of Kansas, Lawrence, KS, USA
| | - German Berbel
- Department of Surgery, University of Kansas Medical Center, Kansas, KS, USA
| | - Jennifer L Robinson
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Elizabeth A Friis
- Bioengineering Graduate Program, School of Engineering, University of Kansas, Lawrence, KS, USA
- Department of Mechanical Engineering, University of Kansas, Lawrence, KS, USA
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30
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Beucler N, Bonnet J, Dagain A. How I do it: simplified craniotomy for acute subdural hematoma in the elderly. Acta Neurochir (Wien) 2023; 165:3181-3185. [PMID: 37707593 DOI: 10.1007/s00701-023-05800-6] [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: 06/16/2023] [Accepted: 09/03/2023] [Indexed: 09/15/2023]
Abstract
CONTEXT Acute subdural hematoma (ASH) is responsible for significant morbidity and mortality in the elderly. As military neurosurgeons, we perform a simplified technique using a linear skin incision and a small craniotomy bone flap in order to ease perioperative tolerance. METHODS The patient lies supine, a pad under the shoulder ipsilateral to the ASH, the head completely rotated on the other side and placed on a circular pad, without head clamp. The linear frontotemporal skin incision should be twice the size of the bone flap's diameter, allowing to access the whole subdural space. Care is taken to obtain complete decompression of the temporal fossa in order to alleviate uncal herniation. A subdural drain can be placed, and the subdural space is filled with warm saline solution in order to create a closed drainage system. CONCLUSION The patient is allowed to sit at postoperative day 1 and to walk at postoperative day 2. Simplified craniotomy for ASH allows to reduce operative time and provides faster functional recovery.
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Affiliation(s)
- Nathan Beucler
- Neurosurgery department, Sainte-Anne Military Teaching Hospital, 2 boulevard Sainte-Anne, 83800, Toulon Cedex 9, France.
- Ecole du Val-de-Grâce, French Military health Service Academy, 1 place Alphonse Laveran, 75230, Paris Cedex 5, France.
| | - Jeanne Bonnet
- Operating theatre (OR nurse), Sainte-Anne Military Teaching Hospital, 2 boulevard Sainte-Anne, 83800, Toulon Cedex 9, France
| | - Arnaud Dagain
- Neurosurgery department, Sainte-Anne Military Teaching Hospital, 2 boulevard Sainte-Anne, 83800, Toulon Cedex 9, France
- Val-de-Grâce Military Academy, 1 place Alphonse Laveran, 75230, Paris Cedex 5, France
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31
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Unadkat P, Parmar C, Lakdawala M. First Global Report of Catastrophic Results Due to Internal Herniation of Roux Limb in the Space Between the Gastric Pouch and Band: a Series of 3 Cases of Banded Roux-en-Y Gastric Bypass (BRYGB). Obes Surg 2023; 33:3706-3709. [PMID: 37749311 DOI: 10.1007/s11695-023-06828-4] [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: 05/15/2023] [Revised: 08/15/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Banded Roux-en-Y gastric bypass (BRYGB) is associated with complications known with the bypass along with specific complications related to the band. Roux-limb gangrene, due to herniation between the gastric pouch and band, however, has no mention in literature. METHODS We report this potentially fatal complication of BRYGB and its management in a series of 3 patients. RESULTS All 3 patients were women, 35-45 years, with a BRYGB (roux limb-150 cm, biliopancreatic limb-100 cm) using a MiniMizer or a Fobi ring with 2-point fixation to the gastric pouch 2 cm above the gastrojejunostomy. All patients presented 3-4 years post-BRYGB, with an average total body weight loss (TWL%) of 41.28%. To discuss video of a single case, a 35-year-old female presented with abdominal pain, hematemesis and signs of abdominal tenderness and guarding. X-Ray abdomen showed distended small bowel loops and CT-scan revealed ischemic small bowel loops with free fluid. Diagnostic laparoscopy showed alimentary/roux limb (AL) gangrene, from the gastrojejunostomy to the jejunojejunostomy. The entire AL had herniated between the gastric pouch and band which had formed an obstructive ring around the herniated bowel loop and led to compromise of blood supply and gangrene. Resection of gangrenous bowel with reversal of BRYGB was done. CONCLUSION Early diagnosis and timely management may save a patient from gangrene. It also raises questions: Is a 2-point fixation of the band to the gastric pouch insufficient? Does a longer roux limb make it prone to herniating in the space between the gastric pouch and band?
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Affiliation(s)
- Pooja Unadkat
- Department of General Surgery and Minimal Access Surgical Sciences, Sir H.N. Reliance Foundation Hospital, Mumbai, India.
| | - Chetan Parmar
- Department of Surgery, The Whittington Hospital NHS Trust, London, United Kingdom.
- Apollo Hospitals Education and Research Foundation, Hyderabad, India.
