Activity of metalloproteinases and adiponectin in obese patients-a possible factor of incisional hernias after bariatric procedures.

PURPOSE: Metalloproteinases are a key component of the pathogenesis of abdominal hernias. Obesity is considered a risk factor in herniogenesis and hernia recurrence. The aim of this study was to evaluate the serum concentrations of metalloproteinase-2 (MMP-2), MMP-9, MMP-13, and adiponectin in morbidly obese and non-overweight controls. MATERIALS AND METHODS: The participants were recruited from among patients undergoing bariatric and non-bariatric surgery and divided into two groups: I (body mass index (BMI)≥35 kg/m2, n=40) and II (BMI<25 kg/m2, n=30). Serum concentrations of MMP-2, MMP-9, MMP-13, and adiponectin were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: A statistically significant difference between groups was observed for MMP-2 concentration. The median MMP-9 concentration was higher in the obese group, but the difference was not statistically significant. Median MMP-13 concentrations did not differ between groups. Serum adiponectin concentration was insignificantly higher in the non-obese group. CONCLUSIONS: The elevated serum MMP-2 and MMP-9 concentrations in obese individuals may be related to the higher incidence of incisional hernias in this population.

Do we need changes in the organization of training in the hernia treatment in Poland? A survey on the acknowledgment of the recommendations of international hernia societies by surgeons.

In the therapy of an inguinal hernia, there is a huge variety in the way of treating and the choice of surgical technique. Practice shows that the intraoperative improvisation and surgeons' own modifications of the original techniques have become part of routine procedure. No mandatory hernia registration system causes the actual detailed herniology status in our country remains unknown. The aim of the study was to summarize the results of a survey on knowledge of a hernia according to the standards developed by international hernia societies compared with everyday clinical practice. During the International Conference Hernia in Poland, which took place on 10 December 2016 in Zakopane we conducted an interactive session among 106 surgeons dealing with hernias. Surgeons responded to 66 questions about daily surgical practice and decision making in their centers, and 27 questions for the assessment of the world's latest treatment recommendations regarding groin hernias. The most common method of using the implant technique Lichtenstein, used by 91% of doctors. 20% of surgeons in planned operations in adult men routinely uses no mesh technique. Almost 80% of respondents do not apply TEP or TAPP. Only 45.7% of surgeons customize surgical technique to the patient. Only 7 of the 27 analyzed recommendation has been accepted by more than 90% of respondents. 9 of the 27 recommendations were approved by less than half of the surgeons. In the case of 11 recommendations, surgeons simultaneously failed to comply with these recommendations in daily practice. Deficiencies in the system of training and the underfunding of medical procedures cause insufficient TAPP/ TEP availability in Poland in an inguinal hernia. Improvement of the surgeons' knowledge on how to perform surgery.

The experience and awareness of laparoendoscopic procedures among Polish surgeons in everyday clinical practice.

INTRODUCTION: In 2012, a total of 56 647 inguinal hernia repairs were performed in Poland. However, the absence of a uniform hernia repair register obscures the current herniology status in Poland, especially regarding laparoendoscopic procedures. AIM: To determine the awareness of laparoendoscopic procedures among Polish surgeons and to ascertain their everyday clinical practice. MATERIAL AND METHODS: The data were collected at the national hernia conference in 2016, during an interactive session for surgeons with a special interest in herniology. They could respond to the survey items using the VoxVote application. All items and response options were displayed on participants' smartphones. The questions were related to transabdominal preperitoneal/totally extraperitoneal (TAPP/TEP) hernia repair. The surgeons responded to 27 questions regarding routine inguinal hernia repair. One hundred and six surgeons from all regions of Poland participated in the survey. RESULTS: 19.2% of respondents never inform patients about the possibility of performing laparoendoscopic repair. 45.2% admitted that they had referred a patient with a difficult inguinal hernia to another hospital or surgeon. Seventy-five percent stated they would be willing to perform TAPP/TEP if the reimbursement rates were more favourable. In bilateral hernias, 61.6% of the respondents perform a two-step open repair, while only 25% perform a single-stage laparoendoscopic repair of bilateral hernia. In women, only 13.3% perform laparoendoscopic hernia repairs, and 19.0% do not use mesh. CONCLUSIONS: The skill level to perform TAPP/TEP repair is still inadequate among Polish surgeons. The absence of accurate data makes it impossible to verify whether the treatment methods used are compliant with the guidelines.

