RESUMO
Previous reports have described laparoscopic mesh repair for lumbar hernia due to iliac crest bone harvest, but there have been no reports of reoperation with laparoscopic mesh repair for recurrent cases after laparoscopic mesh repair. Here, we describe the case of a 72-year-old Japanese woman with lumbar hernia recurrence 6 years after laparoscopic mesh repair for lumbar hernia due to iliac crest bone harvest. We performed a successful reoperation with laparoscopic mesh repair. Laparoscopic surgery should be considered to elucidate the mechanism of recurrence, previous mesh position, and the area that must be covered to prevent recurrence again.
Assuntos
Hérnia Abdominal/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Laparoscopia , Idoso , Transplante Ósseo/efeitos adversos , Transplante Ósseo/métodos , Feminino , Hérnia Abdominal/diagnóstico por imagem , Hérnia Abdominal/etiologia , Humanos , Ílio/cirurgia , Hérnia Incisional/diagnóstico por imagem , Hérnia Incisional/etiologia , Região Lombossacral , Recidiva , Reoperação , Telas Cirúrgicas , Coleta de Tecidos e Órgãos/efeitos adversos , Coleta de Tecidos e Órgãos/métodosRESUMO
At Queens Medical Centre, Nottingham, alveolar bone grafts (ABG) for patients with cleft lip and palate (CLP) were performed by two surgeons following the same surgical protocol, but with different postoperative iliac crest donor site analgesia: surgeon A used a donor site bolus of levobupivacaine, whilst surgeon B used a donor site epidural catheter (EC) infusing levobupivacaine. A healthcare evaluation was conducted in two phases to establish the effectiveness of analgesia for CLP patients undergoing ABGs. Data were collected prospectively in 2016 and 2018. Cleft patients postoperative to ABG were included. Outcome measures were pain scores at 2, 4, 6, 12, and 24 hours, time to mobilization, and time to food intake. Mean pain scores at the first evaluation were <1 out of 10 for all time points, except 24 hours (score 2.0 for bolus, 1.8 for EC). There was no statistically significant difference between the groups for any of the outcomes measured. As EC conferred no advantage, surgeon B changed to bolus administration and a second evaluation was performed. The mean pain score for the second evaluation was 1.7 and higher pain scores were more common with lower doses of levobupivacaine. The data suggest that bolus injection can produce safe, effective pain control provided an adequate dose is given.
Assuntos
Analgesia , Fissura Palatina , Transplante Ósseo , Humanos , Ílio , Dor , Dor Pós-OperatóriaRESUMO
Autogenous bone harvest is the gold standard for restoring deficiencies of the recipient site. A deficient site requires adequate grafting before placement of implants; therefore, proper understanding of the wide variety of grafting options is the key to successfully planned implant dentistry. This provides general dentists with a better understanding of autogenous bone harvest and the variety of techniques available to provide the best outcomes for the patient.