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1.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509884

RESUMO

Management of large abdominal wall desmoid tumours is complicated due to the unpredictable behaviour of desmoids and the need for laborious reconstruction of the abdominal wall after wide local excision. A multidisciplinary team approach, including surgeons, oncologists and plastic surgeons, is necessary for proper management. This case highlights the diagnostic and surgical challenges related to the reconstruction of abdominal wall defect, after radical excision of a 30×30×25 cm desmoid tumour, originating from left rectus muscle. The defect was closed successfully by a perspicuous technique of posterior component separation. The awareness of this straightforward technique will allow the surgeons to do these radical procedures with confidence and without any consternation of complex reconstructive procedures.


Assuntos
Parede Abdominal/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais , Fibromatose Abdominal/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Telas Cirúrgicas , Adulto , Feminino , Fibromatose Abdominal/diagnóstico por imagem , Fibromatose Abdominal/patologia , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Carga Tumoral
2.
J Surg Res ; 257: 317-325, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32889330

RESUMO

BACKGROUND: Onlay mesh repair (OMR) has proven to be a widely used, simple, and effective technique for treatment and prevention of hernia occurrence. Despite established benefits, there is still a lack of widespread adoption. In this study, we present the Dual Tacker Device (DTD), an enabling technology that directly addresses the limitations to the adoption of OMR, saving surgical time and effort and making OMR more reproducible across a wide range of patients. METHODS: The DTD mesh fixation system is a semiautomated, hand-held, disposable, multipoint onlay mechanical mesh fixation system that is able to rapidly and uniformly tension and fixate mesh for both hernia treatment and prevention. A cadaveric porcine model was used as a pilot test conducted during a 2 day session to assess the usability of the device and to show that the DTD provided equivalent or superior biomechanical support compared with the standard of care (hand-sewn, OptiFix). RESULTS: Our study included 37 cadaveric porcine incisional closure abdominal wall models. These were divided into four groups: DTD-mediated OMR (n = 14), hand-sewn OMR (n = 7), OptiFix OMR (n = 9), and suture-only repair (no mesh) (n = 7). Eight surgical residents performed device-mediated and hand-sewn OMR. Average time to completion was fastest in the DTD cohort (45.6s) with a statistically significant difference compared with the hand-sewn cohort (343.1s, P < 0.01). No difference in tensile strength was noted between DTD (195.32N), hand-sewn (200.48N), and OptiFix (163.23N). Discreet hand movements were smallest in the DTD (29N) and significant (P < 0.01) when compared with hand-sewn (202N) and OptiFix (35N). CONCLUSIONS: The use of the DTD is not only feasible, but demonstrated improvement in time to completion and economy of movement over current standard of care. While more testing is needed and planned, compared with conventional approaches, the DTD represents a robust proof of principle with promising implications for clinical feasibility and adoptability.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Hérnia Ventral/cirurgia , Herniorrafia/instrumentação , Telas Cirúrgicas , Técnicas de Sutura/instrumentação , Animais , Fenômenos Biomecânicos , Cadáver , Ergonomia , Estudos de Viabilidade , Hérnia Ventral/etiologia , Hérnia Ventral/prevenção & controle , Herniorrafia/métodos , Humanos , Modelos Animais , Duração da Cirurgia , Projetos Piloto , Cirurgiões/psicologia , Suínos , Resistência à Tração
3.
Am Surg ; 86(8): 981-984, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32779473

