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1.
BJOG ; 127(1): 88-97, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31544327

RESUMO

OBJECTIVE: To assess the short-term incidence of serious complications of surgery for urinary incontinence or pelvic organ prolapse. DESIGN: Prospective longitudinal cohort study using a surgical registry. SETTING: Thirteen public hospitals in France. POPULATION: A cohort of 1873 women undergoing surgery between February 2017 and August 2018. METHODS: Preliminary analysis of serious complications after a mean follow-up of 7 months (0-18 months), according to type of surgery. Surgeons reported procedures and complications, which were verified by the hospitals' information systems. MAIN OUTCOME MEASURES: Serious complication requiring discontinuation of the procedure or subsequent surgical intervention, life-threatening complication requiring resuscitation, or death. RESULTS: Fifty-two women (2.8%, 95% CI 2.1-3.6%) experienced a serious complication either during surgery, requiring the discontinuation of the procedure, or during the first months of follow-up, necessitating a subsequent reoperation. One woman also required resuscitation; no women died. Of 811 midurethral slings (MUSs), 11 were removed in part or totally (1.4%, 0.7-2.3%), as were two of 391 transvaginal meshes (0.5%, 0.1-1.6%), and four of 611 laparoscopically placed mesh implants (0.7%, 0.2-1.5%). The incidence of serious complications 6 months after the surgical procedure was estimated to be around 3.5% (2.0-5.0%) after MUS alone, 7.0% (2.8-11.3%) after MUS with prolapse surgery, 1.7% (0.0-3.8%) after vaginal native tissue repair, 2.8% (0.9-4.6%) after transvaginal mesh, and 1.0% (0.1-1.9%) after laparoscopy with mesh. CONCLUSIONS: Early serious complications are relatively rare. Monitoring must be continued and expanded to assess the long-term risk associated with mesh use and to identify its risk factors. TWEETABLE ABSTRACT: Short-term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh.


Assuntos
Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Colposcopia/efeitos adversos , Colposcopia/mortalidade , Colposcopia/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Incidência , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/mortalidade , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Sistema de Registros , Slings Suburetrais/efeitos adversos , Slings Suburetrais/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Centros Cirúrgicos/estatística & dados numéricos , Adulto Jovem
2.
Am Surg ; 85(10): 1113-1117, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657305

RESUMO

Although recommendations help guide surgeons' mesh choice in abdominal wall reconstruction (AWR), financial and institutional pressures may play a bigger role. Standardization of an AWR algorithm may help reduce costs and change mesh preferences. We performed a retrospective review of high- and low-risk patients who underwent inpatient AWR between 2014 and 2016. High risk was defined as immunosuppression and/or history of infection/contamination. Patients were stratified by the type of mesh as biologic/biosynthetic or synthetic. These cohorts were analyzed for outcome, complications, and cost. One hundred twelve patients underwent complex AWR. The recurrence rate at two years was not statistically different between high- and low-risk cohorts. No significant difference was found in the recurrence rate between biologic and synthetic meshes when comparing both high- and low-risk cohorts. The average cost of biologic mesh was $9,414.80 versus $524.60 for synthetic. The estimated cost saved when using synthetic mesh for low-risk patients was $295,391.20. In conclusion, recurrence rates for complex AWR seem to be unrelated to mesh selection. There seems to be an excess use of biologic mesh in low-risk patients, adding significant cost. Implementing a critical process to evaluate indications for biologic mesh use could decrease costs without impacting the quality of care, thus improving the overall value of AWR.


Assuntos
Parede Abdominal/cirurgia , Materiais Biocompatíveis/economia , Redução de Custos , Sobremedicalização/economia , Telas Cirúrgicas/economia , Algoritmos , Materiais Biocompatíveis/efeitos adversos , Estudos de Coortes , Humanos , Hospedeiro Imunocomprometido , Sobremedicalização/estatística & dados numéricos , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias , Recidiva , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Telas Cirúrgicas/efeitos adversos , Telas Cirúrgicas/estatística & dados numéricos
3.
Am Surg ; 85(10): 1159-1161, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657315

RESUMO

There are conflicting views regarding techniques for repair of small umbilical hernias (UHs). Here, we compare the recurrence rate in primary repair with that reported for mesh repair by examining a single surgeon's practice at a large medical center with a comprehensive electronic medical record. A six-year retrospective review of primary UH repairs between January 2012 and December 2017 at Kaiser Permanente Los Angeles Medical Center was undertaken. Patients were identified through a database search of the electronic medical record. The primary endpoint of UH recurrence was examined; median follow-up was 3.4 years. Primary, elective UH repair was performed in 244 patients; 71 per cent of hernias were small (<2 cm). The total number of recurrences was seven (3%). The t test analysis showed significant differences in the average size of hernia defects between those with recurrences (2 cm) and those without (1.4 cm), P < 0.05. Primary repair affords low infection and recurrence rates, comparable to those reported for mesh repair. Our single-surgeon/large-volume study contributes to the evidence that primary UH repair is a safe and durable method, with low risk of recurrence. The use of absorbable monofilament suture, and selection for lower BMI and smaller hernia sizes proved to be effective.


