Pain after laparascopic bilateral hernioplasty : Early results of a prospective randomized double-blind study comparing fibrin versus staples.

BACKGROUND: The use of fibrin for mesh fixation in laparascopic hernioplasty has theoretical advantages in that it could result in reducing postoperative pain. The objective of this study is to demonstrate this improvement in postoperative pain with the highest level of evidence possible. METHODS: Unicenter single surgeon prospective randomized double-blind study of transabdominal preperitoneal (TAPP) bilateral hernioplasties comparing autologous fibrin sealant (FG) used for mesh fixation on one side and staples (SG) on the other. Data were collected regarding anthropometric measures, costs, complications and pain evaluation at postoperative days 7, 30 and 180 using a visual analogue scale. The patients were also asked to answer the following simple question: "On which side do you have more pain?" RESULTS: Twenty-two eligible patients were included in the study. Both groups were comparable. The operating time was significantly longer (30 min more) in the FG. The incidence of seroma was similar in both groups, and that of hematoma was higher in the SG (0 vs. 9.1%). At 1 week, the visual analogue scale scores were significantly lower in the FG (median: 1.7 vs. 4.5; MWU:103.5, p < 0.05). At 1 month, this difference became clinical and statistically insignificant. 72.7% of the patients referred more pain on the side with staples at 1 week, 38% at 1 month, and 0% at 6 months (after patients with hernia recurrence were excluded). The recurrence rate was higher in the FG (9.9 vs. 13.6%). A hernia in the FG cost 200 Euros more than that in the SG, or even more if a complete economic study is considered. CONCLUSIONS: The use of fibrin produces less postoperative pain in the first week, but prolongs operating time and increases costs. Moreover, there appears to be a higher recurrence rate and a lower incidence of hematoma, while the incidence of seroma remains unchanged.

Trocar site hernia after laparoscopic ventral hernia repair.

BACKGROUND: The incidence of trocar site hernia (TSH) after laparoscopic ventral hernia repair (LVHR) is reported to be low. The present study investigates the associated risk factors, with a view to preventing this complication. METHODS: A retrospective study was made of the incidence of TSH in a personal series of LVHR, recording anthropometric and clinical data on the patients. Risk factors were assessed by bivariate and multivariate analyses. The patients were subjected to clinical and telephone follow-up. RESULTS: In a series of 27 LVHR, the incidence of TSH was 22% (6 patients). The use of meshes larger than 10 x 15 cm for LVHR was the only TSH risk factor to reach statistical significance. Female gender and diabetes showed a higher incidence in the TSH group. CONCLUSIONS: The use of large meshes may be a risk factor for TSH. We believe this to be due to dilatation of the trocar orifice during introduction of the mesh, and also to postoperative retraction of the mesh.

The use of radiotherapy for early breast cancer in woman at different ages.

Age is an important feature at the time of early breast cancer diagnosis. Radiotherapy is a mandatory component of treatment for breast-conserving strategies in early disease stages. Breast radiotherapy has rapidly evolved in the last 20 years. A tendency to less treatment volume (partial-breast irradiation) and less treatment time (hypofractionation) is consolidated in modern radiation oncology practice. Age and risk for local recurrence guide the decision-making process to electro-optimal treatment. Radiotherapy technological versatility offers multiple options for individualized (risk-age adapted) recommendations.

Randomized clinical trial of mesh fixation with "double crown" versus "sutures and tackers" in laparoscopic ventral hernia repair.

BACKGROUND: Although laparoscopic intra-peritoneal mesh repair (LVHR) is a well-established treatment option to repair ventral and incisional hernias, no consensus in the literature can be found on the best method of fixation of the mesh to the abdominal wall. METHODS: Between December 2004 and July 2008, 76 patients undergoing a LVHR were randomized between mesh fixation using a double row of spiral tackers (DC) (n = 33) and mesh fixation with transfascial sutures combined with one row of spiral tackers (S&T) (n = 43), in the WoW trial (with or without sutures). Patients were clinically examined and evaluated using a visual analog scale for pain (VAS) in rest and after coughing 4 h post-operatively, after 4 weeks and 3 months after surgery. Primary endpoint of the study was abdominal wall pain, defined as a VAS score of at least 1.0 cm, at 3 months post-operative. Quality of life was quantified with the SF-36 questionnaire preoperatively and after 3 months. Secondary endpoint was the recurrence rate at 24-month follow-up. RESULTS: The DC and S&T group were comparable in age, gender, ASA score, BMI, indication, hernia, and mesh variables. The DC group had a significant shorter operating time compared with the S&T group (74 vs 96 min; p = 0.014) and a significant lower mean VAS score 4 h post-operatively (in rest; p = 0.028/coughing; p = 0.013). At 3 months, there were significant more patients in the S&T group with VAS score ≥1.0 cm (31.4 vs 8.3 %; p = 0.036). Clinical follow-up at 24 months was obtained in 63 patients (82.9 %). The recurrence rate at 24 months was 7.9 % overall (5/63). There were more recurrences in the S&T group (4/36) than in the DC group (1/27), but this difference was not significant (11.1 vs 3.7 %; p = 0.381). CONCLUSION: We found that double-crown fixation of intra-peritoneal mesh during laparoscopic ventral hernia repair was quicker, was less painful immediately post-operative and after 3 months, and did not increase the recurrence rate at 24 months. In hernias at a distance from the bony borders of the abdomen, transfascial sutures can be omitted if a double crown of tackers is placed.

