Science.gov

Sample records for hernia repair surgery

  1. Laparoscopic Inguinal Hernia Repair

    MedlinePLUS

    ... Laparoscopic Inguinal Hernia Repair Surgery Patient Information from SAGES Download PDF Version Find a SAGES Surgeon About ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  2. Laparoscopic Ventral Hernia Repair

    MedlinePLUS

    ... Login Laparoscopic Ventral Hernia Repair Patient Information from SAGES Download PDF Version Find a SAGES Surgeon Approximately ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  3. Diaphragmatic hernia repair - congenital

    MedlinePLUS

    ... correct an opening or space in a baby's diaphragm. This opening is called a hernia. It is ... down into place through the opening in the diaphragm and into the abdominal cavity. The surgeon repairs ...

  4. Intestinal Obstruction After Totally Extraperitoneal Laparoscopic Inguinal Hernia Repair

    PubMed Central

    Rink, Joanne

    2004-01-01

    Laparoscopic hernia repair is a frequently performed operation. Although it has many advantages over open inguinal hernia repair, laparoscopic surgery is not without complications. Small bowel obstruction is a complication unique to laparoscopic repair of inguinal hernias. It is reported following transabdominal preperitoneal repairs. We present a case of small bowel incarceration through a peritoneal defect after a totally extraperitoneal inguinal hernia repair. Techniques to avoid this complication are presented. The literature is reviewed. PMID:14974673

  5. Laparoscopic Repair of Left Lumbar Hernia After Laparoscopic Left Nephrectomy

    PubMed Central

    Milone, Luca; Gumbs, Andrew; Turner, Patricia

    2010-01-01

    Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair. PMID:21333197

  6. Risk of Late-Onset Adhesions and Incisional Hernia Repairs after Surgery

    PubMed Central

    Bensley, Rodney P; Schermerhorn, Marc L; Hurks, Rob; Sachs, Teviah; Boyd, Christopher A; O’Malley, A James; Cotterill, Philip; Landon, Bruce E

    2013-01-01

    BACKGROUND Long-term adhesion-related complications and incisional hernias after abdominal surgery are common and costly. There are few data on the risk of these complications after different abdominal operations. STUDY DESIGN We identified Medicare beneficiaries who underwent endovascular repair of an abdominal aortic aneurysm from 2001–2008 who presumably are not at risk for laparotomy-related complications. We identified all laparoscopic and open operations involving the abdomen, pelvis, or retroperitoneum and categorized them into 5 groups according to invasiveness. We then identified laparotomy-related complications for up to 5 years after the index operation and compared these with the baseline rate of complications in a control group of patients who did not undergo an abdominal operation. RESULTS We studied 85,663 patients, 7,513 (8.8%) of which underwent a laparotomy, including 2,783 major abdominal operations, 709 minor abdominal operations, 963 ventral hernia repairs, 493 retroperitoneal/pelvic operations, and 2,565 laparoscopic operations. Mean age was 76.7 years and 82.0% were male. Major abdominal operations carried the highest risk for adhesion-related complications (14.3% and 25.0% at 2 and 5 years compared with 4.0% and 7.8% for the control group; p < 0.001) and incisional hernias (7.8% and 12.0% compared with 0.6% and 1.2% for the control group; p < 0.001). Laparoscopic operations (4.6% and 10.7% for adhesions, 1.9% and 3.2% for incisional hernias) carried the lowest risk. CONCLUSIONS Late-onset laparotomy-related complications are frequent and their risk extends through 5 years beyond the perioperative period. With the advancement and expansion of laparoscopic techniques and its attendant lower risk for long-term complications, these results can alter the risk-to-benefit profile of various types of abdominal operations and can also strengthen the rationale for additional development of laparoscopic approaches to abdominal operations. PMID:23623220

  7. Hernia

    MedlinePLUS

    ... surrounds the muscle. This layer is called the fascia. Which type of hernia you have depends on ... problems. Surgery repairs the weakened abdominal wall tissue (fascia) and closes any holes. Most hernias are closed ...

  8. The laparoscopic hiatoplasty with antireflux surgery is a safe and effective procedure to repair giant hiatal hernia

    PubMed Central

    2014-01-01

    Background Although minimally invasive repair of giant hiatal hernias is a very surgical challenge which requires advanced laparoscopic learning curve, several reports showed that is a safe and effective procedure, with lower morbidity than open approach. In the present study we show the outcomes of 13 patients who underwent a laparoscopic repair of giant hiatal hernia. Methods A total of 13 patients underwent laparoscopic posterior hiatoplasty and Nissen fundoplication. Follow-up evaluation was done clinically at intervals of 3, 6 and 12 months after surgery using the Gastro-oesophageal Reflux Health-Related Quality of Life scale, a barium swallow study, an upper gastrointestinal endoscopy, an oesophageal manometry, a combined ambulatory 24-h multichannel impedance pH and bilirubin monitoring. Anatomic recurrence was defined as any evidence of gastric herniation above the diaphragmatic edge. Results There were no intraoperative complications and no conversions to open technique. Symptomatic GORD-HQL outcomes demonstrated a statistical significant decrease of mean value equal to 3.2 compare to 37.4 of preoperative assessment (p?hernia recurrence was recorded in the study group, treated respecting several crucial surgical principles, e.g., complete sac excision, appropriate crural closure, also with direct hiatal defect where possible, and routine use of antireflux procedure. PMID:24401085

  9. Robotic Repair of Giant Paraesophageal Hernias

    PubMed Central

    Seetharamaiah, Rupa; Romero, Rey Jesús; Kosanovic, Radomir; Gallas, Michelle; Verdeja, Juan-Carlos; Rabaza, Jorge

    2013-01-01

    Background and Objectives: Giant paraesophageal hernia accounts for 5% of all hiatal hernias, and it is commonly seen in elderly patients with comorbidities. Some series report complication rates up to 28%, recurrence rates between 10% and 25%, and a mortality rate close to 2%. Recently, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) has shown equivocal benefits when used for elective surgeries, whereas for complex procedures, the benefits appear to be clearer. The purpose of this study is to present our preliminary experience in robotic giant paraesophageal hernia repair. Methods: We retrospectively collected data from patients who had a diagnosis of giant paraesophageal hernia and underwent a paraesophageal hernia repair with the da Vinci Surgical System. Results: Nineteen patients (12 women [63.1%]) underwent surgery for giant paraesophageal hernia at our center. The mean age was 70.4 ± 13.9 years (range, 40–97 years). The mean American Society of Anesthesiologists score was 2.15. The mean surgical time and hospital length of stay were 184.5 ± 96.2 minutes (range, 96–395 minutes) and 4.3 days (range, 2–22 days), respectively. Nissen fundoplications were performed in 3 cases (15.7%), and 16 patients (84.2%) had mesh placed. Six patients (31.5%) presented with gastric volvulus, and 2 patients had other herniated viscera (colon and duodenum). There were 2 surgery-related complications (10.5%) (1 dysphagia that required dilatation and 1 pleural injury) and 1 conversion to open repair (partial gastric resection). No recurrences or deaths were observed in this series. Conclusion: In our experience robotic giant paraesophageal hernia repair is not different from the laparoscopic approach in terms of complications and mortality rate, but it may be associated with lower recurrence rates. However, larger series with longer follow-up are necessary to further substantiate our results. PMID:24398199

  10. Evolution and advances in laparoscopic ventral and incisional hernia repair.

    PubMed

    Vorst, Alan L; Kaoutzanis, Christodoulos; Carbonell, Alfredo M; Franz, Michael G

    2015-11-27

    Primary ventral hernias and ventral incisional hernias have been a challenge for surgeons throughout the ages. In the current era, incisional hernias have increased in prevalence due to the very high number of laparotomies performed in the 20(th) century. Even though minimally invasive surgery and hernia repair have evolved rapidly, general surgeons have yet to develop the ideal, standardized method that adequately decreases common postoperative complications, such as wound failure, hernia recurrence and pain. The evolution of laparoscopy and ventral hernia repair will be reviewed, from the rectoscopy of the 4(th) century to the advent of laparoscopy, from suture repair to the evolution of mesh reinforcement. The nuances of minimally invasive ventral and incisional hernia repair will be summarized, from preoperative considerations to variations in intraoperative practice. New techniques have become increasingly popular, such as primary defect closure, retrorectus mesh placement, and concomitant component separation. The advent of robotics has made some of these repairs more feasible, but only time and well-designed clinical studies will tell if this will be a durable modality for ventral and incisional hernia repair. PMID:26649152

  11. Evolution and advances in laparoscopic ventral and incisional hernia repair

    PubMed Central

    Vorst, Alan L; Kaoutzanis, Christodoulos; Carbonell, Alfredo M; Franz, Michael G

    2015-01-01

    Primary ventral hernias and ventral incisional hernias have been a challenge for surgeons throughout the ages. In the current era, incisional hernias have increased in prevalence due to the very high number of laparotomies performed in the 20th century. Even though minimally invasive surgery and hernia repair have evolved rapidly, general surgeons have yet to develop the ideal, standardized method that adequately decreases common postoperative complications, such as wound failure, hernia recurrence and pain. The evolution of laparoscopy and ventral hernia repair will be reviewed, from the rectoscopy of the 4th century to the advent of laparoscopy, from suture repair to the evolution of mesh reinforcement. The nuances of minimally invasive ventral and incisional hernia repair will be summarized, from preoperative considerations to variations in intraoperative practice. New techniques have become increasingly popular, such as primary defect closure, retrorectus mesh placement, and concomitant component separation. The advent of robotics has made some of these repairs more feasible, but only time and well-designed clinical studies will tell if this will be a durable modality for ventral and incisional hernia repair. PMID:26649152

  12. Dynamic intermittent strain can rapidly impair ventral hernia repair.

    PubMed

    Kallinowski, Friedrich; Baumann, Elena; Harder, Felix; Siassi, Michael; Mahn, Axel; Vollmer, Matthias; Morlock, Michael M

    2015-11-26

    Ventral hernia repair fails frequently despite advanced mesh inserting surgery. A model for dynamic intermittent straining (DIS) of ventral hernia repairs was developed. The influence of phospholipids, position, overlap, fixation and tissue quality of various meshes on the durability of hernia repair was studied. DIS comprises the repetition of submaximal impacts delivered via a hydraulically driven plastic containment. Pig tissues simulate a ventral hernia with a standardized 5cm defect. Commercially available meshes strengthened with tacks, glue and sutures were used to bridge this defect in an underlay (IPOM) or sublay (retromuscular) position starting with a 5cm overlap in all directions. We tested 35 different ways of ventral hernia repair with up to 425 submaximal intermittent dynamic impacts until mesh dislocation occurred 10 times or a maximum of 4000 impacts each were withstood. The likelihood of a failing repair was related to the mesh, the lubricants, the position, the overlap, the fixation and the tissue quality. Most meshes dislocated easily and required fixation. One of the meshes tested was stable without fixation with a 5cm overlap and failed after reducing the overlap. Phospholipids exerted a strong influence on the biomaterial tested. The sublay position was about 10% more durable in comparison to the IPOM position. DIS revealed distinct degrees of stability with primarily stable, intermediate and primarily unstable repairs. Based on the DIS results available, the currently used ventral hernia repair options can be classified. In the future, DIS investigations can improve the durability of hernia repair. PMID:26476761

  13. Laparoscopic ventral hernia repair: a community hospital experience.

    PubMed

    Saiz, A A; Willis, I H; Paul, D K; Sivina, M

    1996-05-01

    From October 1993 to April 1994, laparoscopic ventral hernia repair was performed on 10 patients, all of whom had a history of failed ventral hernia repair and at least two prior ventral hernia repair procedures. Patients presented with complaints of abdominal discomfort, painful mass at the hernia site, or vague abdominal discomfort. No operative deaths occurred. Two patients had minor complications: a seroma at the repair site, which resolved spontaneously, and a superficial wound infection at a trochar site, which responded to an oral cephalosporin. Six patients were discharged within 24 hours of surgery and one patient was operated on as an outpatient and discharged the same day. Follow-up of all patients ranged from 10 to 17 months. No evidence of hernia recurrence has been noted. Some recurrent ventral hernias are amenable to laparoscopic repair, and this technique may be preferable in some patients, especially those who have had an earlier failed open repair with mesh. We do not advocate use of our technique for the first repair of a ventral hernia. Long-term follow-up is still needed to determine recurrence rates compared with conventional open techniques. PMID:8615557

  14. Current Trends in Laparoscopic Ventral Hernia Repair

    PubMed Central

    Patapis, Paul; Zavras, Nick; Tzanetis, Panagiotis; Machairas, Anastasios

    2015-01-01

    Background and Objectives: The purpose of this study was to analyze the surgical technique, postoperative complications, and possible recurrence after laparoscopic ventral hernia repair (LVHR) in comparison with open ventral hernia repair (OVHR), based on the international literature. Database: A Medline search of the current English literature was performed using the terms laparoscopic ventral hernia repair and incisional hernia repair. Conclusions: LVHR is a safe alternative to the open method, with the main advantages being minimal postoperative pain, shorter recovery, and decreased wound and mesh infections. Incidental enterotomy can be avoided by using a meticulous technique and sharp dissection to avoid thermal injury. PMID:26273186

  15. Current developments in hernia repair; meshes, adhesives, and tacking.

    PubMed

    Powell, Benjamin S; Voeller, Guy R

    2010-10-01

    Open and laparoscopic hernia surgery continues to evolve with new products allowing surgeons multiple choices in treating their patients. The evolution towards tension-free techniques in dealing with hernias requires that today's surgeons know the options available in meshes as well as fixation methods in order to have the best outcomes. In recent years, there has been a rapid expansion in the number of meshes available. Currently, there are numerous uncoated, coated, and biologic meshes in production that can be used in hernia repair. This paper will focus on the latest developments in coated meshes that allow for intra-abdominal placement as well as the different types of biologic meshes and their typical uses. Tacking devices for laparoscopic hernia repair now come in titanium as well as absorbable devices. AbsorbaTack™ (Covidien, Norwalk, CT) and Sorbafix™ (Davol, Warwick, RI) are two of the newest absorbable tacking devices thought to possibly benefit patients with decreased pain and long-term complications as compared with their titanium counterparts. Adhesives continue to be used more and more for hernia repair, especially in inguinal and paraesophageal hernia repairs. Tissucol™/Tisseel™ (Baxter, Deerfield, IL) and Evicel™ (Ethicon, Somerville, NJ) are two types of fibrin glues that are available for use in hernia repair. Practitioners using these biologic adhesives think there is less pain compared with tacking. PMID:21082565

  16. Parastomal hernia repair.

    PubMed

    O'Neill, Conor H; Borrazzo, Edward C; Hyman, Neil H

    2015-04-01

    Parastomal herniation is a common clinical occurrence. Historically, there has been a high recurrence rate after repair, and conservative management is usually recommended for patients with mild symptoms. When operative intervention is warranted, we opt for a laparoscopic mesh sublay over the fascial defect and lateralization of the stoma limb, or the Sugarbaker technique. In patients who are considered poor risk for laparoscopy/laparotomy requiring repair, we perform a fascial onlay with mesh utilizing an anterior circumstomal approach. PMID:25504464

  17. Which mesh for hernia repair?

    PubMed Central

    Brown, CN; Finch, JG

    2010-01-01

    INTRODUCTION The concept of using a mesh to repair hernias was introduced over 50 years ago. Mesh repair is now standard in most countries and widely accepted as superior to primary suture repair. As a result, there has been a rapid growth in the variety of meshes available and choosing the appropriate one can be difficult. This article outlines the general properties of meshes and factors to be considered when selecting one. MATERIALS AND METHODS We performed a search of the medical literature from 1950 to 1 May 2009, as indexed by Medline, using the PubMed search engine (). To capture all potentially relevant articles with the highest degree of sensitivity, the search terms were intentionally broad. We used the following terms: ‘mesh, pore size, strength, recurrence, complications, lightweight, properties’. We also hand-searched the bibliographies of relevant articles and product literature to identify additional pertinent reports. RESULTS AND CONCLUSIONS The most important properties of meshes were found to be the type of filament, tensile strength and porosity. These determine the weight of the mesh and its biocompatibility. The tensile strength required is much less than originally presumed and light-weight meshes are thought to be superior due to their increased flexibility and reduction in discomfort. Large pores are also associated with a reduced risk of infection and shrinkage. For meshes placed in the peritoneal cavity, consideration should also be given to the risk of adhesion formation. A variety of composite meshes have been promoted to address this, but none appears superior to the others. Finally, biomaterials such as acellular dermis have a place for use in infected fields but have yet to prove their worth in routine hernia repair. PMID:20501011

  18. Fibrin Sealant: A Review of the History, Biomechanics, and Current Applications for Prosthetic Fixation in Hernia Repair.

    PubMed

    Watson, Jefferson Tyler; Webb, David L; Stoikes, Nathaniel F N; Voeller, Guy R

    2015-11-01

    The role of surgical adhesives in hernia repair has continued to evolve. The purpose of this chapter is to review the role of fibrin sealant and its application in general surgery for mesh fixation, specifically the history, biomechanics, and clinical utilization. The utilization of fibrin sealant for repair of groin hernias, both open and laparoscopic, ventral hernias, and hiatal hernias will be discussed. PMID:26696538

  19. Delayed repair for traumatic abdominal wall hernia: is it safe?

    PubMed

    Sall, I; El Kaoui, H; Bouchentouf, S M; Ait Ali, A; Bounaim, A; Hajjouji, A; Baba, H; Fahssi, M; Alhyane, A; Zentar, A; Sair, K

    2009-08-01

    Abdominal wall hernias after trauma have been recognized for more than a century, with the first case reported as occurring after a fall. Traumatic abdominal wall hernias (TAWHs) after blunt trauma are uncommon. The timing of definitive repair, early or delayed, is not clear. We report a case on TAWH and mesenteric avulsion, highlighting the reasons for immediate or delayed repair. A single case study can hardly be considered as a basis for profound changes in the management of post traumatic hernias. However, damage to all layers of the abdominal wall indicates high-energy trauma. In such cases, the damage is not, in all probability, limited to the integumentary system. For the moment, the timing of surgery in any TAWH should be considered differently according to the trauma, the wall defect, clinical and radiological findings, associated injuries, and the clinical status of the patient. PMID:19153644

  20. [Laparoscopic repair of umbilical hernias--initial experience].

    PubMed

    Germanov, G; Tsvetkov, I; Radionov, M; Pozharliev, T

    2006-01-01

    In this study the autors present their initial experience with 8 patients with umbilical hernias, operated laparoscopically in the surgery clinic of the university hospital "Sweta Anna" in Sofia for the period from 2002 to 2005. There were no intraoperative complications as well suppurations detected for a 18 months postoperative follow up. We found out lesser postoperative pain and shorter reccurence period by the laparoscopically operated patients in comparison with these, who had undergone a conventional repair. The autors made a review of the related literature and the conclusion, that LVHR is a effective, suitable method for operative treatment of umbilical hernias greater than 4 cm and recidive ones. PMID:18788109

  1. Laparoscopic surgery for left paraduodenal hernia.

    PubMed

    Fukunaga, Masaki; Kidokoro, Akio; Iba, Toshiaki; Sugiyama, Kazuyoshi; Fukunaga, Tetsu; Nagakari, Kunihiko; Suda, Masaru; Yosikawa, Seiichirou

    2004-04-01

    Paraduodenal hernia is a rare condition but the most common internal hernia. We describe the case of a 51-year-old man who was admitted with a complaint of 2 months' duration of recurrent left lower abdominal pain. Left paraduodenal hernia complicated by bowel malrotation was diagnosed, and the patient underwent laparoscopic surgery since no bowel necrosis was observed. The bowel incarcerated in the hernial sac was reduced, and an Endostitch was used to close the hernial orifice with continuous sutures. The postoperative course was good, and the patient was discharged 7 days after surgery. For paraduodenal hernia without bowel necrosis, particularly a left hernia, reduction of the incarcerated bowel and closure of the hernial orifice are relatively easy in terms of technique, and laparoscopic surgery may be the surgical method of choice because of its minimal invasiveness and aesthetic advantage. PMID:15107222

  2. Laparoscopic Repair of Giant Paraesophageal Hernia: 100 Consecutive Cases

    PubMed Central

    Luketich, James D.; Raja, Siva; Fernando, Hiran C.; Campbell, William; Christie, Neil A.; Buenaventura, Percival O.; Keenan, Robert J.; Schauer, Philip R.

    2000-01-01

    Objective To summarize the authors’ laparoscopic experience for paraesophageal hernia (PEH). Summary Background Data Laparoscopic antireflux surgery and repair of small hiatal hernias are now routinely performed. Repair of a giant PEH is more complex and requires conventional surgery in most centers. Giant PEH accounts for approximately 5% of all hiatal hernias. Medical management may be associated with a 50% progression of symptoms and a significant death rate. Conventional open surgery has a low death rate, but complications are significant and return to routine activities is delayed in this frequently elderly population. Recently, short-term outcome studies have reported that minimally invasive approaches to PEH may be associated with a lower complication rate, a shorter hospital stay, and faster recovery. Methods From July 1995 to February 2000, 100 patients (median age 68) underwent laparoscopic repair of a giant PEH. Follow-up included heartburn scores and quality of life measurements using the SF-12 physical component and mental component summary scores. Results There were 8 type II hernias, 85 type III, and 7 type IV. Sac removal, crural repair, and antireflux procedures were performed (72 Nissen, 27 Collis-Nissen). The 30-day death rate was zero; there was one surgery-related death at 5 months from a perioperative stroke. Intraoperative complications included pneumothorax, esophageal perforation, and gastric perforation. There were three conversions to open surgery. Major postoperative complications included stroke, myocardial infarction, pulmonary emboli, adult respiratory distress syndrome, and repeat operations (two for abscess and one each for hematoma, repair leak, and recurrent hernia). Median length of stay was 2 days. Median follow-up at 12 months revealed resumption of proton pump inhibitors in 10 patients and one repeat operation for recurrence. The mean heartburn score was 2.3 (0, best; 45, worst); the satisfaction score was 91%; physical and mental component summary scores were 49 and 54, respectively (normal, 50). Conclusion This report represents the largest series to date of laparoscopic repair of giant PEH. In the authors’ center with extensive experience in minimally invasive surgery, laparoscopic repair of giant PEH was successfully performed in 97% of patients, with a minimal complication rate, a 2-day length of stay, and good intermediate results. PMID:10998659

  3. The repair of umbilical hernia in cirrhotic patients: 18 consecutive case series in a single institute

    PubMed Central

    Yu, Byung Chul; Lee, Giljae

    2015-01-01

    Purpose Traditionally, the surgical repair of umbilical hernia in cirrhotic patients with ascites is avoided because of a significant recurrence rate and perioperative morbidity/mortality. However, recent reports recommend early elective surgery in these patients because surgery-related complications can be reduced with minimally invasive surgery and development of perioperative patient care. The current study was conducted to analyze safety and feasibility of umbilical hernia repairs performed in a single institute. Methods A single center retrospective analysis of patients' data was conducted. Eighteen patients with umbilical hernia accompanied by liver cirrhosis underwent hernia repair in the period between 2005 and 2012. The charts of these patients were reviewed and demographic data, postoperative complications, and recurrence were recorded. Results Eleven males and seven females with a mean age of 62.9 years were analyzed. Two of the patients were classified as Child's class A, 11 as Child's class B, and five as Child's class C. Four patients underwent emergency surgery because of perforations in the hernia sac in two cases and incarcerated hernias in the other two cases. Of the 18 patients who underwent surgery, four (22%) experienced a recurrence, three (17%) developed edema at the surgical sites, one (5%) experienced hepatic coma, and one (5%) showed postoperative variceal hemorrhage. All of these events occurred after emergency surgery. Conclusion In contrast to traditional concepts, early and elective repair of umbilical hernia can be performed easily and safely in cirrhotic patients. PMID:26236698

  4. A case of de Garengeot hernia: the feasibility of laparoscopic transabdominal preperitoneal hernia repair

    PubMed Central

    Al-Subaie, Saud; Mustafa, Hatem; Al-Sharqawi, Noura; Al-Haddad, Mohanned; Othman, Feras

    2015-01-01

    Introduction de Garengeot hernia is described as the presence of an appendix in a femoral hernia. This rare hernia usually presents with both diagnostic and therapeutic dilemmas. Presentation of case We report a case of a 59 year-old woman with a one-year history of a right irreducible femoral hernia. She underwent diagnostic laparoscopy with an intraoperative diagnosis of de Garengeot hernia. This was followed by a laparoscopic transabdominal preperitoneal (TAPP) approach for hernia repair. Discussion The long-standing presentation of de Garengeot hernia is seldomly reported in literature. There has been no standard approach of treatment for de Garengeot hernias described, possibly due to the rarity of this condition. The unusual presentation of the hernia prompted us to undergo a diagnostic laparoscopy first, during which the appendix was seen incarcerated in a femoral hernia sac. We were easily able to proceed for a laparoscopic TAPP approach for hernia repair without the need for conversion to an open repair. Conclusion We were able to obtain an accurate diagnosis of an appendix within a long-standing irreducible femoral hernia through diagnostic laparoscopy followed by transabdominal preperitoneal (TAPP) approach for hernia repair. We would like to underline the usefulness of laparoscopy as a valuable tool in the diagnosis and treatment of this unusual presentation of groin hernias. PMID:26432998

  5. Endoscope-assisted Inguinal Hernia Repair

    PubMed Central

    Lal, Pawan; Ganguly, P. K.; Arora, M. P.; Hadke, N. S.

    2005-01-01

    Background: Since the advent of laparoscopic inguinal hernia repair, the procedure has invited numerous controversies, and although the procedure has some definitive advantages, no definitive indications for its use have been formulated. The objective of this study was to investigate a novel method for inguinal hernia repair (through a small 2 cm to 2.5 cm) single skin incision that combines the time-tested fundamentals of Lichtenstein's tension-free repair with the advantages of laparoscopic assistance. Methods: The study was conducted as a randomized, controlled trial over a 1-year period and included 50 patients. Only patients with simple reducible hernias without associated comorbid conditions were included. The patients were randomized into 2 groups of 25 patients each. One group underwent conventional tension-free meshplasty, while the other group underwent the repair through a single 2-cm to 2.5-cm skin incision with laparoscopic assistance. This repair was carried out with the help of an indigenously designed steel retractor, 10-mm laparoscope, and conventional instruments; the mesh was fixed with the help of endotacks. Univariate analysis of variance techniques using SPSS 7.5 software was used for data analysis. Results: Two groups were compared for time taken for the procedure, size of skin incision, postoperative pain, complications, return to work, and cosmetic appearance. The results showed a significant decrease in postoperative pain and an earlier return to work, along with much improved cosmesis for the new procedure. Conclusions: Although the study was conducted with a limited number of patients and a very short follow-up, it is worth considering this method over laparoscopic and conventional techniques, especially in reducible hernias. PMID:15791969

  6. Hiatus Hernia Repair with Bilateral Oesophageal Fixation

    PubMed Central

    Martin, David

    2015-01-01

    Background. Despite advances in surgical repair of hiatus hernias, there remains a high radiological recurrence rate. We performed a novel technique incorporating bilateral oesophageal fixation and evaluated outcomes, principally symptom improvement and hernia recurrence. Methods. A retrospective study was performed on a prospective database of patients undergoing hiatus hernia repair with bilateral oesophageal fixation. Retrospective and prospective quality of life (QOL), PPI usage, and patient satisfaction data were obtained. Hernia recurrence was assessed by either barium swallow or gastroscopy. Results. 87 patients were identified in the database with a minimum of 3 months followup. There were significant improvements in QOL scores including GERD HRQL (29.13 to 4.38, P < 0.01), Visick (3 to 1), and RSI (17.45 to 5, P < 0.01). PPI usage decreased from a median of daily to none, and there was high patient satisfaction (94%). 57 patients were assessed for recurrence with either gastroscopy or barium swallow, and one patient had evidence of recurrence on barium swallow at 45 months postoperatively. There was an 8% complication rate and no mortality or oesophageal perforation. Conclusions. This study demonstrates that our technique is both safe and effective in symptom control, and our recurrence investigations demonstrate at least short term durability. PMID:26065030

  7. Percutaneous suturing technique and single-site umbilical laparoscopic repair of a Morgagni hernia: Review of three cases.

    PubMed

    Zouari, M; Jallouli, M; Bendhaou, M; Zitouni, H; Mhiri, R

    2015-12-01

    Morgagni hernias are uncommon, accounting for only 1-2% of all congenital diaphragmatic hernia. Minimally invasive surgery is today the gold standard treatment. We present a technique using percutaneous suturing and single-site umbilical laparoscopic repair of Morgagni hernia in three children. Recovery was uneventful in all three patients. There was no recurrence and the chest radiograph remained normal during the postoperative follow-up. The percutaneous suturing technique and single-site umbilical laparoscopic repair of a Morgagni hernia is an easy and effective alternative to standard laparoscopic repair. PMID:26552622

  8. Surgery for an Inguinal Hernia

    MedlinePLUS

    ... and Plug-ins EHC Component EPC Project Topic Title Surgical Options for Inguinal Hernia: Comparative Effectiveness Review Full Report Research Review Aug. 17, 2012 Related Products for this Topic Research Protocol Apr. 11, ...

  9. Anaesthesia for a Rare Case of Down's Syndrome with Morgagni's Hernia Undergoing Laparoscopic Repair.

    PubMed

    Nanjundaswamy, Nethra H; Marulasiddappa, Vinay

    2015-05-01

    Morgagni's hernia is a type of congenital diaphragmatic hernia and it is rare in children. The association between Down's syndrome and Morgagni's hernia in children is also rare. Laparoscopic repair is a preferred surgical approach than open surgical procedures as laparoscopy offers a bilateral view of Morgagni's hernia, minimal tissue damage and a faster recovery. When children with Down's syndrome and associated Morgagni's hernia present for laparoscopic repair, they pose several complex challenges to the anaesthetist due to the involvement of multiple organ systems, difficulties in airway management and effects of laparoscopic surgery on the organ systems. Therefore, such children need a very careful anaesthetic plan, including a thorough preoperative assessment and preparation for a successful perioperative outcome. PMID:26155537

  10. Comparative Study of Prolene Hernia System and Lichtenstein Method for Open Inguinal Hernia Repair

    PubMed Central

    Badkur, Mayank

    2015-01-01

    Background Prolene Hernia System (PHS) is a bi-layered polypropylene mesh with a connector that combines the anterior and posterior inguinal hernia repair, but still not very popular in this part of the country. Hence a prospective & randomized comparative study was undertaken to compare PHS with the already popular Lichtenstein Hernia Repair (LHR) and determine the post-operative outcome. Materials and Methods Total 67 inguinal hernia repairs were randomly assigned to either PHS or LHR method, and data was collected regarding various outcome measures like duration of surgery, post-operative pain, requirement of analgesia, return to normal activity, and early and late complications. Results Mean duration of surgery was significantly higher for PHS group than LHR group (65.4 min vs 51.26 min, p-value <0.0001). Significant difference was noted between the PHS and LHR group in terms of moderate to severe post-operative pain (15.15% vs 41.18%,p-value 0.018), time of requirement of analgesia (3.7 vs 4.6 days, p-value 0.024), and time to return to normal activity (2.7 vs 3.4 days, p-value 0.023), all in favour of the former technique. No intra-operative complication was noted in either of the groups. 5 patients had early complications in PHS group and 6 in LHR group, but this was statistically not significant. The average time of follow-up for the study was 7.8 month, ranging from 1 to 18 months. Chronic inguinal pain was noted in 1 and 2 patients respectively in PHS and LHR group, again statistically not significant. No recurrence was noted in both the groups till the time of follow-up. Conclusion PHS is a safe and better alternative to the time honored Lichtenstein hernia repair with the added advantage of strengthening whole of myopectineal orifice, and virtually eliminating any risk of recurrence. PMID:26266158

  11. Transfascial suture in laparoscopic ventral hernia repair; friend or foe?

    PubMed

    Sahu, Diwakar; Das, Somak; Wani, Majid Rasool; Reddy, Prasanna Kumar

    2015-01-01

    'Suture hernia' is fairly a new and rare type of ventral hernia. It occurs at the site of transfascial suture, following laparoscopic ventral hernia repair (LVHR). Employment of transfascial sutures in LVHR is still debatable in contrast to tackers. Prevention of mesh migration and significant post-operative pain are the pros and cons with the use of transfascial sutures, respectively. We report an unusual case of suture hernia or transfascial hernia, which can further intensify this dispute, but at the same time will provide insight for future consensus. PMID:25883460

  12. Surgical Site Occurrences of Simultaneous Panniculectomy and Incisional Hernia Repair.

    PubMed

    Warren, Jeremy A; Epps, Matthew; Debrux, Cart; Fowler, James L; Ewing, Joseph A; Cobb, William S; Carbonell, Alfredo M

    2015-08-01

    Horizontal panniculectomy (PAN) offers the advantage of wide exposure for hernia repair with elimination of excess skin and adiposity, at the expense of massive subcutaneous flap creation and its attendant risks. We report our experience with ventral hernia repair (VHR) with PAN compared with patients with hernia repair alone. A prospective database was reviewed retrospectively for all patients undergoing open VHR + PAN. A matched cohort of patients without PAN was used for comparison, resulting in 43 study and 43 control patients. Incidence of surgical site occurrences (SSO), surgical site infection (SSI), and recurrence were analyzed. A total of 43 patients underwent PAN + VHR with mesh. Mean body mass index was 34.3 kg/m(2), with 35 per cent having undergone prior bariatric surgery. Repair techniques included retromuscular (74.4%), preperitoneal (11.6%), intraperitoneal (6.9%), onlay (4.6%), and suture (2.3%). Mesh used was polypropylene (76.7%), polyester (18.6%), bioabsorbable (2.3%), and polytetrafluoroethylene (ePTFE) (2.3%). Component separation was performed in 44.2 per cent of patients. There was a significant difference in total SSO between PAN + VHR and VHR alone (46.5% vs 27.9%; P < 0.001), though the difference for individual SSOs was not significant. There was no difference in SSI between groups (16.3% vs 20.9%; P = 0.776). Mean follow-up was 11.4 months, with recurrence rate of 11.6 per cent in the PAN group and 9.3 per cent in the control group (P = 0.725). Panniculectomy at the time of VHR does not increase the incidence of SSI, though higher rates of skin necrosis and cellulitis were seen. There is no difference in recurrence. This approach is a valid option for patients with excessive abdominal panniculus requiring VHR. PMID:26215237

  13. Comparison of Coskun and Lichteinstein hernia repair methods for groin hernia

    PubMed Central

    Cete, Hayri Mükerrem; Saylam, Bar??; Özer, Mehmet Vasfi; Düzgün, Arife Polat; Co?kun, Faruk

    2015-01-01

    Purpose Coskun hernia repair technique has been reported to be an effective new fascia transversalis repair with its short-term follow-up results. Our aim is to determine the results of Coskun hernia repair technique and to compare it with Lichtenstein technique. Methods At this comparative retrospective study a total of 493 patients, who had groin hernia repair procedure using Coskun or Lichtenstein technique, between January 1999 and March 2010 were enrolled into the study. Patients were reached by telephone and invited to get a physical examination. Results Out of 493 groin hernia repairs, 436 (88.5%) were carried out by residents and 57 (11.5%) by attending surgeons. Lichtenstein technique was the choice in 241 patients and 252 patients underwent Coskun hernia repair technique. Groin hernia recurrence was detected in 8 patients (3.1%) in Coskun hernia repair group and 7 patients (2.9%) in Lichtenstein group. Comparison of early complication rates in Coskun group (3.9%) and Lichtenstein group (4.5%) showed no significant difference. Late complication rates were significantly higher in Lichtenstein group (1.2% vs. 4.9%). The operation time was shorter in Coskun group (44 minutes) than in Lichtenstein group (60 minutes). Subgroup of patients, whose hernia repair operations were carried out by attending surgeons, had a recurrence rate of 0% and 3.8%, in Coskun group and Lichtenstein group, respectively. Conclusion This study showed that Coskun hernia repair technique has a similar efficacy with Lichtenstein repair, on follow-up. PMID:26366383

  14. Simultaneous Prosthetic Mesh Abdominal Wall Reconstruction with Abdominoplasty for Ventral Hernia and Severe Rectus Diastasis Repairs

    PubMed Central

    Cheesborough, Jennifer E.

    2015-01-01

    Background: Standard abdominoplasty rectus plication techniques may not suffice for severe cases of rectus diastasis. In the authors’ experience, prosthetic mesh facilitates the repair of severe rectus diastasis with or without concomitant ventral hernias. Methods: A retrospective review of all abdominal wall surgery patients treated in the past 8 years by the senior author (G.A.D.) was performed. Patients with abdominoplasty and either rectus diastasis repair with mesh or a combined ventral hernia repair were analyzed. Results: Thirty-two patients, 29 women and three men, underwent mesh-reinforced midline repair with horizontal or vertical abdominoplasty. Patient characteristics included the following: mean age, 53 years; mean body mass index, 26 kg/m2; average width of diastasis or hernia, 6.7 cm; and average surgery time, 151 minutes. There were no surgical-site infections and two surgical-site occurrences—two seromas treated with drainage in the office. After an average of 471 days’ follow-up, none of the patients had recurrence of a bulge or a hernia. Conclusions: For patients with significant rectus diastasis, with or without concomitant hernias, the described mesh repair is both safe and durable. Although this operation requires additional dissection and placement of prosthetic mesh in the retrorectus plane, it may be safely combined with standard horizontal or vertical abdominoplasty skin excision techniques to provide an aesthetically pleasing overall result. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. PMID:25539311

  15. Mathematical modelling of implant in an operated hernia for estimation of the repair persistence.

    PubMed

    Lubowiecka, Izabela

    2015-01-01

    This paper presents mathematical modelling of an implanted surgical mesh used in the repair process of the abdominal hernia. The synthetic implant is simulated by a membrane structure. The author provides a material modelling of the implant based on the dense net model appropriate for technical fabrics. The accuracy of the proposed solution is evaluated by comparing the simulations of the dynamic behaviour of the system with the experiments carried out on physical models of implanted mesh. The model can be used to estimate the repair persistence for different mesh materials, fixing systems and different numbers of tacks to be provided during the surgery in order to resist the cough pressure and required action to avoid hernia recurrence. The persistence of the repaired hernia is assessed on the basis of the values of the forces in the tissue-implant joints because the usual form of the repair failure is due to as the joint disconnection or tissue failure. PMID:23808908

  16. Systematic review of open techniques for parastomal hernia repair.

    PubMed

    Al Shakarchi, J; Williams, J G

    2014-05-01

    Parastomal hernia formation is common following formation of an abdominal stoma, with the risk of subsequent incarceration, obstruction and strangulation. Current treatment options include non-operative management, stoma relocation and fascial repair with or without mesh. The purpose of this systematic review was to evaluate the effectiveness and safety of open mesh repair of a parastomal hernia and to compare open non-mesh fascial repair with mesh techniques of parastomal hernia repair. Electronic databases were searched for studies comparing the two surgical techniques in accordance with preferred reporting items for systematic reviews and meta-analyses. The primary outcome of the study was the comparison of recurrence rates of parastomal hernia for each technique. Secondary outcomes included comparison of mortality, wound infection, mesh infection and any other complication. Twenty-seven studies of parastomal hernia repair were included and divided into two subgroups for open mesh repair and non-mesh fascial repair. Non-mesh fascial repair resulted in a high recurrence rate (around 50%). Reported recurrence rates for mesh repair were substantially lower, at 7.9-14.8%, depending on the position of the mesh in relation to the abdominal fascia and the length of follow-up. Morbidity and mortality did not differ significantly between the techniques used to repair a parastomal hernia. This study shows that mesh repair of a parastomal hernia is safe and significantly reduces the rate of recurrence compared with sutured repair, which should only be used in exceptional circumstances. There is insufficient evidence to determine which mesh technique (onlay, sublay or underlay) is most successful in terms of recurrence rates and morbidity. PMID:24448678

  17. Small bowel obstruction by mesh migration after umbilical hernia repair.

    PubMed

    Di Muria, Antonio; Formisano, Vincenzo; Di Carlo, Filippo; Aveta, Achille; Giglio, Domenico

    2007-01-01

    A case of intestinal obstruction due to mesh migration is described. A 61 year old patient affected by BPCO and chronic atrial fibrillation is admitted for mechanical intestinal obstruction. He underwent a umbilical hernia repair with mesh and omphalectomy 6 years before. Laparotomy revealed the obstruction due to an inflammatory block including polypropylene mesh penetrating an ileal loop. Intestinal resection and mechanical isoperistaltic L-L anastomosis is performed. The post-operative period is complicated by cardiorespiratory problems and the patient comes discharged in XVII day. The prosthesis migration after umbilical hernia repair is an event never described in the literature; instead rare cases of migration after inguinal hernia repair are reported. The pathophysiological mechanisms of this complication are not still cleared and that makes necessary a careful technique in the use of the hernia mesh. PMID:17518333

  18. Anaesthesia for a Rare Case of Down’s Syndrome with Morgagni’s Hernia Undergoing Laparoscopic Repair

    PubMed Central

    Marulasiddappa, Vinay

    2015-01-01

    Morgagni’s hernia is a type of congenital diaphragmatic hernia and it is rare in children. The association between Down’s syndrome and Morgagni’s hernia in children is also rare. Laparoscopic repair is a preferred surgical approach than open surgical procedures as laparoscopy offers a bilateral view of Morgagni’s hernia, minimal tissue damage and a faster recovery. When children with Down’s syndrome and associated Morgagni’s hernia present for laparoscopic repair, they pose several complex challenges to the anaesthetist due to the involvement of multiple organ systems, difficulties in airway management and effects of laparoscopic surgery on the organ systems. Therefore, such children need a very careful anaesthetic plan, including a thorough preoperative assessment and preparation for a successful perioperative outcome. PMID:26155537

  19. Repair of Concomitant Incisional and Parastomal Hernias Using a Hybrid Technique: A Series of 32 Patients

    PubMed Central

    Zhu, Xinyong; Tian, Wen; Li, Jiye; Sun, Pengjun; Pei, Lijuan; Wang, Shijie

    2015-01-01

    Background Concomitant incisional and parastomal hernias is a challenging condition. We used a hybrid technique of sublay and onlay to treat patients with this condition. Material/Methods The clinical data of 32 consecutive patients treated from February 2008 to April 2014 for concomitant incisional and parastomal hernias were retrospectively reviewed. The mean diameter was 9 (range 4–13) cm of the incisional hernias, and 6 (range 4.5–8) cm of the parastomal hernias. Results The mean operative time was 247 (range 220–290) min. The mean hospital stay was 20 (range 14–27) days. All surgical wounds healed by primary intention. Seven patients had postoperative seroma and were well managed with puncture and compression. All 32 patients were followed up for a mean of 48 (range 5–68) months. Four patients recurred with parastomal hernias and were treated with secondary surgery. No further recurrence occurred until the last follow-up. Conclusions This hybrid technique of sublay and onlay is only suitable for the repair of complex incisional and parastomal hernias. PMID:26186130

  20. Reversibility of cardiopulmonary impairment after laparoscopic repair of large hiatal hernia

    PubMed Central

    Asti, Emanuele; Bonavina, Luigi; Lombardi, Massimo; Bandera, Francesco; Secchi, Francesco; Guazzi, Marco

    2015-01-01

    Giant hiatus hernia with or without intrathoracic gastric volvulus often presents with symptoms suggestive of both cardiac and pulmonary compression. Cardiopulmonary impairment may be reversible in these patients by laparoscopic crural repair and fundoplication as shown in this case report. Cardiac magnetic resonance and the cardiopulmonary exercise test may help selecting patients for surgery. These preliminary findings led us to start a prospective study using this multimodality diagnostic approach. PMID:26210719

  1. Clinical presentation and operative repair of hernia of Morgagni

    PubMed Central

    Loong, T; Kocher, H

    2005-01-01

    A 77 year old woman who presented with an incarcerated hernia of Morgagni was successfully treated without complications. A Medline search (1996 to date) along with cross referencing was done to quantify the number of acute presentations in adults compared to children. Different investigating modalities—for example, lateral chest and abdominal radiography, contrast studies or, in difficult cases, computed tomography or magnetic resonance imaging—can be used to diagnose hernia of Morgagni. The favoured method of repair—laparotomy or laparoscopy—is also discussed. A total of 47 case reports on children and 93 case reports on adults were found. Fourteen percent of children (seven out of 47) presented acutely compared with 12% of adults (12 out of 93). Repair at laparotomy was the method of choice but if uncertain, laparoscopy would be a useful diagnostic tool before attempted repair. Laparoscopic repair was favoured in adults especially in non-acute cases. PMID:15640427

  2. Current options in umbilical hernia repair in adult patients

    PubMed Central

    Kulaço?lu, Hakan

    2015-01-01

    Umbilical hernia is a rather common surgical problem. Elective repair after diagnosis is advised. Suture repairs have high recurrence rates; therefore, mesh reinforcement is recommended. Mesh can be placed through either an open or laparoscopic approach with good clinical results. Standard polypropylene mesh is suitable for the open onlay technique; however, composite meshes are required for laparoscopic repairs. Large seromas and surgical site infection are rather common complications that may result in recurrence. Obesity, ascites, and excessive weight gain following repair are obviously potential risk factors. Moreover, smoking may create a risk for recurrence. PMID:26504420

  3. Hiatal Hernia Repair with Gore Bio-A Tissue Reinforcement: Our Experience

    PubMed Central

    Antonino, Agrusa; Giorgio, Romano; Giuseppe, Frazzetta; Giovanni, De Vita; Silvia, Di Giovanni; Daniela, Chianetta; Giuseppe, Di Buono; Vincenzo, Sorce; Gaspare, Gulotta

    2014-01-01

    Type I hiatal hernia is associated with gastroesophageal reflux disease (GERD) in 50–90% of cases. Several trials strongly support surgery as an effective alternative to medical therapy. Today, laparoscopic fundoplication is considered as the procedure of choice. However, primary laparoscopic hiatal hernia repair is associated with upto 42% recurrence rate. Mesh reinforcement of the crural closure decreases the recurrence but can lead to complications, above all nonabsorbable ones. We experiment a new totally absorbable mesh by Gore. Case. We present a case of a 65-year-old female patient with a 6-year classic history of GERD. Endoscopy revealed a large hiatal hernia and esophagitis. pH study was positive for acid reflux; esophageal manometry revealed LES intrathoracic dislocation. With laparoscopic approach, the hiatal hernia defect was identified and primarily repaired, by crural closure. Gore Bio-A Tissue Reinforcement was trimmed to fit the defect accommodating the esophagus. Nissen fundoplication was performed. Result. Bio-A mesh was easily placed laparoscopically. It has good handling and could be cut and tailored intraoperatively for optimal adaptation. There were no short-term complications. Conclusion. Crural closure reinforcement can be done readily with this new totally absorbable mesh replaced by soft tissue over six months. However, further data and studies are needed to evaluate long-term outcomes. PMID:24864221

  4. Long term recurrence, pain and patient satisfaction after ventral hernia mesh repair

    PubMed Central

    Langbach, Odd; Bukholm, Ida; Benth, J?rat? Šaltyt?; Røkke, Ola

    2015-01-01

    AIM: To compare long term outcomes of laparoscopic and open ventral hernia mesh repair with respect to recurrence, pain and satisfaction. METHODS: We conducted a single-centre follow-up study of 194 consecutive patients after laparoscopic and open ventral hernia mesh repair between March 2000 and June 2010. Of these, 27 patients (13.9%) died and 12 (6.2%) failed to attend their follow-up appointment. One hundred and fifty-three (78.9%) patients attended for follow-up and two patients (1.0%) were interviewed by telephone. Of those who attended the follow-up appointment, 82 (52.9%) patients had received laparoscopic ventral hernia mesh repair (LVHR) while 73 (47.1%) patients had undergone open ventral hernia mesh repair (OVHR), including 11 conversions. The follow-up study included analyses of medical records, clinical interviews, examination of hernia recurrence and assessment of pain using a 100 mm visual analogue scale (VAS) ruler anchored by word descriptors. Overall patient satisfaction was also determined. Patients with signs of recurrence were examined by magnetic resonance imaging or computed tomography scan. RESULTS: Median time from hernia mesh repair to follow-up was 48 and 52 mo after LVHR and OVHR respectively. Overall recurrence rates were 17.1% after LVHR and 23.3% after OVHR. Recurrence after LVHR was associated with higher body mass index. Smoking was associated with recurrence after OVHR. Chronic pain (VAS > 30 mm) was reported by 23.5% in the laparoscopic cohort and by 27.8% in the open surgery cohort. Recurrence and late complications were predictors of chronic pain after LVHR. Smoking was associated with chronic pain after OVHR. Sixty point five percent were satisfied with the outcome after LVHR and 49.3% after OVHR. Predictors for satisfaction were absence of chronic pain and recurrence. Old age and short time to follow-up also predicted satisfaction after LVHR. CONCLUSION: LVHR and OVHR give similar long term results for recurrence, pain and overall satisfaction. Chronic pain is frequent and is therefore important for explaining dissatisfaction.