Assuntos
Hérnia Umbilical/cirurgia , Herniorrafia/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , California , Feminino , Hérnia Umbilical/patologia , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fumantes/estatística & dados numéricos , Telas Cirúrgicas/efeitos adversos , Suturas , Técnicas de Fechamento de Ferimentos
4.
Eur J Obstet Gynecol Reprod Biol ; 239: 30-34, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31163354

RESUMO

OBJECTIVES: The pelvic organ prolapse (POP) surgery with implantation of anterior transvaginal mesh (e.g. Elevate or Calistar) may provide objective and subjective improvement as compared to traditional POP repair without mesh. Given differences between the Elevate and the Calistar mesh and their different placement methods, some variation inlong-term clinical outcomes of these anterior vaginal mesh procedures can be expected. STUDY DESIGN: The purpose of the study was to compare the 18-month operative success in patients who had undergone anterior POP surgery with either the Calistar (n = 54) or Elevate mesh (n = 50). RESULTS: There were no between-group differences in objective measures of operative efficacy, including POP-Q anterior stage 0 or I (94% for Calistar, 92% for Elevate) and "no descent beyond the hymen" (98% for Calistar, 94% for Elevate). The proportion of patients with subjective measure of operative efficacy (no vaginal bulge symptoms) did not differ between the groups (91% for Calistar, 78% for Elevate). There were no between-group differences in the proportion of women suffering from vaginal exposure, de novo stress urinary incontinence (SUI), de novo overactive bladder (OAB) symptoms, pelvic floor pain or dyspareunia. The operative cure of OAB symptoms was similar in the groups. The proportion of patients with the operative cure of SUI symptoms was significantly higher in the Calistar as compared to the Elevate group. CONCLUSIONS: The results suggestthat the Calistar system offers similar efficacy in the treatment of anterior and both anterior and apical POP as compared to the Elevate. The use of anterior Calistar is associated with some additional benefits, i.e. SUI treatment in patients with concomitant anterior and both anterior and apical POP and SUI symptoms.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/instrumentação , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/estatística & dados numéricos , Vagina/cirurgia , Idoso , Feminino , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Eur J Obstet Gynecol Reprod Biol ; 234: 120-125, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30684877

RESUMO

OBJECTIVE: The purpose of study is to evaluate the recurrence rate of pelvic organ prolapse after surgical treatment and pre- to postoperative changes in sexual function of patients with different stages of pelvic organ prolapse. METHODS: The presented study was a single-centre observational nonrandomized analysis of an ongoing prospective cohort study evaluating anatomical and clinical outcomes in reproductive aged women scheduled for nature tissue repair of POP staged I-III. Two hundred and ten women were recruited, of whom 120 (57.1%) had the advanced prolapse form (POP-Q III). Women at preoperative POP stage I-II were compared with women at stage III without apical prolapse. RESULTS: The best effectively rate with low recurrence depends on preoperative prolapse stage. The overall objective success rate was about 80% in five years in patients with preoperative stage I-II. Study shows a significant improvement in sexual function in all patients with pelvic organ prolapse in five years after surgery. CONCLUSION: This study showed that women with advanced POP have a higher risk of recurrence after POP native tissue repair compared with early stages and proved the improvement of sexual function especially in women with advanced prolapse forms. Women with early stage of POP should be advised to postpone surgery until progression of complaints because of the high recurrence risk.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Vagina/cirurgia , Adulto , Feminino , Humanos , Prolapso de Órgão Pélvico/fisiopatologia , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Recidiva , Comportamento Sexual , Fatores de Tempo , Resultado do Tratamento
7.
Tech Coloproctol ; 23(1): 25-31, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30604250

RESUMO

BACKGROUND: The aim of this study was to assess the long-term outcomes of laparoscopic rectopexy for full-thickness rectal prolapse (FTRP). METHODS: Data of a prospectively maintained database were analysed. A structured telephone interview was conducted to assess a consecutive series of long-term outcomes of an unselected population who had laparoscopic rectopexy at a single centre between April 2006 and April 2014. The primary outcome was recurrence of FTRP. Secondary outcomes were functional outcomes and morbidity associated with the procedure. RESULTS: A total of 80 patients (74 female, median age of 66 years, range 23-96 years) underwent a laparoscopic rectopexy, of whom 35 (44%) were for recurrent prolapse. Seventy-two patients (90%) had a posterior suture rectopexy, six (8%) had a ventral mesh rectopexy, one (1%) had a combination of both procedures, and one (1%) had a posterior suture rectopexy with a sacrocolpopexy. There was no conversion to open surgery. Three patients (4%) needed reoperation within 30 days after surgery: two due to small bowel obstruction and one for a suspected port site hernia. Seventy-four patients (93%) were available for either clinical follow-up (FU) or telephone interview and there were 17 (23%) recurrences of FTRP at the median FU of 57 months (range 1-121 months). The median time to recurrence was 12 months (range 1-103 months). Recurrence of FTRP was seen in nine patients (12%) within 1 year following surgery. A history of multiple previous prolapse repairs increased the risk of prolapse recurrence (odds ratio 8.33, 95% confidence interval 1.38-50.47, p = 0.020). Based on clinical follow-up of 71 patients up to 1 year, there were 41 patients (58%) who had faecal incontinence prior to rectopexy of whom two patients (5%) had complete resolution of symptoms and 14 (34%) had improvement. CONCLUSIONS: Laparoscopic rectopexy is a safe operation for full-thickness rectal prolapse. The durability of the repair diminished over time, particularly for patients operated on for recurrent prolapse.


