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Surgical Technology International 30
$195.00
Surgical Technology International Vol. 30 contains 73 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
June-2017- ISSN:1090-3941
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both electronic and print versions.
Long-Term Outcome After Laparoscopic Repair of Primary, Unilateral Inguinal Hernia Using a Self-Adhering Mesh
Tim Tollens, MD, Consultant, Halit Topal, MD, Surgical Trainee, Alexander Lucardie, BSc, Registrar, Koen Vermeiren, MD, Consultant, Chris Aelvoet, MD, Consultant, Kurt Devroe, MD, Consultant, Department of General and Abdominal Surgery, Imelda Hospital, Bonheiden, Belgium
769
07-Dec-2016
Following our previous study about a lightweight self-adhering mesh (Adhesix®, Cousin Biotech, Wervicq-Sud, France; distributed by Davol Inc., subsidiary of C.R. Bard, Inc.), we report the long-term results with the use of this mesh in patients treated for a primary, unilateral inguinal hernia without any other hernias. Prospectively collected data of 100 patients between February 2011 and February 2014 were analyzed. The mean follow-up time was 2.7 years (range 1–4), and mean length of hospital stay was 0.6 days (range 0.5–1). At the time of the last follow-up visit, two patients (2%) had a recurrent inguinal hernia. Compared to preoperative values, patients reported a significant reduction in their pain sensation (visual analogue scale, VAS) after one month (4.61 vs. 1.32; P<0.001). A difference in VAS scores remained significant at the last follow-up visit (1.31 vs. 0.28; P<0.001). Patients reported high quality of life scores. Only one patient (1%) developed a clinically significant seroma that required an evacuating puncture. Two patients (2%) had superficial wound infections. Neither mesh infections nor mortalities occurred. This study, with a long follow-up, confirms our previous results: use of the Adhesix® mesh is safe, feasible, and efficient in laparoscopic hernia repair.
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Real-World Clinical Quality Improvement for Complex Abdominal Wall Reconstruction
Bruce Ramshaw, MD, Professor and Chair, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, Brandie (Remi) Forman, BA, Hernia Clinician and Patient Care Manager, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, Karla Moore, PhD, Dean, Academic Assessment and Planning, Daytona State College, Daytona Beach, Florida, Eric Heidel, PHD, Assistant Professor, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, Michael Fabian, MD, Surgeon, Department of Surgery, Halifax Health, Daytona Beach, Florida, Greg Mancini, MD, FACS, Associate Professor, Program Director, Department of Surgery, University Surgeons Associates, Knoxville, Tennessee, Girish P. Joshi, MBBS, MD, FFARCSI, Professor, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Director of Perioperative Medicine and Ambulatory Anesthesia, Parkland Health and Hospital System, Dallas, Texas
806
12-01-2017
Introduction: Traditional methods of clinical research may not be adequate to improve the value of care for patients undergoing abdominal wall reconstruction (AWR). These patients are prone to high complication rates and high costs. Here, we describe a clinical quality improvement (CQI) effort to enhance outcomes for patients undergoing AWR.
Materials and Methods: CQI was applied for the entire care cycle for consecutive patients who underwent AWR from August 2011–September 2015. Initiatives for improving value during this period included use of long-term resorbable synthetic mesh as well as administration of preoperative bilateral transversus abdominus plane (TAP), and intraoperative abdominal wall blocks using long-acting bupivacaine as a part of a multimodal regimen. Outcomes data that measure value in the context of AWR were collected to compare outcomes for the patients who received TAP blocks only, TAP and intraoperative blocks, and those who received no block.
Results: One hundred and two patients who had AWR for abdominal wall pathology were included. Outcomes including total opioid use, duration of stay and opioid use in the postanesthesia care unit (PACU), length of hospital stay (LOS), major wound complications, and costs, all improved over time. Specifically, PACU opioid use, total opioid use, and LOS were decreased in the two groups that received blocks versus a group that did not have any type of block.
Conclusions: CQI program implementation in patients undergoing AWR resulted in measurable improvement of value-based outcomes over time. A CQI effort applied to the entire patient cycle of care should be routinely utilized.