RESUMO

INTRODUCTION: Damage control laparotomy (DCL) is a life-saving surgical technique, but the resultant open abdomen (OA) carries serious morbidity/mortality. Many methods are utilized to manage OAs, but discrepancy exists in distinguishing closure from coverage techniques. We observed a difference in our DCL patient outcomes managed with the Wittmann Patch (WP) closure device versus the more popular ABThera (AB) coverage device. We hypothesized that the WP contributed to an improved fascial closure rate of the OAs after DCL. METHODS: A retrospective review of OAs managed with the AB or WP at our Level 1 trauma center was performed using billing codes to capture DCL patients from 2011 to 2019. Patients were divided into AB alone or WP groups. Major endpoints included primary fascial closure (PFC) and delayed fascial closure (DFC, fascial closure after greater than 7 days). RESULTS: 189 patients were identified as AB and 38 as WP. Rates of death before closure, age, gender, and Injury Severity Score were similar in both groups. PFC = 81%-90% for AB versus WP, respectively. Excluding patients with preexisting hernias PFC = 87%-100% for AB versus WP (P < .05) and DFC = 44%-100% for AB versus WP (P ≤ 0.001). WP had a statistically higher rate of PFC and DFC. There was a decreased incidence of complications in the WP versus AB group. CONCLUSIONS: While not well reported in the peer-reviewed literature, the application of the WP for management of the OA is an active form of pursuing PFC when compared with the AB, a coverage device. Our interinstitutional results have demonstrated superior PFC and DFC rates and fewer complications, in patients managed with the WP compared with the AB.


Assuntos
Abdome/cirurgia , Traumatismos Abdominais/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Laparotomia , Adulto , Idoso , Fasciotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Cicatrização
4.
Zhonghua Wai Ke Za Zhi ; 58(8): 608-613, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727192

RESUMO

Objective: To compare the wound healing time, Surgical site infection (SSI) rate and other postoperative outcomes between the gunsight closure and purse-string closure technique in loop stoma closure. Methods: Between November 2013 and December 2017, a total of 143 patients who underwent gunsight stoma reversal were included in this multicenter prospective randomized controlled trial. The patients were randomized to undergo gunsight (gunsight group, n=72) or purse-string closure technique (purse-string group, n=71). The primary endpoint was wound healing time. The second endpoints were the incidence of SSI, morbidity, and patient satisfaction. Statistical analysis between groups was performed using the t-test, repeated measures analysis of variance, Mann-Whitney U test, χ(2) test or Fisher's exact test. Results: There were 45 males and 27 females with age of 67 (11) (M(Q(R))) years in gunsight group, 42 males and 29 females with age of 65 (20) years in purse-string group. The body mass index, American Society of Anesthesiologist classification, comorbidities, primary diagnosis, the type of ostomy, intraoperative blood loss, perioperative complications, postoperative hospital stay, hospitalization cost, SSI rate and incisional hernia (stoma site) between the 2 groups were not significantly different (P>0.05). Although had a statistically longer operating time (80(10) minutes vs. 70(10) minutes, Z=-2.381, P=0.017), patients who underwent gunsight procedure and a significantly shorter wound healing time (17(2) days vs. 25(4) days, Z=-10.199, P<0.01), higher patient satisfaction score with regards to wound healing time (3(1) vs. 3(1), Z=-4.526, P<0.01), and higher total patient satisfaction score (25(3) vs. 25(3), Z=-2.529, P=0.011) compared with those who underwent purse-string procedure. Conclusions: The gunsight and purse-string techniques are effective procedures for stoma reversal and both have low SSI rate. The gunsight technique is associated with shorter wound healing time, higher levels of patient satisfaction compared with purse-string technique, and is recommended as the closure technique of choice.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais , Enterostomia/efeitos adversos , Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Enterostomia/métodos , Feminino , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Estomas Cirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Técnicas de Sutura , Fatores de Tempo , Cicatrização
5.
Transplant Proc ; 52(6): 1818-1820, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32571708