Assuntos
Laparoscopia/estatística & dados numéricos , Prolapso Retal/cirurgia , Reto/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Prolapso Retal/patologia , Reto/patologia , Recidiva , Reoperação/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Técnicas de Sutura/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
Acta Obstet Gynecol Scand ; 98(4): 451-459, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30578530

RESUMO

INTRODUCTION: The management of pelvic organ prolapse (POP) varies significantly between countries. The objective of this study was to describe the methods used for POP surgery in Finland and to identify the factors that affect clinicians' choice to use either a native tissue repair (NTR) or a mesh repair method. MATERIAL AND METHODS: This prospective cohort study included 3535 surgeries covering 83% of all POP operations performed in Finland in 2015. The operative details and patient characteristics, including the Pelvic Floor Distress Inventory (PFDI-20), were compared between three selected surgical methods: NTR, transvaginal mesh (TVM) and abdominal mesh (AM). The predictive factors for the use of mesh augmentation were also studied with logistic regression analysis. RESULTS: The most common method was NTR (n = 2855, 81%), followed by TVM (n = 429, 12%) and AM (n = 251, 7%). Approximately 92% of the patients who underwent primary prolapse surgery underwent NTR, and mesh surgery was used mainly for recurrent prolapse. The strongest predictor of mesh surgery was previous POP surgery for the same vaginal compartment (adjusted odds ratio [OR] = 56, 95% confidence interval [CI] = 38-84 for TVM; adjusted OR = 22, 95% CI = 14-34 for AM). Other predictive factors for mesh surgery were previous hysterectomy, healthcare district, severe bulge symptoms and advanced prolapse. TVM was associated with advanced anterior prolapse and older age. AM surgery was associated with advanced apical and/or posterior compartment prolapse. PFDI-20 scores were the highest in the AM group (108 vs 103 in the TVM group and 98 in the NTR group, P = 0.012), which indicates more bothersome symptoms than in the other groups. CONCLUSIONS: The Finnish practices follow international guidelines that advocate NTR as the principal surgical method for POP. Synthetic mesh augmentation was mainly used in patients with recurrent and advanced prolapse with severe symptoms. The variation in the rates of mesh augmentation for POP surgery in different hospitals implies a lack of sufficient evidence of the most suitable treatment method and indicates a need for national guidelines.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Prolapso de Órgão Pélvico/cirurgia , Reoperação/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Idoso , Estudos de Coortes , Feminino , Finlândia , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/epidemiologia , Estudos Prospectivos , Vagina/cirurgia
9.
Int Urogynecol J ; 30(4): 537-544, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30327850

RESUMO

INTRODUCTION AND HYPOTHESIS: Vaginal apical suspension is essential for the surgical treatment of pelvic organ prolapse (POP). We aim to evaluate whether the method of apical repair is associated with different re-operation rates for POP recurrence or surgical complications. METHODS: Population-based, retrospective cohort study of all Ontario women receiving primary apical POP repairs from 2003 to 2015. Primary exposure was the method of apical POP repair. Primary outcome was re-operation for recurrent POP, and secondary outcomes were surgical procedures for genito-intestinal (GI) or genitourinary (GU) complications, fistula repair, and mesh revision or removal. RESULTS: Forty-three thousand four hundred fifty-eight women were included. Overall, the number of mesh-based apical repairs decreased over time, while the number of native-tissue repairs slightly increased (p < 0.001). Multivariable Cox proportional hazards (Cox PH) analysis demonstrated a significant increase in repeat POP operations for transvaginal mesh apical repairs (adjusted HR 1.28 [95% CI: 1.10-1.48]), but not in abdominal mesh repairs (adjusted HR 0.96 [95% CI: 0.81-1.13]) compared with vaginal native tissue apical repairs. Overall risk of repeat surgery for fistulas or GI and GU complications remained low (< 0.5%). Risk of mesh removal or revision was 11.5-11.9%, with no difference between abdominal versus vaginal mesh on multivariable analysis (adjusted HR 0.99 [95% CI: 0.78-1.26]). CONCLUSIONS: Re-operation for recurrent POP is highest in transvaginal mesh apical repairs; however, this risk did not differ between abdominal mesh and vaginal native tissue apical repairs. GI and GU re-operations are rare. There is no difference in mesh removal or revision rates between abdominal and vaginal mesh repairs.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso de Órgão Pélvico/cirurgia , Reoperação/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Vagina/cirurgia , Abdome/cirurgia , Idoso , Remoção de Dispositivo , Feminino , Fístula/etiologia , Fístula/cirurgia , Doenças dos Genitais Femininos/etiologia , Doenças dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/tendências , Humanos , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas/efeitos adversos , Fístula Urinária/etiologia , Fístula Urinária/cirurgia
10.
Int Urogynecol J ; 30(4): 603-609, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30283975

