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1.
Am Surg ; 86(2): 110-115, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167045

RESUMO

Several randomized trials comparing self-gripping mesh with polypropylene (PL) mesh in Lichtenstein hernioplasty revealed that the self-gripping mesh significantly reduced the operation time. In these studies, some enrolled only male patients, and in others, the proportion of women was extremely low. The aim of this research was to compare outcomes after self-gripping mesh repair with PL mesh secured with sutures in female Lichtenstein hernioplasty. Female patients with primary unilateral inguinal hernia were assigned randomly to undergo Lichtenstein hernioplasty with a self-gripping ProGrip (PG) mesh or a sutured PL mesh, followed-up at one week, one month, three months, one year, and two years. Demographics, hernia characteristics, and operative outcomes data were analyzed. Pain was assessed with a visual analog scale (0-10), and quality of life (QOL) was estimated by a 36-item short-form general survey (0-26). Forty eight patients in the PG group and 51 participants in the PL group completed the follow-up. The operation time of the PG (54.1 ± 12 minutes) group was significantly shorter than that of the PL (60.9 ± 11.3 minutes) group (P = 0.045). At the one-month follow-up, the incidence of foreign body feeling in the PG group was significantly higher than that in the PL group (P = 0.031), whereas no significant difference was observed in visual analog scale ≥3 and QOL. In a follow-up of three months, one year, and two years, there was no significant difference in foreign body feeling, chronic pain, QOL, and recurrence between two groups. The surgical outcomes of self-gripping mesh are comparable to those of the ordinary PL mesh with a reduced operation time in female Lichtenstein hernioplasty. Registration number: ChiCTR1800017360 (http://www.chictr.org.cn).


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Corpos Estranhos/diagnóstico , Herniorrafia/instrumentação , Humanos , Duração da Cirurgia , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Polipropilenos , Estudos Prospectivos , Qualidade de Vida , Recidiva , Telas Cirúrgicas/efeitos adversos , Suturas , Fatores de Tempo , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(9): e19376, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118783

RESUMO

To introduce the use of a new surgical approach named single-incision bilateral inguinal herniorrhaphy (SBIH) in pediatric surgical population.This was a STROBE-compliant retrospective cohort study using data from 101 patients who had undergone bilateral inguinal herniorrhaphy in our institution. Children with bilateral inguinal hernias without contraindications for surgery, ranging in age from 6 months to 12 years, were included. Fifty-six children with bilateral inguinal hernias underwent SBIH (SBIH group) and 45 patients underwent laparoscopic bilateral inguinal herniorrhaphy (LBIH) (LBIH group). Differences in operative time, postoperative pain, recurrence, and complications between the 2 groups were analyzed. Patient satisfaction with cosmetic result was also investigated using questionnaires.There were no statistically significant differences in operative time (P = .2257), postoperative pain (P = .0607), recurrence (P = .8756), and complications (P = .7467) between the 2 groups. Interestingly, the operation time of girls in SBIH group was significantly shorter than that of the boys in this group (P < .0001), but also shorter than that of girls in LBIH group (P = .0038). Postoperative pain for boys was lower in SBIH group than in the LBIH group (P = .0340). No ascending testis, testicular atrophy, and hydrocele occurred in either group. According to the questionnaire, both procedures had equally high levels of satisfaction for cosmetic results (P = .7531).Initial results show that SBIH for pediatric patients, regardless of gender, is a safe and feasible procedure compared with LBIH with an equally low recurrence rate, few complication, and satisfactory cosmetic outcomes.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Herniorrafia/normas , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Hérnia Inguinal/epidemiologia , Herniorrafia/estatística & dados numéricos , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento
3.
Surg Clin North Am ; 100(2): 379-408, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169185

RESUMO

Robotic-assisted laparoscopic ventral hernia repair (RA-LVHR) has many options. Before applying these techniques, it is important to identify the patient's goals for hernia repair, align yourself with those goals, and apply a technique appropriate for the clinical scenario, and most likely to meet the goals. Fundamental principles of hernia repair must be maintained: avoiding thermal injury to hollow viscera, adequate dissection of abdominal wall, appropriate mesh:defect ratio, stronger fixation where overlap is limited, and more overlap where fixation points are weak. This manuscript will detail available techniques for RA-LVHR along with their their advantages and disadvantages.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Parede Abdominal/cirurgia , Humanos , Telas Cirúrgicas
4.
Surg Clin North Am ; 100(2): 409-415, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169186

