RESUMO
OBJECTIVE: To determine whether the type of prosthetic material and technique of placement influenced long-term complications after repair of incisional hernias. DESIGN: Retrospective cohort analytic study. SETTING: University-affiliated hospital. PATIENTS: Two hundred patients undergoing open repair of abdominal incisional hernias with prosthetic material between 1985 and 1994. INTERVENTIONS: Four types of prosthetic material were used and placed either as an onlay, underlay, sandwich, or finger interdigitation technique. The materials were monofilamented polypropylene mesh (Marlex, Davol Inc, Cranston, RI), double-filamented mesh (Prolene, Ethicon Inc, Somerville, NJ), expanded polytetrafluroethylene patch (Gore-Tex, WL Gore & Associates, Phoenix, Ariz) or multifilamented polyester mesh (Mersilene, Ethicon Inc). MAIN OUTCOME MEASURES: The incidence of recurrence and complications such as enterocutaneous fistula, bowel obstruction, and infection with each type of material and technique of repair were compared with univariate and multivariate analysis. RESULTS: On univariate analysis, multifilamented polyester mesh had a significantly higher mean number of complications per patient (4.7 vs 1.4-2.3; P<.002), a higher incidence of fistula formation (16% vs 0%-2%; P<.001), a greater number of infections (16% vs 0%-6%; P<.05), and more recurrent hernias (34% vs 10%-14%; P<.05) than the other materials used. The additional mean length of stay to treat complications was also significantly longer (30 vs 3-7 days; P<.001) when polyester mesh was used. The deleterious effect of polyester mesh on long-term complications was confirmed on multiple logistic regression (P=.002). The technique of placement had no influence on outcome. CONCLUSION: Polyester mesh should no longer be used for incisional hernia repair.
Assuntos
Hérnia Ventral/cirurgia , Politetrafluoretileno/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Próteses e Implantes/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Fístula Cutânea/epidemiologia , Feminino , Humanos , Incidência , Fístula Intestinal/epidemiologia , Obstrução Intestinal/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos/efeitos adversos , Polietilenos/efeitos adversos , Polipropilenos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese , Recidiva , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Fatores de TempoRESUMO
Physician participation in euthanasia and assisted suicide has been the subject of long-standing debate and is unlikely to be resolved easily or soon. The Pennsylvania Medical Society's Medical Student Section explored this topic recently in a second "mock trial" held in conjunction with the Temple University School of Law and co-sponsored by the Pennsylvania Medical Society Liability Insurance Company. This is an account and essay from that trial.