An analysis of the expression of collagen I and III genes in the fascia of obese patients.

BACKGROUND: The etiology of incisional hernias in the population of morbidly obese patients remains unclear. Most likely, factors other than purely mechanical are at play; it has been ascertained that nonobese patients suffering from inguinal and incisional hernias display alterations in the architecture of the connective tissue. The goal of this study has been to evaluate and compare the relative expression of collagen type I and III genes in the rectus abdominis muscle sheath (RMS) of obese and nonobese individuals to investigate their possible influence on the quality of the connective tissue. MATERIALS AND METHODS: RMS specimens were harvested in the early stages of either bariatric or non-bariatric laparotomies; total RNA was isolated and enzymatically purified from the tissue samples. The resulting material was subjected to a quantitative and qualitative analysis; reverse transcription reactions were then performed and the resulting complementary DNA was used in real-time reverse transcription polymerase chain reactions. The biopsy specimens were also examined by scanning electron microscopy. RESULTS: The real-time reverse transcription polymerase chain reactions, performed on complementary DNA, provided specific amplicons for individual genes. The efficacy of the reactions was rather low. An almost twofold decrease of the relative expression level for type I and III collagen was observed between the two patient groups; the results did not reach statistical significance. Scanning electron microscope photographs have documented a marked difference in the ultrastructure of the RMS in both groups. CONCLUSIONS: The authors have shown that changes in messenger RNA levels for collagen type I and III genes may be related to the pathogenesis of incisional hernia through alterations in the ultrastructure of the RMS fascia. Our report should be considered preliminary; the results should be verified on a larger group of patients.

Nonvariceal upper gastrointestinal tract bleeding - risk factors and the value of emergency endoscopy.

INTRODUCTION: Upper gastrointestinal tract bleeding (UGIB) remains a valid issue of modern medicine. The mortality and recurrence rates remain high and have not decreased as expected over the past decades. AIM OF THE STUDY: to assess the treatment outcomes of nonvariceal UGIB depending on the timing of endoscopy (urgent vs. elective) and to perform an analysis of risk factors for death in patients with nonvariceal UGIB. MATERIAL AND METHODS: Comparative evaluation of treatment outcomes in two groups of patients. Group A consisted of patients undergoing elective endoscopy (n = 187). Group B consisted of patients undergoing emergency endoscopy (n = 295). Moreover, the influence of selected factors on the risk of death and bleeding recurrence was analyzed in the combined population of the two groups. This was done by constructing a logistic regression model and testing dependence hypotheses. RESULTS: In group A the mortality rate was 9.1%, and the recurrence rate was 18.2%. In group B the values were 6.8% and 12.2%, respectively. No statistically significant difference was found (p = NS). In group B the number of surgical interventions, blood transfusions and intensive care admissions was significantly lower (p < 0.05). An analysis of the combined material showed that the factors which correlated with an elevated risk of death included: old age, hemodynamic state (shock), elevated Charlson Comorbidity Index score, hemoglobin concentration, bleeding from a malignant lesion, recurrent bleeding and the need for surgery (p < 0.05). CONCLUSIONS: The use of emergency endoscopy improves the treatment outcomes in patients with UGIB, although no statistically significant decrease in the mortality and recurrence rates could be observed.

[Evaluation of the effect of glucose on Staphylococcus aureus and Escherichia coli biofilm formation on the surface of polypropylene mesh]. / Ocena wplywu glukozy na tworzenie biofilmu przez Staphylococcus aureus i Escherichia coli na powierzchni siatki polipropylenowej.