RESUMO

INTRODUCTION: Serum beta-D-glucan (BDG) levels may increase with anti-adhesion barrier film (ABF) use during pediatric living donor liver transplantation (LDLT). It may affect detection of fungal infections after LDLT. We evaluate BDG levels after pediatric LDLT. METHODS: Pediatric patients who received an ABF during LDLT were included. Patients who may have had fungal infections prior to LDLT were excluded. One sheet of ABF was placed in the peritoneum during abdominal closure. Serum BDG levels before transplantation and on postoperative days (PODs) 1, 4, 7, 14, 21, and 28 and peritoneal fluid BDG levels on PODs 1 and 7 were measured. RESULTS: Sixteen patients received an ABF during LDLT. Median age at transplant was 1.9 years (range, 6-11 years). Median body weight was 12.6 kg (range, 6.8-39 kg). Indications for LDLT were biliary atresia (n = 10) and other (n = 5). Prior to transplantation, the mean serum BDG level was 3.8 pg/mL. Mean Serum BDG levels were 18.1, 38.3, 5.3, 3.8, 3.3, and 3.3 pg/mL on PODs 1, 4, 7, 14, 21, and 28, respectively. Mean peritoneal fluid BDG levels were 485.9 and 240.4 pg/mL on PODs 1 and 7, respectively. No clinical fungal infections were observed. CONCLUSIONS: BDG levels were high in serum and peritoneal fluid after pediatric LDLT. Serum BDG levels normalized after POD 7. Careful interpretation of BDG levels until POD 7 is needed when an ABF has been used.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Transplante de Fígado/efeitos adversos , Micoses/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , beta-Glucanas/sangue , Atresia Biliar/sangue , Atresia Biliar/cirurgia , Biofilmes , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Micoses/diagnóstico , Micoses/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/microbiologia , Período Pós-Operatório , Período Pré-Operatório , Aderências Teciduais/diagnóstico , Aderências Teciduais/microbiologia , Aderências Teciduais/prevenção & controle
6.
Ann R Coll Surg Engl ; 102(7): 519-524, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32538103

RESUMO

INTRODUCTION: Laparostomy is important in the management of patients with intra-abdominal gastrointestinal catastrophe or trauma. It carries significant risk and is resource intensive, both in terms of nursing and surgically. The main goal is to achieve prompt myofascial closure (MFC) in order to minimise morbidity and mortality. Early MFC was initially defined as within 2-3 weeks but there is growing evidence that this should be measured in days. METHODS: Retrospective analysis was undertaken of laparostomy cases between 2016 and 2018 at an acute trust and trauma centre serving a population of 500,000. Indication, duration of open abdomen (OA), number of relook procedures and consultant presence were examined to see whether they affected MFC rates, morbidity and mortality. RESULTS: Overall, 76 laparostomies were performed during the 3-year study period. The most common indication was peritonitis (68.4%). As duration of OA and number of relook procedures increased, the chances of MFC fell significantly. After day 1, MFC rates fell by 20% with each subsequent 24 hours. Leaving the abdomen open primarily at index procedure compared with performing laparostomy following a postoperative complication was associated with significantly higher MFC rates (92.6% vs 68.2%, (p=0.006). The mortality rate was 15.8%. CONCLUSIONS: If the OA is not closed within five days or by the third relook procedure, then achieving MFC is unlikely. Alternative methods should be employed to close the abdomen rather than continuing to take the patient back to theatre for relook laparotomies while increasing the risk of morbidity and mortality. A proactive strategy to forming primary laparostomy at the index procedure has high closure rates.


Assuntos
Abdome/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais , Laparotomia/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Peritonite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Reino Unido/epidemiologia , Adulto Jovem
9.
Transplant Proc ; 52(5): 1468-1471, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32204902

RESUMO

Abdominal wall transplant is developed in the context of intestinal and multivisceral transplant, in which it is often impossible to perform a primary wall closure. Despite the fact that abdominal wall closure is not as consequential in liver transplant, there are circumstances in which it might determine the success of the liver graft, especially in situations that compromise the abdominal cavity and facilitate an abdominal compartment syndrome. CASE 1: A 14-year-old girl suffering from cryptogenic cirrhosis with severe portal hypertension that causes ascites and severe malnutrition. Uneventful liver transplant, with a graft procured from a 14-year-old donor. At the time of wall closure it was decided to implant a nonvascularized fascia graft to supplement the right side of the transverse incision, with a 17 x 7 cm defect. This required reintervention after 4 months for biliary stricture. At that point, the wall graft was almost completely integrated into the native tissue. CASE 2: A 63-year-old man, transplanted for hepatitis C virus+ hepatocellular carcinoma+ nonocclusive portal thrombosis. Thirty-six hours after transplant the patient developed portal thrombosis. Thrombectomy and closure with biological mesh were performed. After 24 hours he was reoperated on for abdominal compartment syndrome and temporary closure with a Bogotá bag. Six days later he underwent omentectomy, intestinal decompression, and left components separation, identifying a 25 x 20 cm defect. For definitive closure, a nonvascularized fascia graft procured from a different donor was used, accomplishing a reduction in intra-abdominal pressure. Nonvascularized fascia transplantation is an interesting alternative in liver transplant recipients with abdominal wall closure difficulties.