Efficacy of PdB in preventing intraoperative risk of infectious diseases.

The objectives of this study were to (1) determine the number of punctures surgeons and assistants suffer during operations involving a laparotomy during the intraabdominal and closure phases; and (2) determine if the number of puncture injuries during wound closure can be reduced using a new surgical instrument (PdB) that protects the surgeon's hands and the patient's viscera against needlesticks. For the first objective, all laparotomies performed during 1 month (n = 52) were controlled, collecting the gloves used and determining the number of perforations. For the second objective, a randomized prospective controlled study, involving two series of 100 medial laparotomies, was carried out. The incidence of perforations was 29% during the intraabdominal phase and 16% during the wound closure phase. The glove perforation rate while closing medial laparotomies was 31.5% if the PdB was not used and 3% if the PdB was used (p < 0.0001). The glove perforation rate during laparotomy is significant, but with the use of the PdB this incidence can be significantly reduced.

The use of radiotherapy for early breast cancer in woman at different ages

Age is an important feature at the time of early breast cancer diagnosis. Radiotherapy is a mandatory component of treatment for breast-conserving strategies in early disease stages. Breast radiotherapy has rapidly evolved in the last 20 years. A tendency to less treatment volume (partial-breast irradiation) and less treatment time (hypofractionation) is consolidated in modern radiation oncology practice. Age and risk for local recurrence guide the decision-making process to electro-optimal treatment. Radiotherapy technological versatility offers multiple options for individualized (risk-age adapted) recommendations (AU)

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La cirugía como tratamiento de una entidad recientemente descrita: linfoma B cutáneo de células de la zona marginal / Surgical treatment of a recently described disease: marginal zone cutaneous B-cell lymphoma

Tras la reciente descripción del linfoma B de células de la zona marginal, el papel de la cirugía en el manejo de los linfomas cutáneos ha pasado de ser de meramente diagnóstico a terapéutico. En este artículo se presenta un caso de linfoma B de células de la zona marginal tratado por nuestro grupo en el que este nuevo esquema terapéutico demostró buenos resultados y la ventaja de la administración de una menor dosis de radioterapia (AU)

Reservorios venosos subcutáneos: disección versus punción / Subcutaneous venous indwelling: cutdown versus percutaneous puncture insertion

- Propósito: Los reservorios venosos subcutáneos (RVS) pueden ser implantados por punción o mediante disección. El objetivo de este estudio es comparar ambas técnicas.- Material y métodos: De una serie de 237 RVS (Healthport,, Baxter, Lessines, Belgica), 100 pacientes fueron aleatorizados a colocación por disección (CD) o por punción percutánea (PP). Los datos demográficos, complicaciones y duración del RVS (definida como duración hasta retirada, último control o exitus del paciente) fueron recogidos en un protocolo prospectivo. Las complicaciones en cada grupo fueron comparadas mediante el test de Fisher.- Resultados: El grupo CD constó de 20 hombres y 30 mujeres (16 cánceres de mama, 10 colorrectales, 6 linfomas, 6 cánceres de pulmón, 6 tumores ORL, 2 mielomas, 2 melanomas y 2 tumores ováricos) con una media de edad de 58.6 años (rango 19-83). El grupo PP constó de 23 hombres y 27 mujeres (20 cánceres colorrectales, 13 mamarios, 5 pulmonares, 5 gástricos, 2 melanomas, 2 ORL, 2 ováricos y 1 linfoma) con una media de edad de 58.2 años (rango 43-76). El grupo CD tuvo 4 (8 por ciento) complicaciones (2 oclusiones, 1 trombosis y 1 mal posición). El grupo PP tuvo 1 (2 por ciento) complicación (trombosis). El grupo CD tuvo una media de tiempo de duración del RVS de 214 días mientras que en el grupo PP fue de 201 días. El test de Fisher (complicaciones) resultó con un valor de 0.152, al que corresponde un p>0.05.- Conclusiones: En nuestra experiencia, la colocación de RVS por disección tiene un índice de complicaciones superior a la colocación mediante punción percutánea. Sin embargo, este aumento del índice de complicaciones no alcanza significancia estadística (AU)