INTRODUCTION: One of the most serious complications associated with the use of implants in hernia surgery is deep surgical site infection involving an implanted biomaterial. Among the major etiological factors of this complication are Staphylococcus aureus and Escherichia coli strains, which have the ability to form a biofilm on the surface of the mesh implant. This process is influenced by many factors, of which, according to current medical knowledge, the concentration of glucose may have a clinical significance. The aim of the presented study was to evaluate the effect of glucose on the formation of biofilm on the surface of monofilament polypropylene mesh. METHODS: The study included 140 bacterial strains (70 S. aureus and 70 E. coli) from the collection of Department of Microbiology Collegium Medicum im. L. Rydygier in Bydgoszcz, Nicolaus Copernicus University in Torun. Evaluation of the effect of two glucose concentrations (0.1% and 0.2%) on biofilm formation was performed using a qualitative (2,3,5-triphenyltetrazolium chloride reduction) and a quantitative ( serial 10-fold dilutions) methods. RESULTS: A qualitative analysis, performed after a period of incubation on substrates containing various concentrations of glucose, has revealed a statistically significant increase in the percentage of S. aureus strains with a very high potential for biofilm formation, while for E. coli an increase was observed in the percentage of strains with a low potential for biofilm formation. In a quantitative analysis of the biofilm of S. aureus forming after incubation on a substrate containing 0.1% and 0.2% glucose, significantly more colony forming units (CFUs) were isolated per one milliliter of the suspension (CFU/ml) than in the control group biofilm samples. On the other hand, the biofilm created by E. coli after a period of incubation on a substrate containing 0.2% glucose yielded significantly fewer CFUs per one milliliter than from the biofilm resulting from incubation on substrate with 0.1% glucose or the control group. No statistically significant difference was found between the numbers of CFUs per one milliliter isolated from E. coli strains after incubation on a substrate with 0.1% glucose and the control group. CONCLUSIONS: At concentrations of 0.1% and 0.2%, glucose increases biofilm formation by S. aureus strains on the surface of monofilament polypropylene mesh; at 0.2% glucose limits biofilm formation in E. coli.

PAI-1 and α2-AP in patients with morbid obesity.

BACKGROUND: Obesity is a multifactorial, progressing and life-long illness that consists in an exaggerated collection of fatty tissue. In 1997 WHO acknowledged that overweight and obesity had the character of an epidemic in developed countries. Studies show that in Poland morbid obesity was diagnosed in 2.2% of women and in 0.6% of men. Thromboembolic incidents occur very often in people with obesity, especially with morbid obesity. In hypercoagulability, fibrinolysis process decides about the scale of clinical symptoms of disorders of the hemostasis. OBJECTIVES: The aim of this study was to assess the chosen parameters of the fibrinolysis process in patients with BMI crossing 40, classified for surgical treatment of obesity. MATERIAL AND METHODS: The study was conducted in 50 patients with BMI > 40, including 30 women and 20 men. The mean age of the patients was 38.5 years. The control group was made up of 20 healthy volunteers, with a mean age of 38 years. In the blood of both groups the following examinations were performed: concentration of tissue plasminogen activator antigen (t-PA:Ag), antigen of the plasminogen activator inhibitor type-1 (PAI-1:Ag), D-dimers, fibrinogen and plasminogen, activity of the α2-antiplasmin (α2-AP). RESULTS: The conducted study showed that in patients with morbid obesity there was a higher concentration of tPA:Ag, PAI-1:Ag, D-dimers and a higher activity of α2-AP. CONCLUSIONS: The conducted study demonstrates that the activation of the fibrinolysis process appeared after the coagulation process, indicated by an increase in the t-PA:Ag concentration and D-dimers concentration in patients with morbid obesity. The essential growth of PAI-1:Ag level and α2-AP level shows strong inhibition of fibrinolysis in patients.

Histologic and immunohistochemical studies of rectus sheath in obese patients.

BACKGROUND: Obesity is a well-established risk factor for incisional hernia development. The exact causative factors have not been clearly defined, and development may result from structural disruptions in the connective tissue of the fasciae. The goal of this study was to compare the content of elastin in the rectus muscle sheath of obese patients and nonobese controls. MATERIALS AND METHODS: The study group consisted of 20 patients with body mass index over 35 kg/m(2) and the control group included 19 patients with normal-range body mass index. The biopsy specimens harvested during surgery were subjected to histologic evaluation, an immunohistochemical reaction with monoclonal anti-elastin antibodies, and the DAB chromatic reaction. The photomicrographs were evaluated using ImageJ software and the percentage of the area affected by the color reaction was assessed. A statistical evaluation was performed. RESULTS: The specimens harvested from persons in the control group showed in hematoxylin-eosin staining a high density of fibrous elements, arranged in regular bundles. In specimens obtained from the morbidly obese, the density of the fibers was lower and their architecture was disrupted; the bundles were thinner and less regularly arranged. Most photographs show adipose tissue infiltrating the structure of the fascia. Statistical analysis of the percentage of the area occupied by elastin showed a statistically significant difference in favor of the controls. CONCLUSIONS: The quantitative and qualitative changes in the elastin content of rectus abdominis muscle sheath fascia in the obese population may indicate a possible local mechanism influencing the development of incisional hernias.