RESUMO

Robotic inguinal hernia repair represents the natural progression of minimally invasive inguinal hernia surgery. This article highlights all aspects of a robotic transabdominal preperitoneal (rTAPP) inguinal hernia repair with mesh, starting with preoperative planning and patient selection, key technical steps, and common postoperative complications and recovery. The most recent published data on robotic inguinal hernia repair are comprehensively reviewed, confirming that rTAPP is a safe and effective option for the repair of unilateral and bilateral inguinal hernias.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Humanos , Laparoscopia/métodos , Telas Cirúrgicas
10.
Am Surg ; 86(2): 146-151, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32106908

RESUMO

We aim to observe and dissect the essential anatomical landmarks in totally extraperitoneal (TEP) procedures. Forty-six TEP procedures in 30 patients were prospectively performed in our department. During the dissection of the preperitoneal space, the following distances between landmarks were measured. D1: the distance from pubic symphysis to the arcuate line in the midline; D2: the distance from the inferior epigastric artery to the lateral border of the arcuate line (before sharp incision was performed); D3: as in D2 (but after sharp incision was performed); D4: the distance from the inferior epigastric artery to the crossing site of vas deferens and obliterated umbilical artery. Furthermore, the morphology of the posterior rectus sheath was documented. The corresponding distance between the anatomical landmarks varied greatly in each individual. D1: 8 ± 1.6 cm (range 4-10 cm). D2: 4.9 ± 0.8 cm (3.5-7 cm). D3: 6.8 ± 0.9 cm (5-9 cm). D4: 6.1 ± 1 cm (4.8-8.5 cm). Complete rectus sheath was found in 30.4 per cent (14/46) of the hernias. Anatomical variations were common in preperitoneal space. The crossing site of vas deferens and obliterated umbilical artery can serve as a landmark for dissection. Complete rectus was present in one-third of hernias, which necessitates a sharp incision for entering the correct lateral preperitoneal space.


Assuntos
Pontos de Referência Anatômicos/anatomia & histologia , Endoscopia/métodos , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Músculos Abdominais/anatomia & histologia , Dissecação/métodos , Artérias Epigástricas/anatomia & histologia , Humanos , Masculino , Estudos Prospectivos , Sínfise Pubiana/anatomia & histologia , Telas Cirúrgicas , Artérias Umbilicais/anatomia & histologia , Ducto Deferente/anatomia & histologia
11.
Khirurgiia (Mosk) ; (1): 53-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994500

RESUMO

OBJECTIVE: To assess position of mesh endoprosthesis in retroperitoneal space after TARR hernioplasty using ultrasound in early and long-term postoperative period. MATERIAL AND METHODS: There were 30 patients with inguinal hernias after TARR procedure. Standard technology of laparoscopic transabdominal preperitoneal hernioplasty was used in all patients. In all cases, a large-pore monofilament polypropylene mesh 10x15 cm was used. Control examination and ultrasound of the mesh implant were performed the next day, in 1, 3, 6, 12 months after surgery. Correct position of the implant was determined by its placement at the level of pubic bone with complete overlap of posterior wall of the inguinal canal and inner ring. RESULTS: US-image of the implant is present in two geometric forms - linear and sinusoid. The shape of prosthesis varies depending on postoperative period and the use of fixing elements. Thus, sinusoidal shape of prosthesis was observed in patients without fixation of prosthesis the next day and in 1 month after TARR. Geometry of the implant acquired the form of a straight line after 3 months and became almost a straight line in 12 months after surgery. Linear shape of prosthesis in early postoperative period was found after intraoperative fixation of endoprosthesis. Sinusoidal shape is noted after 3 months. Ultrasonic pattern of endoprosthesis looked as a thin hyperechoic band with thickness of 1.2-3.9 mm. Mean thickness of prosthesis was 2.2±0.1 mm the next day after surgery, 2.8±0.2 mm after 1 month and 1.6±0.05 mm after 12 months. CONCLUSION: Geometry of synthetic implants after TARR hernioplasty undergoes significant changes and depends on duration of postoperative period and fixation of the prosthesis.