- University College London, London, United Kingdom.
| | - Muffazal Lakdawala
- Department of General Surgery and Minimal Access Surgical Sciences, Sir H.N. Reliance Foundation Hospital, Mumbai, India
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Ji P, Cao T, Zhang Z, Zheng Z, Liang M, Tian CY, Hao T, Chen LL, Hu DH, Han JT, Tao K. [Effects of the anterolateral thigh chimeric perforator flaps in repairing complex wounds of foot and ankle]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:926-932. [PMID: 37899557 DOI: 10.3760/cma.j.cn501225-20230627-00232] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Objective: To investigate the effects of anterolateral thigh chimeric perforator flap in repairing complex wounds of foot and ankle. Methods: A retrospective observational study was conducted. From May 2018 to June 2022, 23 patients who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University to repair complex wounds of foot and ankle with anterolateral thigh chimeric perforator flaps, including 15 males and 8 females, aged from 20 to 66 years. The wounds were all accompanied by bone exposure and defects, and were complicated with varying degrees of infection. All patients underwent debridement and continuous vacuum sealing drainage treatment for 1 week in stage Ⅰ, with the skin and soft tissue defect area after debridement being 10 cm×5 cm to 22 cm×7 cm. In stage Ⅱ, the anterolateral thigh chimeric perforator flap was used to cover the defective wound, of which the muscle flap was used to fill the deep invalid cavity of the ankle joint or cover bone and internal fixation exposures, and the skin flap was used to cover the superficial wound, with the area of the skin flap ranging from 11 cm×6 cm to 23 cm×8 cm, and the area of the muscle flap ranging from 4.0 cm×2.5 cm to 8.0 cm×5.0 cm. The survival of the flap was observed after operation. During follow-up, the color, texture, appearance, and complications of the flap were observed, the function of ankle joint and its range of dorsiflexion motion and plantar flexion motion were measured, and the scar hyperplasia and muscular hernia in donor area were observed. Results: Ecchymosis and epidermal necrosis occurred at the tip of the flap in 1 patient on 5 days after operation and healed after dressing change for 1 week; the other flaps of patients survived successfully. After 6 to 40 months of follow-up, the color, texture, and shape of flaps were good, but 1 patient was not satisfied with the shape of the flap because of flap swelling; the ankle joint movement was basically normal, the dorsiflexion motion was 15-30°, and the plantar flexion motion was 20-45°; the scar hyperplasia in the donor area of the flap was not obvious, and no muscular hernia occurred. Conclusions: The anterolateral thigh chimeric perforator flap can effectively fill the deep invalid cavity of ankle joint and cover the superficial wound at the same time, with minimal damage to the donor site. So it is an ideal flap for repairing the complex wounds of foot and ankle.
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Affiliation(s)
- P Ji
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - T Cao
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - Z Zhang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - Z Zheng
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - M Liang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - C Y Tian
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - T Hao
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - L L Chen
- Department of Orthopedics, Xingping People's Hospital, Xingping 713100, China
| | - D H Hu
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - J T Han
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - K Tao
- Department of Wound Repair, Center for Wound Repair and Regenerative Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
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El Bahri A, Ameur A. Bladder hernia: a rare clinical image. Pan Afr Med J 2023; 46:47. [PMID: 38188882 PMCID: PMC10768545 DOI: 10.11604/pamj.2023.46.47.38892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/19/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Abdessamad El Bahri
- Urology Department, Military Instruction Hospital Mohamed V, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
- Sidi Mohamed Ben Abdallah University, Fez, Morocco
- Mohamed V University, Rabat, Morocco
| | - Ahmed Ameur
- Urology Department, Military Instruction Hospital Mohamed V, Rabat, Morocco
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Montcusí B, Jaume-Bottcher S, Álvarez I, Ramón JM, Sánchez-Parrilla J, Grande L, Pera M. 5-Year Collis-Nissen Gastroplasty Outcomes for Type III-IV Hiatal Hernia with Short Esophagus: A Prospective Observational Study. J Am Coll Surg 2023; 237:596-604. [PMID: 37326320 DOI: 10.1097/xcs.0000000000000785] [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] [Indexed: 06/17/2023]
Abstract
BACKGROUND To assess the 5-year outcomes of patients undergoing Collis-Nissen gastroplasty for type III-IV hiatal hernia with short esophagus. STUDY DESIGN From a prospective observational cohort of patients who underwent antireflux surgery for type III-IV hiatal hernia between 2009 and 2020, those with short esophagus (abdominal length <2.5 cm) in whom a Collis-Nissen procedure was performed and reached at least 5 years of follow-up were identified. Hernia recurrence, patients' symptoms, and quality of life were assessed annually by barium meal x-ray, upper endoscopy, and validated symptoms and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaires. RESULTS Of the 114 patients with Collis-Nissen gastroplasty, 80 patients who completed a 5-year follow-up were included (mean age 71 years). There were no postoperative leaks or deaths. Recurrent hiatal hernia (any size) was identified in 7 patients (8.8%). Heartburn, regurgitation, chest pain, and cough were significantly improved at each follow-up interval (p < 0.05). Preoperative dysphagia disappeared or improved in 26 of 30 patients, while new-onset dysphagia occurred in 6. Mean postoperative QOLRAD scores significantly improved at all dimensions (p < 0.05). CONCLUSIONS Collis gastroplasty combined with Nissen fundoplication provides low hernia recurrence, good control of symptoms, and improved quality of life in patients with large hiatal hernia and short esophagus.