RESUMO

INTRODUCTION AND HYPOTHESIS: Prolapse of the vaginal apex can be treated using multiple surgical modalities. We describe national trends and patient characteristics associated with the surgical approach and compare perioperative outcomes of abdominal versus vaginal repair of apical pelvic organ prolapse (POP). METHODS: The 2006-2012 National Surgical Quality Improvement Program Database was queried for abdominal sacrocolpopexy (ASC) and vaginal apical suspensions. Patients were stratified by whether or not concomitant hysterectomy (CH) was performed or whether or not they were post-hysterectomy (PH). Multivariate logistic regressions were adjusted for confounding variables. RESULTS: A total of 6,147 patients underwent apical POP repair: 33.9% (2,085) ASCs, 66.1% (4,062) vaginal suspensions. 60.0% (3,689) underwent CH. In all cohorts, older patients were less likely to have ASC (CH: OR 0.48, CI 0.28-0.83, p = 0.008 for age ≥ 60; PH: OR 0.28, CI 0.18-0.43, p < 0.001). Over time, the proportion of all vaginal and abdominal repairs remained relatively stable. Use of minimally invasive ASC, however, increased over the study period (trend p < 0.001), and use of mesh for vaginal suspensions decreased (p < 0.001). ASC had a longer median operative time (PH 174 vs 95 min, p < 0.001; CH 192 vs 127 min, p < 0.001). Complication rates were the same for vaginal repairs and ASC, overall and when sub-stratified by hysterectomy status. CONCLUSIONS: Nationally, most apical POP repairs are performed via a vaginal route. Older age was predictive of the vaginal route for both CH and PH groups. ASCs had longer operative times. There has been increased utilization of minimally invasive ASC and decreased use of mesh-augmented vaginal suspensions over time.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/tendências , Prolapso Uterino/cirurgia , Adolescente , Adulto , Fatores Etários , Bases de Dados Factuais , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Histerectomia/efeitos adversos , Histerectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Telas Cirúrgicas/tendências , Vagina/cirurgia , Adulto Jovem
11.
Surgery ; 165(2): 398-405, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30217396

RESUMO

BACKGROUND: Emergent groin hernia repair can be a challenging clinical scenario. We aimed to evaluate the perioperative and long-term outcomes of emergent groin hernia repair at our institution over the last 10 years, with particular interest in surgical approach and mesh use for such cases. METHODS: Adult patients who underwent emergent groin hernia repair from 2005-2015 were retrospectively reviewed. Outcomes included surgical site infections, perioperative complications, readmissions, reoperations, mortality, and long-term hernia recurrence. Predictors of surgical site infection and perioperative complications were investigated using multivariate logistic regression. RESULTS: A total of 257 patients met inclusion criteria (62% males, median age 72). Hernias were most often indirect inguinal (40.9%) and femoral (33.5%), and 45 cases (17.5%) required a bowel resection. Laparoscopic repair was performed in 3 patients (1.2%). Synthetic mesh was placed in 70% of repairs but in only 15% of cases associated with a bowel resection. The medical complications rate was 16.7%; 3.6% had an surgical site infection, and 30-day mortality rate was 3.1%. Older age (odds ratio 1.05) and gross contamination (odds ratio 4.3) were independently associated with complications. Mesh use was not associated with surgical site infection (odds ratio 1.83, P = .49) or perioperative complications (odds ratio 1.02, P = .96). With a median follow-up of 43 months, there were no mesh infections and recurrence rates were similar between mesh and tissue repairs (6.3% vs 6.8%, P = .91). CONCLUSION: Emergent groin hernia repair has high rates of morbidity and mortality most closely associated with increasing age and the presence of contamination. Although mesh use appears to be well tolerated when used in the absence of contamination during emergent groin hernia repair, recurrence rates were similar to tissue repairs.


