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1.
Actas Urol Esp (Engl Ed) ; 47(9): 566-572, 2023 11.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-37084807

RESUMO

INTRODUCTION AND OBJECTIVES: To compare the efficacy of erector spinae plane block (ESPB) and intramuscular (i.m.) diclofenac sodium in regard to pain management and impact on stone-free status in patients undergoing SWL. PATIENTS AND MATERIALS: The study included patients who underwent SWL for kidney stones in our institution. The patients were randomly assigned to the ESPB (Group 1: n = 31) and i.m. 75 mg diclofenac sodium (Group 2: n = 30) groups. The demographic data of the patients, fluoroscopy time during SWL, number of need of targeting, total shocks given, voltage, stone free rates (SFR), analgesy method, number of SWL sessions, VAS score, stone location, maximum stone size, stone volume and Hounsfield unit (HU) were also recorded. RESULTS: A total of 61 patients were included the study. There was no statistically significant difference between the two groups according to stone size, volume and density, SWL duration, total shocks given, voltage, BMI, stone-free status and stone location. Fluoroscopy time and number of need for stone targeting were significantly lower in group 1 than group 2 (p = 0.002, p = 0.021, respectively). The VAS score was significantly lower for group 1 compared to group 2 (p < 0.001). CONCLUSIONS: We observed that the VAS score was lower in the ESPB group compared to i.m. diclofenac sodium group and although it was not statistically significant, we achieved a higher rate of stone-free status in the first session in ESPB group. Most importantly, the patients in the ESPB group were exposed to less fluoroscopy and radiation.


Assuntos
Cálculos Renais , Litotripsia , Bloqueio Nervoso , Humanos , Estudos Prospectivos , Diclofenaco/uso terapêutico , Cálculos Renais/cirurgia , Litotripsia/métodos , Fluoroscopia
2.
Hernia ; 27(4): 943-956, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37335520

RESUMO

PURPOSE: To determine the prevalence of rectus diastasis (RD) in patients with inguinal hernia. MATERIAL AND METHODS: Multicenter, cross-sectional study. Patients with inguinal hernia were included in the study group (IH) and those with benign proctologic complaints created the control group (CG). Age, gender, BMI, family history for inguinal hernias, comorbid diseases, alcohol use, smoking, constipation, malignancy, chemotherapy, number of births, multiple pregnancies and prostate hypertrophy history of all patients in both groups were recorded. All patients were evaluated for RD and umbilical hernias by physical examination. RESULTS: A total of 528 consecutive patients were included in the study (292 IH / 236 CG). Overall prevalence of RD was 35.6% and it was significantly higher in IH than in CG (46.9% vs 21.6%, p < 0.001). Also, umbilical hernia was more frequently detected in the patients with inguinal hernia. Other risk factors for RD were age, BMI, DM, BPH and smoking. The mean inter-rectus distance for 528 patients was 18.1 mm; it was 20.71 ± 10.68 mm in IH and 14.88 ± 8.82 in CG (p < 0.001). It was determined that the increase in age and BMI caused an increase in the inter-rectus distance, and that the presence of DM, inguinal hernia and umbilical hernia increased the inter-rectus distance quantitatively. CONCLUSIONS: The prevalence of RD seems to be higher in patients with inguinal hernia comparing to that in general population. Increased age, high BMI and DM were found to be independent risk factors for RD development.


Assuntos
Hérnia Inguinal , Hérnia Umbilical , Masculino , Humanos , Hérnia Inguinal/complicações , Hérnia Inguinal/epidemiologia , Hérnia Umbilical/complicações , Hérnia Umbilical/epidemiologia , Hérnia Umbilical/cirurgia , Prevalência , Estudos Transversais , Herniorrafia/efeitos adversos
3.
Hernia ; 25(5): 1231-1238, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33904998

RESUMO

PURPOSE: This study aimed to determine whether crossing of the mesh's lateral tails is beneficial in Lichtenstein repairs for medial (direct) inguinal hernias. METHODS: We allocated 116 patients with unilateral medial (direct) inguinal hernias into two groups: mesh tail crossing (group C) or no mesh tail crossing (group N). In group C, the lateral tails were sutured together at the inguinal ligament, whereas the lateral tails were sutured in a parallel position in group N. Visual analog scale (VAS) scores were postoperatively recorded in person at the 1st, 7th, 30th, and 90th days and at the 1st year. The Short-Form Health Survey (SF-36) scores were calculated postoperatively at one month and one year. Examinations to detect hernia recurrence were performed at the end of the 1st year. Follow-ups at the 5th year were performed via phone calls to obtain the Sheffield pain scale and VAS values and to determine the possibility of hernia recurrence. RESULTS: VAS and SF-36 scores at the 1st, 7th, 30th, and 90th days and 1st year were all higher in group C than in group N. In group C, one patient experienced moderate pain, and one experienced severe pain. In the 5th year, VAS and Sheffield pain scores were significantly higher in group C than in group N. CONCLUSIONS: During Lichtenstein repair for medial (direct) inguinal hernias, crossing of the mesh tails may increase the frequency of postoperative chronic inguinal pain.