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Affiliation(s)
- Blanca Montcusí
- From the Section of Upper Gastrointestinal Surgery, Department of Surgery, Hospital del Mar Medical Research Institute Universitat Autònoma de Barcelona (Montcusí, Jaume-Bottcher, Álvarez, Ramón, Grande, Pera), Barcelona, Spain
| | - Sofia Jaume-Bottcher
- From the Section of Upper Gastrointestinal Surgery, Department of Surgery, Hospital del Mar Medical Research Institute Universitat Autònoma de Barcelona (Montcusí, Jaume-Bottcher, Álvarez, Ramón, Grande, Pera), Barcelona, Spain
| | - Idoia Álvarez
- From the Section of Upper Gastrointestinal Surgery, Department of Surgery, Hospital del Mar Medical Research Institute Universitat Autònoma de Barcelona (Montcusí, Jaume-Bottcher, Álvarez, Ramón, Grande, Pera), Barcelona, Spain
| | - José M Ramón
- From the Section of Upper Gastrointestinal Surgery, Department of Surgery, Hospital del Mar Medical Research Institute Universitat Autònoma de Barcelona (Montcusí, Jaume-Bottcher, Álvarez, Ramón, Grande, Pera), Barcelona, Spain
| | - Juan Sánchez-Parrilla
- the Department of Radiology, Hospital del Mar, Universitat Pompeu Fabra (Sánchez-Parrilla), Barcelona, Spain
| | - Luis Grande
- From the Section of Upper Gastrointestinal Surgery, Department of Surgery, Hospital del Mar Medical Research Institute Universitat Autònoma de Barcelona (Montcusí, Jaume-Bottcher, Álvarez, Ramón, Grande, Pera), Barcelona, Spain
| | - Manuel Pera
- From the Section of Upper Gastrointestinal Surgery, Department of Surgery, Hospital del Mar Medical Research Institute Universitat Autònoma de Barcelona (Montcusí, Jaume-Bottcher, Álvarez, Ramón, Grande, Pera), Barcelona, Spain
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Alimi Y, Deldar R, Sosin M, Lofthus A, Nijhar K, Bartholomew AJ, Fan KL, Bhanot P. Outcomes of Immediate Multistaged Abdominal Wall Reconstruction of Infected Mesh: Predictors of Surgical Site Complications and Hernia Recurrence. Ann Plast Surg 2023; 91:473-478. [PMID: 37713152 DOI: 10.1097/sap.0000000000003641] [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] [Indexed: 09/16/2023]
Abstract
BACKGROUND Mesh infection is one of the most devastating complications after ventral hernia repair. To date, no clear consensus exists on the optimal timing of definitive abdominal wall reconstruction (AWR) after excision of infected mesh. We evaluated outcomes of immediate multistaged AWR in patients with mesh infection. METHODS We performed a retrospective review of patients with mesh infection who underwent immediate, multistaged AWR, which consisted of exploratory laparotomy with debridement and mesh explantation, followed by definitive AWR during the same admission. Primary outcomes included hernia recurrence and surgical site occurrences, defined as wound dehiscence, surgical site infection, hematoma, and seroma. RESULTS Forty-seven patients with infected mesh were identified. At mean follow-up of 9.5 months, 5 patients (10.6%) experienced hernia recurrence. Higher body mass index (P = 0.006), bridge repair (P = 0.035), and postoperative surgical site infection (P = 0.005) were associated with hernia recurrence. CONCLUSION Immediate multistaged AWR is an effective surgical approach in patients with infected mesh.
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Affiliation(s)
| | | | - Michael Sosin
- Plastic Surgery Arts of New Jersey, New Brunswick, NJ
| | | | | | | | - Kenneth L Fan
- Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
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Abstract
Despite the heavy reliance of surgeons on mesh with which to repair hernias, less attention is paid to the technical specifications of mesh and/or regulatory processes for bringing medical devices to market during surgical training. This article summarizes some of the key controversies and points regarding mesh materials and regulatory processes related to mesh devices.
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Affiliation(s)
- Ajita S Prabhu
- Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, Crile A-100, Cleveland, OH 44195, USA.
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Schlosser KA, Warren JA. Hernia Mesh Complications: Management of Mesh Infections and Enteroprosthetic Fistula. Surg Clin North Am 2023; 103:1029-1042. [PMID: 37709388 DOI: 10.1016/j.suc.2023.04.011] [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] [Indexed: 09/16/2023]
Abstract
The potential consequences of mesh infection mandate careful consideration of surgical approach, mesh selection, and preoperative patient optimization when planning for ventral hernia repair. Intraperitoneal mesh, microporous or laminar mesh, and multifilament mesh typically require explantation, whereas macroporous, monofilament mesh in an extraperitoneal position is often salvageable. Delayed presentation of mesh infection should raise the suspicion for enteroprosthetic fistula when intraperitoneal mesh is present. When mesh excision is necessary, the surgeon must carefully consider both the risk of recurrent infection as well as hernia recurrence when deciding on single-stage definitive reconstruction versus primary closure with delayed reconstruction.