  5. New injectable elastomeric biomaterials for hernia repair and their biocompatibility.

    PubMed

    Skrobot, J; Zair, L; Ostrowski, M; El Fray, M

    2016-01-01

    Complications associated with implantation of polymeric hernia meshes remain a difficult surgical challenge. We report here on our work, developing for the first time, an injectable viscous material that can be converted to a solid and elastic implant in vivo, thus successfully closing herniated tissue. In this study, long-chain fatty acids were used for the preparation of telechelic macromonomers end-capped with methacrylic functionalities to provide UV curable systems possessing high biocompatibility, good mechanical strength and flexibility. Two different systems, comprising urethane and ester bonds, were synthesized from non-toxic raw materials and then subjected to UV curing after injection of viscous material into the cavity at the abdominal wall during hernioplasty in a rabbit hernia model. No additional fixation or sutures were required. The control group of animals was treated with commercially available polypropylene hernia mesh. The observation period lasted for 28 days. We show here that artificially fabricated defect was healed and no reherniation was observed in the case of the fatty acid derived materials. Importantly, the number of inflammatory cells found in the surrounding tissue was comparable to these found around the standard polypropylene mesh. No inflammatory cells were detected in connective tissues and no sign of necrosis has been observed. Collectively, our results demonstrated that new injectable and photocurable systems can be used for minimally invasive surgical protocols in repair of small hernia defects. PMID:26513412

  6. Laparoscopic Repair of Morgagni Hernia Using Polyvinylidene Fluoride (PVDF) Mesh

    PubMed Central

    Godazandeh, Gholamali; Mortazian, Meysam

    2012-01-01

    We report the cases of two patients diagnosed with Morgagni hernia who presented with nonspecific abdominal symptoms. Both underwent laparoscopic surgery that used a dual-sided mesh, polyvinylidene fluoride (PVDF; Dynamesh IPOM®). The procedures were successful and both patients were discharged with no complications. There was no recurrence in 18 months of follow up.Herein is the report of these cases and a literature review. PMID:24829663

  7. Acute Portomesenteric Venous Thrombosis following Laparoscopic Small Bowel Resection and Ventral Hernia Repair

    PubMed Central

    Sivasambu, Bhradeev; Yogarajah, Meera; Wilson, Thomas

    2015-01-01

    Acute portomesenteric venous thrombosis is a rare but life-threatening complication of laparoscopic surgery that has been described in literature. Prompt diagnosis and early initiation of treatment are vital to prevent life-threatening complications such as mesenteric ischemia and infarction. A 51-year-old lady had laparoscopic small bowel resection and primary anastomosis with ventral hernia repair 4 weeks earlier for partial small bowel obstruction. Her postoperative period was uneventful and she was discharged home. Four weeks after surgery she developed watery diarrhea and generalized abdominal pain for four-day duration. A computed tomography of the abdomen revealed portomesenteric venous thrombosis although a computed tomography of abdomen before surgery 4 weeks back did not show any portomesenteric venous thrombosis. We are reporting a case of acute portomesenteric venous thrombosis as a complication of laparoscopic surgery. PMID:26294984

  8. Acute Osteomyelitis of the Symphysis Pubis after Inguinal Hernia Surgery

    PubMed Central

    Tekin, Recep; Ceylan Tekin, Rojbin; Ceylan Cevik, Figen; Cevik, Remzi

    2015-01-01

    Osteomyelitis of pubic symphysis is infectious inflammatory condition of the symphysis pubis and rare complication of surgery around inguinal and groin region. It should be kept in mind in the differential diagnosis of lower pelvic pain and should be sought in cases of pelvic insufficiency fractures. Herein, we present a case of a 55-year-old man with osteomyelitis of the symphysis pubis following inguinal hernia surgery for diagnosis and management of this rare condition. PMID:25973280

  9. Laparoscopic partially extraperitoneal (PEP) mesh repair for laterally placed ventral and incisional hernias.

    PubMed

    Brady, Richard R W; Ventham, Nicholas T; De Beaux, Andrew C; Tulloh, Bruce

    2014-06-01

    Laparoscopic mesh repair is becoming an increasingly popular method of ventral and incisional hernia repair. Entrapment neuropathy is a recognised complication when tacks are used to fix the mesh, particularly below the inguinal ligament and laterally in the abdominal wall. We describe a novel method of ventral hernia repair, which employs transabdominal extra-peritoneal dissection to create a pocket for mesh placement with complete avoidance of tacks in the postero-lateral abdominal wall. This technique is particularly useful for incisional hernias arising through old stoma wounds or appendicectomy incisions, and for Spigelian and lumbar hernias. PMID:24710242

  10. Inguinodynia following Lichtenstein tension-free hernia repair: a review.

    PubMed

    Hakeem, Abdul; Shanmugam, Venkatesh

    2011-04-14

    Chronic groin pain (Inguinodynia) following inguinal hernia repair is a significant, though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However, moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological. The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors. The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves. Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain, as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved. Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair, use of heavyweight vs lightweight mesh and mesh fixation with sutures vs. glue. Though there is no convincing evidence favouring one over the other, lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients. Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain, though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation. Both non-surgical and surgical options have been tried for chronic groin pain, with their consequent risks of analgesic side-effects, recurrent pain, recurrent hernia and significant sensory loss. By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre- and post-herniorraphy. PMID:21528050

  11. Delayed Presentation of a Bowel Bovie Injury After Laparoscopic Ventral Hernia Repair

    PubMed Central

    Gayagoy, Jennifer; Chaudhary, Sushant; Kolachalam, Ramachandra B.

    2013-01-01

    Introduction: Bowel injury during laparoscopic surgery is a rare but serious complication. A Bovie injury to the bowel can cause delayed perforation of the viscus, thus increasing the possibility of a preventable morbidity. Patients presenting with perforation peritonitis within 24 hours and up to 2 to 3 weeks after laparoscopic Bovie injury to the bowel have been reported in the literature. Case Description: A 74-year-old woman underwent a laparoscopic ventral hernia mesh repair. Intraoperatively, a small area of superficial Bovie injury to the small bowel was repaired with Lembert sutures and tissue glue. Postoperatively, the patient recovered well, but she presented with perforation peritonitis 3 months after surgery. An exploratory laparotomy showed a jejunal perforation in the same area that was injured with cautery and repaired during the previous surgery. The patient was only using inhaled steroids for asthma on and off but had a remote history of chemotherapy and radiation for colorectal cancer. Conclusion: Bovie injury to the bowel has a hidden depth, causing a slow transmural tissue necrosis, and it might also impair local healing and eventually lead to perforation. Thus, the patient may present later than the usual period for wound healing and remodeling as previously reported. Given the disastrous consequence, it is imperative to perform a good surgical repair of even a minor Bovie injury to the bowel. This is the first report of a delayed presentation (>1 month) of a Bovie injury of the bowel. PMID:24018096

  12. The “Inside-out” Technique for Hernia Repair with Mesh Underlay

    PubMed Central

    Berhanu, Aaron E.

    2015-01-01

    Background: An improved method for mesh repair of ventral/incisional hernias after component separation is presented. The use of a Carter-Thomason suture passer (Cooper Surgical, http://www.coopersurgical.com) allows for safe passage of preplaced sutures on the mesh from within the abdominal cavity through the anterior rectus sheath. This “inside-out” method makes the underlay of mesh fast and easy by improving visualization and control of sharp instruments as they are passed through the abdominal cavity. Preplacement of sutures circumferentially on the mesh also improves the distribution of tension around the repair, which may ultimately reduce the risk of hernia recurrence. Methods: The “inside-out” technique was performed on 23 patients at a single tertiary academic medical center from November 2011 to February 2014. We have followed these patients for a median of 24.5 months to assess for postoperative complications and hernia recurrence. Results: We report an acceptable hernia recurrence rate (2 of 23 = 8.7%). One recurrence was observed in a patient who underwent repair of a recurrent ventral hernia and the other had significant loss of domain requiring an inlay mesh. Conclusions: The “inside-out” technique for ventral hernia repair with a mesh underlay after component separation using a Carter-Thomason suture passer is easy, safe, and reliable. We have observed no hernia recurrence in patients who underwent repair for a primary ventral hernia with an underlay technique. PMID:26180723

  13. Emergency and elective laparoscopic repair of spigelian hernias: two case reports and a review of the literature.

    PubMed

    Leff, Daniel Richard; Hassell, Jane; Sufi, Pratik; Heath, Dugal

    2009-08-01

    Diagnosing spigelian hernias through physical examination can be particularly challenging. Increasingly, laparoscopy is being used to both confirm the diagnosis and carry out therapeutic repair. Here, we describe 2 cases of successful laparoscopic repair of spigelian hernias using an Endocatch assisted sutured technique. A review of the literature describing the role of laparoscopy in the management of spigelian hernia is also provided. PMID:19692870

  14. Strangulated ileostomy evisceration following lateralizing mesh repair of parastomal hernia.

    PubMed

    Ramly, E P; Crosslin, T; Orkin, B; Popowich, D

    2014-04-29

    Parastomal hernia formation and ostomy prolapse are relatively common complications of intestinal ostomy construction. Underlay mesh placement with lateralization of the stoma limb appears to be the method of repair with the lowest recurrence rate. Prophylaxis of new stomas with mesh is advocated by many authors. We report the case of an 81-year-old man with chronic steroid-dependent COPD who presented to the emergency department with strangulated small bowel evisceration 9 days following completion abdominal colectomy, and creation of an end ileostomy reinforced with intraperitoneal mesh. This rare complication was related to this patient's risk factors for poor healing including poor nutrition, age, chronic COPD and coughing and steroid dependence with immunosuppression. PMID:24777430

  15. The Use of Nontreated Mosquito-Net Mesh Cloth for a Tension Free Inguinal Hernia Repair: Our Experience

    PubMed Central

    Oribabor, Felix O; Amao, Oluwasegun A; Akanni, Saheed O; Fatidinu, Samuel O

    2015-01-01

    Introduction: The prohibitive costs and scarcity of the imported prosthetic mesh for hernioplasty, has prevented its widespread use in most developing countries. We then set out to ascertain the outcome, complications (undue pain, wound infection, recurrence, and mesh extrusion) and cost implications in the use of a nontreated mosquito-net for inguinal hernioplasty. Materials and Methods: A prospective study of all consecutive adult patients with uncomplicated inguinal hernia who were admitted for open herniorrhaphy between January 2012 and December, 2013 at the Federal Medical Centre, Ido – Ekiti, South West, Nigeria. A sheet of the nontreated mosquito-net mesh 10 cm ? 8 cm, autoclaved, a day prior to surgery was used for each patient's hernia repair. The operation sites were exposed and examined 3rd and 6th postoperative days. Findings were documented for analysis. Result: A total of 130 adult patients were recruited for this study of which 115 of the patients were males and 15 were females. Forty-four (41.53%) had inguinal hernia and 76 (58.46%) of them had inguinoscrotal hernia. They all had successful repair and were followed-up for complications for a period of 6 weeks to 6 months at the surgical out-patient department. Conclusion: Locally-sourced and autoclaved mosquito-net mesh is an effective alternative for hernioplasty especially in situations where commercial mesh is not readily available or affordable. PMID:25838767

  16. [Mutual influence and development between Gastrointestinal surgery and hernia and abdominal wall surgery].

    PubMed

    Chen, Shuang

    2015-11-25

    The aim of this article is to expound on the crossing and influence each other of gastrointestinal surgery and abdominal wall hernia surgery. Although these two departments are independent respectively, but due to the existence of association among anatomy, physiology and pathology, so they are also overlapping. First of all, the abdominal wall and digestive tract are interdependent, and the abdominal wall provides "protection" for gut. In case of large abdominal wall defect, intra-abdominal viscera, breathing, circulation system and spine will change accordingly. In addition, when intra-abdominal pressure increases due to various reasons, laparotomy is an effective way. But laparotomy is not an easy case, but a crisis. One of the most difficult problems is "enteroatmospheric fistulae". Therefore, to avoid serious complications after laparotomy, the concept of planned ventral hernia is proposed. When life safety is threatened by inter-abdominal hypertension, planned abdominal wall hernia is the style to save life. This is a kind of concept of innovation, and is the concrete practice of the theory of damage control surgery. For a planned abdominal wall hernia patient, it is better to wait and watch, and after making a comprehensive assessment, multidisciplinary collaboration mode should be applied to ensure the safety of surgery. PMID:26616795

  17. A case report on management of synergistic gangrene following an incisional abdominal hernia repair in an immunocompromised obese patient

    PubMed Central

    Merali, N.; Almeida, R.A.R.; Hussain, A.

    2015-01-01

    Introduction We present a case on conservative management of salvaging the mesh in an immunocompromised morbidly obese patient, who developed a synergistic gangrene infection following a primary open mesh repair of an incisional hernia. Presentation of case Our patient presented with a surgical wound infection, comorbidities were Chronic Lymphoblastic Leukemia (CLL), Body Mass Index (BMI) of 50, hypertension and diet controlled type-2 diabetes. In surgery, wide necrotic wound debridement, early and repetitive wound drainages with the use of a large pore polypropylene mesh and a detailed surgical follow up was required. High dose intravenous broad-spectrum antibiotic treatment and Negative Pressure Wound Therapy (NPWT) was administrated in combination with adopting a multidisciplinary approach was key to our success. Discussion Stoppa Re et al. complied a series of 360 ventral hernia mesh repairs reporting an infection rate of 12% that were managed conservatively. However, our selective case is unique within current literature, being the first to illustrate mesh salvage in a morbid obese patient with CLL. Recent modifications in mesh morphology, such as lower density, wide pores, and lighter weight has led to considerable improvements regarding infection avoidance. Conclusion This case has demonstrated how a planned multidisciplinary action can produce prosperous results in a severely obese immunocompromised patient with an SSI, following an incisional hernia repair. PMID:26322822

  18. Diaphragmatic hernia repair more than four years after severe trauma: Four case reports

    PubMed Central

    de Nadai, Tales Rubens; Lopes, José Carlos Paiva; Inaco Cirino, Caio César; Godinho, Maurício; Rodrigues, Alfredo José; Scarpelini, Sandro

    2015-01-01

    Introduction Diaphragmatic rupture is an infrequent complication of trauma, occurring in about 5% of those who suffer a severe closed thoracoabdominal injury and about half of the cases are diagnosed early. High morbidity and mortality from bowel strangulation and other sequelae make prompt surgical intervention mandatory. Case presentation Four Brazilian men with a delayed diagnosis of a rare occurrence of traumatic diaphragmatic hernia. Patient one had diaphragmatic rupture on the right side of thorax and the others three patients on the left thoracic side, all they had to approach by a laparotomy and some approach in the chest, either thoracotomy or VATS. This injuries required surgical repositioning of extensively herniated abdominal viscera and intensive postoperative medical management with a careful control of intra-abdominal pressure. Discussion The negative pressure of the thoracic cavity causes a gradually migration of abdominal contents into the chest; this sequestration reduces the abdomen’s ability to maintain the viscera in their normal anatomical position. When the hernia is diagnosed early, the repair is less complicated and requires less invasive surgery. Years after the initial trauma, the diaphragmatic rupture produces dense adhesions between the chest and the abdominal contents. Conclusions All cases demonstrated that surgical difficulty increases when diaphragmatic rupture is not diagnosed early. It should be noted that when trauma to the thoraco-abdominal transition area is blunt or penetrating, a thorough evaluation is required to rule out diaphragmatic rupture and a regular follow-up to monitor late development of this comorbidity. PMID:26241166

  19. The use of dermal automesh for incidental hernia repair in abdominoplasty: Clinical, biochemical, and radiological results.

    PubMed

    Özkaya Mutlu, Özay; Egemen, Onur; Akan, Arzu; Akan, Mithat; Karahangil, Mehmet; Filinte, Gaye; Bozda?, Ergün; Sünbülo?lu, Emin; Kurtul, Hülya

    2015-06-01

    Abdominal wall hernias are often diagnosed on clinical examination or encountered intraoperatively during an abdominoplasty. The aim of this study is to evaluate the long-term results of the use of dermal automesh for the repair of incidental hernias during abdominoplasty operations, and to perform a comparative analysis of the biomechanical strengths of dermal automesh vs biological tissue graft. Between 2008-2012, dermal automesh was used in 12 patients for hernia repair. After repair of hernia, dermal automesh was applied over the repaired area in an onlay fashion. Postoperative follow-up was performed by physical examination and magnetic resonance imaging (MRI) of the abdominal wall. Biomechanical test was performed with prepared samples from excised abdominal panniculus for tensile strength and yield power. Mean age was 45 years (range = 36-54 years). Total follow-up was 26 (14-52) months. MRI studies showed that there were no hernias or defects of the anterior abdominal wall. The tensile strength of the dermal mesh was measured as 15.9 ± 6.0 Mpa (6.4-24.5), maximum load before yield measured 680 ± 175.2 N (336.0-856.0). In conclusion, dermal automesh is a useful option for surgeons who encounter undiagnosed hernias during abdominoplasties. PMID:25384920

  20. Extraperitoneal inguinoscrotal herniation of the ureter: a rare case of recurrence after hernia repair.

    PubMed

    Golgor, E; Stroszczynski, C; Froehner, M

    2009-01-01

    Inguinoscrotal herniation of the ureter is a rare finding with the potential for serious surgical complications. Two anatomic forms are defined. In the more common paraperitoneal variant, the herniating peritoneal sac drags the ureter and sometimes other abdominal structures with it. The uncommon variant--extraperitoneal inguinal herniais without a peritoneal sac and consists of the ureter and fat tissue. We report a case of extraperitoneal inguinoscrotal hernia possibly due to a prior inguinal hernia repair. PMID:19641370

  1. Simultaneous open preperitoneal repair of inguinal hernia with open prostatectomy for benign prostate hyperplasia.

    PubMed

    Johnson, O Kenneth

    2015-01-01

    Where surgical resources are slim, patients may suffer the obstructive symptoms of benign prostate hyperplasia until they present with frank urinary retention and they may have unattended inguinal hernia. The best strategy to take care of patients who have both problems at once has remained elusive. We report a small case series of 10 patients in whom open preperitoneal inguinal hernia repair was done together with suprapubic prostatectomy over a 10-year period in the district hospital. PMID:25406258

  2. Robot-assisted laparoscopic hiatal hernia and antireflux surgery.

    PubMed

    Tolboom, R C; Broeders, I A M J; Draaisma, W A

    2015-09-01

    Gastroesophageal reflux disease is a common disorder of the GE-junction that allows gastric acid to enter the esophagus. Surgery is indicated when the presence of the disease is objectively documented. The laparoscopic Toupet fundoplication is the preferred treatment of GERD. There is no clear advantage in robotic assistance for primary antireflux surgery. In our center we find the robot to be of added value for redo surgery or large and giant hiatal repair. J. Surg. Oncol. 2015; 112:266-270. © 2015 Wiley Periodicals, Inc. PMID:25997926

  3. A Low-Cost Teaching Model of Inguinal Canal: A Useful Method to Teach Surgical Concepts in Hernia Repair

    ERIC Educational Resources Information Center

    Ansaloni, Luca; Catena, Fausto; Coccolini, Frederico; Ceresoli, Marco; Pinna, Antonio Daniele

    2014-01-01

    Objectives: Inguinal canal anatomy and hernia repair is difficult for medical students and surgical residents to comprehend. Methods: Using low-cost material, a 3-dimensional inexpensive model of the inguinal canal was created to allow students to learn anatomical details and landmarks and to perform their own simulated hernia repair. In order to…

  4. Use of barbed suture for peritoneal closure in transabdominal preperitoneal hernia repair

    PubMed Central

    Takayama, Satoru; Nakai, Nozomu; Shiozaki, Midori; Ogawa, Ryo; Sakamoto, Masaki; Takeyama, Hiromitsu

    2012-01-01

    AIM: To investigate the use of the V-Loc wound closure device for transabdominal preperitoneal hernia repair. METHODS: We performed conventional transabdominal preperitoneal hernia repair in 19 patients, including one single incisional case using V-Loc. Except for the use of V-Loc for peritoneal closure, the procedures were the same as those used in conventional techniques. RESULTS: Although the operators included 2 residents who have no experience in laparoscopic herniorrhaphy and intracorporeal suture, the operations were completed. We believe that V-Loc is especially suitable for inexperienced surgeons and the use of V-Loc reduces the operative time by a small amount but reduces operator stress significantly. CONCLUSION: We conclude that V-Loc is the ideal peritoneal closure device for transabdominal preperitoneal hernia repair. PMID:22905286

  5. Parastomal Hernia Repair and Reinforcement: The Role of Biologic and Synthetic Materials

    PubMed Central

    Gillern, Suzanne; Bleier, Joshua I. S.

    2014-01-01

    Parastomal hernia is a prevalent problem and treatment can pose difficulties due to significant rates of recurrence and morbidities of the repair. The current standard of care is to perform parastomal hernia repair with mesh whenever possible. There exist multiple options for mesh reinforcement (biologic and synthetic) as well as surgical techniques, to include type of repair (keyhole and Sugarbaker) and position of mesh placement (onlay, sublay, or intraperitoneal). The sublay and intraperitoneal positions have been shown to be superior with a lower incidence of recurrence. This procedure may be performed open or laparoscopically, both having similar recurrence and morbidity results. Prophylactic mesh placement at the time of stoma formation has been shown to significantly decrease the rates of parastomal hernia formation. PMID:25435825

  6. Parastomal hernia repair and reinforcement: the role of biologic and synthetic materials.

    PubMed

    Gillern, Suzanne; Bleier, Joshua I S

    2014-12-01

    Parastomal hernia is a prevalent problem and treatment can pose difficulties due to significant rates of recurrence and morbidities of the repair. The current standard of care is to perform parastomal hernia repair with mesh whenever possible. There exist multiple options for mesh reinforcement (biologic and synthetic) as well as surgical techniques, to include type of repair (keyhole and Sugarbaker) and position of mesh placement (onlay, sublay, or intraperitoneal). The sublay and intraperitoneal positions have been shown to be superior with a lower incidence of recurrence. This procedure may be performed open or laparoscopically, both having similar recurrence and morbidity results. Prophylactic mesh placement at the time of stoma formation has been shown to significantly decrease the rates of parastomal hernia formation. PMID:25435825

  7. Hernias

    MedlinePLUS

    ... of hernia occurs at the opening of the diaphragm where the esophagus (the pipe that food travels ... If the muscle around the opening to the diaphragm becomes weak, the uppermost part of a person's ...

  8. Significant improvement of biocompatibility of polypropylene mesh for incisional hernia repair by using poly-?-caprolactone nanofibers functionalized with thrombocyte-rich solution

    PubMed Central

    Plencner, Martin; Prosecká, Eva; Rampichová, Michala; East, Barbora; Buzgo, Matej; Vysloužilová, Lucie; Hoch, Ji?í; Amler, Evžen

    2015-01-01

    Incisional hernia is the most common postoperative complication, affecting up to 20% of patients after abdominal surgery. Insertion of a synthetic surgical mesh has become the standard of care in ventral hernia repair. However, the implementation of a mesh does not reduce the risk of recurrence and the onset of hernia recurrence is only delayed by 2–3 years. Nowadays, more than 100 surgical meshes are available on the market, with polypropylene the most widely used for ventral hernia repair. Nonetheless, the ideal mesh does not exist yet; it still needs to be developed. Polycaprolactone nanofibers appear to be a suitable material for different kinds of cells, including fibroblasts, chondrocytes, and mesenchymal stem cells. The aim of the study reported here was to develop a functionalized scaffold for ventral hernia regeneration. We prepared a novel composite scaffold based on a polypropylene surgical mesh functionalized with poly-?-caprolactone (PCL) nanofibers and adhered thrombocytes as a natural source of growth factors. In extensive in vitro tests, we proved the biocompatibility of PCL nanofibers with adhered thrombocytes deposited on a polypropylene mesh. Compared with polypropylene mesh alone, this composite scaffold provided better adhesion, growth, metabolic activity, proliferation, and viability of mouse fibroblasts in all tests and was even better than a polypropylene mesh functionalized with PCL nanofibers. The gradual release of growth factors from biocompatible nanofiber-modified scaffolds seems to be a promising approach in tissue engineering and regenerative medicine. PMID:25878497

  9. Integrating a novel shape memory polymer into surgical meshes to improve device performance during laparoscopic hernia surgery

    NASA Astrophysics Data System (ADS)

    Zimkowski, Michael M.

    About 600,000 hernia repair surgeries are performed each year. The use of laparoscopic minimally invasive techniques has become increasingly popular in these operations. Use of surgical mesh in hernia repair has shown lower recurrence rates compared to other repair methods. However in many procedures, placement of surgical mesh can be challenging and even complicate the procedure, potentially leading to lengthy operating times. Various techniques have been attempted to improve mesh placement, including use of specialized systems to orient the mesh into a specific shape, with limited success and acceptance. In this work, a programmed novel Shape Memory Polymer (SMP) was integrated into commercially available polyester surgical meshes to add automatic unrolling and tissue conforming functionalities, while preserving the intrinsic structural properties of the original surgical mesh. Tensile testing and Dynamic Mechanical Analysis was performed on four different SMP formulas to identify appropriate mechanical properties for surgical mesh integration. In vitro testing involved monitoring the time required for a modified surgical mesh to deploy in a 37°C water bath. An acute porcine model was used to test the in vivo unrolling of SMP integrated surgical meshes. The SMP-integrated surgical meshes produced an automated, temperature activated, controlled deployment of surgical mesh on the order of several seconds, via laparoscopy in the animal model. A 30 day chronic rat model was used to test initial in vivo subcutaneous biocompatibility. To produce large more clinical relevant sizes of mesh, a mold was developed to facilitate manufacturing of SMP-integrated surgical mesh. The mold is capable of manufacturing mesh up to 361 cm2, which is believed to accommodate the majority of clinical cases. Results indicate surgical mesh modified with SMP is capable of laparoscopic deployment in vivo, activated by body temperature, and possesses the necessary strength and biocompatibility to function as suitable ventral hernia repair mesh, while offering a reduction in surgical operating time and improving mesh placement characteristics. Future work will include ball-burst tests similar to ASTM D3787-07, direct surgeon feedback studies, and a 30 day chronic porcine model to evaluate the SMP surgical mesh in a realistic hernia repair environment, using laparoscopic techniques for typical ventral hernia repair.

  10. Spontaneous chylous ascites, chylomediastinum and bilateral chylothoraces encountered during laparoscopic incarcerated paraesophageal hernia repair

    PubMed Central

    Nguyen, Vincent; Vassaur, Hannah; Buckley, F. Paul

    2015-01-01

    Chylous ascites is an accumulation of milky lipid-rich lymph in the peritoneal cavity. Spontaneous chyle leak is a rare occurrence, often associated with malignancy or cirrhosis. This is a report of spontaneous chylous ascites, chylomediastinum and chylothoraces encountered in the setting of an incarcerated paraesophageal hernia. A 60-year-old female presented to the emergency department with epigastric pain, dysphagia and vomiting. Clinical presentation and imaging were concerning for an incarcerated paraesophageal hernia, and the patient was taken to the operating room. During laparoscopic reduction of the hernia and repair, chyle was encountered in the peritoneal cavity, mediastinum and pleural spaces. Postoperatively, the chyle leak resolved with a nonfat diet. The unusual occurrence of a chyle leak in this case may have been due to compression of the thoracic duct within the chest by the incarcerated paraesophageal hernia. PMID:26506835

  11. [Median incisional hernias and coexisting parastomal hernias : new surgical strategies and an algorithm for simultaneous repair].

    PubMed

    Köhler, G

    2014-08-01

    The co-occurrence of incisional and parastomal hernias (PSH) remains a surgical challenge. Standardized treatment guidelines are missing, and the patients concerned require an individualized surgical approach. The laparoscopic techniques can be performed with incised and/or stoma-lateralizing flat meshes with intraperitoneal onlay placement. The purely laparoscopic and laparoscopic-assisted approaches with 3-D meshes offer advantages regarding the complete coverage of the edges of the stomal areas and the option of equilateral or contralateral stoma relocation in cases of PSH, which are difficult to handle due to scarring, adhesions, and large fascial defects >?5 cm with intestinal hernia sac contents. A relevant stoma prolapse can be relocated by tunnel-like preformed 3-D meshes and shortening the stoma bowel. The positive effect on prolapse prevention arises from the dome of the 3-D mesh, which is directed toward the abdominal cavity and tightly fits to the bowel. In cases of large incisional hernias (>?8-10 cm in width) or young patients with higher physical demands, an open abdominal wall reconstruction in sublay technique is required. Component separation techniques that enable tension-free ventral fascial closure should be preferred to mesh-supported defect bridging methods. The modified posterior component separation with transversus abdominis release (TAR) and the minimally invasive anterior component separation are superior to the original Ramirez technique with respect to wound morbidity. By using 3-D textile implants, which were specially designed for parastomal hernia prevention, the stoma can be brought out through the lateral abdominal wall without increased risk of parastomal hernia or prolapse development. An algorithm for surgical treatment, in consideration of the complexity of combined hernias, is introduced for the first time. PMID:24823998

  12. Transabdominal robotic repair of a congenital right diaphragmatic hernia containing an intrathoracic kidney: a case report.

    PubMed

    Chen, Brendan; Finnerty, Brendan M; Schamberg, Neal J; Watkins, Anthony C; DelPizzo, Joseph; Zarnegar, Rasa

    2015-12-01

    Bochdalek diaphragmatic hernia is a rare condition and is typically diagnosed prior to adulthood. Furthermore, right-sided defects are also uncommon due to the location of the liver, but can contain colon, omentum, small bowel, or rarely the kidney. Minimally invasive laparoscopic and thoracoscopic diaphragmatic hernia repairs are associated with improved outcomes when compared to open approaches-recently, robotic-assisted repairs have been performed in children with no morbidity and minimal complications. We report a case of an 80-year-old female who presented with an enlarging right-sided Bochdalek hernia containing an acquired intrathoracic kidney that was repaired using a robotic-assisted laparoscopic transabdominal approach with mesh placement. In this case, the robotic platform's advantages included excellent visualization of the posterolateral defect and efficient suturing during mesh placement. This approach is a viable option for skilled minimally invasive surgeons; however, further studies are warranted to investigate its utility in the management of diaphragmatic hernia repair. PMID:26530841

  13. Anesthetic management of Morgagni hernia repair in an elderly woman

    PubMed Central

    Nama, Rajnish K.; Butala, Bina P.; Shah, Veena R.; Patel, Hiren R.

    2015-01-01

    Adult onset congenital diaphragmatic hernia (CDH) is uncommon but not rare. Morgagni hernia is a rare variant of CDH. The defect tends to be small and patients may remain asymptomatic and diagnosed incidentally. When these patients become symptomatic, they usually present with gastrointestinal and cardiorespiratory symptoms or sometimes as an emergency due to obstruction or strangulation of herniated viscera. Chest radiograph, computed tomography scan, and magnetic resonance imaging are the imaging modalities used for diagnosis of CDH. Cardiopulmonary compromise due to mass effect of hernial contents on lungs, heart and great vessels, and obstruction or strangulation of herniated viscera poses the special challenge before anesthesiologists. Our patient was diagnosed to have Morgagni hernia, at the age of 72 years and underwent laparotomy for the same. This case highlights the key feature of the successful anesthetic management of adult onset CDH. PMID:26712986

  14. Laparoscopic repair of post-esophagectomy diaphragmatic hernias using human acellular dermal matrix.

    PubMed

    Avella, Diego M; Podany, Abigail; Staveley-O'Carroll, Kevin F; Kaifi, Jussuf T

    2011-08-01

    Diaphragmatic hernias occur in up to 2% of patients after esophagectomy with gastric pull-up, and the surgical repair in the setting of a previous esophagectomy is a challenge with high complication rates, in particular with regards to the gastric conduit and its critical vascular supply. We describe two cases and the technique of minimally invasive, laparoscopic repair of diaphragmatic defects with organ herniation after esophagectomy using absorbable human acellular dermal matrix. PMID:21606054

  15. Internal hernia caused by epiploic appendices successfully treated by single-incision laparoscopic surgery (SILS).

    PubMed

    Suzuki, Y; Katagiri, H; Yoshinaga, Y; Lefor, A T; Mizokami, K

    2015-12-01

    Internal hernia is a rare and often overlooked cause of small bowel obstruction. We report a case of internal hernia with an orifice composed of epiploic fat, successfully diagnosed and treated by single-incision laparoscopic surgery. This is the second report of this type of internal hernia and the first reported case addressed laparoscopically. Although the use of laparoscopy for the treatment of small bowel obstruction is not firmly established today, it may be beneficial for both its diagnostic value and as a less invasive treatment. PMID:24577739

  16. Laparoscopic repair of a Morgagni-Larrey hernia: report of three cases.

    PubMed

    Ipek, Turgut; Altinli, Ediz; Yuceyar, Serdar; Erturk, Suphan; Eyuboglu, Erhun; Akcal, Tarik

    2002-01-01

    Morgagni-Larrey hernia is a rare type of diaphragmatic hernia, the diagnosis of which is made incidentally by routine chest X-ray film. We describe a technique for the laparoscopic repair of Morgagni-Larrey hernia which was successfully performed in three adult patients; two women and one man. Two of the patients were asymptomatic and had herniation of only omentum into the right hemithorax; however, one was symptomatic and had herniation of the omentum and large bowel. Tension-free closure of the defects was done using Prolene mesh with a hernia stapler, helical fastener, and Endostitch. There were no early complications and the patients were discharged on the fourth postoperative day. The mean follow-up period was 41 months, and there has been no late morbidity or mortality related to this procedure. Using a laparoscopic approach to repair a Morgagni-Larrey hernia provides an excellent view of the surgical field and allows easy manipulation with minimal surgical trauma, followed by rapid recovery of the patient. PMID:12376790

  17. A new, simple operative approach for bilateral inguinal hernia repair in girls: A single transverse supra-pubic incision

    PubMed Central

    Zarroug, Abdalla E.; Alkhebel, Antar M.; Gibreel, Waleed O.; Almassry, Mohammed

    2015-01-01

    Background: Inguinal hernia repair remains one of the most common operations performed by pediatric surgeons. We described a new surgical approach for treating bilateral inguinal hernias in girls through a small single transverse supra-pubic incision. Materials and Methods: A new approach was performed on female children 12-years-old and younger with bilateral inguinal hernias between January 2005 and April 2012. Technique: A single transverse suprapubic incision (1-1.5 cm) was made. Using sharp and blunt dissection bilateral hernias were exposed and repaired using a standard high ligation. Results: Ninety-nine girls with a preoperative clinical diagnosis of bilateral inguinal hernia were included. Median age was 2 years (range: 1 month to 12 years). All patients underwent general anesthesia. Median operative time was 12 minutes (range 5-22). There were no intra-operative complications or misdiagnosis. Two patients had bilateral sliding hernias and the remainder had indirect hernias. Post-operatively two patients developed non-expanding small hematomas, both treated non-operatively without sequelae. There were zero hernia recurrence and median follow-up was 5 years (range: 1-8 years) on 99% of patients. Conclusion: We described a new, safe, simple, and rapid approach for bilateral inguinal hernia repair in female pediatric population. A single transverse suprapubic skin incision was adequate for exposing both inguinal regions with excellent postoperative results.

  18. Clinical outcomes after elective repair for small umbilical and epigastric hernias.

    PubMed

    Christoffersen, Mette Maria Willaume

    2015-11-01

    Repair for an umbilical or epigastric hernia is one of the most frequently conducted gastrointestinal surgical procedures. Al-though it is a minor procedure, there is no consensus on the optimal repair technique. The readmission rate is surprisingly high due to postoperative pain, wound-related complications, and long-term results in terms of recurrence and chronic pain is not well investigated. The overall objective of this thesis was to improve early and long-term postoperative outcomes after repair for umbilical or epigastric hernias. The present thesis consisted of one RCT, one protocol article for a running RCT, and two register-based cohort studies. An abdominal binder had no analgesic effects or impact on seroma formation. We await early and late post-operative outcomes from a running RCT studying clinical effect of closing the hernia defect (inclusion is expected to end in October 2015). The two cohort studies included in the present theses found that mesh repair halved the long-term risk of recurrence compared with sutured repair. Mesh repair did not increase the risk of chronic pain or rate of reoperation for complications. PMID:26522486

  19. Is transverse abdominis plane block effective following local anesthetic infiltration in laparoscopic totally extraperitoneal hernia repair?

    PubMed Central

    Kim, Mun Gyu; Ok, Si Young; Kim, Sang Ho; Lee, Se-Jin; Park, Sun Young; Yoo, Jae-Hwa; Cho, Ana; Hur, Kyung Yul; Kim, Myung Jin

    2014-01-01

    Background Transverse abdominis plane (TAP) block can be recommended as a multimodal method to reduce postoperative pain in laparoscopic abdominal surgery. However, it is unclear whether TAP block following local anesthetic infiltration is effective. We planned this study to evaluate the effectiveness of the latter technique in laparoscopic totally extraperitoneal hernia repair (TEP). Methods We randomly divided patients into two groups: the control group (n = 37) and TAP group (n = 37). Following the induction of general anesthesia, as a preemptive method, all of the patients were subjected to local anesthetic infiltration at the trocar sites, and the TAP group was subjected to ultrasound-guided bilateral TAP block with 30 ml of 0.375% ropivacaine in addition before TEP. Pain was assessed in the recovery room and post-surgery at 4, 8, and 24 h. Additionally, during the postoperative 24 h, the total injected dose of analgesics and incidence of nausea were recorded. Results: On arrival in the recovery room, the pain score of the TAP group (4.33 ± 1.83) was found to be significantly lower than that of the control group (5.73 ± 2.04). However, the pain score was not significantly different between the TAP group and control group at 4, 8, and 24 h post-surgery. The total amounts of analgesics used in the TAP group were significantly less than in the control group. No significant difference was found in the incidence of nausea between the two groups. Conclusions TAP block following local infiltration had a clinical advantage only in the recovery room. PMID:25558340

  20. Bilateral prevascular herniae – A rare complication of aorto-uniiliac endovascular abdominal aortic aneurysm repair and femoro-femoral bypass

    PubMed Central

    Obinwa, Obinna; Canning, Caitriona; O’Donohoe, Martin

    2015-01-01

    A case of a 78-year-old female with bilateral groin prevascular herniae following an emergency aorto-uniiliac EVAR and femoro-femoral bypass for a ruptured abdominal aortic aneurysm is presented. Primary repair of the herniae was achieved using a preperitoneal approach. The case emphasises a safe approach to dealing with this rare complication. PMID:25890122

  1. Inguinal Hernia and Airport Scanners: An Emerging Indication for Repair?

    PubMed Central

    Cawich, Shamir O.; Maharaj, Ravi; Dan, Dilip

    2013-01-01

    The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency. PMID:24368923

  2. Incidence of inguinal hernia recurrence. Effect of time off work after repair.

    PubMed Central

    Ross, A. P.