Assuntos
Hérnia Inguinal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Hérnia Inguinal/mortalidade , Humanos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Embolia Pulmonar/mortalidade , Recidiva , Estudos Retrospectivos , Sepse/mortalidade , Telas Cirúrgicas/estatística & dados numéricos
12.
Ulus Travma Acil Cerrahi Derg ; 24(6): 501-506, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30516265

RESUMO

BACKGROUND: There are varying opinions on the feasibility of the placement of synthetic materials in contaminated surgical fields. The aim of this study was to investigate the outcomes of the use of a commercially available composite mesh in the presence of abdominal infection. METHODS: Twenty-four hours after the induction of experimental peritonitis, 20 rats were randomized into 2 groups of 10 subjects. After abdominal cleansing with a second laparotomy, the abdomen was closed with running sutures in the control group and the composite mesh was applied in the experimental group before closure. The rats were followed up for findings of sepsis, mortality, and wound infection. On the 28th day, the rats were sacrificed and evaluated for abdominal infection, abdominal adhesions, and bacterial growth in the mesh and tissue cultures. RESULTS: The mortality rate was 0% and 30% in the control and mesh groups, respectively (p=0.21), and the wound infection rate was 20% and 57.1% (p=0.162). In the mesh group, the adhesions were significantly more intense (p=0.018) and significantly more microorganisms proliferated in the tissue cultures (p=0.003). CONCLUSION: The significant increase in the intensity of adhesions and bacterial proliferation, as well as the higher rate of mortality and wound infection in the mesh group indicated that this composite mesh cannot be used safely in the repair of abdominal defects in the presence of abdominal infection.


Assuntos
Peritonite/cirurgia , Telas Cirúrgicas , Infecção da Ferida Cirúrgica , Animais , Modelos Animais de Doenças , Estudos de Viabilidade , Ratos , Telas Cirúrgicas/efeitos adversos , Telas Cirúrgicas/estatística & dados numéricos
13.
J Surg Res ; 230: 137-142, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30100030

RESUMO

BACKGROUND: Despite the recognition that inguinal hernia (IH) repair is cost-effective, repair rates in low- and middle-income countries remain low. Estimated use of mesh in low- and middle-income countries also remains low despite publications about low-cost, noncommercial mesh. The purpose of our study was to assess the current state of IH repair in the northern and transitional zone of Ghana. MATERIALS AND METHODS: A retrospective review of surgical case logs of IH repairs from 2013 to 2017 in 41 hospitals was performed. Multivariate logistic regression was used to determine predictors of mesh use. RESULTS: Eight thousand eighty male patients underwent IH repair. The range of IH repair in each region was 96 to 295 (overall 123) per 100,000 population. Most cases were performed at district hospitals (84%) and repaired nonurgently (93%) by nonsurgeon physicians (66%). Suture repair was most common (85%) although mesh was used in 15%. The strongest predictor of mesh use was when a surgeon performed surgery (odds ratio [OR] 3.13, P <0.001), followed by surgery being performed in a teaching hospital (OR 2.31, P <0.001). Repair at a regional hospital was a negative predictor of mesh use (OR 0.08, P <0.001) as was the use of general anesthesia (OR 0.40, P = 0.001). CONCLUSIONS: Most IH repairs are performed in district hospitals, by nonsurgeon physicians, and without mesh. Rates of repair and the use of mesh are higher than previous estimates in Ghana and Sub-Saharan Africa but not as high as high-income countries.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/instrumentação , Próteses e Implantes/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Gana , Hérnia Inguinal/economia , Herniorrafia/economia , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes/economia , Estudos Retrospectivos , Telas Cirúrgicas/economia
14.
BMC Urol ; 18(1): 53, 2018 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-29855312

RESUMO

BACKGROUND: This study aims to explore the feasibility of anchoring a four-arm transvaginal mesh (TVM) to the mid-urethra to correct an anterior compartment POP-Quantification stage II-III (Q II-III) and concomitant genuine SUI. METHODS: We analysed clinical data from 248 patients with stage II-III anterior prolapse and concomitant SUI who had undergone surgery at a tertiary referral centre in Hungary between January 2008 and June 2010. One hundred and twenty-four women treated with anterior colporrhaphy and 62 patients implanted with a conventional permanent TVM were selected as historical matched controls. Sixty-two patients received a modified permanent TVM, where the mesh was fixed to the mid-urethra with two stitches for the purpose of potentially correcting SUI. Surgical complications were classified using the Clavien-Dindo (CD) classification system. RESULTS: The anti-SUI efficacy was minimally higher in the mTVM group than in the original TVM group (p = 0.44, 96.8% vs 91.9%, respectively), while prosthesis surgery was more effective than anterior colporrhaphy in improving the anterior compartment POP-Q status (96.8, 90.3% vs 64.5%, respectively). Anchoring the mesh did not increase the extrusion rate (p = 0.11). The de novo urge symptoms were not more prevalent among those who had received additional periurethral stitches (p = 1.00, 11.3% vs 12.9%). The incidence of reoperation observed in the mTVM group was non-significantly lower than that in the TVM group (p = 0.15, 6.5% vs 16.1%); however, the difference did not reach the level of significance. The early postoperative complication profile was more favourable among the mTVM patients (classified as CD I: 8.1%; CD II: 1.6%; and CD IIIb: 1.6%) as compared to the TVM group (p = 0.013). CONCLUSIONS: The new, modified mesh surgery represents an effective procedure for prolapse and concomitant SUI with a decreased risk of short- and long-term complications.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/estatística & dados numéricos , Técnicas de Sutura/estatística & dados numéricos , Incontinência Urinária por Estresse/cirurgia , Vagina/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/diagnóstico , Estudos Prospectivos , Resultado do Tratamento , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/etiologia , Vagina/patologia
15.
J Gynecol Obstet Hum Reprod ; 47(9): 443-449, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29920380