Assuntos
Abdome/diagnóstico por imagem , Hérnia Inguinal/diagnóstico por imagem , Herniorrafia/métodos , Abdome/cirurgia , Hérnia Inguinal/cirurgia , Humanos , Laparoscopia , Telas Cirúrgicas , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia
12.
Ann R Coll Surg Engl ; 102(2): 75-83, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31696731

RESUMO

INTRODUCTION: Gynaecological structures such as the ovaries, fallopian tubes, ligaments and uterus are rarely encountered inside a hernial sac. The prevalence of groin hernias containing parts of female genitalia remains unknown. The aim of this review was to summarise the existing evidence on inguinal hernias containing ovaries with or without the other female adnexa. METHODS: A systematic search was conducted for literature published up to February 2018 using the MEDLINE®, Scopus® and Google Scholar™ databases along with the references of the full-text articles retrieved. Papers on observational studies and case reports concerning women who were diagnosed with an ovarian inguinal hernia (pre or intraoperatively) were considered eligible for inclusion in the review. RESULTS: Fifteen papers (13 case reports, 2 case series) comprising seventeen patients (mean age 47.9 years) were evaluated. A left-sided hernia was noted in 13 cases (77%) whereas 4 patients had a right-sided hernia. Eight patients underwent preoperative imaging with computed tomography, ultrasonography or both. This was diagnostic in five cases. In 11 patients, hernia contents were repositioned, 2 had a salpingo-oophorectomy and 2 an oophorectomy. Eight patients underwent hernia repair with mesh placement while three had a herniorrhaphy. CONCLUSIONS: Ovarian inguinal hernias should be considered among the differential diagnoses of a groin mass or swelling. In women of reproductive age, repair of the hernia with the intent to preserve fertility is of critical importance.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Doenças Ovarianas/cirurgia , Ovariectomia , Salpingo-Ooforectomia , Feminino , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/epidemiologia , Herniorrafia/instrumentação , Humanos , Canal Inguinal/diagnóstico por imagem , Canal Inguinal/cirurgia , Doenças Ovarianas/diagnóstico , Doenças Ovarianas/epidemiologia , Ovário/diagnóstico por imagem , Ovário/cirurgia , Prevalência , Telas Cirúrgicas , Tomografia Computadorizada por Raios X , Ultrassonografia
13.
Ann R Coll Surg Engl ; 102(1): e7-e11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31530171

RESUMO

Ehlers-Danlos syndrome is a hereditary connective tissue disorder that has gastrointestinal manifestations in over 50% of its cases. We present the first case of bariatric surgery in a patient with Ehlers-Danlos syndrome and outline management challenges in the context of the relevant literature. A 56-year-old man with type IV Ehlers-Danlos syndrome and a body mass index of 41.8 kg/m2 was referred to the bariatric centre of the Churchill Hospital, Oxford, for consideration of surgery for morbid obesity. His comorbidity included type 2 diabetes, hypertension, dyslipidaemia and obstructive sleep apnoea. He underwent a laparoscopic Roux-en-Y gastric bypass. His initial recovery was uneventful and he was discharged on the first postoperative day. Six weeks later, he presented with 43.9% excess weight loss and improved glycaemic control. Three months postoperatively, however, he complained of dysphagia, regurgitation and postprandial pain. A barium meal and gastroscopy suggested the presence of a gastric diverticulum. A surgical exploration was planned. Intraoperative gastroscopy demonstrated an asymmetrical gastric pouch dilatation and the pouch was therefore refashioned laparoscopically. Despite the initial symptomatic relief, two months later he experienced retrosternal pain with progressive dysphagia. Since then, multiple endoscopic dilatations of the gastro-oesophageal junction have been performed for recurrence of symptoms. Finally, a laparoscopic hiatus hernia repair and adhesiolysis was performed resulting in complete relief of patient's symptoms. Bariatric management of patients with Ehlers-Danlos syndrome can prove challenging. The bariatric team must implement a careful management plan including a detailed consent process, a tailored surgical intervention and a follow-up focused on potential gastrointestinal manifestations.