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Affiliation(s)
- Kathryn A Schlosser
- Department of Surgery, Prisma Health, 701 Grove Road, Support Tower 3, Greenville, SC 29605, USA. https://twitter.com/KT_Schlosser
| | - Jeremy A Warren
- Department of Surgery, Division of Minimal Access Surgery, University of South Carolina School of Medicine Greenville, Prisma Health, 701 Grove Road, Support Tower 3, Greenville, SC 29605, USA.
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Feyrer M, Schuh A, Rupprecht H, Hennig H, Sesselmann S, Koehl P. TRAUMATIC PULMONARY HERNIATION: A RARE CHEST TRAUMA MANIFESTATION. Georgian Med News 2023:104-106. [PMID: 38096525] [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] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Traumatic pulmonary hernia is an uncommon occurrence resulting from chest trauma, typically covered by the skin. Chest trauma may arise from penetrating or blunt mechanisms, with blunt trauma being more frequently observed. When lung herniation transpires, various symptoms such as chest pain, dyspnea, subcutaneous emphysema, bone crepitation, and hemoptysis (in cases of lung parenchymal damage) may manifest. We present the case of a 66-year-old woman suffering from chest pain and dyspnea after blunt chest trauma due to a fall induced by delirium following alcohol abuse.
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Affiliation(s)
- M Feyrer
- 1Department of Industrial Engineering and Health, Institute of Medical Engineering, Technical University of Applied Sciences Amberg-Weiden, Weiden, Germany
| | - A Schuh
- 2Hospital of Trauma Surgery, Department of Musculoskeletal Research, Marktredwitz Hospital, Germany
| | - H Rupprecht
- 3Department of Thoracic Surgery, Neumarkt Hospital, Germany
| | - H Hennig
- 4Emergency Department, Neumarkt Hospital, Germany
| | - S Sesselmann
- 5Technical University of Applied Sciences Würzburg-Schweinfurt, Würzburg, Germany
| | - Ph Koehl
- 6Hospital of Trauma Surgery, Marktredwitz Hospital, Germany
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Hainsworth AJ, Premakumar YS, Griffin N, Solanki D, Morris SJ, Ferrari L, Emmanuel A, Taylor S, Schizas AMP, Williams AB. Pelvic floor imaging in asymptomatic subjects. Colorectal Dis 2023; 25:2001-2009. [PMID: 37574701 DOI: 10.1111/codi.16709] [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: 01/22/2023] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 08/15/2023]
Abstract
AIM The aim of this work was to determine the range of normal imaging features during total pelvic floor ultrasound (TPFUS) (transperineal, transvaginal, endovaginal and endoanal) and defaecation MRI (dMRI). METHOD Twenty asymptomatic female volunteers (mean age 36.5 years) were prospectively investigated with dMRI and TPFUS. Subjects were screened with symptom questionnaires (ICIQ-B, St Mark's faecal incontinence score, obstructed defaecation syndrome score, ICIQ-V, BSAQ). dMRI and TPFUS were performed and interpreted by blinded clinicians according to previously published methods. RESULTS The subjects comprised six parous and 14 nulliparous women, of whom three were postmenopausal. There were three with a rectocoele on both modalities and one with a rectocoele on dMRI only. There was one with intussusception on TPFUS. Two had an enterocoele on both modalities and one on TPFUS only. There were six with a cystocoele on both modalities, one on dMRI only and one on TPFUS only. On dMRI, there were 12 with functional features. Four also displayed functional features on TPFUS. Two displayed functional features on TPFUS only. CONCLUSION This study demonstrates the presence of abnormal findings on dMRI and TPFUS without symptoms. There was a high rate of functional features on dMRI. This series is not large enough to redefine normal parameters but is helpful for appreciating the wide range of findings seen in health.
