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1.
Ann Surg ; 272(2): 241-247, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675536

RESUMO

OBJECTIVE: To determine whether absorbable or nonabsorbable mesh repair of large hiatus hernias is followed by less recurrences at late follow-up compared to sutured repair. SUMMARY OF BACKGROUND DATA: Radiological recurrences have been reported in up to 30% of patients after repair of large hiatus hernias, and mesh repair has been proposed as a solution. Earlier trials have revealed mixed outcomes and early outcomes from a trial reported previously revealed no short-term advantages for mesh repair. METHODS: Multicentre prospective double-blind randomized controlled trial of 3 methods of hiatus hernia repair; sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome - hernia recurrence assessed by barium meal X-ray and endoscopy at 3-4 years. Secondary outcomes - clinical symptom scores at 2, 3, and 5 years. RESULTS: 126 patients were enrolled - 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Clinical outcomes were obtained at 5 years in 89.9%, and objective follow-up was obtained in 72.3%. A recurrent hernia (any size) was identified in 39.3% after suture repair, 56.7% - absorbable mesh, and 42.9% - nonabsorbable mesh (P = 0.371). Clinical outcomes were similar at 5 years, except chest pain, diarrhea, and bloat symptoms which were more common after repair with absorbable mesh. CONCLUSIONS: No advantages were demonstrated for mesh repair at up to 5 years follow-up, and symptom outcomes were worse after repair with absorbable mesh. The longer-term results from this trial do not support mesh repair for large hiatus hernias.


Assuntos
Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura , Implantes Absorvíveis , Adulto , Análise de Variância , Austrália , Distribuição de Qui-Quadrado , Método Duplo-Cego , Feminino , Seguimentos , Hérnia Hiatal/diagnóstico por imagem , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Reoperação/métodos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Cicatrização/fisiologia
2.
World J Surg ; 39(6): 1465-73, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25651955

RESUMO

INTRODUCTION: Laparoscopic surgery is the treatment of choice for repair of large hiatus hernia, but can be followed by recurrence. Repair with prosthetic mesh has been recommended to prevent recurrence, although complications following mesh repair have generated disagreement about whether or not mesh should be used. The early objective and clinical results of a randomized trial of repair with mesh versus sutures have been reported, and revealed few differences. In the current study, we evaluated quality of life outcomes within this trial at follow-up to 2 years. METHODS: In a multicenter prospective double-blind randomized trial three methods for repair of large hiatus hernia were compared: sutures versus repair with absorbable mesh (Surgisis) versus non-absorbable (Timesh). Quality of life assessment using the Short-Form 36 (SF-36) questionnaire was undertaken at 3, 6, 12 and 24 months after surgery. SF-36 outcomes (8 individual scales and 2 composite scales) were determined for each group, and compared between groups, and across different follow-up points. RESULTS: 126 patients were enrolled-43 sutures, 41 absorbable mesh and 42 non-absorbable mesh. 115 (91.3%) completed a preoperative questionnaire, and 113 (89.7%) completed the post-operative questionnaire at 3 months, 116 (92.1%) at 6 months, 114 (90.5%) at 12 months, and 91 (72.2%) at 24 months. The SF-36 Physical and Mental Component Scores (PCS and MCS) improved significantly following surgery, and this improvement was sustained across 24 months follow-up (p < 0.001 for PCS and MCS at each follow-up point). There were no significant differences between the groups for the component scores or the eight SF-36 subscale scores at each follow-up time. 29 individuals had a recurrence at 6 months follow-up, of which 9 were symptomatic. The PCS were higher in patients with recurrence versus without (p < 0.01), and in patients with a symptomatic recurrence versus asymptomatic recurrence versus no recurrence (p = 0.001). CONCLUSION: SF-36 measured quality of life improved significantly after repair of large hiatal hernia at up to 2 years follow-up, and there were no differences in outcome for the different repair techniques. The use of mesh versus no mesh in repair of large hiatal hernia did not influence quality of life.


Assuntos
Hérnia Hiatal/cirurgia , Herniorrafia/instrumentação , Laparoscopia/instrumentação , Qualidade de Vida , Telas Cirúrgicas , Idoso , Método Duplo-Cego , Feminino , Seguimentos , Herniorrafia/métodos , Humanos , Laparoscopia/métodos , Masculino , Período Pós-Operatório , Estudos Prospectivos , Recidiva , Inquéritos e Questionários , Suturas
3.
Ann Surg ; 261(2): 282-9, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25119120

RESUMO

OBJECTIVE: Determine whether absorbable or nonabsorbable mesh in repair of large hiatus hernias reduces the risk of recurrence, compared with suture repair. BACKGROUND: Repair of large hiatus hernia is associated with radiological recurrence rates of up to 30%, and to improve outcomes mesh repair has been recommended. Previous trials have shown less short-term recurrence with mesh, but adverse outcomes limit mesh use. METHODS: Multicentre prospective double blind randomized controlled trial of 3 methods of repair: sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome-hernia recurrence assessed by barium meal radiology and endoscopy at 6 months. Secondary outcomes-clinical symptom scores at 1, 3, 6, and 12 months. RESULTS: A total of 126 patients enrolled: 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Among them, 96.0% were followed up to 12 months, with objective follow-up data in 92.9%. A recurrent hernia (any size) was identified in 23.1% after suture repair, 30.8% after absorbable mesh, and 12.8% after nonabsorbable mesh (P = 0.161). Clinical outcomes were similar, except less heartburn at 3 and 6 months and less bloating at 12 months with nonabsorbable mesh; more heartburn at 3 months, odynophagia at 1 month, nausea at 3 and 12 months, wheezing at 6 months; and inability to belch at 12 months after absorbable mesh. The magnitudes of the clinical differences were small. CONCLUSIONS: No significant differences were seen for recurrent hiatus hernia, and the clinical differences were unlikely to be clinically significant. Overall outcomes after sutured repair were similar to mesh repair.


Assuntos
Hérnia Hiatal/cirurgia , Herniorrafia/instrumentação , Laparoscopia/instrumentação , Telas Cirúrgicas , Suturas , Idoso , Método Duplo-Cego , Feminino , Seguimentos , Hérnia Hiatal/prevenção & controle , Herniorrafia/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Resultado do Tratamento
6.
J Urol ; 168(1): 185, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12050519

RESUMO

PURPOSE: We describe a technique that facilitates retrograde ureteral cannulation and stenting in patients with an ileal conduit. MATERIALS AND METHODS: A standard flexible gastroscope is inserted into the ileal conduit. Guide wires are passed into the ureters under direct vision. Stents are inserted over the guide wires with the aid of the image intensifier. RESULTS: The technique was used repeatedly in 1 patient with a complex history who had ureteral strictures. The procedure is technically easy and it was successful on each occasion. CONCLUSIONS: A fiber optic gastroscope may have advantages over conventional urological instrumentation for inserting ureteral stents in patients with an ileal conduit. This novel, simple technique is less invasive than percutaneous stenting and easier than fluoroscopic cannulation of the ureters. It is readily repeated.


Assuntos
Gastroscópios , Stents , Obstrução Ureteral/terapia , Derivação Urinária , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Exenteração Pélvica , Complicações Pós-Operatórias/terapia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
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