Cyanoacrylate mesh fixation for laparoscopic inguinal hernia repair: a prospective, multicenter, single-arm study.

BACKGROUND: Inguinal hernia repair is among the most frequently performed surgical procedures. Alternatives to penetrating mesh fixation, such as surgical glue, are being investigated for their potential benefit in reducing chronic pain. The aim of this study was to assess the efficacy of the n-hexyl cyanoacrylate glue Ifabond™ for mesh fixation in laparoscopic inguinal hernia repair. METHODS: This prospective, multicenter, single-arm study collected data from laparoscopic inguinal hernia repairs using Ifabond™ (Peters Surgical, Boulogne-Billancourt Cedex, France) and a standard [Promesh® SURG ST (Peters Surgical)/Biomesh® P1 (Cousin Biotech, Wervicq-Sud, France)] or lightweight [Promesh® SURG LI (Peters Surgical)/Premium® Implant (Cousin Biotech)] polypropylene mesh. The primary endpoint was postoperative pain [100-scale Visual Analog Scale (VAS)]. Secondary endpoints were complications, hernia recurrences, and quality of life (QoL) (EQ-5D-3L health index and EQ-VAS). Patients were followed up at 5 weeks and 12 months after surgery. RESULTS: Six-hundred and thirteen patients underwent laparoscopic inguinal hernia repair. Postoperative pain decreased at 5-week (3.97 ± 10.04; p < 0.0001) and 12-month (3.83 ± 11.26; p < 0.0001) follow-up compared with before surgery (26.96 ± 19.42). One hundred and fifteen patients (13.74%) experienced chronic pain in the groin at 12-month follow-up, of whom 14 (2.67%) required analgesics. There were 6 patients with major morbidities and one patient died of an unrelated cause. Two hernia recurrences occurred within 12-month follow-up. Patients' QoL increased from an EQ-5D-3L index score of 0.82 ± 0.19 preoperatively to 0.90 ± 0.15 at 5 weeks (p < 0.0001) and 0.92 ± 0.15 at 12 months after surgery (p < 0.0001). The EQ-VAS general health scoring increased from 79.03 ± 12.69 preoperatively to 84.31 ± 9.97 at 5-week (p < 0.0001) and 84.16 ± 14.48 at 12-month follow-up (p < 0.0001). CONCLUSIONS: Ifabond™ (Peters Surgical) is a safe, reliable, and feasible fixation method for laparoscopic inguinal hernia repair with a very high surgeon satisfaction score, improved patients' QoL, and comparable risk of developing chronic pain and postoperative complications as described in the literature.

Attenuated atrial natriuretic peptide-mediated lipolysis in subcutaneous adipocytes of obese type 2 diabetic men.

Catecholamines and atrial natriuretic peptide (ANP) are major regulators of adipocyte lipolysis. Although obesity is characterized by catecholamine resistance in subcutaneous adipose tissue (SCAT), data on ANP lipolytic response and sensitivity in different adipose tissue (AT) depots of metabolically distinct humans are scarce. Ex vivo catecholamine- and ANP-induced lipolysis was investigated in adipocytes derived from SCAT and visceral AT (VAT) depot of lean (n=13) and obese men, with (n=11) or without (n=18) type 2 diabetes (HbA1c < or ≥ 6.5%). Underlying molecular mechanisms were examined by looking at functional receptors in the NP signalling pathway at the mRNA and protein level. Maximal ANP- and catecholamine-induced lipolysis in SCAT was blunted in obese type 2 diabetics compared with age-matched lean men whereas non-diabetic obese subjects showed intermediate responses. This blunted ANP-mediated lipolytic response was accompanied by lower mRNA and protein expression of the type-A natriuretic peptide (NP) receptor and higher mRNA but reduced protein expression of the scavenging type-C receptor. Maximal ANP-induced lipolysis was lower in VAT compared with SCAT but not different between groups. Collectively, our data show that both ANP- and catecholamine-mediated lipolysis is attenuated in SCAT of obese men with type 2 diabetes, and might be partially explained by NP receptor defects. Therefore, improving maximal ANP responsiveness in adipose tissue might be a potential novel strategy to improve obesity-associated metabolic complications.