    1975-01-01

    A survey of 260 adult male patients who had undergone inguinal hernia repair was carried out to see how long they stayed off work after operation. There was no evidence that a prolonged convalescent period reduced the subsequent hernia recurrence rate. Evidence from the North American literature suggests that patients can resume their usual physical activity without ill effect much sooner after operation than is the current practice in the United Kingdom. General practitioners should be informed of the advice that has been given to their patients about the resumption of physical activities after operation. PMID:1211793

  3. Complex ventral hernia repair with a human acellular dermal matrix and component separation: A case series

    PubMed Central

    Garcia, Alvaro; Baldoni, Anthony

    2015-01-01

    We present a case series of 19 patients requiring complex abdominal hernia repairs. Patients presented with challenging clinical histories with 95% having multiple significant comorbidities including overweight or obesity (84%), hypertension (53%), diabetes (42%), cancer (26%), and pulmonary disease (16%). The majority of patients (68%) had prior abdominal infections and 53% had at least one failed prior hernia repair. Upon examination, fascial defects averaged 282 cm2. Anterior and posterior component separation was performed with placement of a human acellular dermal mesh. Midline abdominal closure under minimal tension was achieved primarily in all cases. Post-operative complications included 2 adverse events (11%) – one pulmonary embolism and one post-operative hemorrhage requiring transfusion; 6 wound-related complications (32%), 1 seroma (5%) and 1 patient with post-operative ileus (5%). Operative intervention was not required in any of the cases and most patients made an uneventful recovery. Increased patient age and longer OR time were independently predictive of early post-operative complications. At a median 2-year follow-up, three patients had a documented hernia recurrence (16%) and one patient was deceased due to unrelated causes. Conclusion Patients at high risk for post-operative events due to comorbidities, prior abdominal infection and failed mesh repairs do well following component separation reinforced with a human bioprosthetic mesh. Anticipated post-operative complications were managed conservatively and at a median 2-year follow-up, a low rate of hernia recurrence was observed with this approach. PMID:26288732

  4. Medial Versus Traditional Approach to US-guided TAP Blocks for Open Inguinal Hernia Repair

    ClinicalTrials.gov

    2012-04-30

    Abdominal Muscles/Ultrasonography; Adult; Ambulatory Surgical Procedures; Anesthetics, Local/Administration & Dosage; Ropivacaine/Administration & Dosage; Ropivacaine/Analogs & Derivatives; Hernia, Inguinal/Surgery; Humans; Nerve Block/Methods; Pain Measurement/Methods; Pain, Postoperative/Prevention & Control; Ultrasonography, Interventional

  5. Treatment of delayed jejunal perforation after irreducible femoral hernia repair with open abdomen management and delayed abdominal closure with skin flap approximation

    PubMed Central

    Yeti?ir, Fahri; Sarer, A. Ebru; Acar, Hasan Zafer; Yaz?c?oglu, Omer; Basaran, Basar

    2015-01-01

    Introduction We show the management of a delayed jejunal perforation, after irreducible femoral hernia operation with the help of negative pressure therapy (NPT) and delayed abdominal closure (DAC) with skin flap approximation in an elderly woman for the first time in the literature. Presentation of case A 76 year-old woman was admitted to the emergency department with irreducible femoral hernia and ileus. After examining the femoral hernia sac and noting the presence of viable intestine within the hernia sac, a femoral hernia repair with mesh was performed. At postoperative day 1 she started to defecate and oral intake was started. The patient was discharged on postoperative day 3. On postoperative day 8, she was re-admitted to the emergency department with septic shock. The patient underwent reoperation. Septic abdomen and delayed perforation from strangulated part of the jejunum were seen. A jejunostomy was opened and patient was treated with open abdomen management and delayed abdominal closure with skin flap. The ostomy was closed 4 months later. Discussion The exact mechanism of delayed presentation of small bowel perforation remains controversial. Delayed intestinal perforation has rarely been reported after blunt abdominal trauma (BAT), conductive burn injuries of the bowel with cautery, or necrosis of strangulated bowel in a hernia sac. Open abdomen (OA) management is a life-saving and challenging strategy in severe generalized peritonitis. Conclusion Delayed bowel perforation may develop after irreducible femoral hernia surgery. OA management with NPT and DAC with skin flap approximation are optimal treatment modalities for the hemodynamically instable patient. PMID:26408935

  6. Cholecystocutaneous fistula: an unusual complication of a para-umbilical hernia repair.

    PubMed

    Dixon, Steven; Sharma, Mitesh; Holtham, Stephen

    2014-01-01

    This case describes a 94-year-old woman who presented 2?years postsutured para-umbilical hernia repair with a painful black lump protruding through her scar with blood stained discharge. This was initially thought to be either ischaemic bowel secondary to strangulated incisional hernia or a large organised haematoma. An urgent CT scan was performed following which the patient passed two large calculi and bile-stained fluid spontaneously through the wound, making the diagnosis somewhat clearer. The scan revealed an incisional hernia containing the gallbladder and two large calculi at the skin surface and an incidental large caecal cancer with surrounding lymphadenopathy. Frail health and the incidental finding of a colon cancer rendered invasive surgical management inappropriate. Therefore, she was managed conservatively with antibiotics. A catheter was inserted into the fistula tract to allow free drainage and alleviate pressure-related symptoms. The patient was discharged following a multidisciplinary team discussion. PMID:24862413

  7. A prospective randomised trial comparing mesh types and fixation in totally extraperitoneal inguinal hernia repairs.

    PubMed

    Cristaudo, Adam; Nayak, Arun; Martin, Sarah; Adib, Reza; Martin, Ian

    2015-05-01

    The totally extraperitoneal (TEP) approach for surgical repair of inguinal hernias has emerged as a popular technique. We conducted a prospective randomised trial to compare patient comfort scores using different mesh types and fixation using this technique. Over a 14 month period, 146 patients underwent 232 TEP inguinal hernia repairs. We compared the comfort scores of patients who underwent these procedures using different types of mesh and fixation. A non-absorbable 15 × 10 cm anatomical mesh fixed with absorbable tacks (Control group) was compared with either a non-absorbable 15 × 10 cm folding slit mesh with absorbable tacks (Group 2), a partially-absorbable 15 × 10 cm mesh with absorbable tacks (Group 3) or a non-absorbable 15 × 10 cm anatomical mesh fixed with 2 ml fibrin sealant (Group 4). Outcomes were compared at 1, 2, 4 and 12 weeks using the Carolina Comfort Scale (CCS) scores. At 1, 2, 4 and 12 weeks, the median global CCS scores were low for all treatment groups. Statistically significant differences were seen only for median CCS scores and subscores with the use of partially-absorbable mesh with absorbable tacks (Group 3) at weeks 2 and 4. However, these were no longer significant at week 12. In this study, the TEP inguinal hernia repair with minimal fixation results in low CCS scores. There were no statistical differences in CCS scores when comparing types of mesh, configuration of the mesh or fixation methods. PMID:25845302

  8. A Preclinical Evaluation of Alternative Synthetic Biomaterials for Fascial Defect Repair Using a Rat Abdominal Hernia Model

    PubMed Central

    Ulrich, Daniela; Edwards, Sharon L.; White, Jacinta F.; Supit, Tommy; Ramshaw, John A. M.; Lo, Camden; Rosamilia, Anna; Werkmeister, Jerome A.; Gargett, Caroline E.

    2012-01-01

    Introduction Fascial defects are a common problem in the abdominal wall and in the vagina leading to hernia or pelvic organ prolapse that requires mesh enhancement to reduce operation failure. However, the long-term outcome of synthetic mesh surgery may be unsatisfactory due to post-surgical complications. We hypothesized that mesh fabricated from alternative synthetic polymers may evoke a different tissue response, and provide more appropriate mechanical properties for hernia repair. Our aim was to compare the in vivo biocompatibility of new synthetic meshes with a commercial mesh. Methods We have fabricated 3 new warp-knitted synthetic meshes from different polymers with different tensile properties polyetheretherketone (PEEK), polyamide (PA) and a composite, gelatin coated PA (PA+G). The rat abdominal hernia model was used to implant the meshes (25×35 mm, n?=?24/ group). After 7, 30, 60, 90 days tissues were explanted for immunohistochemical assessment of foreign body reaction and tissue integration, using CD31, CD45, CD68, alpha-SMA antibodies. The images were analysed using an image analysis software program. Biomechanical properties were uniaxially evaluated using an Instron Tensile® Tester. Results This study showed that the new meshes induced complex differences in the type of foreign body reaction over the time course of implantation. The PA, and particularly the composite PA+G meshes, evoked a milder early inflammatory response, and macrophages were apparent throughout the time course. Our meshes led to better tissue integration and new collagen deposition, particularly with the PA+G meshes, as well as greater and sustained neovascularisation compared with the PP meshes. Conclusion PA, PA+G and PEEK appear to be well tolerated and are biocompatible, evoking an overlapping and different host tissue response with time that might convey mechanical variations in the healing tissue. These new meshes comprising different polymers may provide an alternative option for future treatment of fascial defects. PMID:23185528

  9. Triple-step laparoscopic incisional hernia repair: midline suture closure supported by dorsal component separation and intraperitoneal onlay mesh reinforcement.

    PubMed

    Strey, Christoph W

    2014-12-01

    Incisional hernias remain a surgical challenge when balancing surgical morbidity, functional restoration, and risk of recurrence. Laparoscopic intraperitoneal onlay mesh (IPOM) placement reduces postoperative wound infections and allows fast patient recovery. Yet, current IPOM techniques do not achieve closure of the midline hernia gap, thereby increasing the risk of persistent mesh bulging with poor abdominal wall function. We propose a novel triple-step hernia repair technique that includes tension-free midline reconstruction. It is achieved through laparoscopic dorsal component separation and laparoscopic suture closure of the midline with a 1.0 polydioxanone suture sling. Combining dorsal abdominal wall component separation, a midline closure with adequate suture strength, and IPOM reinforcement merges the benefits of open and laparoscopic hernia repair. This triple-step technique allows static and functional laparoscopic abdominal wall reconstruction. PMID:25189445

  10. Magnesium Versus Bupivacaine Infiltration in Controlling Postoperative Pain in Inguinal Hernia Repair

    PubMed Central

    Razavi, Seyed Sajad; Peyvandi, Hasan; Badrkhani Jam, Ali Reza; Safari, Farhad; Teymourian, Houman; Mohajerani, Seyed Amir

    2015-01-01

    Background: Postoperative pain is one of the most common problems after hernia repair. Decrease in postoperative pain accelerates functional recovery, decreases duration of hospital stay and postoperative morbidity. Objectives: To compare postoperative analgesic effect of infiltration of magnesium versus bupivacaine into incision of inguinal hernia repair. Patients and Methods: In a double blind clinical trial, 80 patients’ candidates for elective inguinal hernia repair were enrolled. Right before closure of incision, in Bupivacaine group 5 mL Bupivacaine 0.5% added to 5 mL normal saline and in Magnesium group, 10 mL Magnesium sulfate 20% was infused subcutaneously. Pain score was measured using numeric rating score (NRS) at 1, 3, 6, 12 and 24 hours postoperatively. If NRS was above 3, 1 mg morphine was administered as rescue analgesic until patient felt comfortable or NRS < 3. Results: Postoperative pain scores at 1 and 3 hours were not significantly different between bupivacaine and magnesium groups (P = 0.21, 0.224; respectively). However, at 6 (P = 0.003), 12 (P = 0.028) and 24 (P = 0.022) hours postoperative, pain score (NRS) was significantly lower in bupivacaine group. Number of patients needed at least 1 dose of rescue morphine (P = 0.001), mean number of episodes asked for morphine during next 24 hours (P = 0.001) and total dose of morphine requirement (P = 0.01) were significantly lower in bupivacaine group. Conclusions: Magnesium infiltration did not decrease total dose and number of episodes needed for morphine rescue analgesic. Bupivacaine infiltration into surgical site was more effective than magnesium sulfate infiltration in postoperative pain control. PMID:26705525

  11. The use of T-bars in laparoscopic ventral hernia repair.

    PubMed

    Saiz, A A; Paul, D; Willis, I H; Sivina, M

    1996-04-01

    During the past 2 years 15 laparoscopic ventral hernias have been performed at our Community Hospital. Marlex mesh has been the material used. We have noticed some difficulty with the grasping and initial anchoring of the mesh. Percutaneously placed prolene sutures allow the mesh to be drawn upward with some effort. By using laparoscopic T-bars for the initial anchoring of the mesh to the anterior abdominal wall then stapling, the operative time was greatly reduced. This modification in technique allows for quicker placement of the mesh during the repair. PMID:8735048

  12. [Current Management of Congenital Diaphragmatic Hernia].

    PubMed

    Sakoda, Akiko; Matsufuji, Hiroshi

    2015-07-01

    Three types of congenital diaphragmatic hernias( Bochdalek hernia, Morgagni hernia, and esophageal hiatus hernia) are described with case presentation. In the Bochdalek hernia, the most common type of congenital diaphragmatic hernia, abdominal contents pass into the thorac bia diaphragmatic defect, limiting the space available for the developing lungs. Resulting lung hypoplasia, many infants experience severe respiratory distress within minutes of birth and may require resuscitation and stabilization of cardio-pulmonary function prior to surgery. The Morgagni hernia is rare and often incidentally diagnosed on routine chest x-ray in asymptomatic patients. Repair is still advisable due to risk of strangulated bowel and respiratory distress. Esophageal hiatal hernias usually produce symptoms of gastroesophageal reflux( GERD) and rarely result in incarceration of stomach or other organs. Surgical interventions for GERD, such as Nissen fundoplication, usually target neurologically impaired children in order to prevent aspiration pneumonia and improve quality of life. Laparoscopic surgery is beneficial for all types of diaphragmatic hernia, especially in older children, but careful consideration should be made based on individual patient background. PMID:26197915

  13. Current state of laparoscopic parastomal hernia repair: A meta-analysis

    PubMed Central

    DeAsis, Francis J; Lapin, Brittany; Gitelis, Matthew E; Ujiki, Michael B

    2015-01-01

    AIM: To evaluate the efficacy and safety of the laparoscopic approaches for parastomal hernia repair reported in the literature. METHODS: A systematic review of PubMed and MEDLINE databases was conducted using various combination of the following keywords: stoma repair, laparoscopic, parastomal, and hernia. Case reports, studies with less than 5 patients, and articles not written in English were excluded. Eligible studies were further scrutinized with the 2011 levels of evidence from the Oxford Centre for Evidence-Based Medicine. Two authors reviewed and analyzed each study. If there was any discrepancy between scores, the study in question was referred to another author. A meta -analysis was performed using both random and fixed-effect models. Publication bias was evaluated using Begg’s funnel plot and Egger’s regression test. The primary outcome analyzed was recurrence of parastomal hernia. Secondary outcomes were mesh infection, surgical site infection, obstruction requiring reoperation, death, and other complications. Studies were grouped by operative technique where indicated. Except for recurrence, most postoperative morbidities were reported for the overall cohort and not by approach so they were analyzed across approach. RESULTS: Fifteen articles with a total of 469 patients were deemed eligible for review. Most postoperative morbidities were reported for the overall cohort, and not by approach. The overall postoperative morbidity rate was 1.8% (95%CI: 0.8-3.2), and there was no difference between techniques. The most common postoperative complication was surgical site infection, which was seen in 3.8% (95%CI: 2.3-5.7). Infected mesh was observed in 1.7% (95%CI: 0.7-3.1), and obstruction requiring reoperation also occurred in 1.7% (95%CI: 0.7-3.0). Other complications such as ileus, pneumonia, or urinary tract infection were noted in 16.6% (95%CI: 11.9-22.1). Eighty-one recurrences were reported overall for a recurrence rate of 17.4% (95%CI: 9.5-26.9). The recurrence rate was 10.2% (95%CI: 3.9-19.0) for the modified laparoscopic Sugarbaker approach, whereas the recurrence rate was 27.9% (95%CI: 12.3-46.9) for the keyhole approach. There were no intraoperative mortalities reported and six mortalities during the postoperative course. CONCLUSION: Laparoscopic intraperitoneal mesh repair is safe and effective for treating parastomal hernia. A modified Sugarbaker approach appears to provide the best outcomes. PMID:26229409

  14. Mechanical Properties of Mesh Materials Used for Hernia Repair and Soft Tissue Augmentation

    PubMed Central

    Pott, Peter P.; Schwarz, Markus L. R.; Gundling, Ralf; Nowak, Kai; Hohenberger, Peter; Roessner, Eric D.

    2012-01-01

    Background Hernia repair is the most common surgical procedure in the world. Augmentation with synthetic meshes has gained importance in recent decades. Most of the published work about hernia meshes focuses on the surgical technique, outcome in terms of mortality and morbidity and the recurrence rate. Appropriate biomechanical and engineering terminology is frequently absent. Meshes are under continuous development but there is little knowledge in the public domain about their mechanical properties. In the presented experimental study we investigated the mechanical properties of several widely available meshes according to German Industrial Standards (DIN ISO). Methodology/Principal Findings Six different meshes were assessed considering longitudinal and transverse direction in a uni-axial tensile test. Based on the force/displacement curve, the maximum force, breaking strain, and stiffness were computed. According to the maximum force the values were assigned to the groups weak and strong to determine a base for comparison. We discovered differences in the maximum force (11.1±6.4 to 100.9±9.4 N/cm), stiffness (0.3±0.1 to 4.6±0.5 N/mm), and breaking strain (150±6% to 340±20%) considering the direction of tension. Conclusions/Significance The measured stiffness and breaking strength vary widely among available mesh materials for hernia repair, and most of the materials show significant anisotropy in their mechanical behavior. Considering the forces present in the abdominal wall, our results suggest that some meshes should be implanted in an appropriate orientation, and that information regarding the directionality of their mechanical properties should be provided by the manufacturers. PMID:23071685

  15. Mesh-Based Transperineal Repair of a Perineal Hernia After a Laparoscopic Abdominoperineal Resection

    PubMed Central

    Lee, Taek-Gu

    2014-01-01

    A perineal hernia (PH) is formed by a protrusion of intra-abdominal viscera through a defect in the pelvic floor. This is a rare complication after a conventional abdominoperineal resection (APR). However, the risk of a PH may be increased after a laparoscopic resection because this technique can cause fewer postoperative adhesions, predisposing the small bowel to sliding down toward the pelvis. However, only a few case reports describe the transperineal approach for the repair of a PH after a laparoscopic APR. We present a case of a PH after a laparoscopic APR; the PH was repaired with synthetic mesh by using a transperineal approach. A transperineal approach using a mesh to reconstruct the pelvic floor is less invasive and more effective. We suggest that this technique should probably be the first choice for treating an uncomplicated PH that occurs after a laparoscopic APR. PMID:25210690

  16. Assessment of Pain and Quality of Life in Lichtenstein Hernia Repair Using a New Monofilament PTFE Mesh: Comparison of Suture vs. Fibrin-Sealant Mesh Fixation

    PubMed Central

    Fortelny, René H.; Petter-Puchner, Alexander H.; Redl, Heinz; May, Christopher; Pospischil, Wolfgang; Glaser, Karl

    2014-01-01

    Background: Inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become the gold standard in open inguinal hernia repair. Despite the low recurrence rates, pain and discomfort remain a problem for a large number of patients. The aim of this study was to compare suture fixation vs. fibrin sealing by using a new monofilament PTFE mesh, i.e., the Infinit® mesh by W. L. Gore & Associates. Methods: This study was designed as a controlled prospective single-center two-cohort study. A total of 38 patients were enrolled and operated in Lichtenstein technique either standard suture mesh fixation or fibrin-sealant mesh fixation were used as described in the TIMELI trial. Primary outcome parameters were postoperative complications with the new mesh (i.e., seroma, infection), pain, and quality of life evaluated by the VAS and the SF-36 questionnaire. Secondary outcome was recurrence assessed by ultrasound and physical examination. Follow-up time was 1?year. Results: Significantly, less postoperative pain was reported in the fibrin-sealant group compared to the suture group at 6?weeks (P?=?0.035), 6?months (P?=?0.023), and 1 year (P?=?0.011) postoperatively. Additionally, trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay were seen in the fibrin-sealant group. Conclusion: Fibrin-sealant mesh fixation in Lichtenstein hernioplasty effectively reduces acute and chronic postoperative pain. Monofilament, macro-porous, knitted PTFE meshes seem to be a practicable alternative to commonly used polypropylene meshes in open inguinal hernia repair. PMID:25593969

  17. Reduction of chronic post-herniotomy pain and recurrence rate. Use of the anatomical self-gripping ProGrip laparoscopic mesh in TAPP hernia repair. Preliminary results of a prospective study

    PubMed Central

    Hoskovec, David

    2015-01-01

    Introduction The role of fixation of the mesh is especially important in the endoscopic technique. The fixation of mesh through penetrating techniques using staples, clips or screws is associated with a significantly increased risk of developing a post-herniotomy pain syndrome. Aim To demonstrate the safety and efficacy of the self-fixating anatomical Parietex ProGrip laparoscopic mesh (Sofradim Production, Trévoux France) used with laparoscopic transabdominal preperitoneal hernia repair. The incidence of chronic post-herniotomy pain and recurrence rate in the follow-up after 12 months were evaluated. Material and methods Data analysis included all patients who underwent inguinal hernia surgery at our Surgical Department within the period from 1.05.2013 to 31.12.2014, who fulfilled the inclusion criteria. Standard surgical technique was used. Data were prospectively entered and subsequently analyzed on the Herniamed platform. Herniamed is an internet-based register in German and English language and includes all data of patients who underwent surgery for some types of hernia. Results There were 95 patients enrolled in the group and there were in total 156 inguinal hernias repaired. The mean follow-up was 15.52 months. At the assessment at 1 year mild discomfort in the groin was reported in 2 patients (3.51%) (1–3 VAS). No recurrence or chronic postoperative pain was reported. Conclusions Laparoscopic inguinal hernia repair using the transabdominal preperitoneal technique with implantation of the ProGrip laparoscopic mesh is a fast, effective and reliable method in experienced hands, which according to our results reduces the occurrence of chronic post-operative inguinal pain with simultaneously a low recurrence rate. PMID:26649083

  18. TIPP and Lichtenstein modalities for inguinal hernia repair: a cost minimisation analysis alongside a randomised trial.

    PubMed

    Koning, G G; Adang, E M M; Stalmeier, P F M; Keus, F; Vriens, P W H E; van Laarhoven, C J H M

    2013-12-01

    The transinguinal preperitoneal (TIPP) technique using a soft mesh with a memory ring was developed recently for inguinal hernia repair. To compare TIPP with the Lichtenstein method, a randomised trial was conducted (ISRCTN93798494). The aim of this study was to perform an economic evaluation of the TIPP modality compared to the Lichtenstein modality from both a hospital and societal perspective alongside the clinical trial. The TULIP study was a double-blind randomised clinical trial comparing two techniques for inguinal hernia repair (TIPP and Lichtenstein). Correct generation of the allocation sequence, allocation concealment, blinding, and follow-up were used/applied according to the recommendations of the Cochrane Handbook. Next to the cost drivers, the short-form-36 health survey (SF-36) data from the TULIP trial was used to determine utility. The SF-36 data from the TULIP trial were revised using the SF-6D algorithm according to Brazier. Two scenarios-a hospital and a societal perspective-were presented. If the analyses showed no difference in effects (on the SF-6D) the cost effectiveness decision rule to cost minimisation was altered. No significant difference in SF-6D utility between both modalities was found (mean difference: 0.888, 95% CI -1.02 to 1.23); consequently, the economic decision rule became cost minimisation. For the hospital perspective no significant differences in costs were found (mean difference: euro -13, 95% CI euro -130 to euro 104). However, when including productivity gains in the analysis, significant differences (P = 0.037) in costs favouring the TIPP modality (mean saving: euro 1,472, 95% CI euro 463- euro 2,714) were found. The results show that TIPP is a cost-saving inguinal hernia repair technique compared to the Lichtenstein modality against equal effectiveness expressed as quality adjusted life week at 1 year given a societal perspective. In the trial, TIPP patients showed on average a quicker recovery of 6.5 days compared to Lichtenstein patients. PMID:23271350

  19. Chronic abdominal pain after ventral hernia due to mesh migration and erosion into the sigmoid colon from a distant site: a case report and review of literature.

    PubMed

    Millas, S G; Mesar, T; Patel, R J

    2015-10-01

    Hernia repair is one of the most commonly performed procedures in general surgery. Use of mesh has been shown to decrease the overall recurrence rate. Mesh implantation, however, carries its own risks and complications. We report a case of a 41-year-old female who presented with nonspecific, chronic lower abdominal pain after ventral hernia repair with mesh implantation. The chronic pain was found to be the consequence of mesh migration and erosion into the sigmoid colon from a previous supraumbilical hernia repair. Hernia repair, use of mesh, and chronic abdominal pain are discussed. PMID:24253380

  20. Adipose-Derived Mesenchymal Stem Cells from Ventral Hernia Repair Patients Demonstrate Decreased Vasculogenesis

    PubMed Central

    Lisiecki, Jeffrey; Eboda, Oluwatobi; Peterson, Jonathan; De La Rosa, Sara; Dimick, Justin; Varban, Oliver A.; Cederna, Paul S.; Wang, Stewart C.; Levi, Benjamin

    2014-01-01

    Introduction. In adipose tissue healing, angiogenesis is stimulated by adipose-derived stromal stem cells (ASCs). Ventral hernia repair (VHR) patients are at high risk for wound infections. We hypothesize that ASCs from VHR patients are less vasculogenic than ASCs from healthy controls. Methods. ASCs were harvested from the subcutaneous fat of patients undergoing VHR by the component separation technique and from matched abdominoplasty patients. RNA and protein were harvested on culture days 0 and 3. Both groups of ASCs were subjected to hypoxic conditions for 12 and 24 hours. RNA was analyzed using qRT-PCR, and protein was used for western blotting. ASCs were also grown in Matrigel under hypoxic conditions and assayed for tubule formation after 24 hours. Results. Hernia patient ASCs demonstrated decreased levels of VEGF-A protein and vasculogenic RNA at 3 days of growth in differentiation media. There were also decreases in VEGF-A protein and vasculogenic RNA after growth in hypoxic conditions compared to control ASCs. After 24 hours in hypoxia, VHR ASCs formed fewer tubules in Matrigel than in control patient ASCs. Conclusion. ASCs derived from VHR patients appear to express fewer vasculogenic markers and form fewer tubules in Matrigel than ASCs from abdominoplasty patients, suggesting decreased vasculogenic activity. PMID:24757684

  1. Cardiac complications after laparoscopic large hiatal hernia repair. Is it related with staple fixation of the mesh? -Report of three cases

    PubMed Central

    Fernandez, Maria del Carmen; Diaz, María; López, Fernando; Martí-Obiol, Roberto; Ortega, J.

    2015-01-01

    Introduction Laparoscopic Nissen operation with mesh reinforcement remains being the most popular operation for large hiatal hernia repair. Complications related to mesh placement have been widely described. Cardiac complications are rare, but have a fatal outcome if they are misdiagnosed. Presentation of cases We sought to outline our institutional experience of three patients who developed cardiac complications following a laparoscopic Nissen operation for large hiatal hernia repair. Discussion Laparoscopic hiatoplasty and Nissen fundoplication are safe and effective procedures for the hiatal hernia repair, but they are not exempt from complications. Fixation technique and material used must be taken into account. We have conducted a review of the literature on complications related to these procedures. Conclusion In the differential diagnosis of hemodynamic instability after laparoscopic hiatal hernia repair, cardiac tamponade and other cardiac complications should be considered.

  2. A MATERIAL COST-MINIMIZATION ANALYSIS FOR HERNIA REPAIRS AND MINOR PROCEDURES DURING A SURGICAL MISSION IN THE DOMINICAN REPUBLIC

    PubMed Central

    Cavallo, Jaime A.; Ousley, Jenny; Barrett, Christopher D.; Baalman, Sara; Ward, Kyle; Borchardt, Malgorzata; Thomas, J. Ross; Perotti, Gary; Frisella, Margaret M.; Matthews, Brent D.

    2013-01-01

    INTRODUCTION Expenditures on material supplies and medications constitute the greatest per capita costs for surgical missions. We hypothesized that supply acquisition at nonprofit organization (NPO) costs would lead to significant cost-savings compared to supply acquisition at US academic institution costs from the provider perspective for hernia repairs and minor procedures during a surgical mission in the Dominican Republic (DR). METHODS Items acquired for a surgical mission were uniquely QR-coded for accurate consumption accounting. Both NPO and US academic institution unit costs were associated with each item in an electronic inventory system. Medication doses were recorded and QR-codes for consumed items were scanned into a record for each sampled procedure. Mean material costs and cost savings ± SDs were calculated in US dollars for each procedure type. Cost-minimization analyses between the NPO and the US academic institution platforms for each procedure type ensued using a two-tailed Wilcoxon matched-pairs test with ?=0.05. Item utilization analyses generated lists of most frequently used materials by procedure type. RESULTS The mean cost savings of supply acquisition at NPO costs for each procedure type were as follows: $482.86 ± $683.79 for unilateral inguinal hernia repair (IHR, n=13); $332.46 ± $184.09 for bilateral inguinal hernia repair (BIHR, n=3); $127.26 ± $13.18 for hydrocelectomy (HC, n=9); $232.92 ± $56.49 for femoral hernia repair (FHR, n=3); $120.90 ± $30.51 for umbilical hernia repair (UHR, n=8); $36.59 ± $17.76 for minor procedures (MP, n=26); and $120.66 ± $14.61 for pediatric inguinal hernia repair (PIHR, n=7). CONCLUSION Supply acquisition at NPO costs leads to significant cost-savings compared to supply acquisition at US academic institution costs from the provider perspective for IHR, HC, UHR, MP, and PIHR during a surgical mission to DR. Item utilization analysis can generate minimum-necessary material lists for each procedure type to reproduce cost-savings for subsequent missions. PMID:24162140

  3. A comparison of post operative pain and hospital stay between Lichtenstein’s repair and Laparoscopic Transabdominal Preperitoneal (TAPP) repair of inguinal hernia: A randomized controlled trial

    PubMed Central

    Salma, Umme; Ahmed, Ishtiaq; Ishtiaq, Sundas

    2015-01-01

    Objective: To compare the open Lichtenstein repair and laparoscopic mesh repair for direct inguinal hernias in terms of immediate post operative pain and length of hospital stay. Methods: This randomized control trial was conducted at Benazir Bhutto Hospital Rawalpindi from January 2009 to June 2010. All patients presenting in the surgical OPD with direct inguinal hernia, ASA I/II, were randomly divided in two equal groups. Group-I, patients underwent Lichtenstein’s repair and Group-II had hernioplasty by laparoscopic method (TAPP). Post operative pain intensity assessed by VAS and hospital stay measured in hours. Results: A total 60 patients of direct inguinal hernia were studied. The mean age was 61.48±7. The range of postoperative pain experienced was 5.55 as per VAS among all patients. In group-I (open hernioplasty) majority of patients (53.33%, n=16) experience severe type of pain where as in group-II, moderate severity of pain was reported by large number of patients (63.34%, n=19). The mean post operative pain intensity as per VAS was 6.23 in group-I and 4.43 in group-II patients. The mean length of hospital stay was slightly less (35.10 hrs) in group-I as compared to group-II (38.70 hrs). Conclusion: There is definitely less post operative pain after laparoscopic repair but hospital stay is same in both the procedures but laparoscopic procedure does increase the cost.

  4. Inguinal hernia: medicolegal implications.

    PubMed Central

    Schofield, P. F.

    2000-01-01

    Repair of an inguinal hernia is one of the commonest operations undertaken by surgeons but the role of trauma in causing inguinal hernia is not well understood. This paper does not attempt to discuss the cause of inguinal hernia but seeks to analyse the cases which may be accepted by the Courts as being due to trauma. PMID:10743429

  5. Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

    PubMed Central

    Chennamsetty, Avinash; Hafron, Jason; Edwards, Luke; Pew, Scott; Poushanchi, Behdod; Hollander, Jay; Killinger, Kim A.; Coffey, Mary P.; Peters, Kenneth M.

    2015-01-01

    Introduction. To explore the long term incidence and predictors of incisional hernia in patients that had RARP. Methods. All patients who underwent RARP between 2003 and 2012 were mailed a survey reviewing hernia type, location, and repair. Results. Of 577 patients, 48 (8.3%) had a hernia at an incisional site (35 men had umbilical), diagnosed at (median) 1.2 years after RARP (mean follow-up of 5.05 years). No statistically significant differences were found in preoperative diabetes, smoking, pathological stage, age, intraoperative/postoperative complications, operative time, blood loss, BMI, and drain type between patients with and without incisional hernias. Incisional hernia patients had larger median prostate weight (45 versus 38 grams; P = 0.001) and a higher proportion had prior laparoscopic cholecystectomy (12.5% (6/48) versus 4.6% (22/480); P = 0.033). Overall, 4% (23/577) of patients underwent surgical repair of 24 incisional hernias, 22 umbilical and 2 other port site hernias. Conclusion. Incisional hernia is a known complication of RARP and may be associated with a larger prostate weight and history of prior laparoscopic cholecystectomy. There is concern about the underreporting of incisional hernia after RARP, as it is a complication often requiring surgical revision and is of significance for patient counseling before surgery. PMID:25709645

  6. National Outcomes for Open Ventral Hernia Repair Techniques in Complex Abdominal Wall Reconstruction.

    PubMed

    Ross, Samuel W; Oommen, Bindhu; Huntington, Ciara; Walters, Amanda L; Lincourt, Amy E; Kercher, Kent W; Augenstein, Vedra A; Heniford, B Todd

    2015-08-01

    Modern adjuncts to complex, open ventral hernia repair often include component separation (CS) and/or panniculectomy (PAN). This study examines nationwide data to determine how these techniques impact postoperative complications. The National Surgical Quality Improvement Program database was queried from 2005 to 2013 for inpatient, elective open ventral hernia repairs (OVHR). Cases were grouped by the need for and type of concomitant advancement flaps: OVHR alone (OVHRA), OVHR with CS, OVHR with panniculectomy (PAN), or both CS and PAN (BOTH). Multivariate regression to control for confounding factors was conducted. There were 58,845 OVHR: 51,494 OVHRA, 5,357 CS, 1,617 PAN, and 377 BOTH. Wound complications (OVHRA 8.2%, CS 12.8%, PAN 14.4%, BOTH 17.5%), general complications (15.2%, 24.9%, 25.2%, 31.6%), and major complications (6.9%, 11.4%, 7.2%, 13.5%) were different between groups (P < 0.0001). There was no difference in mortality. Multivariate regression showed CS had higher odds of wound [odds ratio (OR) 1.7, 95% confidence interval (CI) 1.5-2.0], general (OR 1.5, 95% CI: 1.3-1.8), and major complications (OR 2.1, 95%, CI: 1.8-2.4), and longer length of stay by 2.3 days. PAN had higher odds of wound (OR 1.5, 95%, CI: 1.3-1.8) and general complications (OR 1.7, 95%CI: 1.5-2.0). Both CS and PAN had higher odds of wound (OR 2.2, 95%, CI: 1.5-3.2), general (OR 2.5, 95%, CI: 1.8-3.4), and major complications (OR 2.2, 95%CI: 1.4-3.4), and two days longer length of stay. In conclusion, patients undergoing OVHR that require CS or PAN have a higher independent risk of complications, which increases when the procedures are combined. PMID:26215239

  7. 25(th) Anniversary State-of-the-Art Expert Discussion With Todd A. Ponsky, MD, FACS, on the Advances of Surgical Practice in Pediatric Hernia Repair.

    PubMed

    Ostlie, Daniel J

    2015-11-01

    Dr. Todd A. Ponsky is currently Associate Professor of Surgery and Pediatrics at Northeast Ohio Medical University and a Pediatric Surgeon at Akron Children's Hospital. He attended medical school at Case Western Reserve University in Cleveland, OH, from 1995 to 1999, Residency in General Surgery at The George Washington University in Washington, DC, from 1999 to 2005, Pediatric Surgery Fellowship at Children's National Medical Center in Washington, DC, from 2005 to 2007, and an Advanced Minimally Invasive Pediatric Surgery Fellowship at The Rocky Mountain Hospital for Children in Denver, CO, from 2007 to 2008. Dr. Ponsky has a particular interest in minimally invasive pediatric surgery. He has trained over 200 surgeons in single-port and needlescopic surgery. He has written over 60 manuscripts and almost 20 book chapters. He has a strong focus on surgical education and virtual education and has directed over 20 national/international courses. He has won numerous teaching awards, including "The Faculty Teaching Award" at Case Western Reserve University's Department of Surgery in his first year as a faculty member. He is a reviewer for over 15 medical journals and is on four editorial boards. He is on the leadership of four national societies and has been Program Chair and is currently serving as Secretary on the Executive Committee of The International Pediatric Endosurgery Group (IPEG). He is involved in both outcomes and animal research with a focus on inguinal hernia physiology, foregut motility, and gastric stimulation, as well as endoscopic repair techniques for pure esophageal atresia. He has a wife, Diana, and three daughters, Sasha, Josie, and Ella. PMID:26488579

  8. A new modification of laparoscopic percutaneous extraperitoneal closure procedure for repairing pediatric femoral hernias involving a special needle and a wire loop.

    PubMed

    Tainaka, Takahisa; Uchida, Hiroo; Ono, Yasuyuki; Tanano, Akihide; Shirota, Chiyoe; Yokota, Kazuki; Murase, Naruhiko; Makita, Satoshi; Shirotsuki, Ryo

    2015-08-01

    Femoral hernias are relatively rare in children, and more than half of pediatric femoral hernias are misdiagnosed. A 3-year-old boy was treated for an indirect inguinal hernia at the age of 2, but he exhibited an inguinal bulge one month after the operation. He underwent laparoscopy, and a right femoral hernia was detected. The femoral hernia was laparoscopically repaired via two small incisions: a 1.0-cm umbilical incision for a 3-mm 30° laparoscope and 3-mm grasping forceps and a 5-mm right lateral incision for 3-mm grasping forceps. After the hernia sac had been reflected into the abdominal cavity and resected, the iliopubic tract was sutured to Cooper's ligament using a laparoscopic percutaneous extracorporeal closure (LPEC) needle and 2-0 non-absorbable sutures. Laparoscopy enables the accurate diagnosis of rare and often missed pediatric femoral hernias. Our laparoscopic technique for treating femoral hernias is easy and effective. Although these early results are encouraging, more cases involving longer follow-up periods should be accumulated to confirm the efficacy of our technique. PMID:26412902

  9. A new modification of laparoscopic percutaneous extraperitoneal closure procedure for repairing pediatric femoral hernias involving a special needle and a wire loop

    PubMed Central

    Tainaka, Takahisa; Uchida, Hiroo; Ono, Yasuyuki; Tanano, Akihide; Shirota, Chiyoe; Yokota, Kazuki; Murase, Naruhiko; Makita, Satoshi; Shirotsuki, Ryo

    2015-01-01

    ABSTRACT Femoral hernias are relatively rare in children, and more than half of pediatric femoral hernias are misdiagnosed. A 3-year-old boy was treated for an indirect inguinal hernia at the age of 2, but he exhibited an inguinal bulge one month after the operation. He underwent laparoscopy, and a right femoral hernia was detected. The femoral hernia was laparoscopically repaired via two small incisions: a 1.0-cm umbilical incision for a 3-mm 30° laparoscope and 3-mm grasping forceps and a 5-mm right lateral incision for 3-mm grasping forceps. After the hernia sac had been reflected into the abdominal cavity and resected, the iliopubic tract was sutured to Cooper’s ligament using a laparoscopic percutaneous extracorporeal closure (LPEC) needle and 2–0 non-absorbable sutures. Laparoscopy enables the accurate diagnosis of rare and often missed pediatric femoral hernias. Our laparoscopic technique for treating femoral hernias is easy and effective. Although these early results are encouraging, more cases involving longer follow-up periods should be accumulated to confirm the efficacy of our technique. PMID:26412902

  10. Minimal Incision Scar-Less Open Umbilical Hernia Repair in Adults – Technical Aspects and Short-Term Results

    PubMed Central

    Zachariah, Sanoop K.; Kolathur, Najeeb Mohamed; Balakrishnan, Mahesh; Parakkadath, Arun Joseph

    2014-01-01

    Background: There is no gold standard technique for umbilical hernia (UH) repair. Conventional open UH repair often produces an undesirable scar. Laparoscopic UH repair requires multiple incisions beyond the umbilicus, specialized equipments, and expensive tissue separating mesh. We describe our technique of open UH repair utilizing a small incision. The technique was derived from our experience with single incision laparoscopy. We report the technical details and short-term results. Methods: This is a retrospective analysis of the first 20 patients, who underwent minimal incision scar-less open UH repair, from June 2011 to February 2014. A single intra-umbilical curved incision was used to gain access to the hernia sac. Primary suture repair was performed for defects up to 2?cm. Larger defects were repaired using an onlay mesh. In patients with a BMI of 30?kg/m2 or greater, onlay mesh hernioplasty was performed irrespective of the defect size. Results: A total of 20 patients, 12 males and 8 females underwent the procedure. Mean age was 50 (range 29–82) years. Mean BMI was 26.27 (range 20.0–33.1) kg/m2. Average size of the incision was 1.96 range (1.5–2.5) cm. Mesh hernioplasty was done in nine patients. Eleven patients underwent primary suture repair alone. There were no postoperative complications associated with this technique. Average postoperative length of hospital stay was 3.9 (range 2–10) days. Mean follow-up was 29.94?months (2?weeks to 2.78?years). On follow-up there was no externally visible scar in any of the patients. There were no recurrences on final follow-up. Conclusion: This technique provides a similar cosmetic effect as obtained from single port laparoscopy. It is easy to perform, safe, offers good cosmesis, does not require incisions beyond the umbilicus, and cost effective, with encouraging results on short-term follow-up. Further research is needed to assess the true potential of the technique and the long-term results. PMID:25593956

  11. Pre-operative progressive pneumoperitoneum for repair of a large incisional hernia.

    PubMed

    Quraishi, Abdul Haque M; Borkar, Mrinalini M; Mastud, Mayur M; Jannawar, Gaurav G

    2013-06-01

    Large incisional hernias are difficult to treat surgically because of the post-operative respiratory complications and abdominal compartment syndrome. Pre-operative progressive pneumoperitoneum is a technique which has been used in such cases. We describe a case of a large incisional hernia, where this technique was employed by objectively calculating abdominal and hernial sac volumes on the basis of computerized tomography scan of abdomen with a satisfactory outcome. A review of literature and issues involved in pre-operative progressive pneumoperitoneum have been discussed. PMID:22392573

  12. Sports hernia and femoroacetabular impingement in athletes: A systematic review

    PubMed Central

    Munegato, Daniele; Bigoni, Marco; Gridavilla, Giulia; Olmi, Stefano; Cesana, Giovanni; Zatti, Giovanni

    2015-01-01

    AIM: To investigate the association between sports hernias and femoroacetabular impingement (FAI) in athletes. METHODS: PubMed, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism. RESULTS: FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone (89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries. CONCLUSION: The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy. PMID:26380829

  13. Avian Soft Tissue Surgery.

    PubMed

    Guzman, David Sanchez-Migallon

    2016-01-01

    Basic surgical instrumentation for avian soft tissue surgery includes soft tissue retractors, microsurgical instrumentation, surgical loupes, and head-mounted lights. Hemostasis is fundamental during the surgical procedures. The indications, approach, and complications associated with soft tissue surgeries of the integumentary (digit constriction repair, feather cyst excision, cranial wound repair, sternal wound repair, uropygial gland excision), gastrointestinal (ingluviotomy, crop biopsy, crop burn repair, celiotomy, coelomic hernia and pseudohernia repair, proventriculotomy, ventriculotomy, enterotomy, intestinal resection and anastomosis, cloacoplasty, cloacopexy), respiratory (rhinolith removal, sinusotomy, tracheotomy, tracheal resection and anastomosis, tracheostomy, pneumonectomy) and reproductive (ovocentesis, ovariectomy, salpingohysterectomy, cesarean section, orchidectomy, vasectomy, phallectomy) systems are reviewed. PMID:26611927

  14. Mesh fixation methods in open inguinal hernia repair: a protocol for network meta-analysis and trial sequential analysis of randomised controlled trials

    PubMed Central

    Ge, Long; Tian, Jin-hui; Li, Lun; Wang, Quan; Yang, Ke-hu

    2015-01-01

    Introduction Randomised clinical trials (RCTs) have been used to compare and evaluate different types of mesh fixation usually employed to repair open inguinal hernia. However, there is no consensus among surgeons on the best type of mesh fixation method to obtain optimal results. The choice often depends on surgeons’ personal preference. This study aims to compare different types of mesh fixation methods to repair open inguinal hernias and their role in the incidences of chronic groin pain, risk of hernia recurrence, complications, operative time, length of hospital stay and postoperative pain, using Bayesian network meta-analysis and trial sequential analysis of RCTs. Methods and analysis A systematic search will be performed using PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Biomedical Literature Database (CBM) and Chinese Journal Full-text Database, to include RCTs of different mesh fixation methods (or fixation vs no fixation) during open inguinal hernia repair. The risk of bias in included RCTs will be evaluated according to the Cochrane Handbook V.5.1.0. Standard pairwise meta-analysis, trial sequential analysis and Bayesian network meta-analysis will be performed to compare the efficacy of different mesh fixation methods. Ethics and dissemination Ethical approval and patient consent are not required since this study is a meta-analysis based on published studies. The results of this network meta-analysis and trial sequential analysis will be submitted to a peer-reviewed journal for publication. Protocol registration number PROSPERO CRD42015023758. PMID:26586326

  15. Extended Component Separation for Repair of High Ventral Hernia in Pediatric Omphalocele.

    PubMed

    Miller, Erin A; Goldin, Adam; Tse, Geoffrey N; Tse, Raymond

    2015-09-01

    Abdominal wall reconstruction ideally involves maintenance of domain by restoration of competent fascia and innervated muscle. Component separation allows closure of ventral hernias, but the technique is limited for high abdominal defects in the epigastric region. We describe an extended component separation that facilitated mobilization of the rectus abdominis muscle along its costal insertion to close an upper midline defect in a child with giant omphalocele, who had already undergone previous traditional component separation. PMID:26495216

  16. Extended Component Separation for Repair of High Ventral Hernia in Pediatric Omphalocele

    PubMed Central

    Miller, Erin A.; Goldin, Adam; Tse, Geoffrey N.