The Glubran 2 glue for mesh fixation in Lichtenstein's hernia repair: a double-blind randomized study.

INTRODUCTION: With an average incidence rate of 11%, chronic pain is considered the most serious complication of inguinal hernioplasty after surgical site infection. One of the proposed solutions to this problem is to use tissue adhesive for mesh fixation, which helps prevent nerve and tissue damage. AIM: The goal of this study was to compare mesh fixation with the use of sutures vs. adhesive in Lichtenstein's inguinal hernia repair in a randomized, double-blind one-center study. MATERIAL AND METHODS: The study group consisted of 41 males with primary inguinal hernia undergoing Lichtenstein's repair (20 - adhesive; 21 - suture) and remaining in follow-up from July 2008 to November 2010. Randomization took place during the operation. The follow-up was performed by one surgeon (blinded) according to a pre-agreed schedule; the end-of-study unblinding was performed during the last follow-up visit, usually 16 months postoperatively. RESULTS: In 1 patient from the "adhesive" group, a recurrence was observed one year after the initial repair. The early postoperative pain was less intense in this group. In later postoperative periods the method of mesh fixation had no influence on the pain experienced by the patient. Other complications were not correlated with the method of mesh fixation. CONCLUSIONS: In this randomized, one-center double-blind clinical study of males with primary inguinal hernia it has been show during follow-up that the use of Glubran 2 cyanoacrylate adhesive for mesh implant fixation yields similar recurrence and chronic pain rates as the classical suture technique. In the early postoperative period, the pain reported by these patients was relatively weaker; patients undergoing adhesive mesh fixation experienced a quicker return to daily household activities.

Occurrence of gastrointestinal side effects associated with early use of commercial diets in ITU patients.

BACKGROUND: The purpose of this retrospective study was to analyse the occurrence of gastrointestinal side effects in enterally fed ITU patients. METHODS: We analysed the records of 195 ITU patients fed enterally, over at least five days, with commercial mixtures administered as 20-h infusions. Gastric retention, the number of defecations, and incidents requiring discontinuation of enteral feeding, were noted during the first 3 days of nutrition. RESULTS: Enteral nutrition was usually started during the first week of treatment (median 4, range: 1-33). In 118 patients receiving parenteral nutrition, the median day of implementing enteral feeding was day 5; some received enteral mixtures much earlier (day 2). The mean infusion rates of enteral mixtures were: 33 mL h-1 on day 1, 58 mL h-1 on day 2, and 68 mL h-1 on day 3. Gastric retention was observed in 49 (25.1%) patients during the first day, in 37 (19.0%) on day 2, and in 25 (12.8%) on day 3. Discontinuation of enteral nutrition was necessary in 6 patients due to: surgery (1), high gastric retention (4), gastrointestinal bleeding (1). A statistically significant correlation was found between the occurrence of gastric retention, infusion rates and CRP, and between the number of defecations and infusion rates. CONCLUSIONS: Enteral feeding with commercial diets is well tolerated when implemented gradually. Intolerance and the need for the discontinuation of enteral feeding were usually associated with a worsening of the patient's general condition and progression of the underlying disease.

Desarda versus Lichtenstein technique for primary inguinal hernia treatment: 3-year results of a randomized clinical trial.

