Dual Tack Mesh Fixation System on a Cadaveric Porcine Model-Creation of a Mesh Fixation System for Hernia Treatment and Prevention.

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.

Evaluación y seguimiento de los pacientes sometidos a operación de Whipple o duodenopancreatectomía cefálica en un hospital de IV nivel de Medellín / Evaluation and follow-up of patients undergoing the Whipple procedure (cepahalic pancreatoduodenectomy) at a level IV of care hospital in Medellín Colombia

Objetivo. Evaluar las indicaciones, resultados y supervivencia de los pacientes sometidos a duodenopancreatectomía cefálica en el Hospital Pablo Tobón Uribe de Medellín. Pacientes y métodos. Se incluyeron todos los pacientes sometidos a duodenopancreatectomía cefálica (operación de Whipple), desde abril de 2004 hasta abril de 2011. La información se obtuvo de la base de datos prospectiva de la Unidad de Cirugía Hepato-Biliar y Pancreática del Hospital Pablo Tobón Uribe. Resultados. Se operaron 68 pacientes, con una edad promedio de 59 años (rango, 16-82) y 50 % eran hombres. La principal indicación de la cirugía fue neoplasia maligna (97 %), con la siguiente distribución: adenocarcinoma pancreático, 25 pacientes (36,7 %); carcinoma ampular, 23 (33,8 %); colangiocarcinoma distal, 8 (11,7 %) cáncer de duodeno, 4 (5,8 %), y 8 (11,7 %) tuvieron otras indicaciones. El sangrado operatorio en promedio fue de 455 ml (rango, 200 a 2.000 ml); 5,8 % de los pacientes sangraron 1.000 ml o más; en 35,2 % de los casos se requirió transfusión de glóbulos rojos, con un rango entre 1 y 8 unidades; 5,8 % de los pacientes requirió cinco o más unidades de glóbulos rojos. El rango de estancia en la unidad de cuidados intensivos fue 1 a 20 días, con un promedio de 2 días; 45,5 % de los pacientes estuvo en la unidad de cuidados intensivos un solo día. Se presentaron complicaciones en el 33,8 % de los pacientes, y las más comunes fueron atonía gástrica, infección distante al sitio operatorio, infección del sitio operatorio y sangrado posoperatorio. La mortalidad posoperatoria a 30 días fue de 14,7 % en toda la serie; al hacer un análisis del último grupo de 25 pacientes, la cifra bajó a 8 %, con una supervivencia actuarial de toda la serie de pacientes de 54,4 %. Conclusión. En nuestro hospital, la duodenopancreatectomía cefálica sigue teniendo alta mortalidad en comparación con algunos centros de referencia en el mundo, aunque es evidente que ha mejorado en los últimos años; las cifras de morbilidad están acordes a las reportadas en diferentes series mundiales de excelencia.

Introduction: Objective: To evaluate the indications, results and survival of patients undergoing pancreatoduodenectomy at Hospital Pablo Tobon Uribe of Medellin. Materials and methods: We collected all patients that underwent pancreatoduodenectomy (Whipple operation), from April 2004 to April 2011. The information was obtained from a prospective database from the Hepato-Biliary and Pancreatic Unit of Hospital Pablo Tobón Uribe. Results: 68 patients were operated in total, with an average age of 59 years (16-82), 50% were men; the main indication for surgery was malignant disease (97%), with the following distribution: 25 patients with pancreatic adenocarcinoma ( 36.7%), 23 patients with ampullary carcinoma (33.8%), 8 with distal cholangiocarcinoma (11.7%), 4 patients with duodenal cancer (5.8%) and 11.7% with other indications. Average bleeding at surgery was 455 ml (200-2000ml), 5.8% of patients bled 1000 ml or more, 35.2% of cases required transfusion of red blood cells, with a range of 1-8 units, 5.8% of patients required 5 or more units of red cells. The range of ICU stay was 1-20 days, with an average of 2 days, 45.5% of these patients just stayed one day. Complications occurred in 33.8% of patients, the most common was gastric atony, distant infection and postoperative bleeding. Postoperative mortality at 30 days was 14.7% in the whole series, with an analysis of the last group of 25 patients, the number dropped to 8%, with an actuarial survival of the entire series of 54.4%. Conclusions: In our hospital, pancreatoduodenectomy mortality is still high compared to some reference centers in the world, but clearly has improved in recent years, morbidity results are consistent with those reported in centers of excellence around the world.