    2015-01-01

    Summary: Abdominal wall reconstruction ideally involves maintenance of domain by restoration of competent fascia and innervated muscle. Component separation allows closure of ventral hernias, but the technique is limited for high abdominal defects in the epigastric region. We describe an extended component separation that facilitated mobilization of the rectus abdominis muscle along its costal insertion to close an upper midline defect in a child with giant omphalocele, who had already undergone previous traditional component separation. PMID:26495216

  17. [Functional tendon repair in orthopedic tumor surgery].

    PubMed

    Dominkus, M; Sabeti, M; Kotz, R

    2005-06-01

    Large defects of functional soft tissue structures, e.g., extensor mechanism, ligaments, muscles, and joint capsule, may occur in tumor surgery or revision surgery following conventional joint replacement. Reconstruction can be performed using biological grafts such as free or pedicled tendon-muscle flaps, allografts, or synthetic material. Prerequisites for synthetic material are good biologic tolerance with fibroblastic ingrowth, mechanical resistance to fatigue, and a maximum of tension force with a minimum of elongation. In this study we used a nonresorbable band of longitudinal polyester fibers with a minimal rupture level of 4000 N and an elongation rate less than 7% of its original length. The shape of the band was designed for universal use with 40 cm length and 6 cm width. Its primary indication was augmentation or complete reconstruction of the extensor mechanism of the knee joint after large extra-articular tumor resections in primary bone tumors. Furthermore, its use for hip joint capsule reconstruction in luxation, coverage of megaprostheses of the humerus, and augmentation after biological reconstruction of tendons achieved excellent results. PMID:15883785

  18. Grynfeltt Hernia: A Deceptive Lumbar Mass with a Lipoma-Like Presentation

    PubMed Central

    Zadeh, Jonathan R.; Buicko, Jessica L.; Patel, Chetan; Kozol, Robert; Lopez-Viego, Miguel A.

    2015-01-01

    The Grynfeltt-Lesshaft hernia is a rare posterior abdominal wall defect that allows for the herniation of retro- and intraperitoneal structures through the upper lumbar triangle. While this hernia may initially present as a small asymptomatic bulge, the defect typically enlarges over time and can become symptomatic with potentially serious complications. In order to avoid that outcome, it is advisable to electively repair Grynfeltt hernias in patients without significant contraindications to surgery. Due to the limited number of lumbar hernioplasties performed, there has not been a large study that definitively identifies the best repair technique. It is generally accepted that abdominal hernias such as these should be repaired by tension-free methods. Both laparoscopic and open techniques are described in modern literature with unique advantages and complications for each. We present the case of an unexpected Grynfeltt hernia diagnosed following an attempted lipoma resection. We chose to perform an open repair involving a combination of fascial approximation and dual-layer polypropylene mesh placement. The patient's recovery was uneventful and there has been no evidence of recurrence at over six months. Our goal herein is to increase awareness of upper lumbar hernias and to discuss approaches to their surgical management. PMID:26697256

  19. Laparoscopic repair of a late-presenting Bochdalek diaphragmatic hernia with acute gastric volvulus.

    PubMed

    Hadjittofi, Christopher; Matter, Ibrahim; Eyal, Ori; Slijper, Nadav

    2013-01-01

    An otherwise healthy 17-year-old boy presented to the paediatric emergency department with acute severe epigastric pain. An admission abdominal radiograph demonstrated gastric dilation, associated with an elevated left hemidiaphragm. Subsequent barium contrast imaging confirmed the diagnosis of organoaxial acute gastric volvulus (AGV). Emergent exploratory laparoscopy revealed AGV with migration of the stomach, spleen, pancreatic tail, splenic flexure, left kidney and adrenal through a left-sided Bochdalek diaphragmatic hernia. Following careful mobilisation of the displaced structures, a mesh closure of the diaphragmatic defect was performed. The patient's postoperative chest radiograph was unremarkable, and he was discharged on the sixth postoperative day after an uneventful recovery. At 2 months the patient was well and asymptomatic, with normal barium contrast imaging results. PMID:23519514

  20. Laparoscopic repair of a late-presenting Bochdalek diaphragmatic hernia with acute gastric volvulus

    PubMed Central

    Hadjittofi, Christopher; Matter, Ibrahim; Eyal, Ori; Slijper, Nadav

    2013-01-01

    An otherwise healthy 17-year-old boy presented to the paediatric emergency department with acute severe epigastric pain. An admission abdominal radiograph demonstrated gastric dilation, associated with an elevated left hemidiaphragm. Subsequent barium contrast imaging confirmed the diagnosis of organoaxial acute gastric volvulus (AGV). Emergent exploratory laparoscopy revealed AGV with migration of the stomach, spleen, pancreatic tail, splenic flexure, left kidney and adrenal through a left-sided Bochdalek diaphragmatic hernia. Following careful mobilisation of the displaced structures, a mesh closure of the diaphragmatic defect was performed. The patient's postoperative chest radiograph was unremarkable, and he was discharged on the sixth postoperative day after an uneventful recovery. At 2?months the patient was well and asymptomatic, with normal barium contrast imaging results. PMID:23519514

  1. Handlebar hernia in children.

    PubMed

    Mitchell, P J; Green, M; Ramesh, A N

    2011-05-01

    Handlebar hernia is a rare form of traumatic abdominal wall hernia usually occurring in children. As the name suggests, it results from the blunt impact of a handlebar after a fall from a bicycle. A classic case is described of such a hernia occurring in a 14-year-old boy who presented with minimal external signs of injury, but was found to have significant traumatic disruption to the abdominal wall musculature and peritoneum, requiring surgical repair. A review of the English literature found only 25 cases of handlebar hernias in children less than 16 years of age. The average age is 9 years, and two-thirds of cases occur in boys. The frequency of associated visceral injury is low. The majority of reported cases were managed with surgical exploration and simple suture repair. Despite minimal signs on examination, the history should raise suspicion of significant underlying muscular disruption. PMID:21098798

  2. Rate of repair in minimally invasive mitral valve surgery

    PubMed Central

    Hohenberger, Wolfgang; Lakew, Fitsum; Batz, Gerhard; Diegeler, Anno

    2013-01-01

    Background Valve repair has been shown to be the method of choice in the treatment of patients with severe mitral valve regurgitation. Minimally invasive surgery has raised skepticism regarding the rate of repair especially for supposedly complex lesions, when anterior leaflet involvement or bileaflet prolapse is present. We sought to review our experience of all our patients presenting with degenerative mitral valve regurgitation and operated on minimally invasively. Method From September 2006 to December 2012, 842 patients (mean age 56.12±11.62 years old) with degenerative mitral valve regurgitation and anterior leaflet (n=82, 9.7%), posterior leaflet (n=688, 81.7%) and bileaflet (n=72, 8.6%) prolapses were operated on using a minimally invasive approach. Results 836 patients had a valve repair (99.3%) and received a concomitant ring annuloplasty (mean size, 33.7; range, 28-40). Six patients (0.7%) underwent valve replacement. Two patients had a re-repair due to MR progression or infective endocarditis. Thirty-day mortality was 0.2% (two patients). There were 60 major adverse events (MAE) (7.1%). Conclusions A minimally invasive approach allows repair of almost all degenerative valves with good short-term outcomes in a tertiary referral center, when using proven and efficient surgical techniques. PMID:24349977

  3. Fabrication of silk mesh with enhanced cytocompatibility: preliminary in vitro investigation toward cell-based therapy for hernia repair.

    PubMed

    Guillaume, O; Park, J; Monforte, X; Gruber-Blum, S; Redl, H; Petter-Puchner, A; Teuschl, A H

    2016-02-01

    Recent studies have demonstrated that combining cells with meshes prior to implantation successfully enhanced hernia repair. The idea is to create a biologic coating surrounding the mesh with autologous cells, before transplantation into the patient. However, due to the lack of a prompt and robust cell adhesion to the meshes, extensive in vitro cultivation is required to obtain a homogenous cell layer covering the mesh. In this context, the objective of this publication is to manufacture meshes made of silk fibres and to enhance the cytoadhesion and cytocompatibility of the biomaterial by surface immobilization of a pro-adhesive wheat germ agglutinin (lectin WGA). We first investigated the affinity between the glycoprotein WGA and cells, in solution and then after covalent immobilization of WGA on silk films. Then, we manufactured meshes made of silk fibres, tailored them with WGA grafting and finally evaluated the cytocompatibility and the inflammatory response of silk and silk-lectin meshes compared to common polypropylene mesh, using fibroblasts and peripheral blood mononuclear cells, respectively. The in vitro experiments revealed that the cytocompatibility of silk can be enhanced by surface immobilization with lectin WGA without exhibiting negative response in terms of pro-inflammatory reaction. Grafting lectin to silk meshes could bring advantages to facilitate cell-coating of meshes prior to implantation, which is an imperative prerequisite for abdominal wall tissue regeneration using cell-based therapy. PMID:26704554

  4. Enterocutaneous Fistula Occurring 15 Years after the Prosthetic Mesh Repair of a Recurrent Incisional Hernia - A Case Report.

    PubMed

    Doran, H; Costache, A; Must??ea, P; P?tra?cu, T

    2015-01-01

    A 78 year-old female patient who had been operated in 1999 for a recurrent large incisional hernia, with a 20/20 cm prosthetic mesh sutured to the lateral muscular layers of the abdominal wall, has had a favourable postoperative evolution for over 15 years. The patient was admitted in our clinic for a wound infection in January 2015. The clinical examination revealed a cutaneous fistula with large purulent drainage from the deep space; the outflow was between 30 and 50 ml/day. The fistulography identified the communication with the small bowel. The surgical procedure consisted of an enterectomy, which achieved the excision of 2 lesions of an ileal loop; one of them had a fragment of the prosthesis inside the lumen, while the other was strongly adherent to the internal surface of the prosthesis. An end-to-end anastomosis was then performed, as well as the large excision of the infected prosthesis. Finally, the only possible option was the skin closure. Postoperative recovery was uneventful, and the patient was discharged after 14 days; the reconstruction of the abdominal wall using a composite mesh is expected after few months. This clinical case is demonstrative for a rare and serious complication of a prosthetic mesh repair, which occurred after a very long period of normal clinical condition. PMID:26531795

  5. A Child with Lung Hypoplasia, Congenital Heart Disease, Hemifacial Microsomia, and Inguinal Hernia: Ipsilateral Congenital Malformations

    PubMed Central

    Fan, Chengming; Huang, Can; Liu, Jijia; Yang, Jinfu

    2015-01-01

    A 3-year-old Chinese boy was diagnosed with ipsilateral congenital malformations: right lung hypoplasia, dextroversion of heart, atrial septal defect, hepatic vein drainage directly into the right atrium, facial asymmetry, right microtia and congenital deafness, and indirect inguinal hernia. He underwent indirect inguinal hernia repair at the age of 2. Although without any facial plastic surgery performed, he underwent a repair of atrial septal defect and recovered uneventfully. At 6-month follow-up, the patient was free from any symptom of dyspnea; his heart function returned to the first grade. PMID:26294998

  6. A genome-wide association study identifies four novel susceptibility loci underlying inguinal hernia.

    PubMed

    Jorgenson, Eric; Makki, Nadja; Shen, Ling; Chen, David C; Tian, Chao; Eckalbar, Walter L; Hinds, David; Ahituv, Nadav; Avins, Andrew

    2015-01-01

    Inguinal hernia repair is one of the most commonly performed operations in the world, yet little is known about the genetic mechanisms that predispose individuals to develop inguinal hernias. We perform a genome-wide association analysis of surgically confirmed inguinal hernias in 72,805 subjects (5,295 cases and 67,510 controls) and confirm top associations in an independent cohort of 92,444 subjects with self-reported hernia repair surgeries (9,701 cases and 82,743 controls). We identify four novel inguinal hernia susceptibility loci in the regions of EFEMP1, WT1, EBF2 and ADAMTS6. Moreover, we observe expression of all four genes in mouse connective tissue and network analyses show an important role for two of these genes (EFEMP1 and WT1) in connective tissue maintenance/homoeostasis. Our findings provide insight into the aetiology of hernia development and highlight genetic pathways for studies of hernia development and its treatment. PMID:26686553

  7. Neuroendocrine tumor of the appendix inside an incarcerated Amyand’s hernia

    PubMed Central

    Elbanna, Khaled Y.; Alzahrani, Hassan A.; Azzumeea, Fahad; Alzamel, Hyetham A.

    2015-01-01

    Amyand’s hernia is a rare type of hernia where the vermiform appendix is within an inguinal hernia sac. Tumors of the appendix are quite uncommon. The coincidence of an Amyand’s hernia with neuroendocrine tumor of the appendix, as in our case, is even more rarely reported. We report the case of an 81-year-old male who presented with an incarcerated right inguinal hernia. After resuscitation, the clinical diagnosis was confirmed by computed tomography. It showed an incarcerated right inguinal hernia which contained the distal ileum, cecum, thickened appendix, as well as a small amount of fluid. Subsequently, the patient was prepared for emergency surgery. During the operation, the hernia sac was found and opened. The appendix was swollen. Therefore, appendectomy was performed. The inguinal defect was repaired using the Modified Bassini Technique. The patient had an uneventful postoperative recovery and surprisingly the histopathology of the appendix revealed a 1.5 cm well-differentiated low grade neuroendocrine tumor (carcinoid) of the appendix tip. An incidental finding of neuroendocrine tumor of the appendix in a patient with s hernia is extremely rare. A high index of suspicion is the key to diagnose such a coincidence in order to safely and optimally treat such a condition. PMID:26279257

  8. Parastomal hernia containing stomach.

    PubMed

    Barber-Millet, Sebastian; Pous, Salvador; Navarro, Vicente; Iserte, Jose; García-Granero, Eduardo

    2014-01-01

    Parastomal hernia is the most common late stomal complication. Its appearance is usually asymptomatic. We report a parastomal hernia containing stomach. A 69-year-old patient with end colostomy arrived at the emergency room presenting with abdominal pain associated with vomiting and functioning stoma. She had a distended and painful abdomen without signs of peritoneal irritation and pericolostomic eventration in the left iliac fossa. X-ray visualized gastric fornix dilatation without dilated intestine bowels, and computed tomography showed parastomal incarcerated gastric herniation. Gastrografin (Bayer Australia Limited, New South Wales, Australia) was administered, showing no passage to duodenum. She underwent surgery, with stomal transposition and placement of onlay polypropylene mesh around the new stoma. Parastomal hernias are a frequent late complication of colostomy. Only four gastric parastomal hernia cases are reported in the literature. Three of these four cases required surgery. The placement of prosthetic mesh in the moment of stoma elaboration should be considered as a potential preventive measure. PMID:25058773

  9. Laparoscopic repair for a previously unreported form of ventral hernia on the right iliac fossa in an elderly emaciated woman.

    PubMed

    Yokoyama, T; Kobayashi, A; Shimizu, A; Motoyama, H; Miyagawa, S

    2015-10-01

    An 81-year-old emaciated woman was admitted to our hospital with a one-year history of recurrent bilateral inguinal swellings. Palpable lumps were observed not only in bilateral groin areas, but also on the right iliac fossa (RIF) of her abdomen. During a planned transabdominal preperitoneal laparoscopic herniorrhaphy, a previously unreported form of ventral hernia was observed at a position lateral and cranial to the right internal inguinal ring, which probably corresponded to the palpable lump on the RIF. The hernia orifice was 2 cm in diameter, and a vascular structure ran through the orifice. The contents of the hernia consisted of fatty tissue arising from the retroperitoneal tissue. Routine exploration revealed orifices of the following hernias: left indirect, right direct, bilateral femoral, bilateral obturator, and right Spigelian hernia. Her postoperative course was uneventful and a mass on the right lower quadrant disappeared after operation. PMID:24218077

  10. Heparinized collagen scaffolds with and without growth factors for the repair of diaphragmatic hernia

    PubMed Central

    Brouwer, Katrien M; Wijnen, René M; Reijnen, Daphne; Hafmans, Theo G; Daamen, Willeke F; van Kuppevelt, Toin H

    2013-01-01

    A regenerative medicine approach to restore the morphology and function of the diaphragm in congenital diaphragmatic hernia is especially challenging because of the position and flat nature of this organ, allowing cell ingrowth primarily from the perimeter. Use of porous collagen scaffolds for the closure of surgically created diaphragmatic defects in rats has been shown feasible, but better ingrowth of cells, specifically blood vessels and muscle cells, is warranted. To stimulate this process, heparin, a glycosaminoglycan involved in growth factor binding, was covalently bound to porous collagenous scaffolds (14%), with or without vascular endothelial growth factor (VEGF; 0.4 µg/mg scaffold), hepatocyte growth factor (HGF; 0.5 µg/mg scaffold) or a combination of VEGF + HGF (0.2 + 0.5 µg/mg scaffold). All components were located primarily at the outside of scaffolds. Scaffolds were implanted in the diaphragm of rats and evaluated after 2 and 12 weeks. No herniations or eventrations were observed, and in several cases, growth factor-substituted scaffolds showed macroscopically visible blood vessels at the lung site. The addition of heparin led to an accelerated ingrowth of blood vessels at 2 weeks. In all scaffold types, giant cells and immune cells were present primarily at the liver side of the scaffold, and immune cells and individual macrophages at the lung side; these cell types decreased in number from week 2 to week 12. The addition of growth factors did not influence cellular response to the scaffolds, indicating that further optimization with respect to dosage and release profile is needed. PMID:23867845

  11. Harvey Cushing's Contributions to Plastic Surgery: Bilateral Cleft Lip Repair.

    PubMed

    Molendijk, Josher; Pendleton, Courtney; Rachwalski, Martin; Quinones-Hinojosa, Alfredo; Dorafshar, Amir H

    2014-01-01

    Harvey Cushing has been deemed by many as the neurosurgeon of the 20th century. Cushing's unknown contributions to the field of plastic and reconstructive surgery were only recently reported. Further review of his teaching and operative records, brought from Johns Hopkins to Yale University, revealed an unpublished case of bilateral cleft lip repair that he performed. In this article, we present in detail this comprehensive case and describe, with the help of his personal teaching notes and illustrations, how Cushing combined methods from world-renowned surgeons to approach bilateral cleft lip deformities. PMID:23551074

  12. Successful treatment for patients with chronic orchialgia following inguinal hernia repair by means of meshoma removal, orchiectomy and triple-neurectomy

    PubMed Central

    Narita, Masato; Moriyoshi, Koki; Hanada, Keita; Matsusue, Ryo; Hata, Hiroaki; Yamaguchi, Takashi; Otani, Tetsushi; Ikai, Iwao

    2015-01-01

    Introduction Orchialgia following inguinal hernia repair is rare complication and still challenging since there has been no established surgical treatment because of complexity of nerve innervation to the testicular area. Herein we report a case of postoperative orchialgia following Lichtenstein repair, which was successfully treated by mesh removal, orchiectomy and triple neurectomy. Case presentation A 65-year-old man was referred to our department because of chronic right orchialgia following Lichtenstein hernia repair. He walked with a limp and was unable to walk a long distance. Physical examination revealed the presence of meshoma in the groin area and hypoesthesia in the anterior skin of the right scrotum. His right testis was completely atrophic and located not in the scrotum but in the subcutaneous regions of right groin. He was diagnosed as both neuropathic and nociceptive orchialgia and underwent meshoma removal, triple-neurectomy, and orchiectomy to address these issues. Pathological examination revealed that meshoma was integrated with the structures of the spermatic cord, leading to foreign-body reaction and fibrosis around the genital branch of genitofemoral nerve. The resected right testis was completely-scarred without ischemic changes. Orchialgia disappeared immediately after operation and he was able to walk without a limp. Discussions It is important to distinguish between nociceptive and neuropathic orchialgia. Neuroanatomic understanding is essential to guide treatment options. Orchiectomy is an option but should be reserved for refractory cases with evidence of nociceptive pain accompanied by anatomical changes. Conclusions Triple neurectomy should be considered in patients with neuropathic orchialgia. PMID:26476053

  13. Use of Mesh in Laparoscopic Paraesophageal Hernia Repair: A Meta-Analysis and Risk-Benefit Analysis

    PubMed Central

    Gondan, Matthias; Stock, Christian; Linke, Georg R.; Fritz, Franziska; Nickel, Felix; Diener, Markus K.; Gutt, Carsten N.; Wente, Moritz; Büchler, Markus W.; Fischer, Lars

    2015-01-01

    Introduction Mesh augmentation seems to reduce recurrences following laparoscopic paraesophageal hernia repair (LPHR). However, there is an uncertain risk of mesh-associated complications. Risk-benefit analysis might solve the dilemma. Materials and Methods A systematic literature search was performed to identify randomized controlled trials (RCTs) and observational clinical studies (OCSs) comparing laparoscopic mesh-augmented hiatoplasty (LMAH) with laparoscopic mesh-free hiatoplasty (LH) with regard to recurrences and complications. Random effects meta-analyses were performed to determine potential benefits of LMAH. All data regarding LMAH were used to estimate risk of mesh-associated complications. Risk-benefit analysis was performed using a Markov Monte Carlo decision-analytic model. Results Meta-analysis of 3 RCTs and 9 OCSs including 915 patients revealed a significantly lower recurrence rate for LMAH compared to LH (pooled proportions, 12.1% vs. 20.5%; odds ratio (OR), 0.55; 95% confidence interval (CI), 0.34 to 0.89; p = 0.04). Complication rates were comparable in both groups (pooled proportions, 15.3% vs. 14.2%; OR, 1.02; 95% CI, 0.63 to 1.65; p = 0.94). The systematic review of LMAH data yielded a mesh-associated complication rate of 1.9% (41/2121; 95% CI, 1.3% to 2.5%) for those series reporting at least one mesh-associated complication. The Markov Monte Carlo decision-analytic model revealed a procedure-related mortality rate of 1.6% for LMAH and 1.8% for LH. Conclusions Mesh application should be considered for LPHR because it reduces recurrences at least in the mid-term. Overall procedure-related complications and mortality seem to not be increased despite of potential mesh-associated complications. PMID:26469286

  14. Preclinical Bioassay of a Polypropylene Mesh for Hernia Repair Pretreated with Antibacterial Solutions of Chlorhexidine and Allicin: An In Vivo Study

    PubMed Central

    Pérez-Köhler, Bárbara; García-Moreno, Francisca; Brune, Thierry; Pascual, Gemma; Bellón, Juan Manuel

    2015-01-01

    Introduction Prosthetic mesh infection constitutes one of the major complications following hernia repair. Antimicrobial, non-antibiotic biomaterials have the potential to reduce bacterial adhesion to the mesh surface and adjacent tissues while avoiding the development of novel antibiotic resistance. This study assesses the efficacy of presoaking reticular polypropylene meshes in chlorhexidine or a chlorhexidine and allicin combination (a natural antibacterial agent) for preventing bacterial infection in a short-time hernia-repair rabbit model. Methods Partial hernia defects (5 x 2 cm) were created on the lateral right side of the abdominal wall of New Zealand White rabbits (n = 21). The defects were inoculated with 0.5 mL of a 106 CFU/mL Staphylococcus aureus ATCC25923 strain and repaired with a DualMesh Plus antimicrobial mesh or a Surgipro mesh presoaked in either chlorhexidine (0.05%) or allicin-chlorhexidine (900 ?g/mL-0.05%). Fourteen days post-implant, mesh contraction was measured and tissue specimens were harvested to evaluate bacterial adhesion to the implant surface (via sonication, S. aureus immunolabeling), host-tissue incorporation (via staining, scanning electron microscopy) and macrophage response (via RAM-11 immunolabeling). Results The polypropylene mesh showed improved tissue integration relative to the DualMesh Plus. Both the DualMesh Plus and the chlorhexidine-soaked polypropylene meshes exhibited high bacterial clearance, with the latter material showing lower bacterial yields. The implants from the allicin-chlorhexidine group displayed a neoformed tissue containing differently sized abscesses and living bacteria, as well as a diminished macrophage response. The allicin-chlorhexidine coated implants exhibited the highest contraction. Conclusions The presoaking of reticular polypropylene materials with a low concentration of chlorhexidine provides the mesh with antibacterial activity without disrupting tissue integration. Due to the similarities found with the antimicrobial DualMesh Plus material, the chlorhexidine concentration tested could be utilized as a prophylactic treatment to resist infection by prosthetic mesh during hernia repair. PMID:26556805

  15. Incisional Hernia in Women: Predisposing Factors and Management Where Mesh is not Readily Available

    PubMed Central

    Agbakwuru, EA; Olabanji, JK; Alatise, OI; Okwerekwu, RO; Esimai, OA

    2009-01-01

    Background / Aim: Incisional hernia is still relatively common in our practice. The aim of the study was to identify risk factors associated with incisional hernia in our region. The setting is the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria during a period when prosthetic mesh was not readily available. Patients and Methods: All the women who presented with incisional hernia between 1996 and 2005 were prospectively studied using a standard form to obtain information on pre-hernia (index) operations and possible predisposing factors. They all had open surgical repair and were followed up for 18–60 months. Results: Forty-four women were treated during study period. The index surgeries leading to the hernias were emergency caesarian section 26/44 (59.1%), emergency exploratory laparotomy 6/44 (13.6%), and elective surgeries 12/44 (27.3%). Major associated risk factors were the use of wrong suture materials for fascia repair, midline incisions, wound sepsis, and overweight. Conclusion: For elective surgeries, reduction of weight should be encouraged when appropriate, and transverse incisions are preferred. Absorbable sutures, especially chromic catgut, should be avoided in fascia closure. Antibiotics should be used for complicated obstetric cases. PMID:21483511

  16. Risk of Incisional Hernia after Minimally Invasive and Open Radical Prostatectomy

    PubMed Central

    Carlsson, Sigrid V.; Ehdaie, Behfar; Atoria, Coral L.; Elkin, Elena B.; Eastham, James A.

    2013-01-01

    Purpose The number of radical prostatectomies has increased. Many urologists have shifted from the open surgical approach to minimally invasive techniques. It is not clear whether the risk of post-prostatectomy incisional hernia varies by surgical approach. Materials and Methods In the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset we identified men age 66 and older who had minimally invasive (MIRP) or open radical prostatectomy (ORP) for prostate cancer diagnosed 2003–2007. The main outcome was incisional hernia repair identified in Medicare claims following prostatectomy. We also examined the frequency of umbilical, inguinal and other hernia repairs. Results We identified 3,199 patients who had MIRP and 6,795 who had open radical prostatectomy ORP. The frequency of incisional hernia repair was 5.3% (median follow-up 3.1 years) in the MIRP group and 1.9% (median follow-up 4.4 years) in the ORP group, corresponding to incidence rates of 16.1 and 4.5 per 1000 person-years for MIRP and ORP, respectively. Compared with ORP, MIRP was associated with a more than 3-fold increased risk of incisional hernia repair, controlling for patient and disease characteristics (adjusted hazard ratio 3.39, 95% CI, 2.63–4.38, p <0.0001). MIRP was associated with an attenuated but increased risk of any hernia repair compared with ORP (adjusted hazard ratio 1.48, 95% CI 1.29–1.70, p <0.0001). Conclusions MIRP was associated with a significantly increased risk of incisional hernia compared with ORP. This is a potentially remediable complication of prostate cancer surgery that warrants increased vigilance with respect to surgical technique. PMID:23688847

  17. Antenatal management of isolated congenital diaphragmatic hernia today and tomorrow: ongoing collaborative research and development. Journal of Pediatric Surgery Lecture.

    PubMed

    Deprest, Jan; De Coppi, Paolo

    2012-02-01

    The diagnosis of congenital diaphragmatic hernia should be made prenatally in virtually all cases where routine maternal ultrasonography is available. At that time, the prognosis can be predicted based on whether it is isolated and assessment of lung size and/or the position of the liver. Prenatal intervention may be offered in those selected fetuses that have a predicted poor outcome. The aim of this procedure is to reverse the key determinant of survival-pulmonary hypoplasia. Percutaneous fetal endoscopic tracheal occlusion by a balloon is a minimally invasive procedure that has been shown safe and yields a 50% survival rate in severe cases. The outcome can be predicted by the gestational age at birth, the lung size before and after balloon placement, and whether the balloon has been removed prenatally. Currently, the added value of prenatal intervention is being investigated in the Tracheal Occlusion To Accelerate Lung Growth trial ((TOTAL); a European and North American collaboration). Future developments may include better prediction of outcome by more complex algorithms reflecting combinations of prenatal predictors, gene expression profiling to reflect lung development and response to tracheal occlusion, and alternative prenatal strategies for salvaging the worst cases. Fetuses with severe hypoplasia usually require postnatal operative repair using prosthetic patches, and tissue engineering offers the potential for ex utero culture. PMID:22325377

  18. Clinical Significance of Hiatal Hernia

    PubMed Central

    Hyun, Jong Jin

    2011-01-01

    The relationship between hiatal hernias and gastroesophageal reflux disease (GERD) has been greatly debated over the past decades, with the importance of hiatal hernias first being overemphasized and then later being nearly neglected. It is now understood that both the anatomical (hiatal hernia) and the physiological (lower esophageal sphincter) features of the gastroesophageal junction play important, but independent, roles in the pathogenesis of GERD, constituting the widely accepted "two-sphincter hypothesis." The gastroesophageal junction is an anatomically complex area with an inherent antireflux barrier function. However, the gastroesophageal junction becomes incompetent and esophageal acid clearance is compromised in patients with hiatal hernia, which facilitates the development of GERD. Of the different types of hiatal hernias (types I, II, III, and IV), type I (sliding) hiatal hernias are closely associated with GERD. Because GERD may lead to reflux esophagitis, Barrett's esophagus and esophageal adenocarcinoma, a better understanding of this association is warranted. Hiatal hernias can be diagnosed radiographically, endoscopically or manometrically, with each modality having its own limitations, especially in the diagnosis of hiatal hernias less than 2 cm in length. In the future, high resolution manometry should be a promising method for accurately assessing the association between hiatal hernias and GERD. The treatment of a hiatal hernia is similar to the management of GERD and should be reserved for those with symptoms attributable to this condition. Surgery should be considered for those patients with refractory symptoms and for those who develop complications, such as recurrent bleeding, ulcerations or strictures. PMID:21927653

  19. Acute direct inguinal hernia resulting from blunt abdominal trauma: Case Report

    PubMed Central

    2010-01-01

    We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of the acute swelling and subcutaneous haematoma. The indication for surgery was the potential for visceral strangulation or ischaemia with the patient describing discomfort on coughing. At surgery there was complete obliteration of the inguinal canal with bowel and omentum lying immediately beneath the attenuated external oblique aponeurosis. A modified prolene mesh hernia repair was performed after reconstructing the inguinal ligament and canal in layers. To our knowledge, this is the first documented case of the formation of an acute direct inguinal hernia caused as a result of blunt abdominal trauma with complete disruption of the inguinal canal. Surgical repair outlines the principles of restoration of normal anatomy in a patient who is physiologically recovered from the acute trauma and whose anatomy is distorted as a result of his injuries. PMID:20537142

  20. Laparoscopic treatment of Morgagni-Larrey hernia: technical details and report of a series.

    PubMed

    Percivale, Andrea; Stella, Mattia; Durante, Valentino; Dogliotti, Luca; Serafini, Giovanni; Saccomani, Giovanni; Pellicci, Riccardo

    2005-06-01

    Three patients with Morgagni-Larrey hernia were admitted to the surgical department between August 2000 and September 2003 with slight chest pain and dyspnea. Laparoscopic repair of the diaphragmatic hernia was performed using a tension-free closure of the defects with either Vicryl-Prolene or dual facing mesh fixed by Prolene extracorporeal knots and Endostitch devices. The patients were discharged on postoperative day 5 without complications. Mean follow-up has been 23 months (range, 15-36 months) and no recurrence or morbidity related to the procedure has been seen. Laparoscopic repair of Morgagni-Larrey hernia represents an attractive alternative to open surgery. The benefits are gentle and easy manipulation of the content of the sac, reduced surgical trauma, and rapid and uneventful recovery. PMID:15954834

  1. [Diaphragmatic hernia complicated with diaphragmatic resection by automatic stapling device].

    PubMed

    Minegishi, Kentaro; Nakano, Tomoyuki; Shibano, Tomoki; Maki, Mitsuru; Mitsuda, Sayaka; Yamamoto, Shinichi; Tetsuka, Kenji; Tsubochi, Hiroyoshi; Hasegawa, Tsuyoshi; Endo, Shunsuke

    2014-10-01

    Nowadays, a diaphragmatic lesion is sometimes resected with use of an automatic stapling device, especially through video-assisted thoracoscopic procedure. We herein report 2 patients with a diaphragmatic hernia after diaphragmatic resection by automatic stapling devices. Etiology and cause of postoperative diaphragmatic hernia are discussed. Diaphragmatic resection by mechanical stapler was performed for thymic epithelial tumor recurring at the diaphragmatic pleura in both patients: 48-year-old man and 72-year-old woman. The former patient underwent a right diaphragmatic resection (3×4 cm in size) with a cartridge of mechanical stapler. Computed tomography (CT) and magnetic resonance imaging showed asymptomatic right diaphragmatic hernia 2 months after surgery. No symptom and progression occurred 8 years later. The latter patient underwent a right diaphragmatic resection (6×7 cm in size) with 2 cartridges of mechanical stapler. Diaphragmatic hernia advanced 7 months after surgery and required surgical intervention. Diaphragmatic repair was successful with the use of 8×6 cm expanded polytetrafluoroethylene patch. Surgical stump after diaphragmatic resection with automatic stapling device is easy to rupture during diaphragmatic movement synchronized with respiratory movement. Diaphragmatic resection with use of stapling device, which is a simple procedure, should be contraindicated. PMID:25292370

  2. Laparoscopic bridging vs. anatomic open reconstruction for midline abdominal hernia mesh repair [LABOR]: single-blinded, multicenter, randomized, controlled trial on long-term functional results

    PubMed Central

    2013-01-01

    Background Re-approximation of the rectal muscles along the midline is recommended by some groups as a rule for incisional and ventral hernia repairs. The introduction of laparoscopic repair has generated a debate because it is not aimed at restoring abdominal wall integrity but instead aims just to bridge the defect. Whether restoration of the abdominal integrity has a real impact on patient mobility is questionable, and the available literature provides no definitive answer. The present study aims to compare the functional results of laparoscopic bridging with those of re-approximation of the rectal muscle in the midline as a mesh repair for ventral and incisional abdominal defect through an “open” access. We hypothesized that, for the type of defect suitable for a laparoscopic bridging, the effect of an anatomical reconstruction is near negligible, thus not a fixed rule. Methods and design The LABOR trial is a multicenter, prospective, two-arm, single-blinded, randomized trial. Patients of more than 60 years of age with a defect of less than 10 cm at its greatest diameter will be randomly submitted to open Rives or laparoscopic defect repair. All the participating patients will have a preoperative evaluation of their abdominal wall strength and mobility along with volumetry, respiratory function test, intraabdominal pressure and quality of life assessment. The primary outcome will be the difference in abdominal wall strength as measured by a double leg-lowering test performed at 12 months postoperatively. The secondary outcomes will be the rate of recurrence and changes in baseline abdominal mobility, respiratory function tests, intraabdominal pressure, CT volumetry and quality of life at 6 and 12 months postoperatively. Discussion The study will help to define the most suitable treatment for small-medium incisional and primary hernias in patients older than 60 years. Given a similar mid-term recurrence rate in both groups, if the trial shows no differences among treatments (acceptance of the null-hypothesis), then the choice of whether to submit a patient to one intervention will be made on the basis of cost and the surgeon’s experience. Trial registration Current Controlled Trials ISRCTN93729016 PMID:24165473

  3. [Morgagni Hernia].

    PubMed

    Fiane, A E; Nazir, M; Saebø, A

    1990-05-30

    The article describes a 65 year-old female with a 40 years' history of abdominal discomfort and a supposed intrathoracal lipoma who was admitted to hospital with acute obstruction of the large bowel. Emergency laparotomy revealed a subcostosternal diaphragmatic hernia (hernia of Morgagni) containing omentum and a segment of transverse colon. PMID:2363150

  4. Minimally invasive surgical technique integrating multiple procedures with large specimen extraction via inguinal hernia orifice

    PubMed Central

    Mani, Vishnu R.; Ahmed, Leaque

    2015-01-01

    While laparoscopic surgery can be performed using small skin incisions, any resected specimen must still be able to fit through these opening. For procedures, such as cholecystectomies and appendectomies, this is not usually a problem; however, for large specimens such as bowel or large tumors, this becomes problematic. Currently, the standard technique is to attempt piecemeal removal of the specimen or enlarge one of the laparoscopic incisions, effectively creating a mini laparotomy. Creating a larger incision adds many of the drawbacks of open laparotomy and should be avoided whenever possible. In this article, we present a new technique of combining the repair of an inguinal hernia, umbilical hernia with a duodenal tumor resection in order to extract the specimen through the inguinal hernia orifice. PMID:26703927

  5. Incarcerated inguinal hernia in the presence of Fournier's gangrene: a novel approach to a complex problem.

    PubMed

    Guzzo, James L; Bochicchio, Grant V; Henry, Sharon; Keller, Elena; Scalea, Thomas M

    2007-01-01

    Fournier's gangrene is an aggressive, polymicrobial soft tissue infection that specifically affects the genital and perineal region. Treatment requires early recognition, broad-spectrum intravenous antibiotics, and radical surgical debridement of all infected tissues. Optimal therapy may necessitate multiple debridements that leave the patient with large tissue defects that require skin grafting for scrotal and perineal reconstruction. The presence of other surgical emergencies, such as an incarcerated inguinal hernia, in the face of Fournier's gangrene presents a rare and challenging dilemma to the general surgeon. With the widespread acceptance of tension-free repair utilizing prosthetic mesh in uncomplicated hernia surgery, outcomes have been improved. However, surgical options for hernia repair may become limited in the face of a regional necrotizing soft tissue infection, for which mesh use in an open repair after debridement of infected tissues is generally contraindicated. In this report, the authors describe three consecutive cases of incarcerated inguinal hernia in the presence of concomitant Fournier's gangrene using a laparoscopic approach and natural biomaterial mesh for abdominal wall reinforcement. PMID:17249467

  6. Abdominal closure reinforcement by using polypropylene mesh functionalized with poly-?-caprolactone nanofibers and growth factors for prevention of incisional hernia formation

    PubMed Central

    Plencner, Martin; East, Barbora; Tonar, Zbyn?k; Otáhal, Martin; Prosecká, Eva; Rampichová, Michala; Krej?í, Tomáš; Litvinec, Andrej; Buzgo, Matej; Mí?ková, Andrea; Ne?as, Alois; Hoch, Ji?í; Amler, Evžen

    2014-01-01

    Incisional hernia affects up to 20% of patients after abdominal surgery. Unlike other types of hernia, its prognosis is poor, and patients suffer from recurrence within 10 years of the operation. Currently used hernia-repair meshes do not guarantee success, but only extend the recurrence-free period by about 5 years. Most of them are nonresorbable, and these implants can lead to many complications that are in some cases life-threatening. Electrospun nanofibers of various polymers have been used as tissue scaffolds and have been explored extensively in the last decade, due to their low cost and good biocompatibility. Their architecture mimics the natural extracellular matrix. We tested a biodegradable polyester poly-?-caprolactone in the form of nanofibers as a scaffold for fascia healing in an abdominal closure-reinforcement model for prevention of incisional hernia formation. Both in vitro tests and an experiment on a rabbit model showed promising results. PMID:25031534

  7. Histologic and biomechanical evaluation of a novel macroporous polytetrafluoroethylene knit mesh compared to lightweight and heavyweight polypropylene mesh in a porcine model of ventral incisional hernia repair

    PubMed Central

    Melman, L.; Jenkins, E. D.; Hamilton, N. A.; Bender, L. C.; Brodt, M. D.; Deeken, C. R.; Greco, S. C.; Frisella, M. M.

    2013-01-01

    Purpose To evaluate the biocompatibility of heavyweight polypropylene (HWPP), lightweight polypropylene (LWPP), and monofilament knit polytetrafluoroethylene (mkPTFE) mesh by comparing biomechanics and histologic response at 1, 3, and 5 months in a porcine model of incisional hernia repair. Methods Bilateral full-thickness abdominal wall defects measuring 4 cm in length were created in 27 Yucatan minipigs. Twenty-one days after hernia creation, animals underwent bilateral preperitoneal ventral hernia repair with 8 × 10 cm pieces of mesh. Repairs were randomized to Bard®Mesh (HWPP, Bard/Davol, http://www.davol.com), ULTRAPRO® (LWPP, Ethicon, http://www.ethicon.com), and GORE®INFINIT Mesh (mkPTFE, Gore & Associates, http://www.gore.com). Nine animals were sacrificed at each timepoint (1, 3, and 5 months). At harvest, a 3 × 4 cm sample of mesh and incorporated tissue was taken from the center of the implant site and subjected to uniaxial tensile testing at a rate of 0.42 mm/s. The maximum force (N) and tensile strength (N/cm) were measured with a tensiometer, and stiffness (N/mm) was calculated from the slope of the force-versus-displacement curve. Adjacent sections of tissue were stained with hematoxylin and eosin (H&E) and analyzed for inflammation, fibrosis, and tissue ingrowth. Data are reported as mean ± SEM. Statistical significance (P < 0.05) was determined using a two-way ANOVA and Bonferroni post-test. Results No significant difference in maximum force was detected between meshes at any of the time points (P > 0.05 for all comparisons). However, for each mesh type, the maximum strength at 5 months was significantly lower than that at 1 month (P < 0.05). No significant difference in stiffness was detected between the mesh types or between timepoints (P > 0.05 for all comparisons). No significant differences with regard to inflammation, fibrosis, or tissue ingrowth were detected between mesh types at any time point (P > 0.09 for all comparisons). However, over time, inflammation decreased significantly for all mesh types (P < 0.001) and tissue ingrowth reached a slight peak between 1 and 3 months (P = 0.001) but did not significantly change thereafter (P > 0.09). Conclusions The maximum tensile strength of mesh in the abdominal wall decreased over time for HWPP, LWPP, and mkPTFE mesh materials alike. This trend may actually reflect inability to adequately grip specimens at later time points rather than any mesh-specific trend. Histologically, inflammation decreased with time (P = 0.000), and tissue ingrowth increased (P = 0.019) for all meshes. No specific trends were observed between the polypropylene meshes and the monofilament knit PTFE, suggesting that this novel construction may be a suitable alternative to existing polypropylene meshes. PMID:21279663

  8. Sonographic imaging of Spigelian hernias

    PubMed Central

    Ko?aczyk, Katarzyna; Lubi?ski, Jan; Bojko, Stefania; Ga?dy?ska, Maria; Bernatowicz, El?bieta

    2012-01-01

    The aim of the work was to present clinical material referring to rarely occurring abdominal cavity hernias in semilunar line – Spigelian hernias diagnosed with the help of ultrasound. Material and methods In the period from 1995 to 2001 785 anterior abdominal wall hernias were diagnosed including 11 Spigelian hernias (1.4%) diagnosed in 10 patients (7 women and 3 men) aged from 38 to 65 years old (average age 48). Eight patients complained of spastic pain in abdomen, in 5 of them it was accompanied by bloating and sometimes loud peristalsis. All the patients had been observing the mentioned symptoms from 2 to 5 years. Each of them had had colonoscopy and abdominal cavity ultrasound examination performed, some of them even three times. In 3 women with uterine fibroid the uterus was removed which did not eliminate the symptoms. The ultrasound examination of the abdominal integument was performed mainly with the use of linear transducers of the frequency of 7–12 MHz; in obese patients also convex transducers were used (3,5–6 MHz). Each examination of abdominal integument included the assessment of the following areas: linea alba from xiphoid process to pubic symphysis including umbilicus, both semilunar lines from costal margins to pubic bones, and also inguinal areas. Moreover, all types of postoperative scars were examined. Each hernia was assessed in terms of size (the greatest dimension), hernia sac contents, width of the ring and reducibility under the compression of the transducer. Moreover, cough test and Valsalva's maneuver were performed. Generally, the examination was performed in a standing position. Results In 9 patients hernias were localized unilaterally, in one patient bilaterally. In 7 cases the hernia sac contained small bowel, in 2 cases the preperitoneal and omental fat, and in 2 cases preperitoneal fat only. Eight patients presenting with clinical symptoms underwent operative repair. Conclusion Ultrasound examination is beneficial in confirming the diagnosis of Spigelian hernias especially in terms of proper, therapeutic decision-making.