BACKGROUND: The Shouldice method and other tissue-based techniques are still acknowledged to be acceptable for primary inguinal hernia repair according to the European Hernia Society guidelines. Desarda's technique, presented in 2001, is an original hernia repair method using an undetached strip of external oblique aponeurosis. This randomized trial compared outcomes after hernia repair with Desarda (D) and mesh-based Lichtenstein (L) techniques. METHODS: A total of 208 male patients were randomly assigned to the D or L group (105 vs. 103, respectively). The primary outcomes measured were recurrence and chronic pain. Additionally, early and late complications, foreign body sensation, and return to everyday activity were examined in hospital and at 7, 30 days, and 6, 12, 24, and 36 months after surgery. RESULTS: During the follow-up, two recurrences were observed in each group (p = 1.000). Chronic pain was experienced by 4.8 and 2.9% of patients from groups D and L, respectively (p = 0.464). Foreign body sensation and return to activity were not different between the groups. There was significantly less seroma production in the D group (p = 0.004). CONCLUSIONS: The results of primary inguinal hernia repair with the Desarda and Lichtenstein techniques are comparable at the 3-year follow-up. The technique may potentially increase the number of tissue-based methods available for treating groin hernias.

The ultrastructure of the fascia lata in hernia patients and healthy controls.

BACKGROUND: Current research data indicate that a hernia is a manifestation of a generalized polyethiological connective tissue pathology. The goal of this study was to demonstrate ultrastructural differences in tissues distant from the hernial defect. MATERIALS AND METHODS: Biopsy specimens harvested upon thigh surgery from 12 males aged 25-65 y were compared. Seven of these men had an inguinal hernia or a history thereof. Scanning electron microphotograms taken at a magnification of 50× were analyzed with the use of Image J software. For every patient, 100 thickness measurements were performed of the fibrous elements (cross-sections) visible in five consecutive photograms. The person performing the measurements had no means of identifying the patient from whom the specimen had been harvested. RESULTS: The authors have found the thickness of the fibers to fall in the range from 23.441 u (ImageJ intrinsic units) to 94.878 u in the hernia group and 22.067 u to 303.681 u for the control group. A statistically significant difference was found between the mean values of thickness measurements of the fibrous elements in the study and control groups. CONCLUSIONS: The study has shown that in patients with an inguinal hernia, the mean diameter of fibers within the fascia lata is significantly smaller. This appears to indicate that the process is generalized and that one can expect the structural alterations to occur within the connective tissue of the entire organism. The authors speculate that they may result from a combination of external and internal factors.

Analysis of nutrition mixtures in ITU patients.

BACKGROUND: The aim of this study was to analyse the composition of parenteral nutrition (PN) mixtures used in the ITU. METHODS: Restrospective analysis involved 2124 prescriptions for individual PN bags. They were administered over an 18-month period, to 160 ITU patients with the mean APACHE II score of 26 points (range: 5-61), calculated on admission. The mortality rate was 40%. Nutrition programs were prepared individually following the 2009 ESPEN guidelines. The prescription was modified according to the individual patient's clinical condition. One hundred and sixty prescriptions were analysed on the first day of PN (T1), 139 - on the second day (T2) and 1825 on the third and subsequent days (T3). RESULTS: The mean energy supplies were: 1381 kcal/day (range: 456-2612) on T1, 1467 kcal/day (range: 524-2860) on T2, and 1654 kcal/day (range: 390-2969) on T3. The mean supplies of amino acids, glucose and lipids were as follows: amino acids 68.3 g/day (range:20-120) on T1; 71.6 g/ day (range:27.5-125) on T2; 88.0 g/day (range:11-196) on T3; glucose 210.25 g/day (range: 120- 400) on T1; 218.34 g/day (range: 65-480) on T2; 278.5 g/day (range: 18-520) on T3; lipids 34.9 g/ day (range: 0-100) on T1; 38.7 g/day (range: 0-100) on T2; 52.66 g/day (range: 0-117) on T3. The percentages of non-protein energy from lipids were: 29.25 (0-73) on T1; 31.58 (range: 0-60) on T2; 33.5 (0-60) on T3. The following statistically significant differences were found: T2-T3- (p<0.05). CONCLUSIONS: The compositions of nutrition bags prepared for ITU patients were consistent with the ESPEN guidelines. The composition varied on different days of nutrition. The differences in the supply of nutrition components indirectly confirm the need for individual prescriptions for ITU patients.

Urgent endoscopy in elderly patients with non-variceal upper gastrointestinal bleeding.