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Laparoscopic Treatment of Giant Ventral Hernia: Experience of 35 Patients
Michele Grande, MD, Assistant Professor, Department of Surgery, University Hospital of Tor Vergata, Rome, Italy, Giorgio Lisi, MD, Resident, Department of Surgery, University Hospital of Borgo Roma, Verona, Italy, Michela Campanelli, MD, Resident, Department of Surgery, University Hospital of Modena, Modena, Italy, Simona Grande, Intern, Department of Surgery, University Hospital of Messina, Messina, Italy, Dario Venditti, MD, Assistant Professor, Department of Surgery, University Hospital of Tor Vergata, Rome, Italy, Casimiro Nigro, MD, Assistant Professor, Department of Surgery, University Hospital of Tor Vergata, Rome, Italy, Francesca Cabry, MD, Researcher, Department of Surgery, University Hospital of Modena, Modena, Italy, Massimo Villa, MD, PhD, Assistant Professor, Department of Surgery, University Hospital of Tor Vergata, Rome, Italy
807
18-01-2017
Background: Minimal access surgery for incisional hernia repair is still debated, especially for giant wall defects. Laparoscopic repair may reduce pain and hospital stay. This study was designed to evaluate the feasibility of the laparoscopic technique in giant hernia.
Materials and Methods: From 2007 to 2013, 35 consecutive patients with giant ventral hernia, according to the Chevrel classification, underwent laparoscopic repair. Fourteen patients were obese, with a body mass index (BMI) > 30 and in 21 patients the mean BMI was 24 (range 22–28). In all patients, the wall defect was larger than 20 cm.
Results: Mean operative time was 159±30 minutes, and, for defects larger than 25 cm, it was 210±20 minutes. Patient conversion did not occur. In 29 patients, the mean wall defect was 20x25 cm, and in six patients the mean wall defect was 26x31 cm, and, as measured from within the peritoneal cavity, the mean overlap was 5 cm (range 3–6). Short-term antibiotic prophylaxis consisted of Cefazolin 2 g IV (intravenous) the day of surgery. All patients were discharged within 72–96 hrs. The mean follow-up was 24 months. No infection occurred and no chronic pain was recorded. However, three seroma were observed (outpatient treatment) and two xiphoid recurrences were observed.
Conclusions: Laparoscopic hernia repair is technically feasible and is safe in patients with giant fascial defects as well as obese patients. This operation decreases postoperative pain, hastens the recovery period, and reduces postoperative morbidity and recurrence. This approach should be reserved for patients with no history of previous hernia repair. Further studies are expected to confirm these promising results.
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Trocar Site Hernia After Gastric Bypass
Sandra Ahlqvist, MD, Resident Anesthesiologist, Department of Anesthesia and Intensive care, Sundsvall Hospital, Sundsvall, Sweden, Dennis Björk, MD, Attending Surgeon, Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden, Lena Weisby, MD, Attending Radiologist, Department of Radiology, Sundsvall Hospital, Sundsvall, Sweden, Leif A Israelsson, MD, PhD, Associate Professor, Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden, Yücel Cengiz, MD, PhD, Associate Professor, Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
869
18-05-2017
Background: The 5.2% rate of trocar site incisional hernia (TSIH) reported appears low in view of the proportion of TSIH repairs being performed. Detecting TSIH by clinical examination may be difficult in the obese. The correlation between clinical examination and a novel radiological examination for the detection of TSIH in obese patients was studied.
Materials and Methods: Twenty-six patients subjected to laparoscopic gastric bypass in 2010 underwent clinical and radiological examination by three independent assessors for each method, after a mean follow-up time of 33 months. The computed tomography was in the prone position upon a ring.
Results: At clinical examination, a TSIH was regarded to be present in six out of 26 patients and at CT scan in four. The Fleiss’ Kappa for multiple raters was 0.40 (p = 0.184) with clinical examination and 1 (p <0.05) with CT scan. With CT scan, herniation was diagnosed in three of 26 umbilical trocar sites that had been closed at the index operation, and in one of the 130 other trocar sites that had not been closed.
Conclusions: Clinical examination is not reliable when detecting TSIH in the obese. A CT scan in the prone position was extremely reliable and seems to have the potential of becoming the standard method for detecting TSIH in obese patients.