  9. Strangulated umbilical hernias in children.

    PubMed

    Fall, I; Sanou, A; Ngom, G; Dieng, M; Sankalé, A A; Ndoye, M

    2006-03-01

    Umbilical hernia is a frequent pathology of the anterior abdominal wall in children. The hernia ring closes usually before 4 years, but a strangulation can occur. It is an exceptional complication according to the literature data. Since this complication is rare, we undertook a retrospective study of these strangulations in a 5-year period from January 1997 to December 2001 at Aristide Le Dantec hospital. We collected 41 cases that underwent emergency surgery operations for strangulated umbilical hernias, which represent about 15% of umbilical hernias operated during the same period. The age range was 8 months to 10 years and the average age was 14 months. All the children were examined within 24 h after the onset of the disease and the surgery was immediately performed. In five cases the bowel was necrosed and perforated and we performed a resection followed immediately by an anastomosis. In the follow up, two children presented wound infections and a hernia recurred in one child. There was no mortality. This study conducts us to question western reports which recommend conservative therapy for umbilical hernia in children. PMID:16435134

  10. Management of giant inferior triangle lumbar hernia (Petit's triangle hernia): A rare complication following delayed breast reconstruction with extended latissimus dorsi myocutaneous flap

    PubMed Central

    Munhoz, Alexandre Mendonça; Montag, Eduardo; Arruda, Eduardo Gustavo; Sturtz, Gustavo; Gemperli, Rolf

    2014-01-01

    INTRODUCTION Lumbar triangle hernia after breast reconstruction with latissimus dorsi flap (LDMF) is a very rare complication and few cases were previously described. Muscle mobilization and iatrogenic fascia defect are related etiologic factors. PRESENTATION OF CASE The authors describe a rare case of lumbar hernia in a 58-year-old woman who underwent delayed left breast reconstruction with LDMF. Two months after surgery, a progressive symptomatic lower left lumbar bulge was observed. The CT scan confirmed the diagnosis and delineated an 18 cm lumbar defect filled with lower and large bowel. At operation, the defect was exposed and the hernia sac reduced. In order to obtain stability, the remained local muscle and fascia flaps were mobilized into the defect. Additional strength was achieved with a two-layer closure of prosthetic mesh (intra/extra peritoneal). The patient is currently in the 10th postoperative year of hernia repair and satisfactory lumbar wall contour was achieved. Neither the recurrence of lumbar hernia nor symptoms compliance was noted. DISCUSSION Lumbar hernia is an uncommon complication of LDMF harvest. Although it is a rare disease, general and plastic surgeons must be on alert to avoid complications and misdiagnosis. Seroma differential diagnosis is important in order to avoid bowel perforation due to aspiration. Defect reconstruction is necessary with a muscular and fascia flaps mobilization and synthetic mesh in order to obtain a stable repair. CONCLUSION The knowledge of this rare post-operative complication following delayed breast reconstruction is crucial to its surgical management. Early surgical intervention is warranted in order to avoid severe complications. PMID:24794025

  11. [Contribution of ambulatory digestive surgery].

    PubMed

    Sales, J P

    2000-10-01

    In France, ambulatory surgery is controlled by specific regulations which outline the organization of the facilities. It is practiced less in France than in other countries, but specific governmental incentive policies have been instituted. The characteristic feature of digestive surgery is the high occurrence of post-operative nausea and vomiting due to the peritoneal incision. New surgical procedures and anesthetic regimens allow ambulatory care in children and adults. But the choice of ambulatory care is based on the patient's characteristics more than on surgical procedure and follows well-known selection criteria. The procedures concerned in general surgery are groin hernia repair, proctologic surgery, and subcutaneous tissue surgery. Laparoscopic cholecystectomy and neck surgery in increasing numbers of patients on an ambulatory basis is the first step before expanding ambulatory surgical procedures toward major surgery. Physicians must have a thorough knowledge of ambulatory surgery as an organizational concept. PMID:11033485

  12. Semi-automatic lung segmentation of DCE-MRI data sets of 2-year old children after congenital diaphragmatic hernia repair: Initial results.

    PubMed

    Zöllner, Frank G; Daab, Markus; Weidner, Meike; Sommer, Verena; Zahn, Katrin; Schaible, Thomas; Weisser, Gerald; Schoenberg, Stefan O; Neff, K Wolfgang; Schad, Lothar R

    2015-12-01

    In congenital diaphragmatic hernia (CDH), lung hypoplasia and secondary pulmonary hypertension are the major causes of death and severe disability. Based on new therapeutic strategies survival rates could be improved to up to 80%. However, after surgical repair of CDH, long-term follow-up of these pediatric patients is necessary. In this, dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) provides insights into the pulmonary microcirculation and might become a tool within the routine follow-up program of CDH patients. However, whole lung segmentation from DCE-MRI scans is tedious and automated procedures are warranted. Therefore, in this study, an approach to semi-automated lung segmentation is presented. Segmentation of the lung is obtained by calculating the cross correlation and the area under curve between all voxels in the data set and a reference region-of-interest (ROI), here the arterial input function (AIF). By applying an upper and lower threshold to the obtained maps and intersecting these, a final segmentation is reached. This approach was tested on twelve DCE-MRI data sets of 2-year old children after CDH repair. Segmentation accuracy was evaluated by comparing obtained automatic segmentations to manual delineations using the Dice overlap measure. Optimal thresholds for the cross correlation were 0.5/0.95 and 0.1/0.5 for the area under curve, respectively. The ipsilateral (left) lung showed reduced segmentation accuracy compared to the contralateral (right) lung. Average processing time was about 1.4s per data set. Average Dice score was 0.7±0.1 for the whole lung. In conclusion, initial results are promising. By our approach, whole lung segmentation is possible and a rapid evaluation of whole lung perfusion becomes possible. This might allow for a more detailed analysis of lung hypoplasia of children after CDH. PMID:26277730

  13. Efficacy of tramadol as a preincisional infiltration anesthetic in children undergoing inguinal hernia repair: a prospective randomized study

    PubMed Central

    Numano?lu, Kemal Var?m; Ayo?lu, Hilal; Er, Duygu Tatl?Ebubekir

    2014-01-01

    Background Preincisional local anesthetic infiltration at the surgical site is a therapeutic option for postoperative pain relief for pediatric inguinal hernia. Additionally, tramadol has been used as an analgesic for postoperative pain in children. Recently, the local anesthetic effects of tramadol have been reported. The aim of this study was to determine both the systemic analgesic and the local anesthetic effects of tramadol and to determine how it differs from bupivacaine when administered preincisionally. Methods Fifty-two healthy children, aged 2–7 years, who were scheduled for elective herniorrhaphy were randomly allocated to receive either preincisional infiltration at the surgical site with 2 mg/kg tramadol (Group T, n=26) or 0.25 mL/kg 0.5% bupivacaine (Group B, n=26). At the time of anesthetic administration, perioperative hemodynamic parameters were recorded. The pain assessments were performed 10 minutes after the end of anesthesia and during the first 6-hour period, using pain scores. The time of first dose of analgesia and need for additional analgesia were recorded. Results Between T and B groups, the anesthesia time, perioperative hemodynamic changes, and pain scores were not statistically different. However, in group B, the postoperative analgesic requirement was higher than in group T. Conclusion Tramadol shows equal analgesic effect to bupivacaine and decreases additional analgesic requirement, when used for preincisional infiltration anesthesia in children undergoing inguinal herniorrhaphy. PMID:25285011

  14. Cecal volvulus in giant ventral hernia

    PubMed Central

    Reznichenko, Aleksandr A.; Macaluso, Frank; Zulim, Rebecca

    2015-01-01

    Introduction Colonic volvulus is the third leading cause of the colonic obstruction with cecal volvulus accounting for approximately 40% of all colonic volvulus. Lack of peritonealization of the right colon, adhesions from prior surgery, colonic atony, and distal colonic obstruction are potential risks factors for the development of cecal volvulus. Prersentation of the case 63 year old male with history of multiple prior intraabdominal surgeries and recurrent ventral hernia. Presented with colon perforation, as a result of cecal volvulus, which was contained in a giant ventral hernia. Diagnosis of cecal volvulus was suspected based on preoperative imaging studies, and confirmed in the OR. Patient underwent damage control procedure with subsequent challenging abdominal wall closure. Discussion Axial cecal volvulus and cecal bascule are representing two types of cecal volvulus. Both of these types require a mobile cecum and presence of right colon to occur. It is generally accepted, that mobile cecum is a congenital condition, but in certain situations, particularly after prior intraabdominal surgeries, cecum may lose fixation points and potentially become vulnerable to twisting. This patient with long history of large recurrent ventral hernia had mobile cecum inside the hernia sac and developed cecal volvulus. Conclusion We present a unique case of cecal volvulus in giant ventral hernia after multiple prior intraabdominal surgeries. Challenges in management of this exceptionally difficult patient were discussed. Large ventral hernia with mobile cecum inside hernia sac is a risk factor for cecal volvulus. PMID:25797352

  15. [Treatment of inguinal hernia in a difficult environment: feasibility and efficacy of ilioinguinal and iliohypogastric blocks].

    PubMed

    Goutorbe, P; Lacroix, G; Pauleau, G; Daranda, E; Goin, G; Bordes, J; Meaudre, E; Balandraud, P

    2013-05-01

    Hernia repair is a very frequent surgical procedure; it is estimated that one African in five undergoes this procedure during his lifetime. Patients and methods. We evaluated the feasibility of this surgery under ilioinguinal and iliohypogastric nerve blocks in difficult environments. The medical-surgical group supporting Operation Unicorn has treated 48 inguinal hernias as medical aid to population, including 34 with these nerve blocks. Results. The block did not fail in any case. The mean time until discharge was 6.85 h, which meant that outpatient surgery was possible. Discussion and conclusion. This type of anesthesia is interesting in difficult environments. It is a safe, inexpensive, and easy to learn technique. These qualities should promote its use in countries with a low GNP. PMID:23803581

  16. Advances in the surgical approach to congenital diaphragmatic hernia.

    PubMed

    Zani, Augusto; Zani-Ruttenstock, Elke; Pierro, Agostino

    2014-12-01

    Congenital diaphragmatic hernia is a birth defect that affects about one in 2500 live births. Although the overall survival has improved over the last several decades thanks to advancements in postnatal resuscitation and intensive care treatment, morbidity and mortality remain high. The surgical management of these infants is far from being standardized, and many aspects are still disputed among experts. The timing of surgical repair remains controversial and the indications for the ideal time for surgery have not been validated. The main novelty in the surgical treatment is related to the use of minimally invasive techniques, although these have been associated with intraoperative blood gas disturbances and higher recurrence rates. Herein, we report and comment on the main controversies of postnatal CDH repair in this rapidly evolving field. PMID:25447986

  17. Small Bowel Obstruction Secondary to Interstitial Hernia: Laparoscopic Approach

    PubMed Central

    Alvarez Gallesio, J. M.; Schlottmann, F.; Sadava, E. E.

    2015-01-01

    Interstitial hernias are a rare entity. Most of them are detected incidentally on imaging studies. We present a case of abdominal bowel obstruction secondary to interstitial hernia on the fifth postoperative day of an open incisional hernia repair. Laparoscopy confirmed the diagnosis and led to an accurate treatment avoiding a new laparotomy. In this case, prompt surgical decision based on clinical and CT scan findings allowed a mini-invasive approach with satisfactory outcome. PMID:26576315

  18. Laparoscopic totally extraperitoneal repair without suprapubic port: comparison with conventional totally extraperitoneal repair

    PubMed Central

    Kwon, Ki-Hwak; Han, Won-Kon

    2011-01-01

    Purpose We have treated 24 patients through laparoscopic totally extraperitoneal (TEP) repair without suprapubic port by using reliability and reducing the invasiveness of two surgery. This study is aimed to assess the safety and feasibility of the TEP repair without suprapubic port compared to conventional TEP repair. Methods From September 2007 to 11 May 2010, we compared two groups that suffer from inguinal hernias. One is comprised of 24 patients who were treated without suprapubic port laparoscopic totally extraperitoneal repair (Group A), and the other is comprised of 100 patients who were treated with conventional laparoscopic totally extraperitoneal repair (Group B). Data regarding patient demographics (sex, age, site of hernia, and the type of hernia), operating time, postoperative hospital stay, the use of analgesics, and complications were prospectively collected. Results There was no significant difference noted between two groups in relation to sex, age, site, and the type of hernia. The mean operating time and postoperative hospital stay was longer for the Group B (62.9 minutes, 3.55 days) than for the Group A (59.0 minutes, 2.54 days) (P = 0.389, P < 0.001). Postoperative urinary retention, seroma, wound infection were respectively 4.2%, 8.3%, 0% in Group A, and 12.0%, 8.0%, 7% in group B. There was difference between the two groups, but not statistical significance. Group B used more analgesics than Group A (0.33 vs. 0.48), but it wasn't significant statistically (P = 0.234). Conclusion Although prospective randomized studies with long-term follow-up evaluation are needed to confirm our study between laparoscopic totally extraperitoneal repair without suprapubic-port and conventional laparoscopic totally extraperitoneal repair, our method have some advantages in postoperative pain, urinary retention, operating time, postoperative hospital stay, and cosmetic effect. PMID:22066055

  19. Management of a giant inguinoscrotal hernia with an ulcerated base in a patient with cardiac disease

    PubMed Central

    Turner, E Jane H; Malhas, Amar; Chisti, Imran; Oke, Tayo

    2010-01-01

    Giant inguinal herniae pose a surgical challenge, though not uncommon in the developing world they are a rare presentation in the UK. We present a patient with cardiac disease who presented with a giant inguino-scrotal hernia complicated by a bleeding scrotal ulcer. We describe his medical management and the surgical repair of the hernia and refashioning of his scrotum. PMID:24946352

  20. How has robotic repair changed the landscape of mitral valve surgery?

    PubMed

    Taggarse, Amit K; Suri, Rakesh M; Daly, Richard C

    2015-07-01

    The introduction of robotic technology has revolutionized the performance of certain cardiac surgical procedures such as mitral valve (MV) repair. The foundation of modern MV repair was laid by Dr. Dwight C. McGoon in 1958. The operation was first performed with robotic assistance by Carpentier in 1998 using rudimentary motion-assisted equipment. Today, four generations later, telemanipulation technology enables surgeons to carry out all known methods of MV repair traditionally performed by conventional sternotomy; utilizing tiny port access incisions to safely and reliably eliminate mitral regurgitation. Extubation in the operating room following robotic MV repair is now routine and its benefits are well-documented, including transfer to the step-down from the intensive care unit several hours after surgery. This, in turn, translates into diminished usage of blood products, decreased need for pain medication, earlier dismissal from hospital, more rapid return to work and improved patient satisfaction. In addition, smaller, more cosmetically appealing scars and comparable short and mid-term outcomes of robotic and open MV repair have made the robotic approach a preferred option for many patients who meet appropriate safety criteria. As these procedures become more commonplace in large structural heart practices, it is important to reflect upon how the robotic approach has changed the landscape of MV surgery. We discuss the evolution and current status of robotic MV repair founded upon the principles of safe and effective open mitral valvuloplasty techniques. We will explore the potential of the robotic platform to improve both early referral and patient acceptance of interventions to eliminate severe degenerative mitral regurgitation. PMID:26309846

  1. How has robotic repair changed the landscape of mitral valve surgery?

    PubMed Central

    Taggarse, Amit K.; Daly, Richard C.

    2015-01-01

    The introduction of robotic technology has revolutionized the performance of certain cardiac surgical procedures such as mitral valve (MV) repair. The foundation of modern MV repair was laid by Dr. Dwight C. McGoon in 1958. The operation was first performed with robotic assistance by Carpentier in 1998 using rudimentary motion-assisted equipment. Today, four generations later, telemanipulation technology enables surgeons to carry out all known methods of MV repair traditionally performed by conventional sternotomy; utilizing tiny port access incisions to safely and reliably eliminate mitral regurgitation. Extubation in the operating room following robotic MV repair is now routine and its benefits are well-documented, including transfer to the step-down from the intensive care unit several hours after surgery. This, in turn, translates into diminished usage of blood products, decreased need for pain medication, earlier dismissal from hospital, more rapid return to work and improved patient satisfaction. In addition, smaller, more cosmetically appealing scars and comparable short and mid-term outcomes of robotic and open MV repair have made the robotic approach a preferred option for many patients who meet appropriate safety criteria. As these procedures become more commonplace in large structural heart practices, it is important to reflect upon how the robotic approach has changed the landscape of MV surgery. We discuss the evolution and current status of robotic MV repair founded upon the principles of safe and effective open mitral valvuloplasty techniques. We will explore the potential of the robotic platform to improve both early referral and patient acceptance of interventions to eliminate severe degenerative mitral regurgitation. PMID:26309846

  2. Quantitative CT Imaging of Ventral Hernias: Preliminary Validation of an Anatomical Labeling Protocol

    PubMed Central

    Xu, Zhoubing; Asman, Andrew J.; Baucom, Rebeccah B.; Abramson, Richard G.; Poulose, Benjamin K.; Landman, Bennett A.

    2015-01-01

    Objective We described and validated a quantitative anatomical labeling protocol for extracting clinically relevant quantitative parameters for ventral hernias (VH) from routine computed tomography (CT) scans. This information was then used to predict the need for mesh bridge closure during ventral hernia repair (VHR). Methods A detailed anatomical labeling protocol was proposed to enable quantitative description of VH including shape, location, and surrounding environment (61 scans). Intra- and inter-rater reproducibilities were calculated for labeling on 18 and 10 clinically acquired CT scans, respectively. Preliminary clinical validation was performed by correlating 20 quantitative parameters derived from anatomical labeling with the requirement for mesh bridge closure at surgery (26 scans). Prediction of this clinical endpoint was compared with similar models fit on metrics from the semi-quantitative European Hernia Society Classification for Ventral Hernia (EHSCVH). Results High labeling reproducibilities were achieved for abdominal walls (±2 mm in mean surface distance), key anatomical landmarks (±5 mm in point distance), and hernia volumes (0.8 in Cohen’s kappa). 9 out of 20 individual quantitative parameters of hernia properties were significantly different between patients who required mesh bridge closure versus those in whom fascial closure was achieved at the time of VHR (p<0.05). Regression models constructed by two to five metrics presented a prediction with 84.6% accuracy for bridge requirement with cross-validation; similar models constructed by EHSCVH variables yielded 76.9% accuracy. Significance Reproducibility was acceptable for this first formal presentation of a quantitative image labeling protocol for VH on abdominal CT. Labeling-derived metrics presented better prediction of the need for mesh bridge closure than the EHSCVH metrics. This effort is intended as the foundation for future outcomes studies attempting to optimize choice of surgical technique across different anatomical types of VH. PMID:26509450

  3. Asymptomatic extraperitoneal inguinoscrotal hernia involving ureter: A case presentation and review of the literature

    PubMed Central

    Falidas, Evangelos; Gourgiotis, Stavros; Veloudis, George; Exarchou, Elena; Vlachos, Konstantinos; Villias, Constantinos

    2015-01-01

    An inguinoscrotal hernia is a common disorder that usually contains intraperitoneal organs (small intestine, colon, appendix, ovaries). Extraperitoneal ureteral herniation into an inguinoscrotal hernia is a rare condition and often associated with congenital abnormalities or postoperative anatomic changes. A high index of suspicion is needed in order to avoid intraoperative ureteric injuries. We herein report the case of a ureteric herniation into an inguinoscrotal hernia incidentally found during a scheduled hernia repair.

  4. Possibilities and limits in the treatment of congenital diaphragmatic hernia

    PubMed Central

    Georgescu, R; Chiu?u, L; Neme?, R; Georgescu, I; Stoica, A; Georgescu, E

    2014-01-01

    Abstract Aim: to establish a therapeutic strategy that will improve the prognosis and increase the survival rate in congenital diaphragmatic hernia. Material and method: 14 congenital diaphragmatic hernias (incidence 1/1597 live births, 12 boys and 2 girls with a sex ratio of 6/1, 10 term infants and 4 preterm first degree, 11 natural births and 3 by caesarean section) admitted to the Clinic of Pediatric Surgery Craiova, in a 5-year period (2007-2012), were analyzed from the therapeutic point of view. The "tension free" primary suture was the main surgical procedure to repair the diaphragmatic defect in all cases, preceded by a period of preoperative resuscitation and stabilization (2.8 days on average). Results: We registered a survival rate of 64.29% and a postoperative mortality rate of 35.71%. Conclusions: delayed surgery preceded by a period of the preoperative respiratory resuscitation and stabilization (24-72 hours on average) significantly reduced postoperative mortality and increased the survival rate. PMID:25408771

  5. Postoperative pain, nausea and vomiting among pre- and postmenopausal women undergoing cystocele and rectocele repair surgery

    PubMed Central

    Abaszadeh, Abolfazl; Yari, Fatemeh; Yousefi, Nazanin

    2015-01-01

    Background Postoperative nausea and vomiting (PONV) and postoperative pain are among the most common side-effects of surgery. Many factors, such as a change in the level of sex hormones, are reported to affect these complications. This study aimed to evaluate the probable effects of the menopause on PONV and postoperative pain. Methods Prospective study, in which a total number of 144 female patients undergoing cystocele or rectocele repair surgery under standardized spinal anesthesia were included. Patients were divided into two equally sized sample groups of pre- and postmenopausal women (n = 72). The occurrence of PONV, the severity of pain as assessed by visual analog scale (VAS) pain score, and the quantity of morphine and metoclopramide required were recorded at 2, 4, 6, 12, 18 and 24 h after surgery. Results The mean VAS pain score and the mean quantity of morphine required was higher among premenopausal women (P = 0.006). Moreover, these patients required more morphine for their pain management during the first 24 h after surgery compared to postmenopausal women (P < 0.0001). No difference was observed between the two groups regarding the incidence of PONV (P = 0.09 and P = 1.00 for nausea and vomiting, respectively) and the mean amount of metoclopramide required (P = 0.38). Conclusions Premenopausal women are more likely to suffer from postoperative pain after cystocele and rectocele repair surgery. Further studies regarding the measurement of hormonal changes among surgical patients in both pre- and postmenopausal women are recommended to evaluate the effects on PONV and postoperative pain. PMID:26634082

  6. Bochdalek Hernia With Gastric Volvulus in an Adult

    PubMed Central

    Atef, Mejri; Emna, Trigui

    2015-01-01

    Abstract Bochdalek hernias in adulthood are rare. Symptomatic Bochdalek hernias in adults are rarer, but may lead to fatal complications. Patients with acute gastric volvulus on diaphragmatic hernia are a diagnostic and therapeutic emergency. Here, we report a case of a 56-year-old woman diagnosed with epigastric pain, cough, vomiting since 2 weeks and shortness of breath. Complicated Bochdalek hernia was an incidental finding, diagnosed by chest radiograph, computed tomography (CT), and barium swallow study. Stomach was within the thorax in the left side due to left diaphragmatic hernia of a nontraumatic cause. The patient was prepared for the laparoscopic surgical repair, to close the defect. The patient recovered with accepted general condition and was discharged 9 days later. Diagnoses of Bochdalek hernias in adulthood are challenging. However, although rare, this possibility should be kept in mind to avoid fatal complications. PMID:26705205

  7. Fatal Diaphragmatic Hernia following Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report and Literature Review

    PubMed Central

    Saito, Tomoko; Chiba, Tetsuhiro; Ogasawara, Sadahisa; Inoue, Masanori; Wakamatsu, Toru; Motoyama, Tenyu; Kanogawa, Naoya; Suzuki, Eiichiro; Ooka, Yoshihiko; Tawada, Akinobu; Matsubara, Hisahiro; Yokosuka, Osamu

    2015-01-01

    An 81-year-old man was admitted to our hospital because of right quadrant abdominal pain. On admission, his liver function was Child-Pugh grade C (10 points). Computed tomography (CT) revealed a diaphragmatic herniation of bowel loops into the right thoracic cavity, accompanied by pleural effusion. Although diaphragmatic hernia was successfully repaired by emergency surgery, he died of liver failure 23 days after the surgery. A retrospective reading of CT images revealed the presence of diaphragmatic injury after radiofrequency ablation (RFA) which had been conducted 33 months before the development of diaphragmatic hernia. Of importance, the lesion of the diaphragmatic injury was located on the estimated needle track of RFA for hepatocellular carcinomas in segment 5 and segment 5/8, but not adjacent to their ablation areas. Subsequently, diaphragmatic perforation had been observed 24 months before admission. This suggests that diaphragmatic hernia caused by RFA is not necessarily due to thermal damage of ablation and is possibly life-threatening, at least in some patients with an impaired liver function. PMID:26120308

  8. Repair and prevention of cerebrospinal fluid leakage in transsphenoidal surgery: a sphenoid sinus mucosa technique.

    PubMed

    Amano, Kosaku; Hori, Tomokatsu; Kawamata, Takakazu; Okada, Yoshikazu

    2016-01-01

    Cerebrospinal fluid (CSF) leakage is a common but sometimes serious complication after transsphenoidal surgery (TSS). To avoid this postsurgical complication, we usually repair the CSF leaking area using an autologous material, such as fat, fascia, or muscle graft and sometimes nasonasal septal flap. In this report, we propose a technique using a novel autologous material, sphenoid sinus mucosa (SSM), to repair intraoperative CSF leakage or prevent it postoperatively. On 26 February 2007, we introduced the technique of using SSM to repair or prevent CSF leakage in TSS. Until 30th of June 2014, we performed 500 TSSs for patients with pituitary or parasellar lesions. They were 195 men and 305 women with a mean age of 48.5 years (range, 5-85 years). We used SSM for patching or suturing the arachnoid laceration or dural defect, in lieu of fat or fascia harvested from abdomen or thigh, or made pedicle flap of SSM instead of nasonasal septal flap to cover the sellar floor. Comparing the previous 539 cases not using these techniques before 26 February 2007, intraoperative CSF leakage increased from 49 to 69.4 % (p?repair intraoperative CSF leaks or prevent them postoperatively in TSS was considered useful, effective, less invasive, easier for graft harvesting (same surgical field), and providing natural anatomical reconstruction, without potential donor site morbidity. We can recommend it as a standard method for CSF leaks repair and prevention in TSS. PMID:26338198

  9. Diaphragmatic hernia repair - series (image)

    MedlinePLUS

    ... The lung tissue on the affected side is compressed, fails to grow normally, and is unable to expand after birth. As the child begins to breathe, cry, and swallow, air enters the intestines that are protruding into the ...

  10. Sports Hernia (Athletic Pubalgia)

    MedlinePLUS

    .org Sports Hernia (Athletic Pubalgia) Page ( 1 ) A sports hernia is a painful, so tissue injury that occurs in ... groin area. It most o en occurs during sports that require sudden changes of direction or intense ...

  11. Hernias (For Parents)

    MedlinePLUS

    ... in the groin area, especially when the child cries, coughs, or stands. Sometimes, in boys, the inguinal ... hernia . It is most obvious when the baby cries, coughs, or strains. Umbilical hernias are more common ...

  12. Outcomes of Acute Type A Dissection Repair Before and After Implementation of a Multidisciplinary Thoracic Aortic Surgery Program

    PubMed Central

    Andersen, Nicholas D.; Ganapathi, Asvin M.; Hanna, Jennifer M.; Williams, Judson B.; Gaca, Jeffrey G.; Hughes, G. Chad

    2014-01-01

    Objectives The purpose of this study was to compare the results of acute type A aortic dissection (ATAAD) repair before and after implementation of a multidisciplinary thoracic aortic surgery program (TASP) at our institution, with dedicated high-volume thoracic aortic surgeons, a multidisciplinary approach to thoracic aortic disease management, and a standardized protocol for ATAAD repair. Background Outcomes of ATAAD repair may be improved when operations are performed at specialized high-volume thoracic aortic surgical centers. Methods Between 1999 and 2011, 128 patients underwent ATAAD repair at our institution. Records of patients who underwent ATAAD repair 6 years before (n = 56) and 6 years after (n = 72) implementation of the TASP were retrospectively compared. Expected operative mortality rates were calculated using the International Registry of Acute Aortic Dissection pre-operative prediction model. Results Baseline risk profiles and expected operative mortality rates were comparable between patients who underwent surgery before and after implementation of the TASP. Operative mortality before TASP implementation was 33.9% and was statistically equivalent to the expected operative mortality rate of 26.0% (observed-to-expected mortality ratio 1.30; p = 0.54). Operative mortality after TASP implementation fell to 2.8% and was statistically improved compared with the expected operative mortality rate of 18.2% (observed-to-expected mortality ratio 0.15; p = 0.005). Differences in survival persisted over long-term follow-up, with 5-year survival rates of 85% observed for TASP patients compared with 55% for pre-TASP patients (p = 0.002). Conclusions ATAAD repair can be performed with results approximating those of elective proximal aortic surgery when operations are performed by a high-volume multidisciplinary thoracic aortic surgery team. Efforts to standardize or centralize care of patients undergoing ATAAD are warranted. PMID:24412454

  13. Mitral Valve Repair

    MedlinePLUS

    ... a Thoracic Surgeon? Adult Cardiac Surgery What is Pediatric Heart Disease? What is Risk Adjustment? Valve Repair/Replacement Surgery Mitral Valve Replacement Aortic Valve Mitral Valve Repair Esophageal Surgery Lung/Thoracic Surgery Aneurysm Surgery Arrhythmia Surgery Other Types of Surgery Clinical ...

  14. Eye muscle repair - discharge

    MedlinePLUS

    ... Lazy eye repair - discharge; Strabismus repair - discharge; Extraocular muscle surgery - discharge ... You or your child had eye muscle repair surgery to correct eye muscle ... term for crossed eyes is strabismus. Children most often ...

  15. Modified Graded Repair of Cerebrospinal Fluid Leaks in Endoscopic Endonasal Transsphenoidal Surgery

    PubMed Central

    Park, Jae-Hyun; Choi, Jai Ho; Kim, Young-Il; Kim, Sung Won

    2015-01-01

    Objective Complete sellar floor reconstruction is critical to avoid postoperative cerebrospinal fluid (CSF) leakage during transsphenoidal surgery. Recently, the pedicled nasoseptal flap has undergone many modifications and eventually proved to be valuable and efficient. However, using these nasoseptal flaps in all patients who undergo transsphenoidal surgery, including those who had none or only minor CSF leakage, appears to be overly invasive and time-consuming. Methods Patients undergoing endoscopic endonasal transsphenoidal tumor surgery within a 5 year-period were reviewed. Since 2009, we classified the intraoperative CSF leakage into grades from 0 to 3. Sellar floor reconstruction was tailored to each leak grade. We did not use any tissue grafts such as abdominal fat and did not include any procedures of CSF diversions such as lumbar drainage. Results Among 200 cases in 188 patients (147 pituitary adenoma and 41 other pathologies), intraoperative CSF leakage was observed in 27.4% of 197 cases : 14.7% Grade 1, 4.6% Grade 2a, 3.0% Grade 2b, and 5.1% Grade 3. Postoperative CSF leakage was observed in none of the cases. Septal bone buttress was used for Grade 1 to 3 leakages instead of any other foreign materials. Pedicled nasoseptal flap was used for Grades 2b and 3 leakages. Unused septal bones and nasoseptal flaps were repositioned. Conclusion Modified classification of intraoperative CSF leaks and tailored repair technique in a multilayered fashion using an en-bloc harvested septal bone and vascularized nasoseptal flaps is an effective and reliable method for the prevention of postoperative CSF leaks. PMID:26279811

  16. Incarcerated Grynfeltt-Lesshaft Hernia

    PubMed Central

    Scheffler, Max; Renard, Julien; Bucher, Pascal; Botsikas, Diomidis

    2015-01-01

    Superior lumbar triangle hernia, also known as Grynfeltt-Lesshaft hernia, denotes a subtype of abdominal wall hernia, and more specifically of lumbar hernia, occurring between the 12th rib, the internal oblique muscle, and the quadratus lumborum muscle. We report the case of a 92-year-old female patient in which this form of hernia occurred, complicated by incarceration and acute bowel obstruction. The discussion contains a short résumé of the different kinds of abdominal wall hernias.

  17. PXL01 in Sodium Hyaluronate for Improvement of Hand Recovery after Flexor Tendon Repair Surgery: Randomized Controlled Trial

    PubMed Central

    Wiig, Monica E.; Dahlin, Lars B.; Fridén, Jan; Hagberg, Lars; Larsen, Sören E.; Wiklund, Kerstin; Mahlapuu, Margit

    2014-01-01

    Background Postoperative adhesions constitute a substantial clinical problem in hand surgery. Fexor tendon injury and repair result in adhesion formation around the tendon, which restricts the gliding function of the tendon, leading to decreased digit mobility and impaired hand recovery. This study evaluated the efficacy and safety of the peptide PXL01 in preventing adhesions, and correspondingly improving hand function, in flexor tendon repair surgery. Methods This prospective, randomised, double-blind trial included 138 patients admitted for flexor tendon repair surgery. PXL01 in carrier sodium hyaluronate or placebo was administered around the repaired tendon. Efficacy was assessed by total active motion of the injured finger, tip-to-crease distance, sensory function, tenolysis rate and grip strength, and safety parameters were followed, for 12 months post-surgery. Results The most pronounced difference between the treatment groups was observed at 6 months post-surgery. At this timepoint, the total active motion of the distal finger joint was improved in the PXL01 group (60 vs. 41 degrees for PXL01 vs. placebo group, p?=?0.016 in PPAS). The proportion of patients with excellent/good digit mobility was higher in the PXL01 group (61% vs. 38%, p?=?0.0499 in PPAS). Consistently, the PXL01 group presented improved tip-to-crease distance (5.0 vs. 15.5 mm for PXL01 vs. placebo group, p?=?0.048 in PPAS). Sensory evaluation showed that more patients in the PXL01 group felt the thinnest monofilaments (FAS: 74% vs. 35%, p?=?0.021; PPAS: 76% vs. 35%, p?=?0.016). At 12 months post-surgery, more patients in the placebo group were considered to benefit from tenolysis (30% vs. 12%, p?=?0.086 in PPAS). The treatment was safe, well tolerated, and did not increase the rate of tendon rupture. Conclusions Treatment with PXL01 in sodium hyaluronate improves hand recovery after flexor tendon repair surgery. Further clinical trials are warranted to determine the most efficient dose and health economic benefits. Trial Registration ClinicalTrials.gov NCT01022242; EU Clinical Trials 2009-012703-25. PMID:25340801

  18. Use of the Hadad-Bassagasteguy flap for repair of recurrent cerebrospinal fluid leak after prior transsphenoidal surgery

    PubMed Central

    Brunworth, Joseph; Lin, Tina; Keschner, David B.; Garg, Rohit

    2013-01-01

    The Hadad-Bassagasteguy vascularized nasoseptal pedicled flap (HBF) is an effective technique for reconstruction of skull base defects with low incidence of postoperative cerebrospinal fluid (CSF) leak. Advanced planning is required as posterior septectomy during transsphenoidal surgery can preclude its use due to destruction of the vascular pedicle. We present four cases in which the HBF was successfully used to repair recurrent CSF leaks despite prior posterior septectomy and transsphenoidal surgery. A retrospective chart review was performed on all patients who developed recurrent CSF leak after transsphenoidal surgery over a 7-year period (2006–2013). Data were collected regarding demographics, clinical presentation, intraoperative findings, and surgical outcomes. Four patients who developed recurrent CSF drainage after transsphenoidal surgery were managed with HBF reconstruction during the study period. Two were men and two were women with a mean age of 37 years (range, 24–48 years). All had previously undergone resection of a pituitary macroadenoma via a transsphenoidal approach, with intraoperative CSF leaks repaired using multilayered free grafts. Recurrent CSF rhinorrhea arose 0.37–12 months (mean, 2.98 months) after the initial pituitary surgery. Active CSF drainage could be visualized intraoperatively with posterior septal perforations present. The HBF was successfully used in all cases, with no evidence of recurrent CSF leak after a mean follow-up of 2.35 years. The HBF may be salvaged for repair of recurrent CSF leaks even in the context of prior posterior septectomy and transsphenoidal surgery. However, longer follow-up is necessary to determine the long-term efficacy of this procedure in such revision cases. PMID:24498521

  19. Pediatric heart surgery - discharge

    MedlinePLUS

    Congenital heart surgery - discharge; Patent ductus arteriosus ligation - discharge; Hypoplastic left heart repair - discharge; Tetralogy of Fallot repair - discharge; Coarctation of the aorta repair - discharge; ...

  20. Bladder exstrophy repair

    MedlinePLUS

    Bladder birth defect repair; Everted bladder repair; Exposed bladder repair; Repair of bladder exstrophy ... in boys and is often linked to other birth defects. Surgery is necessary to: Allow the child to ...

  1. Evaluation of the cranial cruciate ligament repair system(®) in surgery for laryngeal hemiplegia in heavy draft horses.

    PubMed

    Sasaki, Naoki; Morita, Yoshinori; Moriyama, Tomoe; Yamada, Haruo

    2009-01-01

    The purpose of this study was to evaluate the effect of the canine cranial cruciate ligament repair system on laryngeal hemiplegia in heavy draft horses. Twenty-four heavy draft horses diagnosed with grade 4 laryngeal hemiplegia were allocated to either the prosthetic laryngoplasty (PL) group (n=14) or a canine cranial cruciate ligament repair system (CCCLRS) group (n=10). Right to left angle quotients (RLQs) of abductions of the arytenoid cartilages were endoscopically evaluated before and after surgery. Post-operative RLQs in the CCCLRS group were significantly lower than those of the PL group (P<0.01). The canine cranial cruciate ligament repair system was revealed to be a good surgical procedure for laryngeal hemiplegia in heavy draft horses. PMID:24833966

  2. Patient Satisfaction After Mohs Surgery is not Dependent on Seeing Post-Mohs Defect Prior to Repair

    PubMed Central

    Dabiri, Ganary; Tiger, Jeffrey; Anderson, Heidi

    2015-01-01

    Background: Optimizing patient satisfaction and scar outcomes is important for the practicing Mohs surgeon. Objective: To evaluate whether showing or not showing patients their post-Mohs defect prior to repair influences scar satisfaction. Materials and methods: Fifty patients with a nonmelanoma skin cancer on their head or neck requiring Mohs micrographic surgery were randomized to either see or not see their post-Mohs defect in the mirror prior to repair. Patients evaluated their scar at Week 1 and Week 4 using the patient scar assessment questionnaire. Results: There was no statistically significant difference in the primary (scar satisfaction) or secondary outcomes (wound care compliance and complication rates) between the two groups. Conclusion: There is no difference in patient scar satisfaction whether patients see or do not see their post-Mohs defect prior to repair. PMID:26705438

  3. Fast Absorbing Gut Suture versus Cyanoacrylate Tissue Adhesive in the Epidermal Closure of Linear Repairs Following Mohs Micrographic Surgery

    PubMed Central

    Kim, June; Cool, Alicia J.; Hanlon, Allison M.; Leffell, David J.

    2015-01-01

    Background: Cyanoacrylate topical adhesives and fast absorbing gut sutures are increasingly utilized by dermatologic surgeons as they provide satisfactory surgical outcomes while eliminating an additional patient visit for suture removal. To date, no head-to-head studies have compared the wound healing characteristics of these epidermal closure techniques in the repair of facial wounds after Mohs micrographic surgery. Objective: To compare the cosmetic outcome of epidermal closure by cyanoacrylate topical adhesive with fast absorbing gut suture in linear repairs of the face following Mohs micrographic surgery. Methods: Fourteen patients with wound length greater than 3cm who underwent Mohs micrographic surgery for nonmelanoma skin cancer of the face were enrolled in this randomized right-left comparative study. Following placement of dermal sutures, half of the wound was randomly selected for closure with cyanoacrylate and the contralateral side with fast absorbing gut suture. Using photographs from the three-month postoperative visit, six blinded individuals rated the overall cosmetic outcome. Results: The present study shows no significant difference in cosmetic outcomes between cyanoacrylate and fast absorbing gut suture for closure of linear facial wounds resulting from Mohs micrographic surgery. Cyanoacrylate tissue adhesive may not be as effective in achieving optimal cosmesis for wounds on the forehead or of longer repair lengths. The majority of patients did not have a preference for wound closure techniques, but when a preference was given, cyanoacrylate was significantly favored over sutures. Conclusion: Cyanoacrylate tissue adhesive and fast absorbing gut suture both result in comparable aesthetic outcomes for epidermal closure of linear facial wounds following Mohs micrographic surgery. Consideration should be given to factors such as need for eversion, hemostasis, and wound tension when selecting an epidermal wound closure method. (ClinicalTrials.gov, Identifier: NCT01298167, http://clinicaltrials.gov/show/NCT01298167). PMID:25741400

  4. Atrial Fibrillation Surgery - Maze Procedure

    MedlinePLUS

    ... a Thoracic Surgeon? Adult Cardiac Surgery What is Pediatric Heart Disease? What is Risk Adjustment? Valve Repair/Replacement Surgery Esophageal Surgery Lung/Thoracic Surgery Aneurysm Surgery Arrhythmia Surgery Atrial Fibrillation Surgery - Maze Procedure ...