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Affiliation(s)
- Alison J Hainsworth
- The Pelvic Floor Unit, Colorectal Department, St Thomas' Hospital, London, UK
| | | | - Nyree Griffin
- The Pelvic Floor Unit, Colorectal Department, St Thomas' Hospital, London, UK
| | - Deepa Solanki
- The Pelvic Floor Unit, Colorectal Department, St Thomas' Hospital, London, UK
| | - Samantha J Morris
- The Pelvic Floor Unit, Colorectal Department, St Thomas' Hospital, London, UK
| | - Linda Ferrari
- The Pelvic Floor Unit, Colorectal Department, St Thomas' Hospital, London, UK
| | - Anton Emmanuel
- Neuro-Gastroenterology Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stuart Taylor
- Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alexis M P Schizas
- The Pelvic Floor Unit, Colorectal Department, St Thomas' Hospital, London, UK
| | - Andrew B Williams
- The Pelvic Floor Unit, Colorectal Department, St Thomas' Hospital, London, UK
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Ortega-Mafla MF, Viveros-Gonzalez V, Saldarriaga-Gil W. Thoracic kidney and diaphragmatic hernia: prenatal diagnosis and successful management. Case report and review of the literature. Rev Colomb Obstet Ginecol 2023; 74:237-243. [PMID: 37937910 PMCID: PMC10652776 DOI: 10.18597/rcog.4020] [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] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/31/2023] [Indexed: 11/09/2023]
Abstract
Objectives To report a case of prenatal diagnosis of ectopic intrathoracic kidney with diaphragmatic hernia managed surgically after birth, and to conduct a review of the literature on prenatal diagnosis of ectopic intrathoracic kidney and perinatal prognosis. Material and methods We report the case of a 28-week fetus in which, on ultrasound imaging, a mass was observed displacing the heart and lung in the right hemithorax, which was was confirmed by magnetic resonance (MR) to be an ectopic intrathoracic kidney (ITEK). After birth, the neonate was approached by laparoscopy to place a mesh in continuity with the diaphragm, leaving the kidney in the abdomen, with good evolution. A search was conducted in the PubMed, Embase and Cochrane databases for cohorts, case reports and case series of prenatal diagnosis of intrathoracic kidney in the fetus. Information was retrieved regarding design, population, imaging diagnosis, treatment and prognosis. Results The search identified 8 studies that met the inclusion criteria, reporting a total of 8 cases. Ultrasound diagnosis showed ectopic intrathoracic kidney associated with diaphragmatic hernia in all the subjects. Fetal magnetic resonance imaging (MRI) was also used in 5 cases. Conclusions Ectopic intrathoracic kidney is a congenital abnormality amenable to prenatal diagnosis. Survival after corrective surgery performed in the neonatal period is common. There is a paucity of publications, limited to case reports, regarding the prenatal diagnosis of this condition.
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dos Santos PV, Hirano ES. Experimental evaluation of the use of starch and carboxymethylcellulose in the prevention of intraperitoneal adhesions in hernia surgery with coated meshes. Acta Cir Bras 2023; 38:e383323. [PMID: 37729350 PMCID: PMC10508194 DOI: 10.1590/acb383323] [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: 05/26/2023] [Accepted: 07/11/2023] [Indexed: 09/22/2023] Open
Abstract
PURPOSE Laparoscopic hernia repair involves a risk of adhesion between coated mesh and viscera. Plant polysaccharides such as starch and carboxymethylcellulose (SC) make up a product that acts as a barrier and prevents intraperitoneal adhesions. This study aimed to evaluate whether topical SC can also reduce adhesions between mesh and intra-abdominal organs. METHODS Forty rats each received placement of two intraperitoneal mesh fragments, one on each side of the abdominal wall. Randomly, 20 animals received SC on the right and other 20 on the left, leaving the contralateral side as a control. Fourteen days after the surgery, the animals underwent an additional laparotomy in which macroscopic analysis was performed. RESULTS As for the percentage of the mesh area affected by adhesion, one (2.6%) animal had > 75% adhesion on the experimental side, and 11 animals (28.9%) on the control side. The adhesion intensity score showed firm adhesions in three (7.9%) animals on the experimental side and nine (23.7%) on the control side. CONCLUSIONS The use of SC decreased the intensity of adhesions and the surface area of the mesh affected by adhesions. There was no negative interference of the product in the incorporation of the mesh into the abdominal wall.
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Affiliation(s)
- Paulo Vicente dos Santos
- Universidade Estadual de Campinas – Postgraduate Program in Surgical Science – Campinas SP – Brazil
| | - Elcio Shiyoiti Hirano
- Universidade Estadual de Campinas – Postgraduate Program in Surgical Science – Campinas SP – Brazil
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Denti FC, Brambilla D, De Luca G, Malvone AP, Maglio A, Oliveri M, Scaduto V, Rosati R, Tamburini AM, Villa G. Parastomal hernia: an overview. Br J Nurs 2023; 32:S22-S30. [PMID: 37682763 DOI: 10.12968/bjon.2023.32.16.s22] [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] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Parastomal hernia (PH) is one of the most frequent ostomy complications, and the reported incidence in the literature is highly variable. As highlighted by the Association of Stoma Care Nurses UK, this complication develops mainly in children and older men over 70, but many predisposing factors are related to the individual patient and surgery. There is no standardised system for assessing PH. The main assessment techniques include objective examination, ultrasound scan and computed tomography. Prevention is based on various interventions by surgeons and stoma care nurses (SCNs). The SCN's primary interventions include accurate patient evaluation, pre-operative ostomy siting, education about body weight management and advice on appropriate exercises. The treatment of PH can be conservative or surgical, and the choice is based on the patient's clinical condition. Ostomy can significantly impact on a patient's quality of life (QoL), and the presence of PH can further aggravate the situation. This overview of PH considers the incidence, aetiology, prevention, treatment and impact on QoL.
