Rectusbanding: a method for the repair of incisional hernias.

BACKGROUND: We report on a new method of incisional hernia repair applicable to any size of hernia and the long-term results of this method. Musculus rectus abdominis is bandaged or partially bandaged in a loose way with a 2-cm-wide band of polypropylene (Prolene) on both sides at a distance of 2 cm, depending on the size of the hernial opening. The aims of this technique, which were defined in 1999 when we started using the method, were to find a simple method for surgeons, a safe mesh fixation and the prevention of a postoperative stiff abdomen. Another aim was to find a method for optimal patient care at reasonable costs. METHODS: Two hundred and seventeen patients underwent an operation according to this method in our department from June 1999 until December 2007. The first 75 patients of this cohort were treated using a technique in which the musculus rectus abdominis was bandaged in a loose way. One hundred and forty-two patients (since October 2001) were treated using a technique in which the muscle was not entirely bandaged. Instead, the polypropylene bands, which had been placed in sublay position, were penetrating the lateral rim through incisions and were fastened there. We included 124 patients (October 2001 to December 2006) in our further examination with a follow-up of 17-79 months. RESULTS: We found a recurrence rate of 6%, 80.1% of the patients had no trouble, 18.1% of the patients had very rarely any complaint, 0.9% of the patients had problems after exercise and 0.9% had permanent problems. All patients had excellent mobility of the abdomen. CONCLUSION: This method was proven to give good results in the long run and can be easily learned by any surgeon. This method is a true alternative to all methods which have been published so far.

[Rectusbanding variation II - a method for the repair of incisional hernias - further developments]. / Reparation von Narbenbrüchen mittels Rectusbanding Variante II - eine Weiterentwicklung.

We report on further developments of the rectusbanding variation II method which is used for the repair of large incisional hernias in 70 patients. Using this method the musculus rectus abdominis is not entirely looped. Instead, the polypropylene bands, which have been placed in sublay position, are penetrating the lateral rim through incisions and are fastened there. Important to note that the polypropylene bands are not used to ligate the abdominal wall. The bands must be placed loosely. This allowed us to reduce the applied material by almost 50 per cent. Although a high number (n = 70) of large incisional hernias (about 150 cm (2), variation I n = 16/20,3%, variation II n = 29/41,4%) were operated upon with this method (rectusbanding variation II) previous excellent results could be further improved (wound infectionrate 2,8%, recurrence rate after 18 months 0%, patients had no complaints and their mobility was excellent). Only the seroma formation rate was slightly increased due to the large size of the hernias. These excellent results are mainly based on the absolutely reliable fixing of the polypropylene bands and the complete mesh coverage by soft tissue. This method can be easily learned by any surgeon and is a true alternative to all conventional methods which have been published so far. In particular laparoscopic methods for incisional hernia repair can be replaced by this technique.

Uso de membrana amniótica homógena para correção de úlcera de córnea perfurada em equino

O artigo não apresenta resumo.Texto original incompleto.

Diagnóstico de plasmocitoma extramedular em um equino por via laparoscópica

O artigo não apresenta resumo.

[The role of the ultracision technique in visceral surgery. Ligature-free operation--an illusion?]. / Ein Erfahrungsbericht mit Ultrazision in der offenen Chirurgie.Die ligaturfreie Operation--eine Illusion?

We report on 431 operations in conventional visceral surgery with the general use of the ultracision technique for preparation (thyroid resections n = 356, colonic resections n = 28, local excisions of the gastric wall n = 3, gastrectomy n = 14, anterior resections of the rectum n = 19, abdominoperineal resection of the rectum [Miles' operation] n = 11). Ligatures were only used for truncal blood vessel ligation. A thorough study of the technical possibilities is a prerequisite for the use of the ultracision technique. The general use of the ultracision technique leads to a revolutionary change of the surgical technique and saves a considerable amount of suture material. In combination with the use of bipolar electrocoagulation the ultracision technique makes the operation fast and leads to a major reduction of bleeding. The biggest disadvantage of the ultracision technique in comparison to the conventional surgical technique is the high cost of the device at present. Despite of savings of suture material, swabs and blood transfusions, the costs for the ultracision scissors are still higher due to its single use.

[Rectusbanding by polypropylene-mesh--a new method for incisional hernia repair]. / Rectusbanding mit Polypropylenenetzstreifen--eine neue Methode zur Reparation von Narbenbrüchen.