  5. Resection of Ileoinguinal and Ileohypogastric Nerves Combined with Gluing in Modified Lichtenstein Repair.

    PubMed

    Baer, Andreas; Bohnert, Nicholas; Goretzki, Peter E; Lammers, Bernhard J

    2015-05-01

    We conducted a cohort trial to investigate the relevance of resection of the ilioinguinal and iliohypogastric nerves in combination with mesh fixation with BioGlue™ (CryoLife® Inc., Kennsaw, Georgia) in modified Lichtenstein repair to the development of chronic pain and hernia recurrence.1 In all, 430 patients underwent Lichtenstein repair. In 247 patients the mesh was fixed by means of glue, and in 183 patients it was fixed with conventional sutures. In all cases the inguinal nerves N. ilioinguinalis and N. iliohypogastricus were located and resected after identification to prevent nerve reaction to the mesh. The pain intensity was measured with a numeric analogous scale (NAS) 24 hours after surgery. All complications were recorded with a follow-up of up to 5 years. There was a significantly lower pain intensity level in the gluing group compared with the suture group 24 hours after surgery (0.016 t test). The level was 3.8±2.4 in bilateral hernia and 3.3±2.1 in unilateral hernia in the gluing group. It was 4.7±3.3 in unilateral and 3.7±2.2 in bilateral hernia in the suture group. The cut-suture time was lower in the gluing group. There were no severe pain syndromes (NAS?4) in the gluing group and only 1.1% in the suture group. There was a higher incidence of non-bacterial wound infections in the gluing group (3.6%) than in the suture group (1.1%). The rate of recurrence after 5 years amounted to 2.0% in the gluing group and 2.2% in the suture group. The technique of using BioGlue™ for mesh fixation combined with systematic nerve dissection reduces acute and chronic postoperative pain after modified Lichtenstein repair. Only 2 of 430 patients suffered from severe chronic pain. Combined gluing and systematic resection of the inguinal nerves is more comfortable than standard Lichtenstein repair. PMID:26055002

  6. Left paraduodenal hernia accompanying chylous ascites.

    PubMed

    Yu, Da-Young; Jang, You-Jin; Mok, Young-Jae

    2015-11-01

    Paraduodenal hernia is by far the most common form of congenital internal hernia. Chylous ascites is an accumulation of lymphatic fluid in the peritoneal cavity. It develops when the lymphatic system is disrupted due to traumatic injury or obstruction. A 40-year-old, woman showed up to the Emergency Department with severe, colicky abdominal pain. Tenderness and rebound tenderness were observed at the left abdomen. Abdominal CT confirmed a cluster of dilated proximal small bowel loops with ischemic change, without ascites. The patient underwent an emergency surgery to relieve bowel ischemia. As soon as the peritoneum was exposed, 1.5 L of chylous fluid was found. A hernial sac was found along the posterior side of the mesentery of the inferior mesenteric artery. We resected the hernial sac and pulled out the herniated small bowel. On the sixth day after the surgery, she was discharged without any complication. PMID:26576408

  7. Left paraduodenal hernia accompanying chylous ascites

    PubMed Central

    Yu, Da-Young; Mok, Young-Jae

    2015-01-01

    Paraduodenal hernia is by far the most common form of congenital internal hernia. Chylous ascites is an accumulation of lymphatic fluid in the peritoneal cavity. It develops when the lymphatic system is disrupted due to traumatic injury or obstruction. A 40-year-old, woman showed up to the Emergency Department with severe, colicky abdominal pain. Tenderness and rebound tenderness were observed at the left abdomen. Abdominal CT confirmed a cluster of dilated proximal small bowel loops with ischemic change, without ascites. The patient underwent an emergency surgery to relieve bowel ischemia. As soon as the peritoneum was exposed, 1.5 L of chylous fluid was found. A hernial sac was found along the posterior side of the mesentery of the inferior mesenteric artery. We resected the hernial sac and pulled out the herniated small bowel. On the sixth day after the surgery, she was discharged without any complication. PMID:26576408

  8. Amyand hernia: Case report and review of the literature

    PubMed Central

    Morales-Cárdenas, Adrián; Ploneda-Valencia, César Felipe; Sainz-Escárrega, Victor Hugo; Hernández-Campos, Alvaro Cuauhtemoc; Navarro-Muñiz, Eliseo; López-Lizarraga, Carlos René; Bautista-López, Carlos Alfredo

    2015-01-01

    Introduction Amyand Hernia is a rare disease seen in approximately 1% of all hernias, complications of it, like acute appendicitis, or perforated appendicitis are even more rare, about 0.1%. Its diagnosis is very difficult in the pre-operative period; it is usually an incidental finding. Presentation of case This paper describes the case of a forty-year-old male patient, which was presented to the outpatient clinic of surgery with an incarcerated right side inguinal hernia without any signs of ischemic complications. He was admitted, and an hernioplasty was performed, as an incidental finding we encountered an Amyand hernia treated without appendectomy and placement of a prosthetic mesh without any complications. Discussion This disease represents a very challenging diagnosis, seven years ago the standardization of management had already been established; in this case we encountered a type 1 Amyand's Hernia so we performed a standard tension free hernioplasty without complications. Conclusion Amyand hernia is a rare condition, which represents two of the most common diseases a general surgeon has to face. Standardization of treatment is still ongoing and more prospective studies need to be done. This case demonstrates that this pathology must remain in the mind of the surgeons especially in the event of a strangulated hernia and offer a comprehensive review. PMID:25941568

  9. Hypospadias Repair: A Single Centre Experience

    PubMed Central

    Majeed, Abdul; Ullah, Hidayat; Naz, Shazia; Shah, Syed Asif; Tahmeed, Tahmeedullah; Yousaf, Kanwal; Tahir, Muhammad

    2014-01-01

    Objectives. To determine the demographics and analyze the management and factors influencing the postoperative complications of hypospadias repair. Settings. Hayatabad Medical Complex Peshawar, Pakistan, from January 2007 to December 2011. Material and Methods. All male patients presenting with hypospadias irrespective of their ages were included in the study. The data were acquired from the hospital's database and analyzed with Statistical Package for Social Sciences (SPSS). Results. A total of 428 patients with mean age of 8.12 ± 5.04 SD presented for hypospadias repair. Midpenile hypospadias were the most common. Chordee, meatal abnormalities, cryptorchidism, and inguinal hernias were observed in 74.3%, 9.6%, 2.8%, and 2.1% cases, respectively. Two-stage (Bracka) and TIP (tubularized incised urethral plate) repairs were performed in 76.2% and 20.8% of cases, respectively. The most common complications were edema and urethrocutaneous fistula (UCF). The complications were significantly lower in the hands of specialists than residents (P-value = 0.0086). The two-stage hypospadias repair resulted in higher complications frequency than single-stage repair (P value = 0.0001). Conclusion. Hypospadias surgery has a long learning curve because it requires a great deal of temperament, surgical skill and acquaintance with magnifications. Single-stage repair should be encouraged wherever applicable due to its lower postoperative complications. PMID:24579043

  10. Traumatic diaphragmatic hernia in a clinically normal dog.

    PubMed Central

    Litman, L M

    2001-01-01

    A 3.5-year-old border collie was presented for routine ovariohysterectomy. A preoperative physical examination revealed no abnormalities, but, under anesthesia, the patient became dyspneic and cyanotic. Plain radiography indicated the presence of a diaphragmatic hernia. The herniated structures were returned to the abdomen and the diaphragmatic defect was surgically repaired. Images Figure 1. PMID:11467188

  11. Right congenital diaphragmatic hernia a well-known pathology?

    PubMed

    Daher, P; Zeidan, S; Azar, E; Khoury, M; Melki, I; Mikhael, R

    2003-06-01

    In right congenital diaphragmatic hernia (RCDH), several clinical diagnostic pitfalls are possible and should be known to those caring for infants and children with this disorder. The records of the 18 patients at Hotel Dieu de France Hospital with a history of CDH between 1990 and 1999 were collected; those of the ten who had a RCDH were reviewed retrospectively. The mean age at diagnosis was 6 months; the male-to-female ratio was 2:3. The delay between the first symptom and the diagnosis ranged between 0 and 10.5 months (mean 4.5 months). An acute presentation was observed in four cases, consisting of respiratory distress in three; the 4th presented with gastric volvulus and intestinal obstruction. The presenting symptoms were mild in four cases; recurrent respiratory infections in three and failure to thrive in one. The diagnosis was incidental in two cases during the evaluation of respiratory symptoms attributed to an atrial septal defect. The radiologic findings provided by a chest radiograph (CxR) were sufficient to make an accurate diagnosis in eight cases and peritoneography was useful in one. In six cases, the presenting CxR had been misinterpreted as normal or acute lobar pneumonia. Pathologic findings at surgery consisted of lateral and posterior right diaphragmatic defects in nine cases; the defect was lateral and anterior in one. A hernia sac was found in seven cases; malrotation was present in three. Surgical correction was done by an abdominal approach in nine cases and a thoracic approach in one. The diaphragmatic defect was repaired by transverse closure in six cases, diaphragm plication in three and prosthetic closure in one. The postoperative outcome was uneventful in eight cases. Two patients died. Thus, RCDH seems to cause less severe symptoms than left-sided LCDH. It usually manifests beyond the neonatal period as respiratory or gastrointestinal symptoms. The diagnosis should be made easily by a CxR. The presence of a hernia sac correlated with a mild presentation. An abdominal surgical approach is preferred. PMID:12695919

  12. Symptomatic Right-Sided Diaphragmatic Hernia in the Third Trimester of Pregnancy

    PubMed Central

    Pollock, Graham; Moore, B. Todd; Serrone, Rosemarie

    2013-01-01

    Background: Laparoscopic repair of incarcerated diaphragmatic hernias is widely recognized as both safe and effective. However, symptomatic diaphragmatic hernias encountered in the setting of pregnancy, while rare, present a significant surgical challenge. Furthermore, right-sided diaphragmatic hernias account for only 13% of cases. Here, we present a case in which a symptomatic, posterior right-sided diaphragmatic hernia, presenting in the later stages of pregnancy, was successfully repaired using a laparoscopic approach. Methods: Our patient is a 42-y-old gravid woman who, at 27 wk gestation, was admitted to the gynecology service with a 2-d history of right upper quadrant abdominal pain, right shoulder pain, abdominal distension, and obstipation. Results: Computed tomography of the chest demonstrated an incarcerated right diaphragmatic hernia. Surgical consultation was obtained, and the patient was taken to the operating room urgently for repair. Intraoperatively, the cecum was reduced and the diaphragm repaired primarily using a laparoscopic approach. The patient recovered well and was discharged home on postoperative day 8 with no complications to the patient or the pregnancy. Conclusion: Laparoscopic reduction and repair of symptomatic incarcerated diaphragmatic hernia can be safely performed in the third trimester of pregnancy. PMID:23925038

  13. Effects of nasal septum perforation repair surgery on three-dimensional airflow: an evaluation using computational fluid dynamics.

    PubMed

    Nomura, Tsutomu; Ushio, Munetaka; Kondo, Kenji; Yamasoba, Tatsuya

    2015-11-01

    The purpose of this research is to determine the cause of nasal perforation symptoms and to predict post-operative function after nasal perforation repair surgery. A realistic three-dimensional (3D) model of the nose with a septal perforation was reconstructed using a computed tomography (CT) scan from a patient with nasal septal defect. The numerical simulation was carried out using ANSYS CFX V13.0. Pre- and post-operative models were compared by their velocity, pressure gradient (PG), wall shear (WS), shear strain rate (SSR) and turbulence kinetic energy in three plains. In the post-operative state, the crossflows had disappeared, and stream lines bound to the olfactory cleft area had appeared. After surgery, almost all of high-shear stress areas were disappeared comparing pre-operative model. In conclusion, the effects of surgery to correct nasal septal perforation were evaluated using a three-dimensional airflow evaluation. Following the surgery, crossflows disappeared, and WS, PG and SSR rate were decreased. A high WS.PG and SSR were suspected as causes of nasal perforation symptoms. PMID:25503100

  14. State of the Art: MR Imaging after Knee Cartilage Repair Surgery.

    PubMed

    Guermazi, Ali; Roemer, Frank W; Alizai, Hamza; Winalski, Carl S; Welsch, Goetz; Brittberg, Mats; Trattnig, Siegfried

    2015-10-01

    Cartilage injuries are common, especially in athletes. Because these injuries frequently affect young patients, and they have the potential to progress to osteoarthritis, treatment to alleviate symptoms and delay joint degeneration is warranted. A number of surgical techniques are available to treat focal chondral defects, including marrow stimulation, osteochondral auto- and allografting, and autologous chondrocyte implantation. Although arthroscopy is considered the standard of reference for the evaluation of cartilage before and after repair, it is invasive with associated morbidity and cannot adequately depict the deep cartilage layer and underlying bone. Magnetic resonance (MR) imaging provides unparalleled noninvasive assessment of the repair site and all other joint tissues. MR observation of cartilage repair tissue is a well-established semiquantitative scoring system for repair tissue that has primarily been used in clinical research studies. The cartilage repair osteoarthritis knee score (CROAKS) optimizes comprehensive morphologic assessment of the knee joint after cartilage repair. Furthermore, quantitative, compositional MR imaging measurements (eg, T2, T2*, T1?), delayed gadolinium-enhanced MR imaging of cartilage (dGEMRIC), and sodium imaging are available for biochemical assessment. These quantitative MR imaging techniques help assess collagen content and orientation, water content, and glycosaminoglycan and/or proteoglycan content both in the repair tissue as it matures and in the "native" cartilage. In this review, the authors discuss the principles of state-of-the-art morphologic and compositional MR imaging techniques for imaging of cartilage repair and their application to longitudinal studies. (©) RSNA, 2015 Online supplemental material is available for this article. PMID:26402492

  15. Prosthetic patch stabilization of crural repair in antireflux surgery in children.

    PubMed

    Simpson, B; Ricketts, R R; Parker, P M

    1998-01-01

    Nissen fundoplication is a frequently performed procedure by pediatric surgeons for the treatment of gastroesophageal reflux. Reoperation for failed fundoplication is necessary in 10 per cent of children and in 25 per cent of neurologically impaired children. In an attempt to reduce the postoperative recurrence of gastroesophageal reflux and wrap herniation, we have modified our Nissen fundoplication by reinforcing the crural repair with a horseshoe-shaped prosthetic patch. Between 1993 and 1995, 38 children underwent a Nissen fundoplication with prosthetic patch crural repair. Tension-free crural repair was performed over an esophageal dilator by suturing a horseshoe-shaped Dacron patch posterior to the esophagus. After crural repair, the standard Nissen 360 degrees wrap was constructed. Of the 38 children, 56 per cent (n = 21) were neurologically impaired. In 18 per cent of patients, the operation was performed for recurrent reflux due to wrap herniation after a Nissen fundoplication without prosthetic patch repair. One child required esophageal dilatation postoperatively for dysphagia related to esophageal stenosis. After a mean follow-up of 15 months, all patients were without symptomatic reflux or had no radiographic evidence of recurrent reflux or wrap herniation. Tension-free crural repair with a prosthetic patch may decrease postoperative reflux and wrap herniation, particularly in neurologically impaired children and in children requiring reoperation for recurrent reflux. PMID:9457040

  16. Cartilage Repair Surgery: Outcome Evaluation by Using Noninvasive Cartilage Biomarkers Based on Quantitative MRI Techniques?

    PubMed Central

    Jungmann, Pia M.; Baum, Thomas; Bauer, Jan S.; Karampinos, Dimitrios C.; Link, Thomas M.; Li, Xiaojuan; Trattnig, Siegfried; Rummeny, Ernst J.; Woertler, Klaus; Welsch, Goetz H.

    2014-01-01

    Background. New quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as outcome measures after cartilage repair. Objective. To review the current literature on the use of quantitative MRI biomarkers for evaluation of cartilage repair at the knee and ankle. Methods. Using PubMed literature research, studies on biochemical, quantitative MR imaging of cartilage repair were identified and reviewed. Results. Quantitative MR biomarkers detect early degeneration of articular cartilage, mainly represented by an increasing water content, collagen disruption, and proteoglycan loss. Recently, feasibility of biochemical MR imaging of cartilage repair tissue and surrounding cartilage was demonstrated. Ultrastructural properties of the tissue after different repair procedures resulted in differences in imaging characteristics. T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), and diffusion weighted imaging (DWI) are applicable on most clinical 1.5?T and 3?T MR scanners. Currently, a standard of reference is difficult to define and knowledge is limited concerning correlation of clinical and MR findings. The lack of histological correlations complicates the identification of the exact tissue composition. Conclusions. A multimodal approach combining several quantitative MRI techniques in addition to morphological and clinical evaluation might be promising. Further investigations are required to demonstrate the potential for outcome evaluation after cartilage repair. PMID:24877139

  17. Strangulated obturator hernia - an unusual presentation of intestinal obstruction.

    PubMed

    Zeeshan, Saqib; Muhammad, Khalid; Chughtai, Jehanzeb; Ademola, Moses; Masood, Aqsa; Johnston, Sean

    2009-09-01

    An 81-year-old Caucasian emaciated female presented with 3 days history of colicky abdominal pain nausea, projectile vomiting and abdominal distension. A pre-operative diagnosis of mechanical bowel obstruction was made. The absence of characteristic clinical signs in this thin elderly woman with a small bowel obstruction failed to provide a pre-operative diagnosis. She underwent a midline laparotomy and resection and anastomosis of small bowel and repair of the strangulated right obturator hernia. The high mortality rate associated with this type of abdominal hernias requires a high index of suspicion to facilitate rapid diagnosis and prompt surgical intervention if the survival rate is to be improved. PMID:19728946

  18. Meckel's diverticulum incarcerated in a transmesocolic internal hernia

    PubMed Central

    Wu, Si-Yuan; Ho, Meng-Hsing; Hsu, Sheng-Der

    2014-01-01

    Intestinal obstruction is a common complication associated with Meckel’s diverticulum in adults. The diverticulum itself or its fibrous band can lead to an intestinal volvulus, intussusceptions, or closed-loop obstructions, which require surgery. The incarceration of Meckel’s diverticulum in either inguinal or femoral hernia sacs (Littre’s hernia) is another, less common, etiology underlying intestinal obstruction. This case report describes a 45-year-old man who had an obstruction associated with a Meckel’s diverticulum that passed through a congenital defect in the mesocolon into the right subphrenic space. The patient, who had not undergone abdominal surgery previously, came to the emergency room with acute onset of intermittent epigastric pain and abdominal distention. Computed tomography images showed the presence of a segment of the small bowel and a diverticulum in the right subphrenic space and paracolic gutter. The twisted mesentery and the dilated loops of the proximal small bowel were indicative of an intestinal volvulus and obstruction. Meckel’s diverticulum complicated by a transmesocolic internal hernia was diagnosed, and this condition was confirmed during emergency surgery. The patient’s postoperative recovery was uneventful. This case report highlights another presentation of Meckel’s diverticulum, that is, in combination with a transmesocolic internal hernia. This etiology may lead to an intestinal volvulus and necessitate early surgery. PMID:25309093

  19. Designing innovative retractors and devices to facilitate mitral valve repair surgery

    PubMed Central

    Yozu, Ryohei

    2015-01-01

    Various devices have been developed to facilitate mitral valve surgery, including those that improve mitral valve exposure and assist surgeons with associated procedures. Choosing appropriate supporting devices when performing minimally invasive mitral valve surgery (MIMVS) through a minithoracotomy with endoscopic assistance is critical. Depending on the surgeon’s preference, trans-thoracic or trans-working-port left atrial retractors can be utilized. Although the trans-thoracic retractors provide a simple and orderly working space around the minithoracotomy working port, the positioning of the shaft is difficult and there is an implicit risk of chest wall bleeding. On the other hand, the trans-working-port type provides excellent exposure, is easily handled and manipulated, and facilitates surgeries involving various anatomical structures without special training. A great deal of understanding and knowledge about retractors is necessary to achieve the optimal exposure required to facilitate surgical techniques, and to maintain a reproducible and safe surgical system during mitral valve surgery. PMID:26309847

  20. Hemostasis and other benefits of fibrin sealants/glues in spine surgery beyond cerebrospinal fluid leak repairs

    PubMed Central

    Epstein, Nancy E.

    2014-01-01

    Background: Fibrin sealants (FS)/glues (FG) are primarily utilized in spinal surgery to either strengthen repairs of elective (e.g., intradural tumors/pathology) or traumatic cerebrospinal fluid (CSF) fistulas. Here, additional roles/benefits of FS/FG in spine surgery are explored; these include increased hemostasis, reduction of scar, reduction of the risk of infection if impregnated with antibiotics, and its application to restrict diffusion and limit some of the major complications attributed to the controversial “off-label” use of bone morphogeneitc protein (rhBMP-2/INFUSE). Methods: We reviewed multiple studies, focusing not just on the utility of FS/FG in the treatment of CSF fistulas, but on its other applications. Results: FS/FG have been primarily used to supplement elective/traumatic dural closure in spinal surgery. However, FS/FG also contribute to; hemostasis, reducing intraoperative/postoperative bleeding/transfusion requirements, length of stay (LOS)/costs, reduced postoperative scar/radiculitis, and infection when impregnated with antibiotics. Nevertheless, one should seriously question whether FS/FG should be applied to prevent diffusion and limit major complications attributed to the “off-label” use of BMP/INFUSE (e.g., limit/prevent heterotopic ossification, dysphagia/respiratory decompensation, and new neurological deficits). Conclusions: FS/FG successfully supplement watertight dural closure following elective (e.g., intradural tumor) or traumatic CSF fistulas occurring during spinal surgery. Additional benefits include: intraoperative hemostasis with reduced postoperative drainage, reduced transfusion requirements, reduced LOS, cost, scar, and prophylaxis against infection (e.g., impregnated with antibiotics). However, one should seriously question whether FS/FG should be used to contain the diffusion of BMP/INFUSE and limit its complications when utilized “off-label”. PMID:25289150

  1. Recurrent Congenital Diaphragmatic Hernia in Ehlers-Danlos Syndrome

    SciTech Connect

    Lin, I.C.; Ko, S.F.; Shieh, C.S.; Huang, C.F.; Chien, S.J.; Liang, C.D.

    2006-10-15

    Ehlers-Danlos syndrome (EDS) includes a group of connective tissue disorders with abnormal collagen metabolism and a diverse clinical spectrum. We report two siblings with EDS who both presented with congenital diaphragmatic hernia (CDH). The elder sister suffered from recurrent diaphragmatic hernia twice and EDS was overlooked initially. Echocardiography as well as contrast-enhanced magnetic resonance angiography (MRA) showed dilatation of the pulmonary artery, and marked elongation and tortuosity of the aorta and its branches. A diagnosis of EDS was eventually established when these findings were coupled with the clinical features of hyperelastic skin. Her younger brother also had similar features. This report emphasizes that EDS may present as CDH in a small child which could easily be overlooked. Without appropriate surgery, diaphragmatic hernia might occur. Echocardiographic screening is recommended in patients with CDH. Contrast-enhanced MRA can be helpful in delineation of abnormally tortuous aortic great vessels that are an important clue to the early diagnosis of EDS.

  2. Synthetic bioabsorbable hernia plug for plug and patch inguinal herniorrhaphy implantation technique.

    PubMed

    Doerhoff, Carl

    2012-12-01

    New products have led the way in advancements of inguinal hernia repair. None is more impressive than the evolution of the plug patch. In 1968 Irving Lichtenstein introduced the first Marlex mesh plug repair when he rolled a piece of flat polypropylene into the shape of a cigarette to fill a femoral defect. He later expanded his use of the "cigarette plug" to repair recurrent hernias. Today, a wide array of mesh plugs, ranging from nonabsorbable to partially and fully absorbable biomaterials, are available from manufacturers. While some surgeons have used the plug alone for repair, most believe the overlay patch is of greater importance for the durability of the repair. With larger overlays, it is questionable whether a plug should be a permanent, nonabsorbable material. Heavyweight plugs have been reported to erode, migrate, or cause vocational-limiting inguinodynia. Using a fully absorbable plug in inguinal hernia repair minimizes the risk of these complications. This article focuses on the technical refinements associated with using the completely absorbable GORE BIO-A Hernia Plug (W.L. Gore & Associates, Inc, Elkton, MD) in combination with macroporous polypropylene or polyester. Additionally, this paper describes the use of GORE BIO-A Tissue Reinforcement as an alternative for repair following removal of prior polypropylene plug-patch herniorrhaphy that cause inguinodynia. PMID:23109070

  3. Amyand's Hernia: Rare Presentation of a Common Ailment

    PubMed Central

    Singhal, Sanjeev; Singhal, Anu; Negi, Sanjay Singh; Tugnait, Rahul; Arora, Pankaj Kumar; Tiwari, Bishwanath; Malik, Pawan; Gupta, Lav; Bimal, Amit; Gupta, Abhishek; Gupta, Rahul; Chouhan, Pushkar; Singh, ChandraKant

    2015-01-01

    Inguinal hernia with vermiform appendix as content is known as Amyand's hernia. It is a rare entity but we encountered four cases within six months. A 52-year-old female had high grade fever and evidence of inflammatory pathology involving the ileocaecal region. She was initially managed conservatively and subsequently underwent exploratory laparatomy. The appendix was perforated and herniating in the inguinal canal. Appendectomy was done with herniorrhaphy without mesh placement. A 74-year-old male with bilateral inguinal hernia, of which, the right side was more symptomatic, underwent open exploration. Operative findings revealed a lipoma of the sac and a normal appearing appendix as content. Contents were reduced without appendectomy and mesh hernioplasty was performed. A 63-year-old male with an obstructed right sided hernia underwent emergency inguinal exploration which revealed edematous caecum and appendix as content without any inflammation. Contents were reduced without any resection. Herniorrhaphy was performed without mesh placement. A 66-year-old male with an uncomplicated right inguinal hernia underwent elective surgery. The sac revealed an appendix with adhesions at the neck. Contents were reduced after adhesiolysis and hernioplasty was performed with mesh placement. Emphasis is made to the rarity of disease, variation in presentation, and difference in treatment modalities depending upon the state of appendix. PMID:26576304

  4. Fascial Repair of Laparoscopic Ports with Allis-Hemostat Technique.

    PubMed

    Tavassoli, Alireza; Bagheri, Reza; Feizzadeh, Behzad; Tavassoli, Fatemeh; Barekati, Neusha

    2015-12-01

    Port site hernias are one of the most serious complications associated with laparoscopic surgery. In this study, we present a simple and reliable method for port site closure in laparoscopic surgery. From 2005 to 2011, 500 patients who underwent laparoscopic surgery were enrolled for the study. They were evaluated considering age, sex, indication of laparoscopic surgery, and early and late complications of port site and were followed up at least for 1 year after the surgery. In our study, 180 males and 320 females with mean age of 36 years were enrolled. The most common indication for laparoscopic surgery was cholecystectomy in 320 patients (64 %). There were no early or late complications of port site after surgery. Our method is a new modification of the procedure presented by Spalding. Using Allis forceps and putting it under the fascia seems to be a more suitable technique which facilitates the laparoscopic port repair. We found it to be extremely safe, simple, and easy to teach. PMID:26730002

  5. Quality of inguinal hernia operative reports: room for improvement

    PubMed Central

    Ma, Grace W.; Pooni, Amandeep; Forbes, Shawn S.; Eskicioglu, Cagla; Pearsall, Emily; Brenneman, Fred D.; McLeod, Robin S.

    2013-01-01

    Background Operative reports (ORs) serve as the official documentation of surgical procedures. They are essential for optimal patient care, physician accountability and billing, and direction for clinical research and auditing. Nonstandardized narrative reports are often of poor quality and lacking in detail. We sought to audit the completeness of narrative inguinal hernia ORs. Methods A standardized checklist for inguinal hernia repair (IHR) comprising 33 variables was developed by consensus of 4 surgeons. Five high-volume IHR surgeons categorized items as essential, preferable or nonessential. We audited ORs for open IHR at 6 academic hospitals. Results We audited 213 ORs, and we excluded 7 femoral hernia ORs. Tension-free repairs were the most common (82.5%), and the plug-and-patch technique was the most frequent (52.9%). Residents dictated 59% of ORs. Of 33 variables, 15 were considered essential and, on average, 10.8 ± 1.3 were included. Poorly reported elements included first occurrence versus recurrent repair (8.3%), small bowel viability in incarcerated hernias (10.7%) and occurrence of intraoperative complications (32.5%). Of 18 nonessential elements, deep vein thrombosis prophylaxis, preoperative antibiotics and urgency were reported in 1.9%, 11.7% and 24.3% of ORs, respectively. Repair-specific details were reported in 0 to 97.1% of ORs, including patch sutured to tubercle (55.1%) and location of plug (67.0%). Conclusion Completeness of IHR ORs varied with regards to essential and nonessential items but were generally incomplete, suggesting there is opportunity for improvement, including implementation of a standardized synoptic OR. PMID:24284146

  6. Recurrent inguinal hernia in a preschool girl treated laparoscopically with a preperitoneal transabdominal technique and polypropylene mesh: an alternative in complex cases.

    PubMed

    Weber-Sanchez, A; Weber-Alvarez, P; Garteiz-Martinez, D

    2012-02-01

    We report the case of a 4-year-old girl treated by a laparoscopic transabdominal preperitoneal (TAPP) technique with polypropylene mesh in whom a primary contralateral hernia was found and repaired, closing the orifice with a suture. This 4-year-old female had a medical history of clubfoot treated by surgery during her first year of age, ureteral reimplantation because of stenosis, and laparoscopic cholecystectomy because of hydrocholecystis. She had recurrence 1 year after a conventional inguinal herniorraphy and was treated by the TAPP technique with polypropylene mesh. A primary contralateral hernia was found and repaired, and the orifice was closed with a suture. The child's acceptance of the procedure was good, and the postoperative evolution was uneventful, requiring minimal analgesia in the first 24 h. She was discharged the following day. Two years later, there have been no recurrences, and the girl is developing and carrying out activities in a normal way. The open technique remains the gold standard for hernioplasty in children, but laparoscopy may be an option, and it is possible that in some special cases, the use of mesh to reinforce the inguinal wall using the TAPP technique, although it is controversial, may be justified. PMID:20803043

  7. Early intervention, parastomal hernia and quality of life: a research study.

    PubMed

    North, Jacqui

    Parastomal hernia continues to be a common and distressing problem for stoma patients. But are they preventable? In 2005 and again in 2007, Thompson and Trainor reported that by introducing a simple prevention programme that advised the wearing of support garments for heavy lifting for 1 year after stoma surgery, they significantly reduced the incidence of parastomal hernias. They also found that most of the hernias occurred in the early months after stoma surgery (their intervention programme started 3 months after surgery). The current study builds on Thompson and Trainor's work by introducing an intervention programme at a much earlier stage, with specific advice to wear a lightweight support garment on discharge from hospital in place of normal underwear. Advice was also given about lifting and participants were started on an abdominal exercise programme. Quality of life was monitored at discharge, 3 months, 6 months and 1 year. The results show reduced hernia rates and an increased quality of life for these patients. The aim was to improve on the results of Thompson and Trainor in reducing parastomal hernias, improving quality of life and reducing costs to the NHS through fewer complications associated with hernias, and wasted prescriptions for unused, inappropriate or ill-fitting support wear. PMID:24642768

  8. Traumatic abdominal wall hernia associated with small bowel injury-case report.

    PubMed

    Constantin, Vlad; Carâp, Alexandru; Bobic, Simona; Albu, M?d?lina; Nica, Elvira; Socea, Bogdan

    2015-04-01

    Traumatic abdominal wall hernias (TAWHs) are rare. Their diagnosis is mostly clinical and can be overlooked in the setting of trauma and distracting injuries or they can be misinterpreted as parietal hematomas. Associated lesions can influence decision making regarding time of operation and surgical technique. Our case highlights the management of a high-energy TAWH that associates a small bowel traumatic lesion. Surgical repair of TAWHs should follow general hernia repair principles. Further exploration of surgical options is necessary for a consensus to be reached. PMID:25972687

  9. Retinal detachment repair

    MedlinePLUS

    Retinal detachment repair is eye surgery to place a retina back into its normal position. The retina is ... it. This article describes the repair of rhegmatogenous retinal detachments. These occur due to a hole or tear ...

  10. CONGENITAL DIAPHRAGMATIC HERNIA

    PubMed Central

    Adams, Burton E.

    1954-01-01

    Treatment of congenital diaphragmatic hernia in infants is a matter of semi-emergency and should be done as soon as adequate preparations can be made because sometimes fatal complications develop swiftly. In preoperative preparation there is great advantage in thorough decompression of the abdominal viscera, stomach, bowel and bladder. As to operation, the author believes the abdominal approach has most to recommend it. In the postoperative period, continued gastric suction for a brief time, parenteral administration of fluids and use of a Mistogen tent with a high moist oxygen content will facilitate rapid recovery. ImagesFigure 1. PMID:13209363

  11. Role of conventional radiology and MRi defecography of pelvic floor hernias

    PubMed Central

    2013-01-01

    Background Purpose of the study is to define the role of conventional radiology and MRI in the evaluation of pelvic floor hernias in female pelvic floor disorders. Methods A MEDLINE and PubMed search was performed for journals before March 2013 with MeSH major terms 'MR Defecography' and 'pelvic floor hernias'. Results The prevalence of pelvic floor hernias at conventional radiology was higher if compared with that at MRI. Concerning the hernia content, there were significantly more enteroceles and sigmoidoceles on conventional radiology than on MRI, whereas, in relation to the hernia development modalities, the prevalence of elytroceles, edroceles, and Douglas' hernias at conventional radiology was significantly higher than that at MRI. Conclusions MRI shows lower sensitivity than conventional radiology in the detection of pelvic floor hernias development. The less-invasive MRI may have a role in a better evaluation of the entire pelvic anatomy and pelvic organ interaction especially in patients with multicompartmental defects, planned for surgery. PMID:24267789

  12. The importance of surgeon-reviewed computed tomography for incisional hernia detection: a prospective study.

    PubMed

    Baucom, Rebeccah B; Beck, William C; Holzman, Michael D; Sharp, Kenneth W; Nealon, William H; Poulose, Benjamin K

    2014-07-01

    Patients with incisional hernias or abdominal pain are frequently referred with abdominal computed tomography (CT) scans. The purpose of this study was to determine the sensitivity and specificity of a CT radiology report for the detection of incisional hernias. General surgery patients with a history of an abdominal operation and a recent viewable abdominal CT scan were enrolled prospectively. Patients with a stoma, fistula, or soft tissue infection were excluded. The results of the radiology reports were compared with blinded, surgeon-interpreted CT for each patient. Testing characteristics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. One hundred eighty-one patients were enrolled with a mean age of 54 years. Sixty-eight per cent were women. Hernia prevalence was 55 per cent, and mean hernia width was 5.2 cm. The radiology report had a sensitivity and specificity of 79 per cent and 94 per cent, respectively, for hernia diagnosis. The PPV and NPV were 94 and 79 per cent, respectively. Reliance on the CT report alone underestimates the presence of incisional hernia. Referring physicians should not use CT as a screening modality for detection of hernias. Referral to a surgeon for evaluation before imaging may provide more accurate diagnosis and potentially decrease the cost of caring for this population. PMID:24987907

  13. Unusual Diaphragmatic Hernias Mimicking Cardiac Masses

    PubMed Central

    Kim, Si Hun; Kim, Myoung Gun; Kim, Su Ji; Moon, Jeonggeun; Kang, Woong Chol; Shin, Mi-Seung

    2015-01-01

    Hiatal hernia and Morgagni hernia are sorts of diaphragmatic hernias that are rarely detected on transthoracic echocardiography. Although echocardiographic findings have an important role for differential diagnosis of cardiac masses, we often might overlook diaphragmatic hernia. We report three cases of diaphragmatic hernias having specific features. The first case is huge hiatal hernia that encroaches left atrium with internal swirling flow on transthoracic echocardiography. The second case is a hiatal hernia that encroaches on both atria, incidentally detected on preoperative echocardiography. The third case is Morgagni hernia which encroaches on the right atrium only. So, we need to consider possibility of diaphragmatic hernia when we find a cardiac mass with specific echocardiographic features. PMID:26140154

  14. Congenital Diaphragmatic Hernia

    PubMed Central

    2012-01-01

    Congenital Diaphragmatic Hernia (CDH) is defined by the presence of an orifice in the diaphragm, more often left and posterolateral that permits the herniation of abdominal contents into the thorax. The lungs are hypoplastic and have abnormal vessels that cause respiratory insufficiency and persistent pulmonary hypertension with high mortality. About one third of cases have cardiovascular malformations and lesser proportions have skeletal, neural, genitourinary, gastrointestinal or other defects. CDH can be a component of Pallister-Killian, Fryns, Ghersoni-Baruch, WAGR, Denys-Drash, Brachman-De Lange, Donnai-Barrow or Wolf-Hirschhorn syndromes. Some chromosomal anomalies involve CDH as well. The incidence is < 5 in 10,000 live-births. The etiology is unknown although clinical, genetic and experimental evidence points to disturbances in the retinoid-signaling pathway during organogenesis. Antenatal diagnosis is often made and this allows prenatal management (open correction of the hernia in the past and reversible fetoscopic tracheal obstruction nowadays) that may be indicated in cases with severe lung hypoplasia and grim prognosis. Treatment after birth requires all the refinements of critical care including extracorporeal membrane oxygenation prior to surgical correction. The best hospital series report 80% survival but it remains around 50% in population-based studies. Chronic respiratory tract disease, neurodevelopmental problems, neurosensorial hearing loss and gastroesophageal reflux are common problems in survivors. Much more research on several aspects of this severe condition is warranted. PMID:22214468

  15. Appendicitis in an obturator hernia.

    PubMed

    Camerlinck, Michael; Vanhoenacker, Filip; De Vuyst, Dimitri; Quanten, Inge

    2011-04-01

    We present a case of a 79-year-old female with a history of pain at the right groin for 9 days. Computer tomography of the pelvis showed herniation of the appendix through the obturator canal with a huge abscess surrounding the right hip joint. Laparotomy was performed and histopathology confirmed a perforated necrotic tip of the herniated appendix. An obturator hernia is a rare hernia of the pelvic floor. It is most common in old, emaciated, multiparous women and can cause groin pain with extension to the medial aspect of the thigh. In case of incarceration of bowel, patients also present with obstruction. Isolated incarceration of the appendix, however, does not cause obstruction. The diagnosis of an obturator hernia is often delayed, due to a non-specific clinical presentation. CT scan may offer the clue to the correct diagnosis and should be performed in case of a possible obturator hernia. PMID:20532882

  16. [Indications for laparoscopic treatment of large incisional hernias].

    PubMed

    Dietz, U A; Wiegering, A; Germer, C-T

    2015-04-01

    Hernia surgeons and patients have learned to appreciate the advantages of minimally invasive laparoscopic procedures. After overcoming the early learning curve phase, smaller wound surface areas, shorter operation times and briefer hospital stays have become routine. Severe surgery-related complications are rare. Patients with poor risk profiles (e.g. age >70 years, BMI >30 and nicotine consumption) profit especially from these advantages. This positive picture is clouded, however, by the need for an intraperitoneal mesh and specifically by the unchanged recurrence rate. The latter is not significantly lowered even by laparoscopic intraperitoneal on-lay mesh (laparoscopic IPOM) procedures. The current literature shows that irrespective of surgical technique, e.g. retromuscular mesh or laparoscopic IPOM, the risk profile and size of the hernia defect are independent factors that determine the prognosis for recurrence. While a cure of incisional hernia is no longer the only goal, the new indication scenario has two main goals: (a) for young patients at low risk or in patients for whom functional and morphological reconstruction of the abdominal wall are of primary importance, an open retromuscular mesh procedure is indicated (despite the higher morbidity) and (b) for older patients and chiefly for patients with a complex risk profile for whom treatment of the ventral hernia symptoms is paramount, laparoscopic procedures are indicated (due to the lower morbidity). This algorithm assumes that the treating surgeons have the requisite expertise and is discussed using the examples of four complex case reports. PMID:25060397

  17. Richter’s Hernia and Sir Frederick Treves: An Original Clinical Experience, Review, and Historical Overview

    PubMed Central

    Steinke, Wolfgang; Zellweger, René

    2000-01-01

    Objective To describe the clinical recognition, pathology, and management of Richter’s hernia and to review the relevant literature of the past 400 years. Summary Background Data The earliest known reported case of Richter’s hernia occurred in 1598 and was described by Fabricius Hildanus. The first scientific description of this particular hernia was given by August Gottlob Richter in 1778, who presented it as “the small rupture.” In 1887, Sir Frederick Treves gave an excellent overview on the topic and proposed the title “Richter’s hernia.” To his work—a cornerstone to modern understanding—hardly any new aspects can be added today. Since then, only occasional case reports or small series of retrospectively collected Richter’s hernias have been published. Methods The authors draw on their experience with 18 prospectively collected cases treated in the ICRC Lopiding Hospital for War Surgery in northern Kenya between February and December 1998 and review the relevant literature of the past 400 years. Results The classic features of Richter’s hernia were confirmed in all case studies of patients: only part of the circumference of the bowel is entrapped and strangulated in the hernial orifice. The involved segment may rapidly pass into gangrene, yet signs of intestinal obstruction are often absent. The death rate in the authors’ collective was 17%. Conclusion Richter’s hernia is a deceptive entity whose high death rate can be reduced by accurate diagnosis and early surgery. Considering the increasing incidence at laparoscope insertion sites, awareness of this special type of hernia with its misleading clinical appearance is important and of general interest. PMID:11066144

  18. Polyglactine/Polypropylene Mesh vs. Propylene Mesh: Is There a Need for Newer Prosthesis in Inguinal Hernia?

    PubMed Central

    Khan, Nadim; Bangash, Adil; Sadiq, Muzaffaruddin; Ul Hadi, Ain; Hamid, Haris

    2010-01-01

    Background/Aim: To compare outcomes of light and heavy weight mesh for repair of inguinal hernia. Materials and Methods: This study was conducted at the Department of Surgery; Lady Reading Hospital, Peshawar from January 1, 2007 to December 31, 2008. Patients were divided into two groups based on the type of mesh implanted for inguinal hernia repair. Group 1 included patients in whom light weight composite (VyproII®) mesh is implanted: Group 2 included patients in whom polypropylene (ProleneR) mesh is implanted. Data concerning the complications and post operative pain in the perioperative and postoperative period were collected and analyzed. Categorical data were presented as percentages with 95% confidence intervals and compared using a ?2test and P<0.05 were considered significant. Results: Following allocation and exclusion of violating cases, 111 patients in group 1 and 138 patients in group 2 were analyzed. The mean age in group 1 was 38.20 ± 13.34 years and in group 2 was 39.55 ± 13.70 (P = 0.434). In group 1, hematoma formation was observed in four cases (3.6%), while it was observed in six cases (4.2%) in group 2 (P = 0.766). During the entire study, ten patients in all developed urinary retention, three of which required transient catheterization. One year post operation, there was a recurrence in only five cases overall, while only two patients complained of pain (P = 0.826). Conclusion: The frequency of postoperative pain and complications in patients was similar in both groups. PMID:20065567

  19. Spinal hernia tissue autofluorescence spectrum.

    PubMed

    Varanius, Darius; Terbetas, Gunaras; Vaitkus, Juozas V; Vaitkuviene, Aurelija

    2013-02-01

    The laser intervertebral disc decompression may provide appropriate relief in properly selected patients with contained disc herniations. The present investigation aims to characterise intervertebral disc material by autofluorescence induced by laser light. Degeneration of the intervertebral disc is associated with progressive biochemical changes in disc material. Percutaneous laser disc decompression has become rather popular for the treatment of lumbar disc herniation, but there are problems in the selection of patients. For this purpose, recognition of the disc composition is necessary. We propose a new type of spectroscopic investigation. It is advantageous to the characterization of intervertebral disc material. Intervertebral disc specimens were removed during open surgery from different disc locations. Preoperative patients' MRI was evaluated using the Pfirrmann disc degeneration and Komori scale for migrating of herniated nucleus pulposus. Adjacent slices of stained disc sections were evaluated by histology/histochemistry and autofluorescence spectra. Comparison of the MRI, spectral, histological and histochemical data was performed. The MRI Komori scale correlated with the histology Boos degeneration index. In the histochemistry, collagens other than collagens I and II of the disc were distinguished with best positive correlation coefficient (0.829) and best negative one (-0.904) of proteoglycans of sequester to Boos index. A correlation of the IV Gaussian component of the hernia spectra with the Boos index was established. The Gaussian component correlation with different collagen types and proteoglycan was determined for the disc and sequester. "Autofluorescence-based diagnosis" refers to the evaluation of disc degeneration by histological and histochemical evaluation; it can provide additional data on the degeneration of an intervertebral disc. PMID:22389123

  20. BWH emergency radiology-surgical correlation: traumatic spigelian hernia with right colonic injury.

    PubMed

    Gates, Alexander A; Desai, Naman S; Sodickson, Aaron D; Khurana, Bharti; Gates, Jonathan D

    2015-12-01

    We present a case of a young man who fell off his motorbike 2 days before presentation to the hospital with a complaint of gastrointestinal upset and abdominal pain. Contrast-enhanced CT of the abdomen and pelvis demonstrated a right-sided traumatic spigelian hernia and an ascending colon injury necessitating operative repair of both. PMID:25933510

  1. Genetics Home Reference: Congenital diaphragmatic hernia

    MedlinePLUS

    ... of Congenital Diaphragmatic Hernia University of Michigan Health System You might also find information on the diagnosis or management of congenital diaphragmatic hernia in Educational resources and Patient support . General information about the ...

  2. Mitral Valve Repair Surgery

    MedlinePLUS Videos and Cool Tools

    ... end, where the valve doesn’t leak, the stress is taken off the chordal structure. But as ... on and as patients are put under increased stress and strain. Another question: “I will have mitral ...

  3. Effect of yoga therapy in reversible inguinal hernia: A quasi experimental study

    PubMed Central

    Alagesan, Jagatheesan; Venkatachalam, Suthakar; Ramadass, Anandbabu; Mani, Sankar B

    2012-01-01

    Background: Hernia is an abnormal protrusion of an organ or tissue through a defect in its surrounding walls which most commonly involves the abdominal wall, particularly the inguinal region. The treatment options for hernia ranges from simple exercises to modern surgeries. The effect of yoga therapy is not scientifically examined for reversible inguinal hernia and hence this study is undertaken with the aim to test the effect of selected asanas in reversible inguinal hernia. Materials and Methods: A quasi experimental trail of 19 males through consecutive sampling was done with selected asanas for three months and the outcome was measured by a questionnaire focusing on pain, aggravating factors, relieving factors and frequency of occurrence of symptoms of hernia. Results: The pre and post interventional data were compared statistically and found significant reduction of symptoms with P?0.001 in pain, frequency of occurrence and aggravating factors. The relieving factors showed significant increase with P?0.001. Conclusion: Yoga therapy with selected asanas is effective in the treatment of reversible inguinal hernia. PMID:22346061

  4. Prenatal diagnosis of ectopic intrathoracic kidney in a fetus with a left diaphragmatic hernia.

    PubMed

    Panda, Britta; Rosenberg, Victor; Cornfeld, Daniel; Stiller, Robert

    2009-01-01

    Intrathoracic renal ectopia as a result of a congenital diaphragmatic hernia (CDH) is a rare congenital anomaly. We present a case in which the prenatal diagnosis of an ectopic intrathoracic kidney was made on routine anatomical survey at 28 weeks' gestation. Color doppler sonography imaging revealed the renal artery coursing into the infant's thorax and was consistent with CDH, but fetal MRI suggested an intact diaphragm. However, neonatal evaluation confirmed the diagnosis of intrathoracic kidney with posterior CDH, which was repaired without complication. In contrast to diaphragmatic hernia with liver or bowel herniation, infants with intrathoracic ectopic kidneys generally do well. PMID:18615674

  5. Emergency liver transplant in patient with Child-Pugh class C cirrhosis and strangulated umbilical hernia.

    PubMed

    Chaudhary, Abhideep; Daga, Sachin; Goyal, Neerav; Ramaswamy, Vasudevan Karisangal; Agarwal, Shaleen; Pareek, Shishir; Ray, Ramdip; Wadhawan, Manav; Gupta, Subash

    2013-02-01

    The authors report the case of a patient who presented with small bowel obstruction while awaiting liver transplant for Child-Pugh class C cirrhosis. He underwent emergency liver transplant with resection of the small bowel after the obstruction did not improve with conservative management. The authors believe this is the first case of successful emergency liver transplant with resection of the small bowel in a patient with decompensated Child-Pugh class C liver cirrhosis and strangulated umbilical hernia. This case suggests the possibility of improved outcomes of emergency hernia repair in patients with liver cirrhosis when small bowel resection is combined with liver transplant. PMID:23190414

  6. Intercostal variant of lumbar hernia in lumbocostovertebral syndrome: our experience with 6 cases.

    PubMed

    Sengar, Mamta; Manchanda, Vivek; Mohta, Anup; Jain, Vishesh; Das, Swarup

    2011-10-01

    Lumbocostovertebral syndrome (LCVS) is a rare type of congenital lumbar hernia. Its features include lumbar hernia associated with genitourinary, vertebral, and rib anomalies. Less than 25 cases have been reported to date. We describe the clinical manifestations and associated anomalies in 6 cases of LCVS managed by us. The patients with suspected LCVS syndrome should be evaluated by detailed clinical history, examination, conventional radiography, magnetic resonance imaging spine, ultrasound abdomen, and echocardiography. The defect can be repaired using local tissues in infancy. There is a need for long-term follow-up for possible late recurrence and scoliosis. PMID:22008337

  7. Rectal duplication with sciatic hernia

    PubMed Central

    Nosek, Marzena; Golonka, Anna; Kali?ska-Lipert, Anita

    2015-01-01

    Rectal duplications represent 5% of all duplications in the alimentary tract, and they are very rarely diagnosed during the neonatal period. The authors present the method of investigation and the results of surgical treatment of a full-term neonate with a sciatic hernia containing a rectal duplication. The procedure started with three-port laparoscopy, but excision of the tubular duplication of the rectum was possible only by a transanal endorectal pull-through approach. The sciatic hernia was closed, and plastic sutures on the buttock finished the procedure. The coincidence of sciatic hernia with rectal duplication is extremely rare, and the method of treatment depends exclusively on the anatomical conditions. PMID:26240629

  8. Medical management of acute type a aortic dissection in association with early open repair of acute limb ischemia may prevent aortic surgery

    PubMed Central

    Gionis, Michalis N.; Kaimasidis, George; Tavlas, Emmanouel; Kontopodis, Nikolaos; Plataki, Marina; Kafetzakis, Alexandros; Ioannou, Christos V.