INTRODUCTION: Age of the patient is an important prognostic factor in patients with non-variceal upper gastrointestinal bleeding (UGIB). Despite that fact, current treatment algorithms do not differentiate UGIB management according to the patient's age. AIM: To compare treatment outcomes in patients below and above 75 years of age, treated for UGIB with urgent endoscopy. MATERIAL AND METHODS: Prospective analysis of treatment outcomes in 295 patients with non-variceal UGIB divided into two age groups (group A < 75 years of age, group B > 75 years of age). Urgent endoscopy (up to 3 h since admission) was performed in 292 patients. The groups were compared in regards to the duration of symptoms, previous UGIB, presence of factors predisposing to UGIB (NSAIDs, peptic ulcer disease, liver cirrhosis, and previous gastrointestinal surgery), haemodynamic state and haemoglobin (Hb) levels on admission. We analysed the causes of UGIB, severity of UGIB on the Forrest scale, type of endoscopic bleeding control method, and co-morbidities with use of the Charlson Co-morbidity Index (CCI). Treatment outcomes were assessed in regard of mortality rate, UGIB-recurrence rate, duration of hospital stay, amount of transfused blood products and the requirement of intensive therapy unit (ITU) or other departments' admissions. Patients were followed until their discharge home. RESULTS: Mortality rate was 6.8% (group A vs. B: 3.5% vs. 18.7%; p = 0.001). Upper gastrointestinal bleeding recurrence was noted in 12.2% of patients (group A vs. B: 12.5% vs. 10.9%; p = 0.73). 2.4% of patients required surgery for UGIB (group A vs. B: 1.7% vs. 4.7%; p = 0.16). Patients in group B required ITU admission more frequently (group A vs. B: 1% vs. 4.7%; p < 0.01). The mean hospital stay (4.3 days) and the mean number of transfused packed red blood cells (PRBCs) (2.35 Units) did not differ between the groups. Patients in group B used NSAIDS much more frequently, more often had hypovolaemic shock and had a higher CCI score. CONCLUSIONS: Urgent endoscopy is an important and broadly accepted method of treatment of UGIB. Despite strict adherence to the modern UGIB-treatment algorithms, mortality remains high in the elderly. Thus, these patients need particular attention. The presented study indicates that the standard management might not be sufficient in elderly patients.

[Evaluation of Staphylococcus aureus and Escherichia coli biofilm formation on the surface of polypropylene mesh]. / Ocena tworzenia biofilmu przez Staphylococcus aureus i Escherichia coli na powierzchni siatki polipropylenowej.

A serious complication of hernioplasty with the use of a biomaterial implant is deep surgical site infection (SSI) encompassing the implant. Among the most common etiological factors of deep SSI in patients after hernioplasty are Staphylococcus aureus and Escherichia coli strains, which may create a biofilm on the surface of synthetic implants. The aim of this study was assessment of biofilm formation by S. aureus and E. coli on the surface ofpolypropylene mesh. The study included 108 strains (62 S. aureus and 46 E. coli) from the collection of Department of Microbiology Collegium Medicum im. L. Rydygier in Bydgoszcz, Nicolaus Copernicus University in Torun (CM UMK). Evaluation of biofilm formation was performed using the method of reduction of 2,3,5-triphenyltetrazolium chloride (TTC) and a scanning electron microscope. In the group of S. aureus strains, 88.7% isolates formed biofilm very strongly, 1.6% strongly, and 9.7% poor. Among E. coli strains, 54.3% isolates were characterized by very strong biofilm formation, while 45.7% strong biofilm formation. Strains ofS. aureus strongly than E. coli form a biofilm on the surface of monofilament polypropylene mesh.

Intragastric Balloon (BIB system) in the treatment of obesity and preparation of patients for surgery - own experience and literature review.