We report on a new method of incisional hernia repair applicable to any size. With exception of an area 1 cm medial of the m. rectus abdominis where the strip penetrates the anterior wall of the rectus sheath for a better fixation, the muscle ist looped in a loose way with a 2 cm wide band of polypropylene (Prolene(R)) on both sides at a distance of 2 cm depending on the size of the hernial opening. Different models of strips were used in 27 % of the cases adapted to anatomical particularities of the hernial opening. Anterior and posterior wall of the rectus sheath are closed by a continuous panacryl suture which covers the strip. Because of the wide subcutaneous excavation extending to the lateral margin of the rectus sheath an extensive drainage by Redon-Drainages as well as compression bandages are important therapeutical procedures until formation of seromas has finished. For perioperative antibiotic prophylaxis we used Cefuroxime (3 x 1,5 i. v.). From 07/1999 until 10/2001 75 patients underwent an operation in our department. The direct postoperative complications observed were: Seroma formation up to 300 ml after discharge in 5 patients (6,6 %) and wound infections in 2 patients (2,8 %). In none of the cases the mesh had to be removed. In a follow-up period of 6 to 24 months we found 2 recurrences in 60 patients (3,3 %). These were related to technical failures of the beginning. 64.9 % of the patients were free of complaints after 6 months and almost 96 % after one year. Only 3 patients (4 %) had to take analgetic drugs occasionally. With regard to the mobility of the abdominal wall we found no measurable limitation. The method of Rectusbanding is easy to learn for every surgeon and with little material the mesh-strip can be fixed safely. It can be cut to individual sizes and shapes adapted to the fascial proportions of the hernial opening.

[Laparoscopic versus conventional appendectomy]. / Laparoskopische versus konventionelle Appendektomie.

From 1/1995 to 8/1997 857 appendectomies were observed in a prospective study. From then on in our clinic has done more laparoscopic then conventional operations, and has developed in the years before a permanent laparoscopic team. For all operations resterilized MIC-instruments are used. Preparation is done with bipolaric instruments and scissor, the appendix stump is supplied a with Röder-sling. The expensive Endo-GIA was used only 3x, if the coecumpole was also inflamed. Because of the fantastic intraabdominal view additional findings quickly be recognized through the laparoscopic method. It was then possible, to plan the therapeutic management exactly. Also variations of the appendix-position are seen clearly and can be operated on without other incisions. There is no significant difference in time between the two methods as we have seen here in practice (35.3 minutes for the conventional and 43.8 for the laparoscopic operation)--they will assimilate, when the surgeon is routine. Fat and muscular patients profit definitely. The problems of wound infection have been rarely observed by the laparoscopic operation. The rate of intraabdominal abscesses was 1.9% and therefore higher as by the conventional method (0.2%). This could be reduced during the period of the study, because we now often lavage and drain. We think that there are no surgical opponent indication to the laparoscopic appendectomy. The reliable conventional technique has to be an obligate technique also in future.

[Results of treatment of acute cholecystitis following conservative therapy, interval operation and early operation]. / Behandlungsergebnisse der akuten Cholezystitis nach konservativer Therapie, Intervalloperation und Frühoperation.

The results achieved by conservative treatment interval operation and early operation in 981 patients suffering from acute cholecystitis were compared in a retrospective study by means of electronic data processing (EDP). There is no difference in length of operating time, intra- and postoperative complications and mortality rate between operation at an interval and early operation. By introducing the early operation the total mortality rate of all patients suffering from acute cholecystitis decreased from 7% to an average of 2.5%.

[Cholestasis syndrome in acute cholecystitis]. / Cholestasesyndrom bei akuter Cholezystitis.

A slight rise in bilirubin values and rises of the serum transaminases belong to the symptoms of acute cholecystitis and do not necessarily stand for an occlusion of the bile duct, i.e. for a cholestase. They admit conclusions as to the seriousness of the inflammation and especially the alkaline phosphatase gives clear indication of additional choledocholithiasis. Even with a general attitude in favour of early surgery, there should be undertaken a comprehensive laboratory diagnostic prior to surgery.

[Rationalization and limits of diagnostic and operative measures in invasive cholestasis diagnosis (percutaneous transhepatic cholangiography) in primary medical care]. / Rationalisierung und Begrenzung diagnostischer und operativer Massnahmen durch die invasive Cholestasediagnostik (perkutane transhepatische Cholangiographie) in der medizinischen Grundbetreuung.

In a case of jaundice PTC enables the surgeon to detect its mechanical cause without further delay. This method is especially helpful in smaller hospitals without CT or even sonographic equipment. Explorative laparotomy is no longer necessary. An immediate decision can be made whether to perform a palliative or curative procedure or only to install a percutaneous bile drainage.

[Monday to Friday-clinic (author's transl)]. / Erfahrungen mit einer Montag-Freitag-Station.

On a Monday to Friday ward with 21 beds in 1 1/2 years 1149 patients underwent the following operations: appendectomy 23%, hernioplasty (femoral and inguinal) 20,5%, phimoses 14,4%, cryptorchidism 9,7%, anal fistula and fissure 7,8%, hydrocelectomy 2,9%, saphenectomy 2,7%, haemorrhoidectomy 2,9%, excisions of Dupuytren's contracture 1,0%, varicocelectomy 0,4% pacemaker implantations 2,7%, other operations and patients for diagnostics 8,5%. The standardised diagnostic procedure is performed during the prehospital time. On Monday all patients were operated upon and dismissed on Friday. The operative results are good. The in-patient time is 4,5 days. - The advantage of this system is: increase of scheduled in-patient surgery, short stay, prophylaxis of noso - comial infections, more efficiency.