Assuntos
Dor Crônica , Hérnia Inguinal , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Recidiva , Telas Cirúrgicas , Resultado do Tratamento
4.
G Chir ; 30(10): 437-9, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19954586

RESUMO

BACKGROUND AND AIM: Umbilical hernia frequently accompanies cholelithiasis. It is possible to repair these hernias after completing cholecystectomy. We herein describe a simple modified technique for the repair. PATIENTS AND METHOD: The technique was applied to 10 patients undergone laparoscopic cholecystectomy. After cholecystectomy has been performed, periumbilical trocar incision is extended toward the umbilicus. The hernia sac is sent into the abdominal cavity and one or two simple sutures are put to approximate the fascial edges of the umbilical hernia. A similar approximation is done for trocar hole. A piece of polypropylene mesh covering both defects with an adequate overlap at four edges is fixed in onlay position. RESULTS: No wound complications were recorded. After a median of 23 months (6-40 months) follow-up no recurrence was observed. CONCLUSION: This simple modified repair may especially be useful in centers where the surgeons can easily perform cholecystectomy laparoscopically, but are not familiar with laparoscopic hernia repair and mesh placement or haven't the equipment and material necessary for a laparoscopic repair.


Assuntos
Colecistectomia Laparoscópica , Hérnia Umbilical/cirurgia , Colelitíase/complicações , Colelitíase/cirurgia , Hérnia Umbilical/complicações , Humanos , Procedimentos Cirúrgicos Operatórios/métodos
6.
Transplant Proc ; 43(3): 781-6, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21486597

RESUMO

OBJECTIVE: With the developments in laparoscopic surgery, open donor nephrectomy has been widely replaced by laparoscopic donor nephrectomy. Presented herein is the comparison of laparoscopic live donor nephrectomy (LLDN) and open live donor nephrectomy (OLDN) results performed at our institute. MATERIALS AND METHODS: Patients who underwent OLDN between July 2006 and August 2008 or LLDN between August 2008 and July 2010 were included in this retrospective age- and gender-matched case-controlled study. OLDN was performed with a 45° semi-flank position using a self-retaining retractor. LLDN operations were performed used a 90° flank position by the transperitoneal route under 12-15 mm Hg carbon dioxide (CO(2)) pressure. A Pfannenstiel incision was used in all LLDN for graft extraction. The renal artery and vein were controlled with Satinsky clamps in OLDN, whereas renal arteries were controlled with nonabsorbable polymer locking clips and renal veins with 2.5/45 mm EndoGIA vascular staplers in LLDN. RESULTS: Thirty patients underwent OLDN and 31 LLDN. The mean ages among the OLDN and LLDN patients were 44.9 ± 21.9 and 46.3 ± 18.4, respectively. There was no significant difference in mean age and gender distribution of patients between OLDN and LLDN groups by the design of the study. The OLDN group consisted of 4 (13%) right and 26 (87%) left nephrectomies; the LLDN group consisted of 3 (9%) right and 28 (91%) left nephrectomies. Mean operative time was 110 ± 18 and 101 ± 28 minutes for OLDN and LLDN, respectively (P < .05; Mann-Whitney U test). Estimated blood loss was 35 ± 15 mL among the OLDN group and 15 ± 24 mL for the LLDN group. Mean hospitalization time in the OLDN and LLDN groups were 3.8 ± 0.5 and 2.6 ± 0.6 days, respectively. There were no conversions to open surgery in the LLDN group. Mean warm ischemia time in the OLDN and LLDN groups were 140 ± 58 seconds and 203 ± 21 seconds, respectively (P < .05; Mann-Whitney U test). There was no difference in recipient serum creatinine levels at 1 week after surgery. CONCLUSION: LLDN was superior to OLDN in terms of operative time, estimated blood loss, length of hospital stay, and postoperative pain. Longer warm ischemia time in the LLDN group did not translate into worse graft function in the recipients.


Assuntos
Transplante de Rim/métodos , Laparoscopia/métodos , Nefrectomia/métodos , Adulto , Fatores Etários , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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