RESUMO

BACKGROUND: Vaginal mesh safety information is limited, especially concerning single incision techniques using ultra lightweight meshes for the treatment of anterior pelvic organ prolapse (POP). OBJECTIVE: To determine the intraoperative and postoperative complication rates after anterior POP repair involving an ultralight mesh (19g/m2): Restorelle® Direct Fix™. METHODS: A case series of 218 consecutive patients, operated on between January 2013 and December 2016 in ten tertiary and secondary care centres, was retrospectively analyzed. Eligible patients had POP vaginal repair (recurrent or not) planned with anterior Restorelle® Direct Fix™ mesh (with or without posterior mesh). Surgical complications were graded using the Clavien-Dindo classification. RESULTS: Intraoperative complications were bladder wound (0.5%), rectal wound (0.5%), ureteral injuries (0.9%). 98.2% of the patient did not have per operative complications. We observed one fail of procedure. Early complications mainly included urinary retention (8.7%) urinary tract infections (5.5%) and haematoma (2.7%). One haematoma required surgical treatment and another, embolization. 80.7% of the patient did not have complications during hospitalization and 80.3% did not have complication at the follow up visit. None of the analyzed factors (age, body mass index, surgical history, grade of prolapse or concomitant procedure) was significantly associated with the risk of perioperative complications. A total of 2.8% patients had grade III complications according Clavien Dindo. None had grade IV or V. CONCLUSIONS: This multicentre case-series on the early experience of the use of anterior Restorelle® Direct Fix™ mesh showed a satisfactory technical feasibility and a low rate of grade III complications according Clavien Dindo. Long term studies are necessary to assess anterior Restorelle® Direct Fix™ mesh performances and to appraise patient satisfaction feedback.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Complicações Intraoperatórias/epidemiologia , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Telas Cirúrgicas/estatística & dados numéricos , Vagina/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , França/epidemiologia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
16.
J Orthop Surg Res ; 13(1): 110, 2018 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-29769141

RESUMO

BACKGROUND: Here, we compared the clinical and radiographic outcomes between coracoclavicular (CC) fixation with Mersilene tape and hook plate for acute unstable acromioclavicular (AC) joint dislocation treatment. METHODS: We enrolled 49 patients with unstable acute AC dislocation who, between January 2010 and January 2014, underwent surgery with single CC suture fixation with Mersilene tape (M group, 25 cases) or clavicle hook plate (H group, 24 cases). In M and H groups, the average age was 43.7 (range 18-72) and 42.0 (range 17-84) years, the male to female ratio of each group was 15:20 and 19:5, and the injured side left to right ratio was 12:13 and 11:13, respectively. All patients were right-handed. We retrospectively compared the operation time, complication rate, visual analog scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, Oxford shoulder scores, and the radiographic outcomes based on reduction loss of CC distance on postoperative follow-up. RESULTS: No significant difference in patient demographics between the two groups in age (p = 0.709), gender (p = 0.217), time from injury to surgery (p = 0.863), and injured side (p = 1.000). The mean follow-up was 26.2 months (range 24-35 months). Nine cases of reduction loss (36%) and one of distal clavicle osteolysis (4%) were noted in the M group. CC distance improvement in the H group was significantly superior to that in the M group at 3 months (before hook plate removal, p < 0.001) and 12 months postoperatively (after hook plate removal, p = 0.004), while subacromial erosions were revealed in nine cases (37.5%) in the H group. No significant difference in operative time (p = 0.846), complication rate (p = 1.000), VAS (p = 0.199), mean UCLA shoulder rating scale (p = 0.353), and Oxford shoulder (p = 0.224) scores between the two groups. CONCLUSIONS: Both hook plate and Mersilene tape fixations provided temporary stabilization of acute type V AC dislocation and yielded comparable clinical outcomes. The hook plate provided better maintenance of reduction of radiographic outcomes. CC suture fixation with Mersilene tape may serve as an alternative method of stabilization which provides acceptable outcome without the need of implant removal.