A mid-term experience with the Cousin Bioring--adjustable gastric band.

BACKGROUND: Since March 2003, we have used the Cousin Bioring in our laparoscopic gastroplasty procedures for morbid obesity. The Bioring belongs to the new generation of adjustable gastric bands. The aim of this study is to review our experience with this particular type of band. METHODS: Between March 2003 and March 2010, 316 patients had a laparoscopic implantation of the Cousin Bioring in our department. As many as 169 patients had the operation at least 5 years ago, of which 161 had a complete follow-up. Short- and long-term results were prospectively collected and analysed. RESULTS: There were no intra-operative and only two mild early post-operative complications. Mortality was zero. The mean percent of excess weight loss (%EWL) was 56% at 5 years, 55% at 6 years and 56% at 7 years. Of the 169 patients, four had a band removal for intolerance and/or insufficient weight loss and 11 (6.5%) developed late complications requiring surgery. We managed to solve all complications by minimally invasive procedures without loss of the device. Fifteen of the 169 patients suffered preoperatively from diabetes mellitus type 2. Ten of these had a remission after 5 years. The quality-of-life was assessed 3 years post-operatively for 164 patients and showed an improvement in 83.5% of them. CONCLUSION: Laparoscopic implantation of the Cousin Bioring is a straightforward and safe operation. Complications occur, but they are rather benign and easy to remediate. The mean weight loss is considered successful (%EWL > 50) and persists 5 to 7 years after the operation.

Successful treatment of liver rupture in a premature infant.

Subcapsular rupture of the liver is a rare and usually lethal complication in preterm infants. A multidisciplinary approach is warranted to achieve the best possible outcome for these children.

Enteral nutrition regimen for neonates with short bowel syndrome.

Short bowel syndrome is characterized as a state of malabsorption after massive resection of the small intestine. It has a wide spectrum of clinical presentations, from mild to severe depending predominantly on the length of intestine remnant. Management is challenging and requires vigorous attention to every detail. Enteral nutrition is the key to intestinal adaptation and reduction of dependency on parenteral nutrition. Therefore, creative ways are essential to maximize enteral nutrition despite obstacles to its use.

Results of lap rebanding procedures after Lap-Band removal for band erosion -- a mid-term evaluation.

BACKGROUND: Late band erosion is an uncommon complication after laparoscopic adjustable gastric banding (LAGB). Overall erosion rate in our practice is approximately 1.6%. Our first 10 erosion patients underwent a rebanding procedure after previous Lap-Band removal. This study gives the results of midterm follow-up. METHODS: 10 patients underwent Lap-Band removal for erosion. Then, 4 to 6 months after band removal, between December 1999 and February 2002, the 10 patients underwent LAGB again. Post-operatively, patients were seen at least every 3 months, and routine endoscopy was performed 1, 2 and 3 years after rebanding. Follow-up in this study was 36-63 (mean 48) months. RESULTS: No postoperative complications occurred; however, the first patient required conversion to laparotomy. Mean BMI was 40.6 (34-50) at the time of the initial LAGB, 34.3 (31-44) at the time of rebanding, and is 28.5 (22-38) at present. There have been 2 late complications: 1 pouch dilatation and 1 port leak. No re-erosions have developed. Satisfaction has been excellent in 9 patients and moderate in 1. CONCLUSION: Laparoscopic rebanding is a safe, feasible, minimally invasive and efficacious option as a second bariatric procedure after Lap-Band removal for erosion. However, if the patient is not pleased with the first band, a different bariatric operation should be considered. Our results in the mid-term are excellent, but longer follow-up is necessary to draw definitive conclusions.