ABSTRACT
The development of an oral care path focuses on the identification of the early indicators of disease. Once the risks have been identified and diagnosed, the proper therapies can be selected and prescribed. The experienced practitioner must meld clinical experience and observation with evidence-based scientific dentistry and information on the treatment and prevention of continued disease for the prosthodontic patient after restorations have been completed. The incorporation of dental implants has not allowed for complications of caries and periodontal disease on teeth and implants. Osseoseparation is necessary for justification of continued maintenance.
Subject(s)
Dental Caries/therapy , Dental Prosthesis, Implant-Supported/microbiology , Fluorides/therapeutic use , Mouth/microbiology , Risk Assessment/methods , Toothpastes/chemistry , Anti-Infective Agents/therapeutic use , Dental Caries/diagnosis , Dental Caries/etiology , Humans , Xerostomia/chemically induced , Xerostomia/complications , Xerostomia/physiopathologyABSTRACT
BACKGROUND: Fixation of mesh is typically performed to minimize risk of recurrence in laparoscopic inguinal hernia repair. Mesh fixation with staples has been implicated as a cause of chronic inguinal pain. Our study aim is to compare mesh fixation using a fibrin sealant versus staple fixation in laparoscopic inguinal hernia and compare outcomes for hernia recurrence and chronic inguinal pain. METHODS AND PROCEDURES: PubMed was searched through December 2010 by use of specific search terms. Inclusion criteria were laparoscopic total extraperitoneal repair inguinal hernia repair, and comparison of both mesh fibrin glue fixation and mesh staple fixation. Primary outcomes were inguinal hernia recurrence and chronic inguinal pain. Secondary outcomes were operative time, seroma formation, hospital stay, and time to return to normal activity. Pooled odds ratios (OR) were calculated assuming random-effects models. RESULTS: Four studies were included in the review. A total of 662 repairs were included, of which 394 were mesh fixed by staples or tacks, versus 268 with mesh fixed by fibrin glue. There was no difference in inguinal hernia recurrence with fixation of mesh by staples/tacks versus fibrin glue [OR 2.13; 95% confidence interval (CI) 0.60-7.63]. Chronic inguinal pain (at 3 months) incidence was significantly higher with staple/tack fixation (OR 3.25; 95% CI 1.62-6.49). There was no significant difference in operative time, seroma formation, hospital stay, or time to return to normal activities. CONCLUSIONS: The meta-analysis does not show an advantage of staple fixation of mesh over fibrin glue fixation in laparoscopic total extraperitoneal inguinal hernia repair. Because fibrin glue mesh fixation with laparoscopic inguinal hernia repair achieves similar hernia recurrence rates compared with staple/tack fixation, but decreased incidence of chronic inguinal pain, it may be the preferred technique.
Subject(s)
Fibrin Tissue Adhesive/therapeutic use , Hernia, Inguinal/surgery , Herniorrhaphy/methods , Laparoscopy/methods , Surgical Stapling/methods , Analgesics/therapeutic use , Chronic Pain/etiology , Costs and Cost Analysis , Groin , Humans , Length of Stay/statistics & numerical data , Pain, Postoperative/etiology , Postoperative Complications/etiology , Recovery of Function , Recurrence , Seroma/etiology , Surgical Mesh , Surgical Wound Infection/etiology , Treatment OutcomeABSTRACT
BACKGROUND: Recurrence rates after ventral incisional hernia repair are reported to be as high as 33% and are associated with considerable morbidity and lost time. The purpose of this study was to determine if retrofascial mesh placement reduces the incidence of recurrence as well as the severity of wound infections. METHODS: A prospective database covering the period from January 1995 to June 2003 was maintained. All patients underwent a standardized technique by a single surgeon. Polypropylene mesh was placed between the fascia and the peritoneum with the fascia closed over the mesh. RESULTS: There were 150 patients (126 women, 24 men) with a mean age of 55 years. Their average weight was 88 kg, with an average body mass index of 32. Sixty-three (42%) of the hernias were recurrences of a previous repair. The average size of the hernia was 8 x 14 cm. There was 1 postoperative mortality. There was a 9% postoperative infection rate with 2 patients (1%) requiring mesh removal. Long-term follow-up evaluation has revealed 3 recurrences (2%) and 3 readmissions for bowel obstruction with 1 patient requiring surgical release. There were no fistulas noted. CONCLUSIONS: Incisional hernia repair with mesh placed in the retrofascial position decreases both the risk for recurrence and the severity of wound infection without significant problems from bowel obstruction or enteric fistula.