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Affiliation(s)
- Francesco Carlo Denti
- Enteral Stoma Nurse, Stoma Care Unit, San Raffaele Scientific Institute, Milan; Adjunct Professor Nursing, Vita Salute San Raffaele University, Milan, Italy
| | - Davide Brambilla
- Enteral Stoma Nurse, Stoma Care Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni De Luca
- Nurse, Gastrointestinal Surgery Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrea Maglio
- Enteral Stoma Nurse, Gastrointestinal Surgery Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Oliveri
- Nurse, Gastrointestinal Surgery Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Vitalba Scaduto
- Nurse, Gastrointestinal Surgery Unit, San Raffaele Scientific Institute; Adjunct Professor Nursing, Vita Salute San Raffaele University, Milan, Italy
| | - Riccardo Rosati
- Chief Surgeon, Gastrointestinal Surgery Unit, San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Marco Tamburini
- Surgeon, Gastrointestinal Surgery Unit, San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Villa
- Assistant Professor of Nursing, Center for Nursing Research and Innovation, Vita Salute San Raffaele University, Milan, Italy
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Quigley F. An exercise project to prevent parastomal hernia and promote patient health. Br J Nurs 2023; 32:S42-S44. [PMID: 37682770 DOI: 10.12968/bjon.2023.32.16.s42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Affiliation(s)
- Fiona Quigley
- The Stoma Nursing Service, Shantallow Health Centre, Western Health and Social Care Trust, Londonderry, winners of a Gold Award in the Stoma Care Nurse of the Year category of the BJN Awards 2023
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Mills J. Rethinking recovery: rehabilitation and intra-abdominal pressure management to reduce the risk of parastomal hernia. Br J Nurs 2023; 32:S18-S20. [PMID: 37682759 DOI: 10.12968/bjon.2023.32.16.s18] [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] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Julie Mills, RN, Global Ostomy Nurse Engagement Manager, Convatec, writes that parastomal hernia is a common and consequential complication of stoma surgery, but the risk can be reduced with a structured rehabilitation programme based on appropriate core abdominal exercises, supported by the full multidisciplinary team.
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Affiliation(s)
- Julie Mills
- RN, Global Ostomy Nurse Engagement Manager, Convatec
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45
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Abbitt D, Netsanet A, Kovar A, Choy K, Jones TS, Cassell B, Hammad H, Reveille RM, Wikiel KJ, Jones EL. Losing weight to achieve joint or hernia surgery: is the intragastric balloon the answer? Surg Endosc 2023; 37:7212-7217. [PMID: 37365392 DOI: 10.1007/s00464-023-10209-4] [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: 04/04/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Obesity is an epidemic, with its accompanying medical conditions putting patients at increased risk of postoperative complications. For patients undergoing elective surgery, preoperative weight loss provides an opportunity to decrease complications. We sought to evaluate the safety and efficacy of an intragastric balloon in achieving a body mass index (BMI) < 35 kg/m2 prior to elective joint replacement or hernia repair. METHODS Retrospective review of all patients who had intragastric balloon placement at a level 1A VA medical center from 1/2019 to 1/2023. Patients who had a scheduled qualifying procedure (knee/hip replacement or hernia repair) and had a BMI > 35 kg/m2 were offered intragastric balloon placement to achieve 30-50lbs (13-28 kg) weight loss prior to surgery. Participation in a standardized weight loss program for 12 months was required. Balloons were removed 6 months after placement, preferentially concomitant with the qualifying procedure. Baseline demographics, duration of balloon therapy, weight loss and progression to qualifying procedure were recorded. RESULTS Twenty patients completed intragastric balloon therapy and had balloon removal. Mean age 54 (34-71 years), majority (95%) male. Mean balloon duration was 200 ± 37 days. Mean weight loss was 30.8 ± 17.7lbs (14.0 ± 8.0 kg) with an average BMI reduction of 4.4 ± 2.9. Seventeen (85%) patients were successful, 15 (75%) underwent elective surgery and 2 (10%) were no longer symptomatic after weight loss. Three patients (15%) did not lose sufficient weight to qualify or were too ill to undergo surgery. Nausea was the most frequent side effect. One (5%) patient was readmitted within 30 days for pneumonia. DISCUSSION Intragastric balloon placement resulted in an average 30lbs (14 kg) weight loss over 6 months allowing more than 75% of patients to undergo joint replacement or hernia repair at an optimal weight. Intragastric balloons should be considered in patients requiring 30-50lbs (13-28 kg) weight loss prior to elective surgery. More study is needed to determine the long-term benefit of preoperative weight loss prior to elective surgery.
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Affiliation(s)
- Danielle Abbitt
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17Th Ave, Aurora, CO, C-305, USA.
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA.