Assuntos
Parede Abdominal , Técnicas de Fechamento de Ferimentos Abdominais , Fáscia/transplante , Transplante de Fígado/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Parede Abdominal/cirurgia , Adolescente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Lancet ; 395(10222): 417-426, 2020 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-32035551

RESUMO

BACKGROUND: Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. METHODS: In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. FINDINGS: Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43-0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26-0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60-1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54-1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. INTERPRETATION: Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. FUNDING: National Institute for Health Research Research for Patient Benefit and Allergan.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Hérnia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Telas Cirúrgicas , Estomas Cirúrgicos , Adulto , Idoso , Colágeno , Colo/cirurgia , Método Duplo-Cego , Feminino , Hérnia/etiologia , Hérnia/prevenção & controle , Humanos , Íleus/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos
12.
Isr Med Assoc J ; 22(1): 43-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927805

RESUMO

BACKGROUND: Temporary abdominal closure (TAC) surgical technique relates to a procedure in which the post-surgical abdominal wall remains open in certain indications. The Bogota bag (BB) technique is a tension-free TAC method that covers the abdominal contents with a sterilized fluid bag. There are very few reports of pediatric patients treated with this technique. OBJECTIVES: To describe our institution's 15 years of experience using the BB technique on pediatric patients. METHODS: A retrospective cohort study describing our experience treating patients with BB was conducted. The medical files of 17 pediatric patients aged 0-18 years were reviewed. RESULTS: Between January 2000 and December 2014, 17 patients were treated with BB at our medical center (6 females, median age 12 years). Indications for BB were a need for a surgical site re-exploration, mechanical inability for primary abdominal closure, and high risk for ACS development. Median BB duration was 5 days and median bag replacement was 2 days. Median ICU length of stay (LOS) was 10 days and hospital LOS was 27 days. The ICU admission and BB procedure was tolerated well by 6 patients who were discharged home without complications. Of the remaining 11 patients, 6 patients died during the admission (35%) and the others presented with major complications not related to the BB but to the patient's primary disease. CONCLUSIONS: This report represents the largest series of children treated with BB. The technique is simple to perform, inexpensive, and has very few complications.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais , Abdome/cirurgia , Parede Abdominal/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
13.
Khirurgiia (Mosk) ; (1): 40-45, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994498

RESUMO

OBJECTIVE: To improve the results of treatment of patients undergoing laparotomy by using of a new method of aponeurosis suturing after laparotomy. MATERIAL AND METHODS: Training process for a new method of aponeurosis suturing after laparotomy was organized on the patented medical simulator for learning the technique of laparotomy closure. The method was introduced into surgical practice later. The study involved 130 patients who underwent emergency abdominal surgery through median laparotomy. The main group consisted of 70 patients (laparotomy closure using the proposed method (RF patent No.2644846 dated 02/14/18). Interrupted sutures were applied for aponeurosis suturing in the control group. RESULTS: Duration of laparotomy closure was similar in both groups. Postoperative ventral hernias in 1 year after surgery occurred in 5 (8%) patients of the main group and in 11 (18%) patients of the control group. CONCLUSION: The proposed method of aponeurosis suturing after laparotomy is mastered by students and serves as effective method for prevention of postoperative ventral hernias and eventration.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/educação , Aponeurose/cirurgia , Hérnia Ventral/prevenção & controle , Hérnia Incisional/prevenção & controle , Laparotomia/efeitos adversos , Técnicas de Sutura/educação , Fáscia , Hérnia Ventral/etiologia , Humanos , Hérnia Incisional/etiologia , Laparotomia/educação , Modelos Anatômicos
14.
Eur J Vasc Endovasc Surg ; 59(2): 227-236, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31911135