Assuntos
Articulação Acromioclavicular/cirurgia , Placas Ósseas/estatística & dados numéricos , Luxações Articulares/cirurgia , Polietilenotereftalatos/uso terapêutico , Escápula/cirurgia , Técnicas de Sutura/estatística & dados numéricos , Articulação Acromioclavicular/diagnóstico por imagem , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Escápula/diagnóstico por imagem , Telas Cirúrgicas/estatística & dados numéricos , Fita Cirúrgica/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
17.
Orv Hetil ; 159(10): 397-404, 2018 Mar.
Artigo em Húngaro | MEDLINE | ID: mdl-29504419

RESUMO

INTRODUCTION: The prevalence of pelvic organ prolapse (POP) with aging is escalating alarmingly, and now becoming a growing epidemic among the elderly. Synthetic transvaginal mesh (TVM) has been employed with increasing popularity in the treatment of POP until the end of the last decade. After the U.S. Drug and Food Administration (FDA) warnings in the years 2008 and 2011, the number of vaginal mesh operations has decreased dramatically. AIM: The aim of the study was to evaluate and compare the anti-POP effectivity, the anti-stress incontinence (anti-SUI) efficacy, and the late (36 months) post-operative complications of the anterior vaginoplasty and the TVM operations. METHOD: We analysed the clinical data from 120 patients with stage II-III anterior prolapse and concomitant SUI who had undergone surgery at a tertiary referral centre in Hungary between January 2013 and January 2014. Sixty patients underwent Kelly-Stoeckel vaginoplasty and the other 60 cases had TVM operation. The surgical complications were classified using the Clavien-Dindo (CD) classification system. RESULTS: The anti-POP (91.6% vs. 63.3%; p<0.001) and the anti-SUI efficacy (90% vs. 55%, p<0.001) were significantly higher in the TVM group than in the vaginoplasty group, while the overall extrusion rate was found 8.3% after a 3-year follow-up. The Clavien-Dindo score (CD) proved that the early post-operative complication profile was similar among the TVM patients as compared to the vaginoplasty group (p = 0.405). CONCLUSION: Vaginal mesh surgery represents an effective procedure for prolapse and concomitant SUI with a decreased risk of short- and long-term complications. Orv Hetil. 2018; 159(10): 397-404.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Telas Cirúrgicas/estatística & dados numéricos , Incontinência Urinária por Estresse/cirurgia , Prolapso Uterino/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Hungria , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Satisfação do Paciente , Telas Cirúrgicas/efeitos adversos , Estados Unidos , United States Food and Drug Administration , Incontinência Urinária por Estresse/epidemiologia , Prolapso Uterino/epidemiologia
18.
Rev. cuba. cir ; 57(1): 72-77, ene.-mar. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-960349

RESUMO

Los defectos de pared abdominal son un desafío para los cirujanos plásticos. El sarcoma de partes blandas es muy recidivante y hay que hacer amplias exéresis con margen oncológico y como consecuencia quedan amplias zonas por reconstruir. El colgajo transverso de recto abdominal es una opción reconstructiva de esta región con buenos resultados estéticos y funcionales. El objetivo del trabajo es mostrar los resultados de la reconstrucción inmediata de la pared abdominal luego de una amplia exéresis oncológica. Se presenta una paciente femenina, mestiza, de 60 años, con diagnóstico de sarcoma de partes blandas, que abarcaba todo el hemiabdomen ínfero izquierdo hasta límites del reborde costal izquierdo, comprometía aponeurosis, el músculo recto izquierdo, y pequeña parte del peritoneo que se reparó. Se decidió una amplia exéresis y se planificó la reconstrucción con un colgajo miocutáneo transverso de recto del abdomen. Se utilizaron mallas de polipropileno. Se logró la reconstrucción inmediata del defecto oncológico con buenos resultados estéticos y funcionales(AU)


Abdominal wall defects are a challenge for plastic surgeons. Soft-tissue sarcoma is very recurrent and it is necessary to make extensive exeresis with oncological margin and, as a result, there are large areas to be reconstructed. The transverse rectus abdominis flap is a reconstructive option for this region and with good aesthetic and functional results. The objective of the work is to show the results of the immediate reconstruction of the abdominal wall after an extensive oncological exeresis. We present the case of a female patient, mestiza, aged 60 years, with a diagnosis of soft-tissue sarcoma, which encompassed all the left inferior hemiabdomen to the left costal margin limits, compromised the aponeurosis, the left rectus muscle, and a small part of the peritoneum that was repaired. A wide exeresis was decided and the reconstruction was planned with a transverse rectus abdominis myocutaneous flap. Polypropylene meshes were used. The immediate reconstruction of the oncological defect was achieved with good aesthetic and functional results(AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias de Tecidos Moles/diagnóstico , Telas Cirúrgicas/estatística & dados numéricos , Parede Abdominal/cirurgia , Retalho Miocutâneo/efeitos adversos
19.
Rev. cuba. cir ; 57(1): 1-9, ene.-mar. 2018. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-960341

