Influence of inguinal hernia mesh repair on testicular flow and sperm autoimmunity.

BACKGROUND: The incidence of infertility caused by the mesh inguinal hernia repair is not known. The aim of this study was to determine circulation and immunological testicular disorders after inguinal hernia mesh repair which can be related with infertility. METHODS: From February 2010 to December 2010, 43 male patients who underwent inguinal hernia mesh repair were included in a prospective study. Testicular, capsular and intratesticular arterial flow dynamics were measured by Color Doppler ultrasound before the operation, in early and late postoperative period. The antisperm antibodies were analyzed before hernia repair and 5 months after. RESULTS: The difference between patients who underwent laparoscopic (Group I) and anterior open tension-free hernia repair (Group II) in age, duration of symptoms and hernia characteristics were not significant. Statistically significant differences were found in peak-systolic and end-diastolic velocity in testicular and intratesticular arteries in Group II and in peak-systolic velocity on all levels in Group I. Only Group I had significant differences in resistive index of intratesticular arteries. All the values returned to basal in late postoperative period except testicular peak-systolic velocity in Group I which stayed in normal range. Wilcox matched pair test showed significant difference between preoperative and late postoperative measurements of the antisperm antibodies only in Group II, but it was within normal range in all cases. CONCLUSIONS: Inguinal hernia mesh repair do not have clinically significant influence on testicular flow and immunological response.

Lateral thermal damage to rat abdominal wall after harmonic scalpel application.

BACKGROUND: Use of the Harmonic Scalpel transduces a lower amount of energy to tissues, thereby limiting the potential for lateral thermal damage and deep penetration because only low temperatures are reached. The working principle of the Harmonic Scalpel is the transformation of electric power into the longitudinal mechanical movement of the instrument tip. This study aimed to determine the effects from varying durations of Harmonic Scalpel application on the experimental model of rat abdominal wall without skin. METHODS: After the rats had been anesthetized, and a laparotomy was performed. The Harmonic Scalpel shears were used on the muscular part of the abdominal wall without skin. Different durations of output power 3 were applied: a single 5-s application, a single 10-s application, and a regimen of two sequential 5-s applications. Each animal in each group of 10 received five individual activations, after which the animals were killed. Tissue samples were fixed and embedded in paraffin before sections were taken and stained. Using light microscopy and morphometric imaging analysis, the width of tissue lateral thermal damage was measured from the point of Harmonic Scalpel incision. RESULTS: The rat abdominal wall showed lateral thermal damage over a mean width of 0.0522 +/- 0.0097 mm after a 5-s Harmonic Scalpel application, a damage width of 0.1544 +/- 0.0419 mm after a 10-s application, and a damage width of 0.1020 +/- 0.0430 mm after a 5-s application followed by 5 s of inactivity and another 5 s of activity. These differences in thermal damage width between all the groups are statistically significant. CONCLUSIONS: The findings lead to the conclusion that tissue lateral thermal damage after Harmonic Scalpel application at standard output power is greater when a longer sustained period of application is used. Lateral thermal damage also is greater if the Harmonic Scalpel application time is continuous rather than of the same total duration with a brief midpoint interruption.

Hyperbaric oxygenation as adjuvant therapy to surgery of emphysematous cholecystitis.

Three cases of emphysematous cholecystitis are presented. The role of hyperbaric oxygenation as excellent adjuvant therapy to urgent surgical as well as intensive conservative treatment is emphasized.

Modified intraparietal vagotomy in the treatment of perforated duodenal ulcer.

BACKGROUND/AIMS: The purpose of this study was to introduce modified intraparietal vagotomy as a safe procedure and a method of choice in the treatment of perforated duodenal ulcers. METHODOLOGY: Eighty-six patients with perforated duodenal ulcers underwent oversewing of the perforated ulcer and modified intraparietal selective vagotomy. The site of perforation was sewn over and an abdominal cavity lavage was performed. The posterior vagal nerve was resected, and a modified intraparietal anterior vagotomy was performed. During the postoperative period, after twenty days, six months and one year, respectively, we analyzed the following data: body weight, signs of gastroesophageal reflux, subjective discomfort, early postoperative complications, gastroduodenoscopic findings, basal acid output (BAO), and maximal acid output stimulated by pentagastrin (PAO). RESULTS: There was no mortality in our group, the post-operative morbidity was insignificant, and the duration of operation was shorter in comparison to other vagotomy methods. BAO and PAO values were similar to those in the literature when proximal selective vagotomy (PSV) was performed. There were no cases of duodenogastric or gastroesophageal reflux nor re-occurrence of ulcer disease, as confirmed by gastroduodenoscopy. According to the modified Visick's criteria, 94% of the patients followed-up were classified as group 1. CONCLUSION: We consider the modified intraparietal vagotomy to be the method of choice in the treatment of perforated duodenal ulcers because of the simple surgical technique involved, the shorter duration of surgery, and the avoidance of standard PSV complications. The surgery can be performed even by a less experienced surgeon, independently of the patient's age and condition. This modification is suitable for laparoscopic surgery.

[Viscerosynthesis--use of mechanical sutures in digestive tract surgery]. / Viscerosinteza--primjena mehanickog sava u digestivnoj kirurgiji.

Mechanical suture (stapler) was applied 164 times in digestive surgery in the period from October 1985 to December 1988. There have been performed 82 anastomoses (30 low collateral, 20 esophagointestinal, 20 ileocolic, 10 enteroenteral and 2 colocolic) and 76 closure of intestines. Anastomoses were performed with EEA stapler in 50, GIA stapler in 30 and TA stapler in 2 cases. Intraoperative complications related to the use of stapler were observed in 4.8% cases. Clinically manifested dehiscence of the stapler anastomoses was evident in 4.8% (82) and immediate cause of death in 1.2% (1) case. The incidence of secondary wound infection after four years was 2.4%. No clinically manifested stenosis of anastomoses were observed within the follow up period from one to four years.