UNLABELLED: Despite the recognition of bariatric surgery as the only effective method of weight reduction, we remain in search of minimally invasive methods, both for the treatment of obesity and preparation of patients for surgical procedures. The aim of the study was to determine intragastric balloon (Allergan) implantation results as the only method of treating obesity, and patient preparation for further stages of abdominal hernia operations, as well as other surgical procedures. MATERIAL AND METHODS: The study presented own results considering the use of Bioenteric Intragastric Balloons (BIB system) in the treatment of pathological obesity, and preparation of patients for bariatric surgery and abdominal hernia operations. The study group comprised 18 female and 7 male patients. Average patient age amounted to 50.6 and 54 years, respectively. Indications for intragastric balloon insertion were as follows: preparation for hernia (10 cases) and bariatric (5 patients) operations, and weight reduction management (8 patients). In two cases the implantation of the intragastric balloon served the preparation for gynecological and orthopedic (vertebral column) operations. One female patient was prepared for both bariatric and hernial surgery. The procedure was performed under general anesthesia. Statistical analysis considered 22 patients (one female patient was excluded from analysis, due to death, two other were excluded because of lack of sufficient data).Results. In case of two patients the intragastric balloon system was removed before 6 months had elapsed because of intolerance. One female patient died during the observation period for reasons not related to the procedure. The obtained BMI reduction ranged between 2 and 6 kg/m2, which amounted to a maximum weight loss of 24 kg. In one patient a weight gain of 2 kg was observed. Considering patients prepared for abdominal hernia operations weight reduction was greater and better maintained after the removal of the BIB system. CONCLUSIONS: According to the authors of the presented study the intragastric balloon serves its role as a bridge to bariatric procedures and weight reduction, before planned extensive postoperative hernia operations. The use of the intragastric balloon only to reduce weight has no medical and economic justification.

Ultrastructural differences in rectus sheath of hernia patients and healthy controls.

BACKGROUND: The etiology of inguinal hernia remains unclear. Research data indicate the presence of pathologic alterations within the connective tissue; their exact character remains the subject of dispute. The search for new methods to diagnose connective tissue abnormalities, and thoroughly explain the character of the ultrastructural alterations, continues. MATERIALS AND METHODS: The study group included 10 male patients aged 18-60 y (five with primary inguinal hernia and five with acute appendicitis with no history of hernia). A specimen of the rectus muscle sheath was harvested from all of them upon surgery. The tissue samples were fixed and examined by spectrofluorometry and fluorescence microscopy, yielding fluorescence spectra and microscopic fluorescence images. RESULTS: Both techniques have demonstrated significant differences between the biopsy samples harvested from hernia patients and healthy controls. The groups of fluorescence spectra were shifted relative to each other and showed maximum emission at different wavelengths after excitation with 350 nm light (arbitrarily chosen for one of the cross-link proteins). The spectra obtained for healthy controls were more homogenous, while the spectra of the hernia samples differed even between each other. In microscopic images, the difference was a more chaotic distribution of fluorophores in the samples obtained from hernia patients. CONCLUSIONS: The evidence of significant differences between the samples harvested from the same location from hernia patients and healthy controls, found by fluorescence techniques, indicates the presence of abnormalities in the connective tissue forming the rectus muscle sheath. This area is not a part of the hernial defect, therefore, we can assume that the changes can be attributed to a generalized process.

In vivo biofilm on the surface of a surgical mesh implant.

Mesh hernioplasty is among the most frequently performed surgical procedures. The introduction of mesh implants has decreased recurrence rates, but the use of synthetic materials carries the risk of infection and biofilm formation. This paper presents the course of the disease in the case of biofilm formation on the surface of an implanted surgical mesh. Antimicrobial therapy and partial removal of the implant were unsuccessful. Recurring surgical site infection could be managed only through total excision of the infected implant.

[Abdominal wall closure techniques--the results of the Polish surgeons' survey]. / Metody szycia powloki brzusznej--wyniki badania ankietowego chirurgów polskich.

AIM OF THE STUDY: The results of a survey designed to investigate abdominal wall closure techniques have been analyzed in this report. MATERIAL AND METHODS: The participants were asked to choose a method of abdominal wall closure in groups of patients with progressively increasing risk of wound healing complications. RESULTS: Sixty-nine surgeons responded (median age 41 years), with a median professional life of 15 years. In low and moderate-risk patients, abdominal wall closure plan was similar; the peritoneum and fascia would be closed separately. Continuous absorbable sutures were most frequently picked. Treatment option choices were more diversified in the high-risk group. No dominant surgical method could be found; different suturing materials were proposed, mainly in the form of interrupted sutures. In almost every third patient antieventration sutures were taken as a option. CONCLUSION: A correlation was found between the risk group and surgical technique, the use of interrupted/continuous sutures and anti-eventration sutures. Dexon, Vicryl and PDS were most frequently selected sutures by surgeons who responded to the survey.