Assuntos
Síndrome de Ehlers-Danlos/complicações , Obesidade Mórbida/cirurgia , Transtornos de Deglutição/etiologia , Diabetes Mellitus Tipo 2/complicações , Endoscopia do Sistema Digestório/métodos , Derivação Gástrica/métodos , Hérnia Hiatal/diagnóstico , Hérnia Hiatal/etiologia , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação
14.
Ann R Coll Surg Engl ; 102(2): e39-e41, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31532226

RESUMO

Approximately 5% of intestinal obstruction cases are caused by internal herniation. Caecal herniation through the foramen of Winslow is considered a rare event. The management of caecal herniation remains challenging due to the lack of literature highlighting this pathology. A 66-year-old woman was admitted with a 24-hour history of epigastric pain radiating to the back. The pain was associated with nausea and vomiting of gastric contents. On examination, the abdomen was soft with mild tenderness but no signs of peritonism or distension. The abdominal x-ray and a computed tomography were in keeping with caecal volvulus and confirmed that the caecum was not in the right iliac fossa. In a midline laparotomy procedure, the ileum, caecum and ascending colon were noted to be herniating into the foramen of Winslow. A right hemicolectomy with a handsewn anastomosis was performed. The foramen of Winslow was not closed. No postoperative complications occurred. A literature review showed a lack of similar cases with no agreed management consensus. The laparotomy approach is comparable to the laparoscopic approach and no caecal herniation recurrence after open/laparoscopic surgical procedures were identified. Awareness of caecal herniation allows early diagnosis and timely surgical management is needed in prevent patient morbidity and mortality.


Assuntos
Ceco/diagnóstico por imagem , Colo Ascendente/diagnóstico por imagem , Hérnia Abdominal/diagnóstico por imagem , Idoso , Doenças do Ceco/diagnóstico por imagem , Doenças do Ceco/cirurgia , Ceco/cirurgia , Colo Ascendente/cirurgia , Feminino , Hérnia Abdominal/cirurgia , Herniorrafia/métodos , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Radiografia Abdominal , Tomografia Computadorizada por Raios X
15.
J Surg Res ; 246: 62-72, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31561179

RESUMO

Recurrence rates in the laparoscopic repair of the hiatal hernia range from 12% to 59%. Limitation of reinforcement has been principally the risk of adverse events caused by synthetic materials. Biologic and resorbable synthetic materials are valid alternatives. This study compares the host response to all these materials after hiatal hernia repair. A total of 20 Landrace pigs, underwent laparoscopic primary hiatal hernia repair and reinforced with a polypropylene mesh (PROLENE: polypropylene [PP]), an absorbable synthetic scaffold (GOREBIO-A: polyglycolic acid [PGA]), a urinary bladder matrix scaffold, (Gentrix: urinary bladder matrix [UBM]), or without reinforcement, control group (C). Animals were survived for 3 months. Endpoints included gross morphology, biomechanical testing, and histology. Pigs in PP and PGA groups showed fibrosis at the repair site, with robust adhesions. In UBM and C groups, only mild adhesions were found. Load at failure (gr) and stiffness (gr/mm) of PP were higher than C group (PP:2103 ± 548.3 versus C:951.1 ± 372.7, P = 0.02; PP:643.3 ± 301 versus C:152.6 ± 142.7, P = 0.01). PGA and UBM values for both parameters were in between PP and C samples. However, stiffness in UBM was tended to be lower than PP group, and approached a significant difference (643.3 ± 301 versus 243 ± 122.1, P = 0.0536). In UBM group, the histology resembled native tissue. By contrast, PP and PGA groups showed mononuclear infiltrates, fibroencapsulation, necrosis, remnants of mesh, and disorganized tissue that was validated with a histologic score. In this setting, UBM scaffolds showed the most appropriate features for hiatal hernia repair, recovering the tissue properties that can help reduce the possibility of early failure and prevent complications associated with the implanted material.