| | - Adom Netsanet
- School of Medicine, University of Colorado, Aurora, CO, USA
| | - Alexandra Kovar
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17Th Ave, Aurora, CO, C-305, USA
| | - Kevin Choy
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17Th Ave, Aurora, CO, C-305, USA
| | - Teresa S Jones
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17Th Ave, Aurora, CO, C-305, USA
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA
| | - Benjamin Cassell
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA
- Department of Gastroenterology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hazem Hammad
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA
- Department of Gastroenterology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert Matthew Reveille
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA
- Department of Gastroenterology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Krzysztof J Wikiel
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17Th Ave, Aurora, CO, C-305, USA
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA
| | - Edward L Jones
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17Th Ave, Aurora, CO, C-305, USA
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA
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46
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Alves AS, Balaphas A, Zuo K, Hauser P, Neroladaki A, Raffoul T. Spontaneous lesser omental herniation resolved by laparoscopic surgery: case report and systematic literature review. Surg Endosc 2023; 37:6704-6710. [PMID: 37479840 PMCID: PMC10462501 DOI: 10.1007/s00464-023-10279-4] [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] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/02/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Despite its extremely low incidence, intra-abdominal herniation through the lesser omentum is associated with a high mortality rate and must be recognized early and treated urgently. To overcome a lack of data on the management of this condition, we collected and reviewed all the reported cases of operated lesser omental hernia and presented the case of a patient treated by laparoscopy for an isolated lesser omental hernia. METHODS According to PRISMA guidelines and using PubMed, Cochrane Library, and Web of Science, a systematic literature review of cases of lesser omental hernia treated by surgery was performed on February 12, 2023. RESULTS Of 482 articles, 30 were included for analysis and only 9 articles presented an isolated hernia through the lesser omentum. Among these, 4 patients were female and the median age was 38. Upper abdominal pain and vomiting were reported in 7 out of 9 patients. The small bowel was responsible for 78% (7/9) of all lesser omental herniations. All of them were treated by laparotomy. In addition, we describe the case of a 65-year-old woman without prior surgical history who was treated by laparoscopy for a spontaneous closed loop hernia through the lesser omentum without any other associated hernias. CONCLUSION Mostly associated with prior surgery or trauma, this type of herniation could sometimes occur spontaneously without any sign of peritonitis. Due to the high mortality rate, internal abdominal hernias should always be ruled out with a CT scan in front of patients presenting with persisting acute abdominal pain and no alternative diagnosis.
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Affiliation(s)
- André S Alves
- Faculty of Medicine, University of Geneva, 1211, Geneva, Switzerland
| | - Alexandre Balaphas
- Faculty of Medicine, University of Geneva, 1211, Geneva, Switzerland.
- Department of Surgery, Neuchâtel Hospital Network, Maladière 45, 2000, Neuchâtel, Switzerland.
| | - Katie Zuo
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 1UL, UK
| | - Philipp Hauser
- Division of Radiology, Hôpital de la Tour, 1217, Geneva, Switzerland
| | | | - Toni Raffoul
- Division of Digestive Surgery, Hôpital de la Tour, 1217, Geneva, Switzerland
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Park JKH, Lee S, Yang EJ, Heo CY, Jeong JH, Myung Y. Outcomes of leaflet-shaped acellular dermal matrix with a thickness-gradient for abdominal fascial defect repair in muscle-sparing TRAM flap-based breast reconstruction. Asian J Surg 2023; 46:3581-3586. [PMID: 37537053 DOI: 10.1016/j.asjsur.2023.07.017] [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: 12/04/2022] [Revised: 05/24/2023] [Accepted: 07/09/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Numerous fascial closure techniques have been used to reduce donor site morbidities after transverse rectus abdominis myocutaneous (TRAM) flap harvest. A leaflet-shaped acellular dermal matrix (ADM) with a thickness gradient was designed to cover the defect effectively and to withstand the pressure applied to the lower portion of the defect. The complication and functional recovery rates of the donor site of the custom ADM were compared with those of previous methods of fascial closure (primary closure and polypropylene mesh assisted closure). MATERIALS AND METHODS A retrospective review of patients undergoing immediate or delayed breast reconstruction using muscle-sparing TRAM flaps was performed. Abdominal bulging, hernia, wound dehiscence, infection, seroma, and hematoma rates were compared. The Back Performance Scale measured four months postoperatively was compared to evaluate the donor site's recovery rate. RESULTS A total of 173 patients were analyzed. The three groups did not differ in hernia, wound dehiscence, infection, and hematoma rates. However, the abdominal bulging rate was lower in the primary closure group, while the seroma rate was higher in the mesh group. Functional recovery was the fastest in the custom ADM group. CONCLUSION A thickness-gradient, leaflet-shaped ADM can be effectively used as an onlay graft to cover the abdominal fascial defect, with similar complication rates, while providing a faster recovery of abdominal function.
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Affiliation(s)
- Joseph Kyu-Hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University School of Medicine, South Korea
| | - Seungjun Lee
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University School of Medicine, South Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University School of Medicine, South Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University School of Medicine, South Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University School of Medicine, South Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University School of Medicine, South Korea.