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Long-Term Results of Fixation-Free Incisional Hernia Repair Using a Tentacle-Shaped Implant
Giuseppe Amato, MD, Consulting Professor, Postgraduate School of General Surgery, University of Cagliari, Cagliari, Italy, Giorgio Romano, MD, Associate Professor, Department of General Surgery and Emergency, University of Palermo, Palermo, Italy, Thorsten Goetze, MD, PhD, Private Docent, Institut für Klinisch-Onkologische Forschung, Nordwest Krankenhaus Frankfurt, Frankfurt, Germany, Luca Gordini, MD, Physician, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy, Enrico Erdas, MD, Physician, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy, Fabio Medas, MD, Physician, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy, Piergiorgio Calò, MD , Full Professor, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
852
03-05-2017
Introduction: The fixation and the overlap of the mesh represent an open issue in incisional hernia repair. An exclusively designed prosthesis has been developed to assure a suture-free repair and a broader coverage of the abdominal wall. This study describes the long-term results of incisional hernia procedures carried out positioning a tentacle-shaped implant through a specifically developed surgical technique.
Materials and Methods: A proprietary symmetrically-shaped flat mesh constituted by a large central body with integrated radiating arms was used to repair incisional hernias in 68 patients. The prosthesis was placed in preperitoneal/retromuscular sublay. The friction of the straps passing through myotendineal structures of the abdomen was intended to assure an adequate grip to firmly hold the device in place with a broad overlap of the hernia defect in a fixation-free fashion. All tentacle straps were positioned through a special needle passer crossing the abdominal wall laterally from the defect borders then cut short in the subcutaneous layer.
Results: In a long-term follow-up of 12 to 96 months (mean 58 months), 11 seromas occurred. No infections, hematomas, chronic pain, mesh dislocation, or recurrence have been reported.
Conclusions: The tentacle strap system of the prosthesis effectively ensured reduced skin incision and an easier implant placement avoiding the need for suturing the mesh. Regularly performed computed tomography (CT) and ultrasound (US) investigations proved that the arms of the implant ensured a proper orientation and stabilization of the mesh in association with a broad defect overlap. The specifically developed surgical procedure showed a quick postoperative recovery, a very low complication rate, and no recurrences, even in the long-term.
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Hiatal Hernia Repair: Current Evidence for Use of Absorbable Mesh to Reinforce Hiatal Closure
Lucian Panait, MD, FACS, Minimally Invasive Surgeon, AtlantiCare Physician Group, Department of Surgery, Egg Harbor Township, New Jersey, Yuri W. Novitsky MD, FACS, Professor of Surgery, Case Western Reserve School of Medicine, Director, Cleveland Comprehensive Hernia Center, Director, Advanced GI Surgery/MIS Fellowship, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
843
11-06-2017
Introduction: There continues to be debate regarding the best surgical technique for the treatment of paraesophageal hernias. While laparoscopic and robotic approaches are widely employed around the world, the benefits of mesh use to reinforce hiatal closure are still not well established. The goal of this manuscript is to describe the currently available results with biologic and bioabsorbable meshes for treatment of paraesophageal hernias, particularly with reference to the rate of recurrence.
Materials and Methods: A systematic review of the literature was conducted to identify studies describing treatment of hiatal hernias with biologic or bioabsorbable mesh. The available studies were categorized as comparative (when authors compared results with a different patient cohort undergoing suture repair of the hiatus without mesh reinforcement) and non-comparative, and organized by levels of evidence.
Results: We identified two randomized control trials, a long-term follow-up to one of the trials, a prospective case control study, one retrospective case control study, two meta-analyses of the above-mentioned studies, as well as 11 non-comparative studies, which included two prospective, 10 retrospective, and two case series. Most studies involved the use of different biologic meshes, while bioabsorbable mesh use was only described in four of the retrospective studies mentioned. The results are variable, however, most authors found a benefit from hiatal closure reinforcement with mesh.
Conclusions: The available literature lacks definitive evidence to support the use of biologic or bioabsorbable materials to reinforce hiatal closure in the cure of paraesophageal hernias. Further studies are needed to assess newer materials and longer-term effects of existing products.
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