RESUMO

OBJECTIVES: Patients with abdominal aortic aneurysms (AAAs) have a high prevalence of incisional hernia following open repair. The choice of incision and closure technique has a significant impact on this post-operative complication. Multiple techniques exist, as well as various comparative analyses, but clinical consensus is lacking. The objective was to perform a systematic review and meta-analysis of AAA laparotomy and closure technique and the risk of incisional hernia development. METHODS: The systematic review was performed according to the PRISMA guidelines. A literature search of all original research published until January 2019 was made. Outcome measures were surgical approach, closure technique, hernia rates, length of follow up, and method of hernia recognition. Groups were divided according to method of abdominal incision and closure technique. Differences in outcome between closure techniques were expressed as risk ratios with 95% confidence interval (CI) using a random effects model. RESULTS: Fifteen studies were included with a cumulative cohort of between 388 and 3 399 patients compared in each group. Abdominal closure with a suture to wound length ratio of more than 4:1 compared with less than 4:1, RR 0.42 (95% CI 0.27-0.65), and abdominal closure with mesh compared with without mesh augmentation, RR 0.24 (95% CI 0.10-0.60) reduced the risk of incisional hernia. There were no significant differences in incisional hernia rate between transverse abdominal incision vs. vertical midline incision, RR 0.57 (95% CI 0.31-1.06) and between midline transperitoneal vs. all retroperitoneal incisions, RR 1.19 (95% CI 0.54-2.61). CONCLUSION: Choice of abdominal closure technique after aneurysm surgery impacts the risk of developing incisional hernia. The use of a supportive mesh significantly reduces the risk of incisional hernia in vertical midline incisions. The same is true if a suture to wound ratio of more than 4:1 is used.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Aneurisma da Aorta Abdominal/cirurgia , Hérnia Incisional/epidemiologia , Telas Cirúrgicas , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Feminino , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/prevenção & controle , Masculino , Prevalência , Fatores de Risco , Técnicas de Sutura/efeitos adversos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
15.
World J Surg ; 44(1): 95-99, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31549201

RESUMO

INTRODUCTION: A laparotomy is commonly required to gain abdominal access. A safe standardized access and closure technique is warranted to minimize abdominal wall complications like wound infections, burst abdomen and incisional hernias. Stitches are recommended to be small and placed tightly, obtaining a suture length-to-incision length (SL/WL) ratio of ≥ 4:1. This can be time-consuming and difficult to achieve especially following long trying surgical procedures. The aim was to develop and evaluate a new mechanical suture device for standardized wound closure. METHODS: A mechanical suture device (Suture-tool) was developed in collaboration between a medical technology engineer team with the aim to achieve a standardized suture line of high quality that could be performed speedy and safe. Ten surgeons closed an incision in an animal tissue model after a standardized introduction of the instrument comparing the device to conventional needle driver suturing (NDS) using the 4:1 technique. Outcome measures were SL/WL ratio, number of stitches and suture time. RESULTS: In total, 80 suture lines were evaluated. SL/WL ratio of ≥ 4 was achieved in 95% using the Suture-tool and 30% using NDS (p < 0,001). Number of stitches was similar. Suture time was 30% shorter using the Suture-tool compared to NDS (2 min 54 s vs. 4 min 5 s; p < 0.001). CONCLUSIONS: The mechanical needle driver seems to be a promising device to perform a speedy standardized high-quality suture line for fascial closure.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Técnicas de Sutura/instrumentação , Parede Abdominal/cirurgia , Animais , Feminino , Humanos , Hérnia Incisional/cirurgia , Masculino , Agulhas , Suturas
16.
Updates Surg ; 72(1): 171-177, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31621034

RESUMO

Use of open abdomen (OA) progressively acquired increasing importance with the diffusion of the damage control management of critical patients. The purpose of the present study is to identify the state of the art about the use of OA in Italy, focusing on techniques, critical issues and clinical outcomes. A prospective analysis of adult patients enrolled in the IROA, limited to the Italian participating centres was performed. 375 patients were enrolled. Mean age was 64 ± 16 years old, 56% of the patients were male, mean BMI was 26.9 ± 5.2. Main indications for using OA were secondary peritonitis (32.5%), post-operative peritonitis (22.9%) and trauma (11.7%). Main OA techniques used were commercial negative pressure wound therapy (49.6%) and Bogotà bag (27.7%). Definitive closure of the abdomen was reached in 82.4% of patients after 6 ± 7 days of OA. The primary fascia closure rate was 84.7%. Overall mortality was 29.1%. The complication rate was 50.8%, with an enteroatmospheric fistula incidence: 7.5%. A univariate analysis performed on complication type found the duration of OA treatment (p = 0.024) to be statistically significant. Univariate analysis on mortality risk identified as significant age, duration of OA (in days) and pancreatitis as indication; multivariate analysis confirmed age (p < 0.001) and pancreatitis (p = 0.002) as statistically significant. A large variety of behaviours towards the patient requiring OA exists. A strong acceptance of common, recognized and evidence-based guidelines is essential, to obtain more uniformity in patient management and coherence of collected data, thus leading to improvement in outcomes and reduction of costs.