    2013-01-01

    Summary Background: Acute type A aortic dissection (AAAD) is a cardiovascular emergency with a high potential for death. Rapid surgical treatment is indicated to prevent fatal complications. Aggressive appropriate medical management starts at first suspicion and is essential to prevent exacerbation or rupture of the dissection. Despite improved surgical techniques, perioperative care and the development of specialized cardiovascular centers, mortality remains high. Organ ischemia is a catastrophic manifestation of aortic dissection, demanding acute surgical intervention in specialized cardiovascular centers. Case Report: We present the case of a 62-year-old man with isolated acute limb ischemia due to an acute type A aortic dissection treated in a regional general hospital, without a specialized cardiovascular service, with immediate open malperfusion repair and aggressive medical management. The patient did not undergo further surgical aortic repair, and after a 30-month follow-up he remains symptom free and in good clinical condition, suggesting that although aortic surgery remains the gold standard for treatment of acute Type A dissection, appropriate medical management and early malperfusion repair may offer an initial limb- or life-saving procedure. Conclusions: This staged approach gives clinicians more time to properly evaluate and transfer the patient to a specialized cardiovascular center, and in some cases may even offer a definite treatment. PMID:23569563

  9. Analysis of the efficacy of pediatric day surgery

    PubMed Central

    Letts, Mervyn; Davidson, Darin; Splinter, William; Conway, Patricia

    2001-01-01

    Objectives To assess the efficacy and safety of a pediatric day surgery program and its benefits to the child and family. Design A review and analysis of prospectively gathered data. Setting The Children’s Hospital of Eastern Ontario (CHEO), a university-affiliated pediatric centre with a referral base of 2.5 million people. Patients All children undergoing day surgery at CHEO during the 5 years between 1992 and 1997. Interventions All surgical procedures performed on a day surgery basis. Main outcome measures Procedures performed, complications and unexpected admissions. Results An average of 4899 children per year underwent surgical procedures in the ambulatory day surgery program. The 4 commonest procedures performed were myringotomy, tonsillectomy and adenoidectomy, dental procedures, and inguinal hernia repair. The majority of children were between 2 and 7 years of age. Complications were few, averaging 1.6% per year, with postoperative bleeding, primarily secondary to tonsillectomy and adenoidectomy, being the most common. None resulted in permanent disability and there were no deaths. Conclusions Pediatric day surgery is a safe and cost-effective program that benefits the child, the family and the pediatric surgical program. PMID:11407829

  10. Imperforate anus repair - series (image)

    MedlinePLUS

    ... for passage of stool. Complete absence of an anal opening requires emergency surgery for the newborn. Surgical ... for several months before attempting the more complex anal repair. The anal repair involves an abdominal incision, ...

  11. Bone fracture repair - series (image)

    MedlinePLUS

    The three main treatment options for bone fractures are: Casting Open reduction, and internal fixation- this involves a surgery to repair the fracture-frequently, metal rods, screws or plates are used to repair the ...

  12. Enthusiasm, evidence and ethics: the triple E of minimally invasive pediatric surgery.

    PubMed

    Ure, Benno

    2013-01-01

    Minimally invasive techniques are applicable in more than 60% of abdominal and thoracic operations in children. Enthusiasts promoted these techniques for many years. However, level 1 evidence on advantages of minimally invasive surgery in children remains limited. Randomized controlled trials have been conducted for some types of procedures such as laparoscopic appendectomy, fundoplication, pyloromyotomy, and inguinal hernia repair. The results of these studies confirm some advantages of minimally invasive surgery, but for most types of laparoscopic and all types of thoracoscopic procedures, such data remain to be established. This article also focuses on reports on complications and disadvantages which are relevant for final conclusions and recommendations. The ethical implications of the application of new techniques in children are also discussed. On the basis of evidence based data and ethical principles, minimally invasive techniques may be appropriately used in the future. PMID:23331789

  13. Stenosis of the small intestine after reduction of strangulated Littre hernia in an infant.

    PubMed

    Višnji?, S; Car, A; Kralj, R

    2013-04-01

    Herniation and incarceration of a Meckel's diverticulum in a hernial sac-Littre hernia-is a relatively uncommon surgical emergency. Segmental stenosis of small intestine after hernia reduction and consecutive intestinal obstruction is a similarly rare emergency. The combination of both these disorders is extremely uncommon at any age and especially during infancy. The obvious rarity of the condition, its subtle diagnostic features, the potentially ominous course of events and the age of patient indicate early surgery as a life-saving solution. PMID:21789653

  14. Wide range force feedback for catheter insertion mechanism for use in minimally invasive mitral valve repair surgery

    NASA Astrophysics Data System (ADS)

    Ahmadi, Roozbeh; Sokhanvar, Saeed; Packirisamy, Muthukumaran; Dargahi, Javad

    2009-02-01

    Mitral valve regurgitation (MR) is a condition in which heart's mitral valve does not close tightly, which allows blood to leak back into the left atrium. Restoring the dimension of the mitral-valve annulus by percutaneous intervention surgery is a common choice to treat MR. Currently, this kind of open heart annuloplasty surgery is being performed through sternotomy with cardiomyopathy bypass. In order to reduce trauma to the patient and also to eliminate bypass surgery, robotic assisted minimally invasive surgery (MIS) procedure, which requires small keyhole incisions, has a great potential. To perform this surgery through MIS procedure, an accurate computer controlled catheter with wide-range force feedback capabilities is required. There are three types of tissues at the site of operation: mitral leaflet, mitral annulus and left atrium. The maximum allowable applied force to these three types of tissue is totally different. For instance, leaflet tissue is the most sensitive one with the lowest allowable force capacity. For this application, therefore, a wide-range force sensing is highly required. Most of the sensors that have been developed for use in MIS applications have a limited range of sensing. Therefore, they need to be calibrated for different types of tissue. The present work, reports on the design, modeling and simulation of a novel wide-range optical force sensor for measurement of contact pressure between catheter tip and heart tissue. The proposed sensor offers a wide input range with a high resolution and sensitivity over this range. Using Micro-Electro-Mechanical-Systems (MEMS) technology, this sensor can be microfabricated and integrated with commercially available catheters.

  15. Facial nerve surgery in the 19th and early 20th centuries: The evolution from crossover anastomosis to direct nerve repair.

    PubMed

    Shah, S B; Jackler, R K

    1998-03-01

    The historical aspects of facial nerve (FN) anatomy and of Bell's palsy have long been favorite topics of otologic historians. Little attention has been paid, however, to the evolution of FN surgery, a subject with a remarkably rich and engaging history. In the early 13th century, Roland, an Italian surgeon, used a red hot iron to coapt severed nerve endings. In the 17th century, Ferrara, another Italian, sutured injured nerves with tortoise tendon dipped in hot red wine. It was not until the late 19th century that peripheral nerve suture became a subject of serious scientific study. Although it is ironic, the course of events suggests that the evolution of FN repair was greatly stimulated by the development of the modern mastoid operation. Whereas the simple mastoid operation practiced by Wilde (1853) and others carried little risk of FN injury, more adventuresome procedures such as radical mastoidectomy (Kessel, 1885) carried a much greater risk. The abundance of iatrogenic palsies during this era undoubtedly did much to motivate surgeons to seek a better means of restoring facial animation. Most surgeons would be surprised to learn that crossover anastomoses predated direct nerve repair by nearly half a century. In 1879, the German surgeon Drobnik performed the first facial-spinal accessory anastomosis. Over the next two decades, numerous articles were written (most notably by Sir Charles Balance and Harvey Cushing) on crossovers between the FN and cranial nerves IX, X, XI, and XII. Although a few tentative attempts at reapproximating severed FNs took place in the first two decades of this century, it was not until 1925 that an actual suture repair of an intratemporal injury was undertaken. This feat was first accomplished by the famous hand surgeon Sterling Bunnell and shortly thereafter by the otolaryngologist Robert Martin. The evolution of FN surgery in the days predating the operating microscope is a rich tapestry of colorful personalities and clashing egos, which saw promising advances relegated to obscurity and some previously obscure techniques become progressively more promising. PMID:9520063

  16. Brain aneurysm repair - discharge

    MedlinePLUS

    ... endovascular repair: You may have pain in your groin area. You may have some bruising around and ... the doctor put a catheter in through your groin (endovascular surgery), it is okay to walk short ...

  17. Femur fracture repair - discharge

    MedlinePLUS

    You had a fracture (break) in the femur, also called the thigh bone, in your leg. You may have needed surgery to repair ... surgeon will make a cut to open your fracture. Your surgeon will then use special metal devices ...

  18. Achilles tendon repair

    MedlinePLUS

    Achilles tendon rupture-surgery; Percutaneous Achilles tendon rupture repair ... To fix your torn Achilles tendon, the surgeon will: Make a cut down the back of your heel Make several small cuts rather than one ...

  19. Effect of pubic bone marrow edema on recovery from endoscopic surgery for athletic pubalgia.

    PubMed

    Kuikka, L; Hermunen, H; Paajanen, H

    2015-02-01

    Athletic pubalgia (sportsman's hernia) is often repaired by surgery. The presence of pubic bone marrow edema (BME) in magnetic resonance imaging (MRI) may effect on the outcome of surgery. Surgical treatment of 30 patients with athletic pubalgia was performed by placement of totally extraperitoneal endoscopic mesh behind the painful groin area. The presence of pre-operative BME was graded from 0 to 3 using MRI and correlated to post-operative pain scores and recovery to sports activity 2 years after operation. The operated athletes participated in our previous prospective randomized study. The athletes with (n = 21) or without (n = 9) pubic BME had similar patients' characteristics and pain scores before surgery. Periostic and intraosseous edema at symphysis pubis was related to increase of post-operative pain scores only at 3 months after surgery (P = 0.03) but not to long-term recovery. Two years after surgery, three athletes in the BME group and three in the normal MRI group needed occasionally pain medication for chronic groin pain, and 87% were playing at the same level as before surgery. This study indicates that the presence of pubic BME had no remarkable long-term effect on recovery from endoscopic surgical treatment of athletic pubalgia. PMID:24350624

  20. Periappendicular Abscess Presenting within an Inguinal Hernia

    PubMed Central

    Loberant, Norman; Bickel, Amitai

    2015-01-01

    The presence of the appendix within an inguinal hernia is a rare finding. We present the case of an elderly woman who developed appendicitis within an inguinal hernia, complicated by a supervening periappendicular abscess. She was successfully treated with a combination of antibiotics and percutaneous drainage. PMID:26605128

  1. [Morgagni's hernia erroneously interpreted as a lipoma].

    PubMed

    Tschakert, H

    1985-03-01

    The author describes the problems of properly diagnosing Morgagni's hernia via non-invasive x-ray examination. A case history is reported as an example. Diagnosis can be confirmed, especially with small hernias which do not contain parts of intestine or liver, by additional subtle sonography and high-resolutien computed tomography. PMID:3886266

  2. Liver scan in traumatic right hemidiaphragmatic hernia

    SciTech Connect

    Suzuki, Y.

    1985-01-01

    Liver imaging was performed in two patients with traumatic right hemidiaphragmatic hernia. It has elucidated the cause of obliteration of the right hemidiaphragmatic shadow on the chest x-ray. These cases are illustrative of the usefulness of liver imaging in the diagnosis of traumatic right hemidiaphragmatic hernia as well as hepatic injury.

  3. Long-term anisotropic mechanical response of surgical meshes used to repair abdominal wall defects.

    PubMed

    Hernández-Gascón, B; Peña, E; Pascual, G; Rodríguez, M; Bellón, J M; Calvo, B

    2012-01-01

    Routine hernia repair surgery involves the implant of synthetic mesh. However, this type of procedure may give rise to pain and bowel incarceration and strangulation, causing considerable patient disability. The purpose of this study was to compare the long-term behaviour of three commercial meshes used to repair the partially herniated abdomen in New Zealand White rabbits: the heavyweight (HW) mesh, Surgipro(®) and lightweight (LW) mesh, Optilene(®), both made of polypropylene (PP), and a mediumweight (MW) mesh, Infinit(®), made of polytetrafluoroethylene (PTFE). The implanted meshes were mechanical and histological assessed at 14, 90 and 180 days post-implant. This behaviour was compared to the anisotropic mechanical behaviour of the unrepaired abdominal wall in control non-operated rabbits. Both uniaxial mechanical tests conducted in craneo-caudal and perpendicular directions and histological findings revealed substantial collagen growth over the repaired hernial defects causing stiffness in the repair zone, and thus a change in the original properties of the meshes. The mechanical behaviour of the healthy tissue in the craneo-caudal direction was not reproduced by any of the implanted meshes after 14 days or 90 days of implant, whereas in the perpendicular direction, SUR and OPT achieved similar behaviour. From a mechanical standpoint, the anisotropic PP-lightweight meshes may be considered a good choice in the long run, which correlates with the structure of the regenerated tissue. PMID:22100101

  4. Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14 618 Patients

    PubMed Central

    Bosanquet, David C.; Ansell, James; Abdelrahman, Tarig; Cornish, Julie; Harries, Rhiannon; Stimpson, Amy; Davies, Llion; Glasbey, James C. D.; Frewer, Kathryn A.; Frewer, Natasha C.; Russell, Daphne; Russell, Ian; Torkington, Jared

    2015-01-01

    Background The incidence of incisional hernias (IHs) following midline abdominal incisions is difficult to estimate. Furthermore recent analyses have reported inconsistent findings on the superiority of absorbable versus non-absorbable sutures. Objective To estimate the mean IH rate following midline laparotomy from the published literature, to identify variables that predict IH rates and to analyse whether the type of suture (absorbable versus non-absorbable) affects IH rates. Methods We undertook a systematic review according to PRISMA guidelines. We sought randomised trials and observational studies including patients undergoing midline incisions with standard suture closure. Papers describing two or more arms suitable for inclusion had data abstracted independently for each arm. Results Fifty-six papers, describing 83 separate groups comprising 14 618 patients, met the inclusion criteria. The prevalence of IHs after midline incision was 12.8% (range: 0 to 35.6%) at a weighted mean of 23.7 months. The estimated risk of undergoing IH repair after midline laparotomy was 5.2%. Two meta-regression analyses (A and B) each identified seven characteristics associated with increased IH rate: one patient variable (higher age), two surgical variables (surgery for AAA and either surgery for obesity surgery (model A) or using an upper midline incision (model B)), two inclusion criteria (including patients with previous laparotomies and those with previous IHs), and two circumstantial variables (later year of publication and specifying an exact significance level). There was no significant difference in IH rate between absorbable and non-absorbable sutures either alone or in conjunction with either regression analysis. Conclusions The IH rate estimated by pooling the published literature is 12.8% after about two years. Seven factors account for the large variation in IH rates across groups. However there is no evidence that suture type has an intrinsic effect on IH rates. PMID:26389785

  5. Irreducible indirect inguinal hernia containing uterus and bilateral adnexa in a premature female infant: report of an exceptional case and review of the literature.

    PubMed

    Cascini, Valentina; Lisi, Gabriele; Di Renzo, Dacia; Pappalepore, Nicola; Lelli Chiesa, Pierluigi

    2013-01-01

    Indirect inguinal hernia is the most common congenital anomaly in the pediatric age group. About 15-20% of hernias in infant girls contain ovary, sometimes with a Fallopian tube. The presence of the uterus incarcerated with the adnexa is a very unusual occurrence in female infants with normal kariotype and phenotype, being commonly associated with several disorders of sex development. The surgical repair of this form of hernia is more difficult than a common herniorrhaphy because of the adhesions between the organs and the wall of the sac and the risk of damage during their freeing. We present a rare case of irreducible indirect inguinal hernia containing uterus and bilateral adnexa (fallopian tubes and ovaries) in a premature female infant, discussing the etiopathogenesis and the surgical features of this disorder. PMID:23331833

  6. The role of n-butyl-2-cyanoacrylate in the repair of traumatic diaphragmatic injuries

    PubMed Central

    Bas, Gurhan; Ozkan, Orhan Veli; Alimoglu, Orhan; Eryilmaz, Ramazan; Sahin, Mustafa; Okan, Ismail; Cevikbas, Ugur

    2015-01-01

    Diaphragmatic injuries either by blunt or penetrating trauma require prompt surgical intervention and are often exigent to repair. N-butyl-2-cyanoacrylate (n-butyl-2-CA) is a tissue adhesive which has gained wide application in many areas of surgery including emergency. To repair the extensive injuries of the diaphragm it may be necessary the use of synthetic mesh by fixing it with sutures or staples. The use of tissue adhesives may circumvent the potential problems associated with mesh fixation. This study aimed to evaluate the efficacy and safety of tissue adhesives usage for mesh fixation in diaphragmatic injury repair. Twenty-four rats were divided into 3 groups each of them containing 8 rats. A 1- cm diaphragmatic defect was created in all rats. The defect was repaired by polypropylene suture in Group I, by mesh fixed with sutures in group II and by mesh fixed with n-butyl-2-CA in group III. The rats were sacrificed after 1 month. The episode of hernia and the adhesions were assessed by adhesion density score. Also, the abscess and inflammation in the repaired tissue were evaluated microscopically. The Kruskal-Wallis test was performed for the histopathological analysis. No diaphragmatic hernia was detected in any group. While Group III had higher adhesion density scores than group I (P: 0.027), there were no differences between group III and II (P: 0.317) and group II and I (P = 0.095) regarding adhesion density scores. The inflammation grade was higher in group III than group I and II (P < 0.001) and was higher in group II than group I (P < 0.05). There was no differences between each groups, concerning microabcsess formation (P > 0.05). Repair of traumatic diaphragmatic injury in penetrating wound, with polypropylene mesh fixed by n-butyl-2-CA in rats appears to be as efficacious and safe as conventional methods in early period. However, further experimental and clinical study are needed to compare the long-term results of adhesive mesh repair with those of the traditional sutured techniques. PMID:26131179

  7. [Prenatal diagnosis of a right thoracic congenital ectopic kidney with a diaphragmatic hernia: A combination with a good prognosis].

    PubMed

    Cessans, C; Pharamin, J; Crouzet, K; Kessler, S; Puget, C; Bouali, O; Galinier, P; Marcoux, M-O

    2015-11-01

    Ectopic intrathoracic kidney is a rare congenital anomaly, usually asymptomatic. This anomaly is sometimes associated with a diaphragmatic hernia. Few cases of this combination have been described, often in the absence of a prenatal diagnosis. We report on the case of a female newborn infant who was diagnosed with an ectopic intrathoracic right kidney and a diaphragmatic hernia upon 33weeks of gestation. The patient underwent surgery on the first day of life and the respiratory and renal outcomes were simple. We review the literature and discuss the seemingly good prognosis of this combination. PMID:26385648

  8. Amyand's hernia: Our experience in the laparoscopic era.

    PubMed

    Sahu, Diwakar; Swain, Sudeepta; Wani, Majid; Reddy, Prasanna Kumar

    2015-01-01

    Amyand's hernia is a rare presentation of inguinal hernia, in which the appendix is present within the hernia sac. This entity is a diagnostic challenge due to its rarity and vague clinical presentation. A laparoscopic approach can confirm the diagnosis as well as serve as a therapeutic tool. When the appendix is not inflamed within the inguinal hernia sac, then appendicectomy is not always necessary. Our case series emphasize the same presumption as three patient of Amyand's hernia underwent laparoscopic transabdominal preperitoneal hernioplasty without appendicectomy. The aim of this paper is to review the literature with regards to Amyand's hernia and provide new insight in its diagnosis and treatment. PMID:25883458

  9. Amyand's hernia: Our experience in the laparoscopic era

    PubMed Central

    Sahu, Diwakar; Swain, Sudeepta; Wani, Majid; Reddy, Prasanna Kumar

    2015-01-01

    Amyand's hernia is a rare presentation of inguinal hernia, in which the appendix is present within the hernia sac. This entity is a diagnostic challenge due to its rarity and vague clinical presentation. A laparoscopic approach can confirm the diagnosis as well as serve as a therapeutic tool. When the appendix is not inflamed within the inguinal hernia sac, then appendicectomy is not always necessary. Our case series emphasize the same presumption as three patient of Amyand's hernia underwent laparoscopic transabdominal preperitoneal hernioplasty without appendicectomy. The aim of this paper is to review the literature with regards to Amyand's hernia and provide new insight in its diagnosis and treatment. PMID:25883458

  10. Abdominal aortic aneurysm repair - open - discharge

    MedlinePLUS

    AAA - open - discharge; Repair - aortic aneurysm - open - discharge ... You had open aortic aneurysm surgery to repair an aneurysm (a widened part) in your aorta, the large artery that carries blood to your ...

  11. [Bochdalek's hernia in a mentally retarded adolescent].

    PubMed

    Nicho Salvador, Héctor; Acuña Fernández, Leoncio; Amado Ramírez, Julio; Nicho Gómez, Andrea

    2007-01-01

    Bochdalek hernia is a congenital defect of the lateral posterior or vertebral lumbar region on the left side of diaphragm, caused by a foramen on it, through which viscera displaced from abdomen to pleural cavity. This is a pathology frequently observed in just born babies but rarely found in teenagers or adults. In world medical history only 100 cases in adults have been reported. We present a case of a 16 years old male patient with moderate mental retard who suddenly suffered from convulsions; this was the second time it happened, because the first time (3 months ago) he showed the same clinical picture but with no further complications. Anticonvulsives were administered to the patient in the general hospital E.R., but immediately after that, he had uncontrollable and frequent nausea, vomits and regurgitation when eating. He also showed anxiety, desperation and even aggressiveness. He was also very thirsty. Three days later the patient was transferred to the gastroenterology unit where we observed the symptoms above mentioned. He also presented sialorrhea. After many difficulties to find the diagnosis due to the patient's problems to communicate even with his relatives help, we decided to perform a surgery. Endoscopy showed total occlusion of the gastric-esophagus connection and an abdomen and thorax X-r showed an abnormal image with hydro aerial level in nearly all left hemithorax. The surgical findings showed total displacement of stomach, spleen, part of the small intestine, ascending colon, cecum, appendix and proximal part of transverse colon to the left hemithorax. Surgical corrections were performed. The clinical case resolved satisfactorily. The late age of the patient, type and treatment are discussed. PMID:17712398

  12. Early Primary Care Provider Follow-up and Readmission After High-Risk Surgery

    PubMed Central

    Brooke, Benjamin S.; Stone, David H.; Cronenwett, Jack L.; Nolan, Brian; DeMartino, Randall R.; MacKenzie, Todd A.; Goodman, David C.; Goodney, Philip P.

    2014-01-01

    IMPORTANCE Follow-up with a primary care provider (PCP) in addition to the surgical team is routinely recommended to patients discharged after major surgery despite no clear evidence that it improves outcomes. OBJECTIVE To test whether PCP follow-up is associated with lower 30-day readmission rates after open thoracic aortic aneurysm (TAA) repair and ventral hernia repair (VHR), surgical procedures known to have a high and low risk of readmission, respectively. DESIGN, SETTING, AND PARTICIPANTS In a cohort of Medicare beneficiaries discharged to home after open TAA repair (n = 12 679) and VHR (n = 52 807) between 2003 to 2010, we compared 30-day readmission rates between patients seen and not seen by a PCP within 30 days of discharge and across tertiles of regional primary care use. We stratified our analysis by the presence of complications during the surgical (index) admission. MAIN OUTCOMES AND MEASURES Thirty-day readmission rate. RESULTS Overall, 2619 patients (20.6%) undergoing open TAA repair and 4927 patients (9.3%) undergoing VHR were readmitted within 30 days after surgery. Complications occurred in 4649 patients (36.6%) undergoing open TAA repair and 4528 patients (8.6%) undergoing VHR during their surgical admission. Early follow-up with a PCP significantly reduced the risk of readmission among open TAA patients who experienced perioperative complications, from 35.0% (without follow-up) to 20.4% (with follow-up) (P < .001). However, PCP follow-up made no significant difference in patients whose hospital course was uncomplicated (19.4% with follow-up vs 21.9% without follow-up; P = .31). In comparison, early follow-up with a PCP after VHR did not reduce the risk of readmission, regardless of complications. In adjusted regional analyses, undergoing open TAA repair in regions with high compared with low primary care use was associated with an 18% lower likelihood of 30-day readmission (odds ratio, 0.82; 95% CI, 0.71–0.96; P = .02), whereas no significant difference was found among patients after VHR. CONCLUSIONS AND RELEVANCE Follow-up with a PCP after high-risk surgery (eg, open TAA repair), especially among patients with complications, is associated with a lower risk of hospital readmission. Patients undergoing lower-risk surgery (eg, VHR) do not receive the same benefit from early PCP follow-up. Identifying high-risk surgical patients who will benefit from PCP integration during care transitions may offer a low-cost solution toward limiting readmissions. PMID:25074237

  13. A promising new device for the prevention of parastomal hernia.

    PubMed

    Hoffmann, Henry; Oertli, Daniel; Soysal, Savas; Zingg, Urs; Hahnloser, Dieter; Kirchhoff, Philipp

    2015-06-01

    Parastomal hernia (PSH) is the most frequent long-term stoma complication with serious negative effects on quality of life. Surgical revision is often required and has a substantial morbidity and recurrence rate. The development of PSH requires revisional surgery with a substantial perioperative morbidity and high failure rate in the long-term follow-up. Prophylactic parastomal mesh insertion during stoma creation has the potential to reduce the rate of PSH, but carries the risk of early and late mesh-related complications such as infection, fibrosis, mesh shrinkage, and/or bowel erosion. We developed a new stomaplasty ring (KORING), which is easy to implant, avoids potential mesh-related complications, and has a high potential of long-term prevention of PSH. Here we describe the technique and the first use. PMID:25432883

  14. Amyand's Hernia with Perforated Appendix in a Neonate.

    PubMed

    Sandhu, Asif; Liaqat, Naeem; Nayyar, Sajid Iqbal; Faryal, Rehman; Shafique, Shanze

    2014-09-01

    When vermiform appendix is found in the inguinal hernial sac, the condition is called Amyand's hernia (AH). Appendix in hernial sac can be normal, inflamed or perforated. It can present as complicated hernia or acute scrotum. We present a case of Amyand's hernia in a 25-day-old male who presented with an obstructed hernia having perforated appendix in the hernial sac. PMID:25374801

  15. Amyand’s Hernia with Perforated Appendix in a Neonate

    PubMed Central

    Sandhu, Asif; Nayyar, Sajid Iqbal; Faryal, Rehman; Shafique, Shanze

    2014-01-01

    When vermiform appendix is found in the inguinal hernial sac, the condition is called Amyand’s hernia (AH). Appendix in hernial sac can be normal, inflamed or perforated. It can present as complicated hernia or acute scrotum. We present a case of Amyand’s hernia in a 25-day-old male who presented with an obstructed hernia having perforated appendix in the hernial sac. PMID:25374801

  16. Incarceration of the hepatic lobe in incisional hernia: A case report

    PubMed Central

    Eken, Huseyin; Isik, Arda; Buyukakincak, Sercan; Yilmaz, Ismayil; Firat, Deniz; Cimen, Orhan

    2015-01-01

    Introduction Incisional hernias are abnormal peritoneal outward pouch-like protrusions that develop due to defects that arise as a result of the disruption of the fascia's continuity after abdominal surgery. Presentation of case A 77-year-old female patient presented to the emergency department of our hospital with complaints of abdominal swelling, abdominal pain, nausea and vomiting. The patient was recommended for surgery. It was decided that the primary fascia closure and onlay patch was the most appropriate approach. Discussion When the defect in the abdominal wall grows, the functionality of the related abdominal wall is disrupted thereby eliminating the dynamic structure of the abdominal wall. Incisional hernias lead to a significant number of job losses and morbidity and negatively affect quality of life. Moreover, the formations in the hernia pouch might lead to higher risk of strangulation and dysfunction. Conclusion Subcutaneous herniation of the left lobe of the liver passing through the abdominal wall is a very rare condition. PMID:26155360

  17. [Left paraduodenal hernia with particular evolution].

    PubMed

    Bâtc?, V; Albi?a, O; Sima, O; Rogin, T; Bîtc?, T

    2008-01-01

    Paraduodenal hernia is a rare situation, less than 400 cases being published in literature. This condition is difficult to explore, diagnose appear within an occlusive syndrome. The etiopathology involves perturbation of intestinal rotation during the intrauterine life, producing paraduodenal fossa, which generates conditions for internal hernias and occlusive situations. We present the case of a 36 years old woman with chronic epigastric pain, diagnosed as duodenal ulcer, later as acute pancreatitis and in the end as high occlusion syndrome. Open laparotomy was performed, uncovering a strangulated left paraduodenal hernia, with severe pathologic lesions of the intestinal loops. Kelotomy and pure-string suture of parietal defect was performed. Post-operative evolution has been difficult with hepatic failure with coagulopathy and diffuse intestinal hemorrhage, threatening the patient's life. Intensive care lead eventually to a favorable condition. The rarity of this disease, difficulty of diagnosis and the particular evolution were the reasons to present this rare case. PMID:18717286

  18. Antibacterial activity of triclosan chitosan coated graft on hernia graft infection model.

    PubMed

    Cakmak, Attila; Cirpanli, Yasemin; Bilensoy, Erem; Yorganci, Kaya; Cali?, Sema; Sariba?, Zeynep; Kaynaro?lu, Volkan

    2009-11-01

    The use of mesh in hernia repair has become common, because of lower recurrence rate and simple application. Data from the meta-analysis and the multi-central studies support the use of meshes in hernia repair. One of the complications due to the hernia repair with mesh is the infection. The incidence range is between 1 and 10%. Triclosan embedded commercial absorbable suture materials are used to reduce surgical site infection rate. This study was planned on mesh infection model, because of the low incidence rate. The agent isolated from mesh infections was mostly Staphylococcus aureus and thus it was used as the infecting agent in this research. To achieve a better therapeutic efficacy, triclosan was formulated in chitosan gels. Chitosan is an attractive biopolymer because of its biocompatible, biodegradable, bioadhesive properties. Gel formulations using chitosans (low, medium and high molecular weight) were prepared in 1% (v/v) acetic acid solution and in vitro release profiles were evaluated. Gel formulations showed release profile extended up to 7 days and high molecular weight chitosan gel formulation was released higher quantity drug than other formulations. Meshes coated with triclosan loaded chitosan gel were used to reduce bacterial count and to prevent mesh infection in the study. 24h and simultaneous bacteria inoculation was used to model mesh infection. The rats were observed for 8 days by means of surgical site infection. On the eighth day, the animals were sacrificed and the grafts were removed. Tissue squeezers were used to liberate bacterias from removed grafts. The isolated suspensions were cultured on blood agar plates and colony-forming units were counted overnight. Grafts coated with triclosan loaded chitosan gel presented satisfactory preventive effect against graft infection. PMID:19501640

  19. Successful Management of a Perforated Interposed Substernal Ileocolon Caused by Right Pleural Hernia.

    PubMed

    Shiozaki, Atsushi; Fujiwara, Hitoshi; Konishi, Hirotaka; Arita, Tomohiro; Kosuga, Toshiyuki; Morimura, Ryo; Murayama, Yasutoshi; Komatsu, Shuhei; Kuriu, Yoshiaki; Ikoma, Hisashi; Nakanishi, Masayoshi; Ichikawa, Daisuke; Okamoto, Kazuma; Otsuji, Eigo

    2016-01-01

    A 73-year-old man underwent esophagectomy and reconstruction with interposition of the ileocolon through the substernal tract. Ten months later he presented with sudden pain in the right side of his chest that developed after vomiting. Emergency surgical intervention revealed a right pleural hernia of the esophageal substitute and a 3-cm perforation in the cecum. After suturing the perforation directly, we made the redundant ileum straight and pulled down the repaired cecum into the abdominal cavity to prevent intrathoracic leakage, successfully preserving the reconstructed organ. This rare case emphasizes the importance of careful dissection of the pleura and the use of a suitable length of ileocolon for reconstruction. PMID:26694309

  20. Fibrolipomas masquerading as abdominal hernias

    PubMed Central

    Watson, Hannah Isabella; Saunders, Andrew John

    2013-01-01

    A 15-year-old Caucasian girl presented to her general practitioner with a tender, irreducible mass in the paraumbilical region. On examination, two small masses could be felt. She was referred to general surgery. Ultrasound imaging and MRI were unremarkable. However, clinical suspicion suggested multiple areas of abdominal wall herniation. The patient was admitted for elective surgery to exclude herniation. At operation, three subcutaneous masses were found but with no evidence of abdominal wall herniation. Histopathology results from the specimens showed mature adipose tissue mixed with fibrous deposits. There was no evidence of malignancy. A diagnosis of fibrolipoma was given. PMID:24343803

  1. Transumbilical scarless surgery with thoracic trocar: easy and low-cost

    PubMed Central

    Okur, Mehmet Hanifi; Aydogdu, Bahattin; Arslan, Mehmet Serif; Cimen, Hasan; Otcu, Selcuk

    2013-01-01

    Purpose Single-site laparoscopic surgery has become increasingly common. We herein report an easy and low-cost thoracic trocar technique (TTT) for these types of procedures and recommend the simpler name "transumbilical scarless surgery" (TUSS) to minimize confusion in nomenclature. Methods We retrospectively reviewed patients who underwent TUSS by TTT using a thoracic trocar and surgical glove in our hospital between November 2011 and November 2012. Operating time, postoperative stay, and complications were detailed. Results A total of 101 TUSS by TTT were successfully performed, comprising appendectomy (n = 63), ovarian cyst excision (n = 7), splenectomy (n = 5), nephroureterectomy (n = 5), orchidopexy (n = 4), pyeloplasty (n = 3), nephrolithotomy (n = 2), orchiectomy (n = 2), varicocelectomy (n = 2), lymphangioma excision (n = 2), ureterectomy (n = 1), Morgagni diaphragmatic hernia repair (n = 1), ovarian detorsion (n = 1), antegrade continence enema (n = 1), intestinal resection anastomosis (n = 1), and intestinal duplication excision (n = 1). Kirschner wires were used for some organ traction. Nine patients required an additional port, but no major complications occurred. The postoperative stay (mean ± standard deviation) was 3.2 ± 1.4 days, and operating time was 58.9 ± 38.3 minutes. Conclusion We recommend the simpler name of TUSS to minimize confusion in nomenclature for all transumbilical single-incision laparoendoscopic surgeries. TTT is an easy and low-cost TUSS technique. PMID:23741694

  2. Wireless live streaming video of laparoscopic surgery: a bandwidth analysis for handheld computers.

    PubMed

    Gandsas, Alex; McIntire, Katherine; George, Ivan M; Witzke, Wayne; Hoskins, James D; Park, Adrian

    2002-01-01

    Over the last six years, streaming media has emerged as a powerful tool for delivering multimedia content over networks. Concurrently, wireless technology has evolved, freeing users from desktop boundaries and wired infrastructures. At the University of Kentucky Medical Center, we have integrated these technologies to develop a system that can wirelessly transmit live surgery from the operating room to a handheld computer. This study establishes the feasibility of using our system to view surgeries and describes the effect of bandwidth on image quality. A live laparoscopic ventral hernia repair was transmitted to a single handheld computer using five encoding speeds at a constant frame rate, and the quality of the resulting streaming images was evaluated. No video images were rendered when video data were encoded at 28.8 kilobytes per second (Kbps), the slowest encoding bitrate studied. The highest quality images were rendered at encoding speeds greater than or equal to 150 Kbps. Of note, a 15 second transmission delay was experienced using all four encoding schemes that rendered video images. We believe that the wireless transmission of streaming video to handheld computers has tremendous potential to enhance surgical education. For medical students and residents, the ability to view live surgeries, lectures, courses and seminars on handheld computers means a larger number of learning opportunities. In addition, we envision that wireless enabled devices may be used to telemonitor surgical procedures. However, bandwidth availability and streaming delay are major issues that must be addressed before wireless telementoring becomes a reality. PMID:15458077

  3. A Primer on Wound Healing in Colorectal Surgery in the Age of Bioprosthetic Materials

    PubMed Central

    Lundy, Jonathan B.

    2014-01-01

    Wound healing is a complex, dynamic process that is vital for closure of cutaneous injuries, restoration of abdominal wall integrity after laparotomy closure, and to prevent anastomotic dehiscence after bowel surgery. Derangements in healing have been described in multiple processes including diabetes mellitus, corticosteroid use, irradiation for malignancy, and inflammatory bowel disease. A thorough understanding of the process of healing is necessary for clinical decision making and knowledge of the current state of the science may lead future researchers in developing methods to enable our ability to modulate healing, ultimately improving outcomes. An exciting example of this ability is the use of bioprosthetic materials used for abdominal wall surgery (hernia repair/reconstruction). These bioprosthetic meshes are able to regenerate and remodel from an allograft or xenograft collagen matrix into site-specific tissue; ultimately being degraded and minimizing the risk of long-term complications seen with synthetic materials. The purpose of this article is to review healing as it relates to cutaneous and intestinal trauma and surgery, factors that impact wound healing, and wound healing as it pertains to bioprosthetic materials. PMID:25435821

  4. Endometriosis of the Vermiform Appendix within a Hernia Sac Infiltrating the Pubic Bone

    PubMed Central

    Ziaja, Damian; Bolkowski, Tomasz; Januszewski, Krzysztof; Skrzypulec-Plinta, Wioletta; Ziaja, Krzysztof

    2015-01-01

    Purpose. Appendicular endometriosis mimicking appendicitis is a rare finding. Inguinal tumor in the course of appendicular endometriosis located within an inguinal hernia sac and infiltrating the periosteum of the pubic bone has not yet been described. Case Report. This paper describes a case of a rapidly enlarging, solid, unmovable, very painful upon palpation inguinal tumor, in a 36-year-old nulliparous woman. During surgery, a hard (approximately 4?cm in diameter) tumor infiltrating the periosteum of the right pubic bone and continuous with the inguinal hernia sac was dissected. The distal segment of the vermiform appendix was an element of the dissected tumor. Histological examination revealed endometriosis of the distal vermiform appendix. After 6 months of hormone treatment, she was referred for reoperation due to tumor recurrence. Once again histological examination of the resected tissue revealed endometriosis. There was no further recurrence of the disease with goserelin therapy. In addition to the case report, we present a review of the literature about endometriosis involving the vermiform appendix and the inguinal canal (Amyand's hernia). Conclusion. This case expands the list of differential diagnoses of nodules found in the inguinal region of women. PMID:25802791

  5. Incarceration of Meckel's diverticulum in a left paraduodenal Treitz' hernia.

    PubMed

    Gerdes, Christoph; Akkermann, Oke; Krüger, Volker; Gerdes, Anna; Gerdes, Berthold

    2015-08-16

    Meckel's diverticula incarcerated in a hernia were first described anecdotally by Littré, a French surgeon, in 1700. Meckel, a German anatomist and surgeon, explained the pathophysiology of this disease 100 years later. In addition, a congenital paraduodenal mesocolic hernia, known as a Treitz hernia, is a rare cause of small bowel obstruction. These hernias are caused by an abnormal rotation of the primitive midgut, resulting in a right or left paraduodenal hernia. We treated a patient presenting with pain and diagnosed extraluminal air in the abdomen after a computed tomography examination. We performed a laparotomy and found a combination of these two seldomly occurring congenital diseases, incarceration and perforation of Meckel's diverticulum in a left paraduodenal hernia. We performed a thorough review of the literature, and this report is the first to describe a patient with a combination of these two rare conditions. We considered the case regarding the variety of terminology as well as the treatment options of these conditions. PMID:26301234

  6. [Value of neuroleptoanalgesia in preventing recurrence of fetal shunts during treatment of diaphragmatic hernias].

    PubMed

    Gruel, Y; Bourdelat, D; Thomas, M; Allouis, M; Babut, J M

    1983-01-01

    A leptanalgesia (Chlorpromazine-morphine) was used in the treatment of postero lateral diaphragmatic hernia in six neonates. The treatment which was begun immediately after the arrival of the child and continued during and after surgery seemed to contribute to the favorable outcome observed in five of the babies. In spite of the empirical nature of their argument, the authors suggest the possible mechanism of action of the treatment. However they recognize that its effectiveness can only be assessed after careful hemodynamic studies. PMID:6850966

  7. Increasing Body Mass Index Is Inversely Related to Groin Hernias.

    PubMed

    Ravanbakhsh, Samine; Batech, Michael; Tejirian, Talar

    2015-10-01

    Few studies describe the relationship between obesity and groin hernias. Our objective was to investigate the correlation between body mass index (BMI) and groin hernias in a large population. Patients with the diagnosis of inguinal or femoral hernia with and without incarceration or strangulation were identified using the Kaiser Permanente Southern California regional database including 14 hospitals over a 7-year period. Patients were stratified by BMI. There were 47,950 patients with a diagnosis of a groin hernia-a prevalence of 2.28 per cent. Relative to normal BMI (20-24.9 kg/m(2)), lower BMI was associated with an increased risk for hernia diagnosis. With increasing BMI, the risk of incarceration or strangulation increased. Additionally, increasing age, male gender, white race, history of hernia, tobacco use history, alcohol use, and higher comorbidity index increased the chance of a groin hernia diagnosis. Complications were higher for women, patients with comorbidities, black race, and alcohol users. Our study is the largest to date correlating obesity and groin hernias in a diverse United States population. Obesity (BMI ? 30 kg/m(2)) is associated with a lower risk of groin hernia diagnosis, but an increased risk of complications. This inverse relationship may be due to limitations of physical exam in obese patients. PMID:26463305

  8. An unusual outcome of a giant ventral hernia

    PubMed Central

    Waheed, Muhammad; Alsenani, Mohammad; Al-Akeely, Muhammad; Al-Qahtani, Hamad

    2015-01-01

    Hernias are routine general surgical problems that may present in any age group, regardless of the patient’s socioeconomic status. We present a rare case of a complicated ventral hernia leading to short bowel. This is an unusual case and is very rarely reported in the literature. This current case report describes a 54-year-old gentleman who presented to the hospital with a giant strangulated ventral hernia causing massive bowel ischemia and resulting in a short bowel. The literature on large abdominal wall hernias leading to short bowel is reviewed, and a discussion on short bowel syndrome is also presented. PMID:26219451

  9. Reducation of Anxiety in Children Facing Hospitalization and Surgery by Use of Filmed Modeling

    ERIC Educational Resources Information Center

    Melamed, Barbara G.; Siegel, Lawrence J.

    1975-01-01

    A group of children (N=60) about to undergo elective surgery for hernias, tonsillectomies, or urinary-genital tract difficulties were shown on hospital admission either a relevant peer modeling film of a child being hospitalized and receiving surgery or an unrelated control film. (Author)

  10. Evaluation of a Video Telescopic Operating Microscope (VITOM) for Pediatric Surgery and Urology: A Preliminary Report

    PubMed Central

    Duel, Barry P.; Gangi, Alexandra; Williams, James A.; Berci, George; Freedman, Andrew L.