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Hootsmans N, Parmiter S, Connors K, Badve SB, Snyder E, Turcotte JJ, Jayaraman SS, Zahiri HR. Outcomes of an enhanced recovery after surgery (ERAS) program to limit perioperative opioid use in outpatient minimally invasive GI and hernia surgeries. Surg Endosc 2023; 37:7192-7198. [PMID: 37353653 DOI: 10.1007/s00464-023-10217-4] [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: 04/01/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Perioperative pain management is important for patient satisfaction while returning to homeostasis in the safest way possible. Studies show that patients don't require as much opioids as once thought. The benefits of ERAS pathways extend beyond enhancement of patients' perioperative experience, and include reducing opioid prescriptions in the face of the ongoing nationwide opioid crisis and evidence of prescription opioids as a contributor. METHODS We performed a retrospective cohort study of patients undergoing same day minimally invasive surgery (MIS) procedures for GI and hernia disease using a minimal-opioid ERAS protocol at two community hospitals between January 2020 and May 2022. We included elective laparoscopic cholecystectomy (LC), laparoscopic appendectomy (LA) for acute appendicitis without perforation, and minimally invasive (laparoscopic and robotic) inguinal and ventral hernia repair or abdominal wall reconstruction (AWR). Primary outcome was postoperative opioid use. RESULTS A total of 509 patients were included, undergoing procedures of MIS hernia repair (52.5%), LC (43.6%), and LA (7.9%). Only 9.4% of patients received opioid prescriptions at discharge, with no difference between groups. Among the patients receiving a prescription at discharge, there was a significant difference in morphine milligram equivalents (MME) prescribed (25.0 ± 0.0 in the LA group, 65.0 ± 41.4 in the LC group, 100.6 ± 46.2 in the MIS hernia/AWR group; P = 0.015). Nine percent of patients called with pain management concerns postoperatively. ASA score ≥ 3 was associated with increased odds for postoperative opioid prescription (OR 2.084; P = 0.014). CONCLUSIONS We demonstrate that an opioid-sparing ERAS program effectively manages pain for patients undergoing multiple outpatient MIS GI/hernia procedures, and suggests generalizability across a diverse range of operations. Therefore, the use of ERAS may safely and effectively expand beyond inpatient MIS and open surgeries that target reduced length of stay to also minimize opioids for outpatient procedures.
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Affiliation(s)
- Norbert Hootsmans
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA.
| | - Sara Parmiter
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | - Kevin Connors
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | - Shivani B Badve
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | - Elise Snyder
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | - Justin J Turcotte
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | | | - H Reza Zahiri
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
- Luminis Health Doctors Community Medical Center, Lanham, MD, USA
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49
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Richards Y. Port-site hernias in patients undergoing laparoscopic and/or robotic surgery: Can they be prevented? J Perioper Pract 2023; 33:269-275. [PMID: 35546520 DOI: 10.1177/17504589221094135] [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] [Indexed: 11/15/2022]
Abstract
As laparoscopic surgery advances into robotic surgery, there still remains the occurrence of port-site hernias. This can have severe consequences for the patient, including needing further surgery such as bowel resection. This has an impact on both patient and the National Health Service as the stay in hospital is prolonged, increasing the demand on staff and creating more expense to the National Health Service. This literature review explores the prevalence of port-site hernias and discovers the recommendations in preventive measures. Findings include the benefit of using non-bladed trocars and further studies need to be conducted into the association between smaller or larger ports and port-site hernias.
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Qafiti FN, Buicko JL. Not deep enough: Modeling the effect of shallow placement of the DaVinci Xi "bariatric" long trocar on the muscular abdominal wall. Surg Endosc 2023; 37:7264-7270. [PMID: 37415018 DOI: 10.1007/s00464-023-10207-6] [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: 04/02/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION The DaVinci Xi Robotic Surgical System (Xi) long cannula (Intuitive Surgical Company, Sunnyvale, CA) provides five additional centimeters of distal length compared to the standard Xi trocar. The extra length allows the cannula to traverse prohibitively thick body wall tissue. Our aims are to quantitatively model the consequences of not preserving the rotational centerpoint of motion (RCM) at the muscular abdominal wall. This is an essential tenet in robotic surgery; it is violated with shallow placement of the long trocar. This leads to unchecked, unnoticed blunt widening of port sites by the robotic arm, increasing hernia risk. METHODS We begin with an exploration of the schematic of the Xi robotic arm as patented by Intuitive (U.S. Patent #5931832). We trigonometrically model the lateral displacement of the abdominal wall at the trocar site with respect to vertical trocar shallowness, instrument tip depth, and instrument tip lateral motion from neutral midline. RESULTS The rigid parallelogram movement structure of the Xi preserves the RCM at the thick black marker printed on every Xi cannula. By limitation of design, both long and standard trocars must have this marker at the exact same distance from their proximal end. The value ranges of our model parameters (presuming a reasonable maximum orientation angle of 45° from midline) are: trocar shallowness [1 cm, 7 cm]; instrument tip depth [0 cm, 20 cm]; instrument tip lateral movement [0.0 cm, 14.1 cm]. Abdominal wall displacement increased proportionally as each instrument tip parameter reached its maximum deviation from the orthogonal midline as described in the plot figure. Maximal wall displacement at maximal shallowness was approximately 7.0 cm. CONCLUSION Robotic surgery revolutionizes modern operation, particularly within bariatrics. However, the current Xi arm design disallows a true long trocar to be used safely without compromising the RCM, thereby risking hernia development.
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Affiliation(s)
- Fred N Qafiti
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University Medicine, 777 Glades Road, Boca Raton, FL, 33431, USA.
| | - Jessica L Buicko
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University Medicine, 777 Glades Road, Boca Raton, FL, 33431, USA
- Bethesda Health System, Baptist Health South Florida, Boynton Beach, FL, USA
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