Assuntos
Abdome/cirurgia , Técnicas de Abdome Aberto/tendências , Técnicas de Fechamento de Ferimentos Abdominais , Fatores Etários , Idoso , Medicina Baseada em Evidências , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa , Pancreatite , Peritonite/mortalidade , Peritonite/cirurgia , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos
17.
J Obstet Gynaecol ; 40(2): 217-221, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31347412

RESUMO

There is scarcity of data about the long-term results such as port-site hernia, body image scale and cosmesis scale outcomes between laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopy (CMPL) for hysterectomy. Eighty women, who underwent total hysterectomy by the LESS (n = 40) and CMPL (n = 40) technique due to benign and malign gynecological disorders, were evaluated with a cosmesis and body image questionnaire in an age-matched cohort study.Median follow-up time was 25 (6-30) months in both groups. The mean age of the patients was 49.3 ± 6.3 years. The mean body image scale scores were 5.3 ± 0.6 and 5.5 ± 1.2 in the LESS and CMPL groups, respectively (p = 0.268). The mean cosmesis and scar scale scores were significantly higher in the LESS group compared to the CMPL group (p = .011 and p < .001, respectively). Port-site hernia was detected in two patients in the LESS group, but not in the CMPL group. There was no cuff dehiscence in the LESS nor in the CMPL group. The LESS technique provides better cosmesis when compared with the CMPL technique. The body image perceptions in the two groups were similar. Women who wish to undergo the LESS surgery should be informed about the risk of incisional hernia.Impact statementWhat is already known on this subject? Short-term results of LESS hysterectomy such as complication rates, additional port requirement, conversion to CMPL or laparotomy, pain score and analgesic use were evaluated in various studies. Several studies have been published on the safety and efficacy of single-port laparoscopic hysterectomy (LH); however, it has been unclear whether single-port LH offers benefits over multiport LH regarding long-term patient satisfaction and cosmetic satisfaction.What do the results of this study add? In this prospective cohort study, we aimed to compare long-term results (at least six months) of abdominal incisional scar between LESS and CMPL surgery for hysterectomy. The LESS technique provides better cosmesis when compared with the CMPL technique, although, the body image perceptions in the two groups were similar.What are the implications of these findings for clinical practice and/or further research? LESS technique can be offered as an option for hysterectomy since it provides better long-term cosmesis compared to CMPL.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Cicatriz/etiologia , Histerectomia/métodos , Laparoscopia/métodos , Satisfação do Paciente/estatística & dados numéricos , Adulto , Idoso , Imagem Corporal/psicologia , Cicatriz/psicologia , Feminino , Humanos , Hérnia Incisional/epidemiologia , Hérnia Incisional/etiologia , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Resultado do Tratamento
18.
Surg Endosc ; 34(1): 88-95, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30941550