RESUMO

Introducción: las eventraciones y las hernias diafragmáticas crónicas son dos afecciones que en ocasiones se confunden; tienen una frecuencia relativamente baja y su estrategia quirúrgica varía. Objetivo: mostrar la experiencia del Hospital Universitario Clínico Quirúrgico Comandante Manuel Fajardo en la atención de enfermos con hernias y eventraciones diafragmáticas. Métodos: se presentan 11 pacientes atendidos desde 1998 hasta 2015 por afecciones del diafragma como eventraciones y hernias diafragmáticas crónicas. Del total, 7 fueron operadas con anillos de hasta 10 cm y dos con más de 10 cm. Resultados: se operaron 9 pacientes con hernias diafragmáticas y 2 con eventraciones. Ocho hernias fueron del lado izquierdo y una derecha. En 8 de las hernias el contenido era multivisceral. La hernia derecha tenía un anillo de más de 10 cm y con el hígado en su contenido. Cinco fueron reparadas mediante superposición de colgajos y en cuatro se necesitó una malla protésica. Las eventraciones se presentaron en dos mujeres, ambas parciales, una derecha y otra izquierda, tratadas con plicatura del hemidiafragma en dos planos. Conclusiones: las hernias y las eventraciones diafragmáticas son entidades parecidas con particularidades y terapéutica diferentes. En las eventraciones, la plicatura del diafragma es la técnica de elección, por vía abierta o de preferencia por toracoscopia. En las hernias diafragmáticas, la reparación depende del tamaño del anillo, hasta 10 cm se prefiere la reparación con superposición de colgajos y en defectos mayores el uso de mallas protésicas, preferentemente por una toracotomía(AU)


Introduction: Chronic diaphragmatic hernias and eventrations are two conditions sometimes mistaken for each other. They have a relatively low frequency and their surgical strategy varies. Objective: To show the experience at Comandante Manuel Fajardo Clinical Surgical University Hospital in the caring for patients with diaphragmatic eventrations and hernias. Methods: 11 patients attended from 1998 to 2015 were presented for diaphragmatic conditions, such as hernias and chronic diaphragmatic eventrations. Of the total, 7 were operated with rings of up to 10 cm. Two were operated for rings of more than 10 cm. Results: 9 patients with diaphragmatic hernias and 2 with incisional hernias were operated. Eight hernias were on the left side. One hernia was on the right side. In 8 of the hernias, the content was multivisceral. The right hernia had a ring of more than 10 cm, and had the liver in its content. Five hernias were repaired by flaps. Four hernias required a prosthetic mesh. The eventrations were presented in two women, both partial: one was on the right and the other was on the left, and both were treated with plication of the hemidiaphragm in two planes. Conclusions: Diaphragmatic hernias and eventrations are similar entities with different characteristics and therapeutics. In eventrations, the plication of the diaphragm is the technique of choice, either openly or preferably by thoracoscopy. In diaphragmatic hernias, repair depends on the size of the ring, up to 10 cm, flap repair is preferred, and in larger defects, it is the use of prosthetic meshes, preferably by thoracotomy(AU)


Assuntos
Humanos , Masculino , Feminino , Telas Cirúrgicas/estatística & dados numéricos , Toracoscopia/estatística & dados numéricos , Eventração Diafragmática/cirurgia , Hérnia Diafragmática Traumática/cirurgia
20.
World Neurosurg ; 113: 198-203, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29482006

RESUMO

OBJECTIVE: Obvious skin flap collapse is often accompanied by reduced neurologic recovery after decompressive craniectomy. This study explored the feasibility of early cranioplasty (EC) in patients with obvious bilateral frontotemporal bone window (BFBW) collapse after decompressive craniectomy. METHODS: Patients with obvious BFBW collapse who underwent EC or traditional cranioplasty (TC) were divided into 3 groups according to their preoperative Glasgow Coma Scale (GCS) scores. The indexes, including postoperative incision healing, salivation symptoms, postoperative infection, and 6-month postoperative follow-up after EC or TC, were compared in each group. RESULTS: Two of 32 patients with GCS scores of 3 to 8 points experienced poor healing of the scalp incision after EC, whereas no TC patients had poor healing. Incision healing significantly differed between these 2 groups (P > 0.05), and long-term prognoses based on GOS scores were the same after a 6-month postoperative follow-up (P > 0.05). In patients with GCS scores of 9 to 12 points, salivation improved by 84.2% and 17.6% in the EC and TC groups, respectively (P < 0.05) after a mean follow-up time of 6 months. Similarly, positive neurologic recovery rates (GOS score 4-5 points) were higher in the EC group (88.9%) than in the TC group (60.0%) (P < 0.05) and did not differ between the EC (79.3%) and TC (80.6%) groups in patients with GCS scores of 13 to 15 points (P > 0.05). However, salivation improved by 86.7% in the EC group but by only 12.5% in the TC group (P < 0.05). CONCLUSION: We therefore recommend EC for patients with obvious BFBW collapse and GCS scores ≥9.


Assuntos
Craniectomia Descompressiva/tendências , Osso Frontal/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Retalhos Cirúrgicos/tendências , Osso Temporal/diagnóstico por imagem , Adulto , Craniectomia Descompressiva/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos/efeitos adversos , Telas Cirúrgicas/estatística & dados numéricos
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