Assuntos
Materiais Biocompatíveis , Hérnia Hiatal/cirurgia , Herniorrafia/instrumentação , Prevenção Secundária/instrumentação , Tecidos Suporte , Implantes Absorvíveis , Animais , Modelos Animais de Doenças , Feminino , Herniorrafia/métodos , Humanos , Teste de Materiais , Prevenção Secundária/métodos , Estresse Mecânico , Telas Cirúrgicas , Sus scrofa
16.
Ann R Coll Surg Engl ; 102(1): e4-e6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31509003

RESUMO

Thoracoabdominal hernia following blunt trauma is extremely rare. Abdominal viscera are more likely to herniate into the thorax if there is traumatic diaphragmatic rupture. We report the case of a patient presenting with a traumatic thoracoabdominal hernia containing part of the right lobe of the liver and the hepatic flexure of the colon. The hernia migrated cranially, to protrude through a seventh intercostal defect despite the diaphragm remaining fully intact. The need for early multispecialty (thoracic and hepatobiliary) surgical repair is highlighted, with improvements in surgical outcome for a complex trauma case by using a novel chest-wall reconstruction technique.


Assuntos
Hérnia Diafragmática Traumática/cirurgia , Herniorrafia/métodos , Ferimentos não Penetrantes/cirurgia , Acidentes por Quedas , Hérnia Diafragmática Traumática/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas das Costelas/etiologia , Fraturas das Costelas/cirurgia , Telas Cirúrgicas , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos não Penetrantes/etiologia
17.
J Surg Res ; 246: 26-33, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31557596

RESUMO

BACKGROUND: Tissue adhesives are a feasible option to fix a hernia repair mesh, avoiding tissue trauma of suture fixation. Classically, they are applied in the form of a drop, although novel applications such as spray are emerging. This study compares the use of a new experimental cyanoacrylate (n-butyl) in the form of a spray or drops. MATERIALS AND METHODS: Three study groups of New Zealand White rabbits were established (n = 6 each) according to the method used to fix a 5 × 3 cm polypropylene mesh in a partial abdominal wall defect model: control group (polypropylene stitches), adhesive drops group, and adhesive spray group. Morphological, immunohistochemical, and biomechanical strength studies were performed at 14 d postimplant. Collagen 1/3 gene ratio was determined by quantitative reverse transcription polymerase chain reaction. RESULTS: In the drops group, the adhesive obstructed the mesh pores and prevented tissue infiltration at the points of application. When the adhesive was applied as a spray, although more numerous, adhesive deposits were smaller and allowed for better host tissue infiltration into the mesh. The inflammatory response was similar in the adhesive groups and more intense than in the control group. Collagen 1/3 mRNA ratio was significantly higher in the spray than the control group. The mechanical resistance of the meshes was similar in all three groups. CONCLUSIONS: The application of the cyanoacrylate adhesive in the form of spray to fix polypropylene meshes in an animal model had a similar inflammatory response compared with droplet application. Neither application impacted the mechanical strength of the repaired area. An increased in collagen 1/3 ratio was found with cyanoacrylate spray compared with suture, and future studies should focus on this pathway.


Assuntos
Cianoacrilatos/administração & dosagem , Hérnia Abdominal/cirurgia , Herniorrafia/métodos , Procedimentos Cirúrgicos sem Sutura/métodos , Adesivos Teciduais/administração & dosagem , Parede Abdominal/cirurgia , Animais , Modelos Animais de Doenças , Herniorrafia/instrumentação , Coelhos , Telas Cirúrgicas , Procedimentos Cirúrgicos sem Sutura/instrumentação , Suturas , Resistência à Tração
20.
Ann R Coll Surg Engl ; 102(3): e73-e74, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31845821

RESUMO

Lung herniation is a rare entity, defined as a protrusion of the lung above the normal confines of thorax; it is caused by increased intrathoracic pressure and defects or weakness of the chest wall. Intercostal lung hernia can occur spontaneously or following thoracic trauma or surgery. Postoperative hernias are more commonly associated with less extensive surgical procedures, such as thoracoscopic surgery or mini-thoracotomy incisions, rather than with major thoracic procedures. We describe the first reported case of postoperative intercostal lung hernia following two-stage totally minimally invasive oesophagectomy for cancer, together with its successful surgical repair.


Assuntos
Esofagectomia/efeitos adversos , Hérnia/etiologia , Pneumopatias/etiologia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Complicações Pós-Operatórias , Adenocarcinoma/cirurgia , Idoso , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Hérnia/terapia , Herniorrafia/métodos , Humanos , Pneumopatias/cirurgia , Masculino , Reoperação , Toracotomia/métodos
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