RESUMO

PURPOSE: Laparoscopic incisional ventral hernia repair (LIVHR) is often followed by seroma formation, bulging and failure to restore abdominal wall function. These outcomes are risk factors for hernia recurrence, chronic pain and poor quality of life (QoL). We aimed to evaluate whether LIVHR combined with defect closure (hybrid) follows as a diminished seroma formation and thereby has a lower rate of hernia recurrence and chronic pain compared to standard LIVHR. METHODS: This study is a multicentre randomised controlled clinical trial. From November 2012 to May 2015, 193 patients undergoing LIVHR for primary incisional hernia with fascial defect size from 2 to 7 cm were recruited in 11 Finnish hospitals. Patients were randomised to either a laparoscopic (LG) or a hybrid (HG) repair group. The main outcome measure was hernia recurrence, evaluated clinically and radiologically at a 1-year follow-up visit. At the same time, chronic pain scores and QoL were also measured. RESULTS: At the 1-year-control visit, we found no difference in hernia recurrence between the study groups. Altogether, 11 recurrent hernias were found in ultrasound examination, producing a recurrence rate of 6.4%. Of these recurrences, 6 (6.7%) were in the LG group and 5 (6.1%) were in the HG group (p > 0.90). The visual analogue scores for pain were low in both groups; the mean visual analogue scale (VAS) was 1.5 in LG and 1.4 in HG (p = 0.50). QoL improved significantly comparing preoperative status to 1 year after operation in both groups since the bodily pain score increased by 7.8 points (p < 0.001) and physical functioning by 4.3 points (p = 0.014). CONCLUSION: Long-term follow-up is needed to demonstrate the potential advantage of a hybrid operation with fascial defect closure. Both techniques had low hernia recurrence rates 1 year after operation. LIVHR reduces chronic pain and physical impairment and improves QoL. TRIAL REGISTRY: Clinical trial number NCT02542085.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Hérnia Ventral/cirurgia , Herniorrafia , Hérnia Incisional/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/prevenção & controle , Qualidade de Vida , Seroma , Telas Cirúrgicas , Feminino , Herniorrafia/efeitos adversos , Herniorrafia/instrumentação , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/psicologia , Prevenção Secundária , Seroma/etiologia , Seroma/prevenção & controle , Seroma/psicologia
19.
J Minim Invasive Gynecol ; 27(2): 473-481, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30959198

RESUMO

STUDY OBJECTIVE: MONOFIX, a new absorbable barbed suture device, has a triangular stopper at the end to hold the suture to the tissue without hooking the looped end or knotting. The aim of this study was to compare the biomechanical strength and histologic features of MONOFIX with other barbed suture devices using a porcine model. DESIGN: Well-designed, controlled trial without randomization. SETTING: Animal laboratory in university hospital. SUBJECTS: Sixteen, 60-kg, mature female domestic pigs (skin closure group) and 5, 60-kg, mature female domestic pigs (fascial closure group). INTERVENTIONS: In the skin closure group, 3-0 MONOFIX versus 2 widely used 3-0 absorbable barbed sutures (3-0 V-Loc 180 or Stratafix). In the fascial closure group, 2-0 MONOFIX versus 1 widely used 2-0 absorbable barbed sutures (2-0 Stratafix). MEASUREMENTS AND MAIN RESULTS: In the skin closure group, the biomechanical wound strength of skin sutured with size 3-0 MONOFIX, V-Loc 180, or Stratafix was evaluated by postoperative day assessment (days 0, 3, 7, 14, and 28). In the fascial closure group, pigs underwent 2 paramedian incisions and were sutured with 2-0 MONOFIX or with 2-0 Stratafix to evaluate histologic reaction. At 6 weeks the tissues around the suture line were excised and microscopically evaluated. The biomechanical strength of the MONOFIX had similar tissue tensile strength compared with the control, regardless of postoperative day. In the fascial closure model, there was no significant difference in the average tissue reaction score between MONOFIX and Stratafix (1.2 ± .3 vs 1.3 ± .3, p = .478). CONCLUSION: This study demonstrated that MONOFIX has equivalent tensile strength and histologic reaction when compared with commonly used barbed suture devices. Accordingly, this preclinical study suggests that the use of MONOFIX is a safe alternative to other barbed suture devices.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Modelos Animais , Sus scrofa , Técnicas de Sutura , Suturas , Animais , Fenômenos Biomecânicos , Procedimentos Cirúrgicos Dermatológicos/instrumentação , Procedimentos Cirúrgicos Dermatológicos/métodos , Desenho de Equipamento , Fáscia/patologia , Fasciotomia/instrumentação , Fasciotomia/métodos , Feminino , Humanos , Laparoscopia/instrumentação , Laparoscopia/métodos , Pele/patologia , Deiscência da Ferida Operatória , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/instrumentação , Suturas/efeitos adversos , Suínos , Resistência à Tração
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