    2013-01-01

    Abstract Introduction Optical magnification is an essential tool in the practice of pediatric surgery. Magnifying loupes are the most frequently used instrument, although their use often comes at the expense of neck pain experienced by the operating surgeon. Recent advances have led to the development of a compact video microscope (VITOM®; Karl Storz Endoscopy GmbH, Tuttlingen, Germany) that displays high-definition magnified images on a flat screen. This study was designed to evaluate VITOM as a potential substitute for loupes in complex open pediatric procedures and to explore VITOM as an effective intraoperative teaching modality for open surgery. Subjects and Methods Three surgeons used the VITOM II exoscope in 20 operations: 14 hypospadias repairs, 2 inguinal hernia repairs, 1 sacrococcygeal teratoma resection, 1 recurrent tracheoesophageal fistula repair, and 2 additional procedures. Surgeons, trainees, and surgical technicians subjectively evaluated image quality; surgeons evaluated handling of VITOM, degree of neck strain, and fatigue. Three midlevel surgical trainees assessed the VITOM potential for teaching value. Overall impressions of each group and consensus opinions were generated. Results All procedures were completed without complication. The consensus opinion of the entire group was that image quality was excellent. The surgeons found VITOM easy to use, and all agreed that neck strain and fatigue were reduced. Surgical trainees felt that VITOM imaging aided in their understanding of procedures and anatomy. Surgical technicians perceived improved operation flow through better visualization of the procedure. Conclusions VITOM provides excellent visualization of pediatric operations with improved surgeon comfort and may serve as a substitute for loupes. Secondarily, we found enhanced trainee learning and potential improvement in the flow of surgical procedures. Further study of VITOM with a larger sample size and validated tools is needed. PMID:23758565

  11. [UPDATE ON MINIMALLY INVASIVE CARDIAC SURGERY].

    PubMed

    Fujita, Tomoyuki; Kobayashi, Junjiro

    2015-09-01

    Minimally invasive surgery is an attractive choice for patients undergoing major cardiac procedures. This paper focuses on minimally invasive mitral valve repair and robotic surgery using the da Vinci Surgical System. Minimally invasive mitral valve repair is usually performed through a right minithoracotomy with direct vision. The techniques used in this procedure are similar to those in open surgery. The outcome of minimally invasive mitral valve repair is also equivalent to that of open surgery, with high levels of patient satisfaction. On the other hand, minimally invasive cardiac surgery using the da Vinci Surgical System has not been approved in Japan except for internal mammary artery harvesting. A Japanese clinical trial of da Vinci surgery for mitral valve repair and atrial septal defect closure has been completed and approval is awaited. Although da Vinci surgery is technically demanding, this less-invasive technique may provide another choice for patients in the near future. PMID:26630738

  12. Cardiac Surgery

    PubMed Central

    Weisse, Allen B.

    2011-01-01

    Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of coronary artery bypass grafting greatly aided the treatment of coronary heart disease. Cardiac transplantation, attempts to use the total artificial heart, and the application of ventricular assist devices have brought us to the present day. Although progress in the field of cardiovascular surgery appears to have slowed when compared with the halcyon times of the past, substantial challenges still face cardiac surgeons. It can only be hoped that sufficient resources and incentive can carry the triumphs of the 20th century into the 21st. This review covers past developments and future opportunities in cardiac surgery. PMID:22163121

  13. Robotic surgery

    MedlinePLUS

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  14. Urethral Calculi in a 7-Year-old Boy Presenting as a Large Scrotal Mass After Surgery of Exstrophy-epispadias Repair.

    PubMed

    Telli, Onur; Gollu, Gulnur; Khanmammadov, Farid; Tastekin, Nil Yasam; Aktug, Tanju

    2015-08-01

    Urethral calculi are extremely rare in pediatric population and are usually presented with dysuria, hematuria, lower urinary tract obstruction, and rarely as a scrotal mass. We here report a giant primary urethral stone presenting as a scrotal mass that developed in the penile urethra resulting from a postsurgical complication of exstrophy-epispadias repair. A 7-year-old boy was admitted with the complaint of scrotal mass and dysuria. Computerized tomography confirmed giant urethral stone impacted to diverticulum of urethra. Cystoscopy revealed a nonobstructed stone in the urethra related to a posterior diverticulum. After scrotal incision, stone was removed with open diverticulectomy. PMID:26199152

  15. Genetic aspects of human congenital diaphragmatic hernia

    PubMed Central

    Pober, BR

    2010-01-01

    Congenital diaphragmatic hernia (CDH) is a common major malformation affecting 1/3000–1/4000 births, which continues to be associated with significant perinatal mortality. Much current research is focused on elucidating the genetics and pathophysiology contributing to CDH to develop more effective therapies. The latest data suggest that many cases of CDH are genetically determined and also indicate that CDH is etiologically heterogeneous. The present review will provide a brief summary of diaphragm development and model organism work most relevant to human CDH and will primarily describe important human phenotypes associated with CDH and also provide recommendations for diagnostic evaluation of a fetus or infant with CDH. PMID:18510546

  16. Genetic causes of congenital diaphragmatic hernia

    PubMed Central

    Wynn, Julia; Yu, Lan; Chung, Wendy K.

    2014-01-01

    Congenital diaphragmatic hernia (CDH) is a moderately prevalent birth defect that, despite advances in neonatal care, is still a significant cause of infant death, and surviving patients have significant morbidity. The goal of ongoing research to elucidate the genetic causes of CDH is to develop better treatment and ultimately prevention. CDH is a complex developmental defect that is etiologically heterogeneous. This review summarizes the recurrent genetic causes of CDH including aneuploidies, chromosome copy number variants, and single gene mutations. It also discusses strategies for genetic evaluation and genetic counseling in an era of rapidly evolving technologies in clinical genetic diagnostics. PMID:25447988

  17. Genetic causes of congenital diaphragmatic hernia.

    PubMed

    Wynn, Julia; Yu, Lan; Chung, Wendy K

    2014-12-01

    Congenital diaphragmatic hernia (CDH) is a moderately prevalent birth defect that, despite advances in neonatal care, is still a significant cause of infant death, and surviving patients have significant morbidity. The goal of ongoing research to elucidate the genetic causes of CDH is to develop better treatment and ultimately prevention. CDH is a complex developmental defect that is etiologically heterogeneous. This review summarizes the recurrent genetic causes of CDH including aneuploidies, chromosome copy number variants, and single gene mutations. It also discusses strategies for genetic evaluation and genetic counseling in an era of rapidly evolving technologies in clinical genetic diagnostics. PMID:25447988

  18. [CLINICO-EXPERIMENTAL SUBSTANTIATION OF INTRAABDOMINAL PLASTY FOR UMBILICAL HERNIAS].

    PubMed

    Joffe, O Yu; Shvets, I M; Tarasyuk, T V; Stetsenko, O P; Tsyura, Yu P

    2015-04-01

    The impact of various methods of plasty, using net implants, on results of umbilical hernias treatment was studied in experimental and clinical investigation. The umbilical hernias plasty was performed in accordance to the IPOM (intraperitoneal on lay mesh) method, application of which have permitted to reduce a hospital stay of the patients as well as their period of social rehabilitation, and to guarantee the best cosmetic effect in comparison with such while making umbilical hernias plasty in accordance to a sub lay method. PMID:26263641

  19. Alternative approaches for mitral valve repair

    PubMed Central

    Goldstone, Andrew B.

    2015-01-01

    Unique situations arise in which alternative exposures for mitral valve surgery offer distinct advantages over traditional approaches. Each exposure facilitates both mitral valve repair and replacement, although the standard repair procedures must be modified to accommodate these non-traditional exposures. Here, we detail the technical considerations required to perform transventricular and transaortic mitral valve repair as well as discuss the advantages for employing these less conventional approaches. PMID:26539353

  20. Variations in lengths of stay and rates of day case surgery: implications for the efficiency of surgical management.

    PubMed Central

    Morgan, M; Beech, R

    1990-01-01

    Variability in lengths of acute hospital stay and rates of day case surgery is shown to be a continuing pattern which occurs both between and within countries. A model of the determinants of health service activity is presented and the contribution of different factors to the observed variations is assessed. Differences in methods of funding health services are identified as a major determinant of the between country variations, while the within country variations largely reflect the influence of local differences in facilities and services and the organisation of care at a hospital level, as well as the independent effects of differences in clinical practice style. The main rationale for advocating a reduction in length of stay and increased use of day surgery is to increase efficiency by reducing costs per case while maintaining the quality of care. These criteria of costs, clinical outcomes and patient acceptability are examined in relation to day case surgery for an intermediate surgical procedure (inguinal hernia repair) and short stay surgery for cholecystectomy. The precise cost savings are shown to depend on the methods of costing, assumptions made and facilities employed, while factors influencing the outcomes achieved include the criteria of patient selection, the surgical techniques employed, and the adequacy of preoperative communication. Barriers to the more widespread adoption of short stay and day case surgery include practical and organisational constraints on clinical practice at a hospital level, lack of awareness among clinicians as to how far their practices differ from current norms, and clinical barriers raised by surgeons who do not see short stay policies as advantageous. Mechanisms to promote changes in clinical practice styles include independent professional audit, peer review, and involvement of clinicians in budgeting and resource allocation. Assessing quality requires that attention is given to patient acceptability and satisfaction as well as to the monitoring of clinical outcomes. PMID:2115068

  1. Cosmetic Surgery

    MedlinePLUS

    ... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face ...

  2. Clinicopathologic Significance of Excision Repair Cross-Complementation 1 Expression in Patients Treated With Breast-Conserving Surgery and Radiation Therapy

    SciTech Connect

    Goyal, Sharad; Yang Qifeng

    2010-03-01

    Purpose: The excision repair cross-complementation 1 (ERCC1) enzyme plays a rate-limiting role in the nucleotide excision repair pathway and is associated with resistance to platinum-based chemotherapy in cancers of the head and neck and the lung. The purpose of this study was to evaluate the clinicopathologic and prognostic significance of ERCC1 expression in a cohort of early-stage breast cancer patients treated with breast conservation therapy. Methods and Materials: Paraffin specimens from 504 women with early-stage breast cancer treated with breast conservation therapy were constructed into tissue microarrays. The array was stained for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) and ERCC1. This was then correlated with clinicopathologic factors and outcomes data. Results: ERCC-1 expression was evaluable in 366 cases (72%). In this group, 32% and 38% of patients received adjuvant chemotherapy and hormonal therapy, respectively. Increased ERCC-1 expression was found to be correlated with ER positivity (p < 0.005), lower T stage (p < 0.017), nodal negativity (p < 0.013), age >50 (p < 0.006), reduced use of adjuvant chemotherapy (p < 0.02), and increased use of adjuvant hormonal therapy (p < 0.004). ERCC1 expression did not correlate with locoregional recurrence-free survival, distant metastasis-free survival, cause-specific survival, or overall survival. In patients who were both ERCC1-negative and -positive, the use of chemotherapy predicted for worse distant metastasis-free survival (p = 0.05 and p = 0.07, respectively) but not cause-specific survival or overall survival. Conclusions: Although ERCC1 expression did not predict for outcome measures in this dataset, overexpression correlated with favorable prognostic factors such as ER positivity, lower T stage, nodal negativity, and age >50. To our knowledge, this is the first study investigating ERCC1 expression in patients receiving adjuvant radiation therapy for breast cancer.

  3. Contralateral inguinal hernial development and ipsilateral recurrence following unilateral hernial repair in infants and children.

    PubMed

    Nazir, M; Saebø, A

    1996-02-01

    The aim of the present study was to evaluate the frequency of contralateral hernial development and ipsilateral recurrence following surgery for unilateral inguinal hernia in infants and children. During the period 1961-1970, 161 infants and children (143 males and 18 females; 0-12 years old) underwent surgery for unilateral inguinal hernia. The patients were followed for 20-29 years (until 1990). 16/143 males (11.2%), and 1/18 females developed a contralateral inguinal hernia; the frequency among patients less than seven years old was significantly higher than the frequency among older children (16/118 > 1/43; p < 0.05). No significant difference was observed between patients primarily operated for rightsided and leftsided hernias. Four/143 boys (2.7%) experienced testicular maldescens. Recurrence after herniotomy was seen in 9/143 males (6.3%), and in 1/18 females. The low frequency of contralateral hernial development, as the risk of surgical complications, indicate that routine contralateral inguinal exploration may not be recommended while operating upon unilateral symptomatic inguinal hernias. Our recurrence rate of 6.2% may mirror the conditions in a general surgical department, where several surgeons and residents operate upon a limited number of paediatric patients. PMID:8629384

  4. Videoscope-assisted cardiac surgery

    PubMed Central

    Chen, Robert Jeen-Chen

    2014-01-01

    Videoscope-assisted cardiac surgery (VACS) offers a minimally invasive platform for most cardiac operations such as coronary and valve procedures. It includes robotic and thoracoscopic approaches and each has strengths and weaknesses. The success depends on appropriate hardware setup, staff training, and troubleshooting efficiency. In our institution, we often use VACS for robotic left-internal-mammary-artery takedown, mitral valve repair, and various intra-cardiac operations such as tricuspid valve repair, combined Maze procedure, atrial septal defect repair, ventricular septal defect repair, etc. Hands-on reminders and updated references are provided for reader’s further understanding of the topic. PMID:24455172

  5. Videoscope-assisted cardiac surgery.

    PubMed

    Chiu, Kuan-Ming; Chen, Robert Jeen-Chen

    2014-01-01

    Videoscope-assisted cardiac surgery (VACS) offers a minimally invasive platform for most cardiac operations such as coronary and valve procedures. It includes robotic and thoracoscopic approaches and each has strengths and weaknesses. The success depends on appropriate hardware setup, staff training, and troubleshooting efficiency. In our institution, we often use VACS for robotic left-internal-mammary-artery takedown, mitral valve repair, and various intra-cardiac operations such as tricuspid valve repair, combined Maze procedure, atrial septal defect repair, ventricular septal defect repair, etc. Hands-on reminders and updated references are provided for reader's further understanding of the topic. PMID:24455172

  6. Robotic Surgery

    NASA Technical Reports Server (NTRS)

    2000-01-01

    The Automated Endoscopic System for Optimal Positioning, or AESOP, was developed by Computer Motion, Inc. under a SBIR contract from the Jet Propulsion Lab. AESOP is a robotic endoscopic positioning system used to control the motion of a camera during endoscopic surgery. The camera, which is mounted at the end of a robotic arm, previously had to be held in place by the surgical staff. With AESOP the robotic arm can make more precise and consistent movements. AESOP is also voice controlled by the surgeon. It is hoped that this technology can be used in space repair missions which require precision beyond human dexterity. A new generation of the same technology entitled the ZEUS Robotic Surgical System can make endoscopic procedures even more successful. ZEUS allows the surgeon control various instruments in its robotic arms, allowing for the precision the procedure requires.

  7. [Pleural hernia of an esophageal graft--late postoperative complication].

    PubMed

    Grabowski, K; Lewandowski, A; Moro?, K; Struty?ska-Karpi?ska, M; B?aszczuk, J; Macha?a, R

    1997-01-01

    Pleural hernia of the oesophageal substitute from pedicled intestinal segment is one of the late postoperative complications. 13 cases of patients with oesophagus reconstructed because of lye ingestion stenosis are presented. Problems concerning diagnosis and treatment of pleural hernia are analysed. Eight patients with minor symptoms were treated conservatively. Five patients were operated, two of them from acute necrosis of the substitute. Necrosis was caused by incarceration of the bowel and torsion of the mesentery. Elective operative treatment consisted of reduction of hernia sac contents, closing of the hernia orifice, chest drainage and temporary gastronomy. In patient operated as an emergency cases necrotic part of substitute was removed. This resulted in oesophageal exclusion in the neck, creating gastronomy. Chest drainage was also performed. PMID:9446380

  8. Incarceration of Meckel's diverticulum in a left paraduodenal Treitz' hernia

    PubMed Central

    Gerdes, Christoph; Akkermann, Oke; Krüger, Volker; Gerdes, Anna; Gerdes, Berthold

    2015-01-01

    Meckel’s diverticula incarcerated in a hernia were first described anecdotally by Littré, a French surgeon, in 1700. Meckel, a German anatomist and surgeon, explained the pathophysiology of this disease 100 years later. In addition, a congenital paraduodenal mesocolic hernia, known as a Treitz hernia, is a rare cause of small bowel obstruction. These hernias are caused by an abnormal rotation of the primitive midgut, resulting in a right or left paraduodenal hernia. We treated a patient presenting with pain and diagnosed extraluminal air in the abdomen after a computed tomography examination. We performed a laparotomy and found a combination of these two seldomly occurring congenital diseases, incarceration and perforation of Meckel’s diverticulum in a left paraduodenal hernia. We performed a thorough review of the literature, and this report is the first to describe a patient with a combination of these two rare conditions. We considered the case regarding the variety of terminology as well as the treatment options of these conditions. PMID:26301234

  9. Anesthesia For In Utero Repair of Myelomeningocele

    PubMed Central

    Ferschl, Marla; Ball, Robert; Lee, Hanmin; Rollins, Mark D.

    2013-01-01

    Recently published results suggest that prenatal repair of fetal myelomeningocele is a potentially preferable alternative when compared to postnatal repair. In this article, the pathology of myelomeningocele, unique physiologic considerations, perioperative anesthetic management, and ethical considerations of open fetal surgery for prenatal myelomeningocele repair are discussed. Open fetal surgeries have many unique anesthetic issues such as inducing profound uterine relaxation, vigilance for maternal or fetal blood loss, fetal monitoring, and possible fetal resuscitation. Postoperative management, including the requirement for postoperative tocolysis and maternal analgesia are also reviewed. The success of intrauterine myelomeningocele repair relies on a well-coordinated multidisciplinary approach. Fetal surgery is an important topic for anesthesiologists to understand, as the number of fetal procedures is likely to increase as new fetal treatment centers are opened across the United States. PMID:23508219

  10. Falciform ligament hernia after laparoscopic cholecystectomy: a rare case and review of the literature.

    PubMed

    Charles, Anthony; Shaikh, Almaas A; Domingo, Shirley; Kreske, Edward

    2005-04-01

    The occurrence of an internal hernia through a congenital or iatrogenic defect in the falciform ligament is extremely rare. In the era of minimally invasive surgery, we present an unusual case of small bowel obstruction after laparoscopic cholecystectomy. An 85-year-old white male presented to the emergency room 2 weeks after an uneventful cholecystectomy and complaining of a colicky, nonradiating right upper quadrant abdominal pain. Hydroxyiminodiacetic acid (HIDA) scan and endoscopic retrograde cholangiopancreatography (ERCP) performed revealed an open ductal system. Abdominal computed tomography (CT) scan was suggestive of a high-grade small bowel obstruction. Exploratory laparotomy revealed a herniated loop of distal ileum, passing from right to left through a defect in the falciform ligament created by the subxyphoid trochar. The surgeon should consider dividing the inferior leaf of the free edge of the falciform ligament, including the round ligament, should an aperture be created during laparoscopic port placement. PMID:15943414

  11. Preoperative Laboratory Testing in Patients Undergoing Elective, Low-Risk Ambulatory Surgery

    PubMed Central

    Benarroch-Gampel, Jaime; Sheffield, Kristin M.; Duncan, Casey B.; Brown, Kimberly M.; Han, Yimei; Townsend, Courtney M.; Riall, Taylor S.

    2012-01-01

    Background Routine preoperative laboratory testing for ambulatory surgery is not recommended. Methods Patients who underwent elective hernia repair (N = 73,596) were identified from the National Surgical Quality Improvement Program (NSQIP) database (2005–2010). Patterns of preoperative testing were examined. Multivariate analyses were used to identify factors associated with testing and postoperative complications. Results A total of 46,977 (63.8%) patients underwent testing, with at least one abnormal test recorded in 61.6% of patients. In patients with no NSQIP comorbidities (N = 25,149) and no clear indication for testing, 54% received at least one test. In addition, 15.3% of tested patients underwent laboratory testing the day of the operation. In this group, surgery was done despite abnormal results in 61.6% of same day tests. In multivariate analyses, testing was associated with older age, ASA (American Society of Anesthesiologists) class >1, hypertension, ascites, bleeding disorders, systemic steroids, and laparoscopic procedures. Major complications (reintubation, pulmonary embolus, stroke, renal failure, coma, cardiac arrest, myocardial infarction, septic shock, bleeding, or death) occurred in 0.3% of patients. After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postoperative complications. Conclusions Preoperative testing is overused in patients undergoing low-risk, ambulatory surgery. Neither testing nor abnormal results were associated with postoperative outcomes. On the basis of high rates of testing in healthy patients, physician and/or facility preference and not only patient condition currently dictate use. Involvement from surgical societies is necessary to establish guidelines for preoperative testing. PMID:22868362

  12. Robot-assisted cardiac surgery.

    PubMed

    Ishikawa, Norihiko; Watanabe, Go

    2015-01-01

    Recognition of the significant advantages of minimizing surgical trauma has resulted in the development of minimally invasive surgical procedures. Endoscopic surgery offers patients the benefits of minimally invasive surgery, and surgical robots have enhanced the ability and precision of surgeons. Consequently, technological advances have facilitated totally endoscopic robotic cardiac surgery, which has allowed surgeons to operate endoscopically rather than through a median sternotomy during cardiac surgery. Thus, repairs for structural heart conditions, including mitral valve plasty, atrial septal defect closure, multivessel minimally invasive direct coronary artery bypass grafting (MIDCAB), and totally endoscopic coronary artery bypass graft surgery (CABG), can be totally endoscopic. Robot-assisted cardiac surgery as minimally invasive cardiac surgery is reviewed. PMID:26134073

  13. An Atypical Case of Right-Sided Bochdalek Hernia in an Adult

    PubMed Central

    Safdar, Syed A.; Jawad, Sami Abdul; Dieguez, Javier; Doraiswamy, Vikram; Kam, Jennifer; Shaaban, Hamid; Miller, Richard A.

    2014-01-01

    Bochdalek hernias are usually congenital in nature and normally present after birth. However, in rare cases, these hernias are present in adulthood. We report an unusual case of a posttraumatic right-sided Bochdalek hernia found incidentally in an adult and treated successfully with conservative management. PMID:25657968

  14. Amyand's Hernia with Appendicitis: A Case Report and Integrative Review

    PubMed Central

    Feitosa Cavalcante, Jéssica; Melo Teixeira Batista, Hermes; Cavalcante Pita Neto, Ivo; Fernandes Frutuoso, Jairo; Rodrigues Pinheiro, Woneska; Maria Pinheiro Bezerra, Italla; de Abreu, Luiz Carlos; de Menezes Silveira, Gylmara Bezerra

    2015-01-01

    Introduction. Inguinal hernia is a common disorder with an estimated prevalence of 1.2% of the entire population and it is 12 times more common in males. Objective. To describe a case of appendix with signs of inflammation in the hernia sac, condition that is rare and difficult to diagnose, and to perform literature review, describing the most relevant aspects and the main controversies. Method. Report of a case and search in PubMed on June 1, 2015, using the terms “Appendix” [MeSH term] AND “hernia, inguinal” [MeSH term]. Results. The search resulted in 38 articles in total, and after deleting the articles that were not part of the inclusion criteria, there were 26 case reports remaining. Discussion. The search resulted in a total of 38 articles and after deleting the articles that were not part of the inclusion criteria, there were 26 case reports remaining. Conclusion. Amyand's hernia is a rare and difficult to diagnose condition, being commonly found occasionally in surgical procedures. It should be remembered in the presence of cases of incarcerated hernia, due to its possible complications if not diagnosed. PMID:26640737

  15. An unusual presentation of Meckel diverticulum as strangulated femoral hernia.

    PubMed

    Zacharakis, Evangelos; Papadopoulos, Vasilios; Athanasiou, Thanos; Ziprin, Paul; Zacharakis, Emmanouil

    2008-01-01

    We report an unusual case of a patient with strangulated Meckel diverticulum in a femoral hernia. A 65-year-old woman presented with a nonradiating, constant pain in the right groin with associated nausea and anorexia. Physical examination revealed a tender, irreducible lump in the right groin area. At operation, a hernia sac containing a strangulated Meckel diverticulum was clearly recognized going through the femoral ring. A diverticulectomy was performed, and the femoral ring was closed with a polypropylene plug. No recurrence has been observed during the 3 year follow-up. Strangulated Meckel diverticulum in a femoral hernia remains a challenging diagnosis due to its extremely rare occurrence. Surgical exploration provides definite diagnosis of this rare condition. PMID:18176301

  16. Wide-Awake Primary Flexor Tendon Repair, Tenolysis, and Tendon Transfer

    PubMed Central

    2015-01-01

    Tendon surgery is unique because it should ensure tendon gliding after surgery. Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table. I applied this method to primary flexor tendon repair in zone 1 or 2, tenolysis, and tendon transfer, and found this approach makes tendon surgery easier and more reliable. This article describes the method that I have used for tendon surgery. PMID:26330947

  17. Right-sided Bochdalek hernia in an adult: a case report

    PubMed Central

    2009-01-01

    Introduction Bochdalek hernia is a type of congenital diaphragmatic hernia that typically presents in childhood - the clinical manifestation of symptoms and diagnosis in adults is extremely rare. There are fewer than 20 cases of right-sided Bochdalek hernia reported in adults in the literature. Case presentation We review a case of a 38-year-old woman with a right-sided Bochdalek hernia who was experiencing abdominal pain and pleural effusion. The diagnosis of Bochdalek hernia was made by chest X-ray and computed tomography. The right lobe of the liver and flexura hepatica of the colon were herniated into the thorax cavity. The hernia was treated via thoracotomy assisted with laparoscopy and she made an uneventful recovery. Conclusion We report a rare case of a right-sided Bochdalek hernia for which our patient was treated successfully. Even though rare, this disorder should be recognised, examined and treated appropriately to avoid complications. PMID:20062780

  18. Warfarin-Associated Diaphragmatic Hernia: An Unusual Diagnosis

    PubMed Central

    Vilhena, Cristina; Gameiro, Cátia; Tomás, Cláudia; Santos, Antónia; Ilgenfritz, Raquel

    2015-01-01

    Fetal warfarin syndrome is a consequence of maternal intake of warfarin during pregnancy and comprises a wide range of manifestations, including some typical facial dysmorphologic features. The authors report a case of prenatal ultrasonographic diagnosis of warfarin embryopathy in an obese woman on unsupervised warfarin prophylaxis at the 16th week of gestation. The fetus presented with facial dysmorphism, pectus excavatum, diaphragmatic hernia, and pulmonary hypoplasia. To the best of our knowledge, this is the second reported case of warfarin-associated diaphragmatic hernia. PMID:26078896

  19. Laparoscopy for perforated Richter hernia with incarcerated foreign body.

    PubMed

    Hartin, Charles W; Caty, Michael G; Bass, Kathryn D

    2011-07-01

    Children often place nonedible objects into their mouths. Occasionally, these objects are inadvertently swallowed, and fortunately, the majority passes spontaneously without intervention. We present the case of a 10-month-old girl who presented with an incarcerated Richter hernia through an indirect inguinal defect containing a wall of sigmoid colon perforated by a swallowed lollipop stick. Although this is a rare case, we conclude that prompt laparoscopic abdominal exploration is an extremely valuable tool in making an accurate diagnosis in difficult-to-reduce or incarcerated hernia cases. PMID:21763852

  20. [Littré hernia as a cause of bowel obstruction].

    PubMed

    Souza, Heitor Soares de; Felício, Ana Carla; Berthier, Guilherme

    2009-04-01

    The authors describe a case of a 60-year-old male with a history of a mass and pain at the right inguinal and epigastric areas. He also reported symptoms of bowel obstruction. Physical examination revealed a mass at right inguinal area, which was not reducible or pulsatile. Surgical findings included hernial sac contents with loop of ileum with signs of ischemia and a Meckel's diverticulum. Histopathological examination showed herniation of the Meckel diverticulum -Littré hernia. The article discusses the history and the incidence of this rare form of hernia. PMID:20076894

  1. [Flexor tendon repair: a short story].

    PubMed

    Moutet, F; Corcella, D; Forli, A; Mesquida, V

    2014-12-01

    This short story of flexor tendon repair aims to illustrate hesitations and wanderings of this surgery. Obviously tendon repair was very early considered, but it developed and diffused rather lately. It became a routine practice only in 20th century. This was due on the one hand, in Occident, to the Galen's dogmatic interdiction, on the other hand, to the repair difficulties of this paradoxical structure. Actually tendon is made of fibroblasts and collagen (sticky substances), and then its only goal is to move. According to this necessity, whatever the used techniques are, gliding is the final purpose. Technical evolutions are illustrated by historical contributions to flexor tendon surgery of several "giants" of hand surgery. PMID:24837978

  2. Mesh repair of vaginal wall prolapse

    PubMed Central

    Kapur, Krishan; Dalal, Vinod

    2014-01-01

    Background Over the last decade, mesh augmented surgical repair is being increasingly used in pelvic organ prolapse. Perigee and Apogee are comprehensive, single-use needle suspension kits that provide a standardized delivery method for mesh or graft-augmented repairs. This study has been carried out to study the safety and efficacy of the Perigee and Apogee mesh repair systems. Methods 10 cases of posterior vaginal wall prolapse with or without Apical prolapse underwent Apogee mesh repair surgery and 10 cases of anterior vaginal wall prolapse underwent Perigee mesh repair surgery. Depending on the findings either Apogee or Perigee or both were used. Patients were followed up for complications of the surgery if any, and for the relief of the symptoms related to prolapse and associated symptoms of bowel/bladder dysfunction. Objective cure rate was prolapse < stage 1 as per the POPQ system. Data collected was statistically analyzed. Results The objective and subjective cure rates were 100%. Postoperative complications were minor. No patient developed de novo urinary urge symptoms, stress urinary incontinence or UTI postoperatively. There were no operative complications like bladder injuries, hematoma and rectal injuries. The mean blood loss was 180 ml and the mean duration of surgery during the Apogee and Perigee mesh repair was 51.5 ± 2.99 min and 60.9 ± 4.65 min respectively. Conclusion In the present study there was a significant improvement in the degree of prolapse after the mesh repair surgeries and the results were consistent even at 12 months follow up. PMID:24843196

  3. Foot Surgery

    MedlinePLUS

    ... About Feet » Foot Health Information Surgery When is Foot Surgery Necessary? Many foot problems do not respond ... restore the function of your foot. Types of Foot Surgery Fusions: Fusions are usually performed to treat ...

  4. Gastroschisis repair

    MedlinePLUS

    ... dressing or a sterile plastic bag. A nasogastric (NG) tube will be inserted through your baby's nose ... will probably need after surgery are: A nasogastric (NG) tube placed through the nose to drain the ...

  5. Dissecting intramyocardial hematoma after robotic mitral valve repair.

    PubMed

    McGrath, Tory; Ushukumari, Deepu; Canale, Leonardo; Gillinov, Marc

    2015-03-01

    We report the first case of a dissecting intramyocardial hematoma discovered intraoperatively after robotic mitral valve repair, potential etiologies relevant to robotic surgery, and its successful management. PMID:25742825

  6. Congenital Diaphragmatic Hernia and Occupational Therapy: A Case Report

    ERIC Educational Resources Information Center

    Bates, Angela C.

    2011-01-01

    This case report describes occupational therapy (OT) intervention in an outpatient setting and outcomes for a child diagnosed with congenital diaphragmatic hernia (CDH) from 4 to 28 months of age. There is little information on therapy intervention and outcomes of children who have survived. The patient is a white male, born at 35 weeks gestation…

  7. [Perforation of a hiatal hernia after a high altitude flight].

    PubMed

    Kenfack, R; Debaize, S; Sztern, B; Joukovsky, P

    2007-03-01

    We report the case of a 84-year-old patient who came to the emergency department for vomiting and epigastralgia which had occurred during an air flight. These symptoms were related to the intraabdominal perforation of a massive hiatal hernia on barotrauma due to high altitude. PMID:17511380

  8. Turbine repair process, repaired coating, and repaired turbine component

    DOEpatents

    Das, Rupak; Delvaux, John McConnell; Garcia-Crespo, Andres Jose

    2015-11-03

    A turbine repair process, a repaired coating, and a repaired turbine component are disclosed. The turbine repair process includes providing a turbine component having a higher-pressure region and a lower-pressure region, introducing particles into the higher-pressure region, and at least partially repairing an opening between the higher-pressure region and the lower-pressure region with at least one of the particles to form a repaired turbine component. The repaired coating includes a silicon material, a ceramic matrix composite material, and a repaired region having the silicon material deposited on and surrounded by the ceramic matrix composite material. The repaired turbine component a ceramic matrix composite layer and a repaired region having silicon material deposited on and surrounded by the ceramic matrix composite material.

  9. Giant recurrent retroperitoneal liposarcoma initially presenting as inguinal hernia: Review of literature

    PubMed Central

    Leão, Pedro; Vilaça, Sónia; Oliveira, Mário; Falcão, Joaquim

    2011-01-01

    INTRODUCTION Liposarcomas comprise around 15% of soft tissue tumors. These tumors of mesodermal origin arise as single tumors, present one histologic type and diverse locations (including the retroperitoneum). Diagnosis of liposarcomas of retroperitoneum is difficult because of this unspecific presentation and in 50–100% of the cases there is recurrence from residual tissue. PRESENTATION OF CASE An 86 year old male patient was admitted in 1996 due to a right and voluminous inguinal hernia. During the herniaplasty, a right paratesticular tumor was isolated and removed. The histologic exam revealed a well-differentiated liposarcoma. A CT scan was performed and a large abdominal mass was detected. The patient underwent a laparotomy and an incomplete resection of the tumor was achieved. After the surgery the patient remained asymptomatic during a long period. Nine years later, the patient underwent another laparotomy with partial removal of the giant recurrent retroperitoneal liposarcoma. CONCLUSION The purpose of this publication is to report the recurrence of giant retroperitoneal liposarcoma, which is an unusual presentation in surgery today. Furthermore, we would like to emphasize the long-term survival of this patient despite partial resection and the possibility of performing a re-resection in this type of cases. PMID:22288059

  10. Motorcycle Repair.

    ERIC Educational Resources Information Center

    Hein, Jim; Bundy, Mike

    This motorcycle repair curriculum guide contains the following ten areas of study: brake systems, clutches, constant mesh transmissions, final drives, suspension, mechanical starting mechanisms, electrical systems, fuel systems, lubrication systems, and overhead camshafts. Each area consists of one or more units of instruction. Each instructional…

  11. Snowmobile Repair.

    ERIC Educational Resources Information Center

    Helbling, Wayne

    This guide is designed to provide and/or improve instruction for occupational training in the area of snowmobile repair, and includes eight areas. Each area consists of one or more units of instruction, with each instructional unit including some or all of the following basic components: Performance objectives, suggested activities for teacher and…

  12. Leakage test during mitral valve repair.

    PubMed

    Watanabe, Taiju; Arai, Hirokuni

    2014-11-01

    Mitral valve repair is the preferred surgical treatment for mitral regurgitation. Cardiac surgeons must increasingly pursue high-quality mitral valve repair, which ensures excellent long-term outcomes. Intraoperative assessment of a competency of the repaired mitral valve before closure of the atrium is an important step in accomplishing successful mitral valve repair. Saline test is the most simple and popular method to evaluate the repaired valve. In addition, an "Ink test" can provide confirmation of the surface of coaptation, which is often insufficient in the assessment of saline test. There are sometimes differences between the findings of the leakage test in an arrested heart and the echocardiographic findings after surgery. Assessment of the mitral valve in an arrested heart may not accurately reflect its function in a contractile heart. Assessment of the valve on the beating heart induced by antegrade or retrograde coronary artery perfusion can provide a more physiological assessment of the repaired valve. Perfusion techniques during beating heart surgery mainly include antegrade coronary artery perfusion without aortic cross-clamping, and retrograde coronary artery perfusion via the coronary sinus with aortic cross-clamping. It is the most important point for the former approach to avoid air embolism with such precaution as CO2 insufflation, left ventricular venting, and transesophageal echocardiography, and for the latter approach to maintain high perfusion flow rate of coronary sinus and adequate venting. Leakage test during mitral valve repair increasingly takes an important role in successful mitral valve reconstruction. PMID:25156036

  13. Understanding and preventing complications in repairing rotator cuff tears.

    PubMed

    Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola

    2012-01-01

    Repair of rotator cuff tears is a common procedure. Prior to approaching this surgery, it should be realized that each surgical step can lead to complications, including those related to positioning and anaesthesia. Stiffness, infection and failure of repair are the more frequent complications reported. PMID:21986055

  14. Fryns syndrome without diaphragmatic hernia. Report on a new case and review of the literature.

    PubMed

    Alessandri, L; Brayer, C; Attali, T; Samperiz, S; Tiran-Rajaofera, I; Ramful, D; Pilorget, H

    2005-01-01

    Fryns syndrome is an autosomal recessive multiple congenital anomaly syndrome characterized by coarse facies, diaphragmatic hernia, distal limb hypoplasia and malformations of the cardiovascular, gastrointestinal, genitourinary and central nervous systems. Diaphragmatic hernia is a leading diagnostic feature in Fryns syndrome, recorded in more than 80% of cases. We report a newborn with clinical features of Fryns syndrome except the diaphragmatic hernia. Cases of Fryns syndrome without diaphragmatic hernia are reviewed. Even in the absence of diaphragmatic hernia, pulmonary anomalies are described in Fryns syndrome, especially pulmonary hypoplasia. Fetal mice, exposed to nitrofen, have a high incidence of congenital diaphragmatic hernia and other malformations similar to that seen in Fryns syndrome. Nitrofen might target molecular mechanisms similar to those involved in Fryns syndrome. PMID:16440878

  15. Meniscal Repair

    PubMed Central

    Yoon, Kyoung Ho

    2014-01-01

    The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint. Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy. Thus, there has been growing interest in meniscal repair. In addition, with increased understanding of the important roles of the meniscal root and advancement of diagnostic methods, efforts have been made to ensure preservation of the meniscal roots. In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well. PMID:24944971

  16. Repairing Conveyor 

    E-print Network

    Unknown

    2011-08-17

    ..................................................................................................... 26 2.9 Bronze anchor from the Bodrum Museum of Underwater Archaeology, with associated stock showing clear curvature ................. 27 x 2.10 Wood remains attached to ABX-7 and what appears... intended as a repair or an attempt to complete the construction of a previously unfinished temple.3 Having sourced the drums 1 Pulak and Rogers 1994, 18-20. 2 Carlson and Aylward 2010, 145. 3...

  17. Sigmoid carcinoma localized in the sac of a right inguinoscrotal hernia

    PubMed Central

    Falidas, Evangelos; Gourgiotis, Stavros; Papachrysostomou, Marios; Oikonomou, Christiana; Villias, Constantinos

    2015-01-01

    The inguinoscrotal hernia with colonic malignancy in the sac presents rare but severe consequence. The most common side of this type of hernia is the left one while the most common part of the large bowel is the sigmoid colon. The clinical picture can be easily confused with simple inguinoscrotal hernia unless the clinician is alert to the presence of certain sinister symptoms and signs. We report an extremely rare case of a 91-year-old man presented with anemia who had a right inguinoscrotal hernia containing a sigmoid colon carcinoma.

  18. Repair of a Complex Congenital Cardiac Defect

    MedlinePLUS Videos and Cool Tools

    ... 00:00:14 ANNOUNCER: Over the next hour, live from Children's Hospital Boston's cardiac OR, see cardiac surgeons repair a complex congenital cardiac defect. Each year the pediatric cardiac surgery program provides surgical care to approximately 1,100 patients, including more than 700 cases of open ...

  19. Acute acalculous cholecystitis after abdominal wall repair (Rives-Stoppa).

    PubMed

    Reurings, Jurrian C; Diaz, Ruben P D; Penninga, Luit; Nellensteijn, David R

    2014-01-01

    Acute acalculous cholecystitis (AAC) is a rare condition normally occurring in critically ill patients. Compared to acute calculous cholecystitis, AAC is associated with complications and has a worse outcome. Hence, knowledge of this condition is very important. We describe a case of a 31-year-old man who developed AAC after abdominal wall repair with mesh (Rives-Stoppa procedure) 1 day after discharge from the hospital. To the best of our knowledge, this is the first paper to report AAC after abdominal incisional hernia repair. Although it is known to be more common in critically ill patients, AAC can also occur postoperatively in outpatients. Early recognition and treatment of AAC may improve outcome. PMID:24739656

  20. After Surgery

    MedlinePLUS

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  1. Turbinate surgery

    MedlinePLUS

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery ... There are several types of turbinate surgery: Turbinectomy: All or part of the lower turbinate is taken out. This can be done in several different ways, but sometimes a ...

  2. Brain aneurysm repair

    MedlinePLUS

    ... aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm ... Your scalp, skull, and the coverings of the brain are opened. A metal clip is placed at ...

  3. Aortic aneurysm repair - endovascular

    MedlinePLUS

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... leaking or bleeding. You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. ...

  4. Past, present, and future of minimally invasive mitral valve surgery.

    PubMed

    Schmitto, Jan D; Mokashi, Suyog A; Cohn, Lawrence H

    2011-09-01

    Minimally invasive mitral valve surgery (mini-MVS) has evolved into a safe and efficient surgical option for many patients. The overall complication rate is reduced, patient satisfaction increased, and hospital costs are lower with this approach, while providing safe and durable surgery. The repair/replacement of mitral valves via a minimally invasive technique represents a significant recent paradigm shift in cardiac surgery. The rapid development and refinement of minimally invasive valve surgery has enabled the repair of complex valves and, most importantly, has yielded similar results to those provided by standard surgical approaches. PMID:22066352

  5. Length of stay and cost analysis of neonates undergoing surgery at a tertiary neonatal unit in England.

    PubMed

    Shetty, S; Kennea, N; Desai, P; Giuliani, S; Richards, J

    2016-01-01

    Introduction There is a lack of knowledge on the average length of stay (LOS) in neonatal units after surgical repair of common congenital anomalies. There are few if any publications reporting the activity performed by units undertaking neonatal surgery. Such activity is important for contracting arrangements, commissioning specialist services and counselling parents. The aim of this study was to describe postnatal LOS for infants admitted to a single tertiary referral neonatal unit with congenital malformations requiring surgery. Methods Data on nine conditions were collected prospectively for babies on the neonatal unit over a five-year period (2006-2011). For those transferred back to their local unit following surgery, the local unit was contacted to determine the total LOS. Only those babies who had surgery during their first admission to our unit and who survived to discharge were included in the study. Cost estimates were based on the tariffs agreed for neonatal care between our trust and the London specialised commissioning group in 2011-2012. Results The median LOS for the conditions studied was: gastroschisis 35 days (range: 19-154 days), oesophageal atresia 33 days (range: 9-133 days), congenital diaphragmatic hernia 28 days (range: 7-99 days), intestinal atresia 24 days (range: 6-168 days), Hirschsprung's disease 21 days (range: 15-36 days), sacrococcygeal teratoma 17 days (range: 12-55 days), myelomeningocoele 15.5 days (range: 8-24 days), anorectal malformation 15 days (range: 6-90 days) and exomphalos 12 days (range: 3-228 days). The total neonatal bed day costs for the median LOS ranged from £8,701 (myelomeningocoele) to £23,874 (gastroschisis). The cost of surgery was not included. Conclusions There is wide variation in LOS for the same conditions in a single neonatal unit. This can be explained by different types and severity within the same congenital anomalies, different surgeons and other clinical confounders (eg sepsis, surgical complications, associated anomalies). These data will enable us to give more detailed information to families following prenatal or postnatal diagnosis. They also allow more detailed planning of resource allocation for neonatal admissions. PMID:26688402

  6. INTERNAL REPAIR OF PIPELINES

    SciTech Connect

    Robin Gordon; Bill Bruce; Nancy Porter; Mike Sullivan; Chris Neary

    2003-05-01

    The two broad categories of deposited weld metal repair and fiber-reinforced composite repair technologies were reviewed for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Preliminary test programs were developed for both deposited weld metal repairs and for fiber-reinforced composite repair. To date, all of the experimental work pertaining to the evaluation of potential repair methods has focused on fiber-reinforced composite repairs. Hydrostatic testing was also conducted on four pipeline sections with simulated corrosion damage: two with composite liners and two without.

  7. Evolving endoscopic surgery.

    PubMed

    Sakai, Paulo; Faintuch, Joel

    2014-06-01

    Since the days of Albukasim in medieval Spain, natural orifices have been regarded not only as a rather repugnant source of bodily odors, fluids and excreta, but also as a convenient invitation to explore and treat the inner passages of the organism. However, surgical ingenuity needed to be matched by appropriate tools and devices. Lack of technologically advanced instrumentation was a strong deterrent during almost a millennium until recent decades when a quantum jump materialized. Endoscopic surgery is currently a vibrant and growing subspecialty, which successfully handles millions of patients every year. Additional opportunities lie ahead which might benefit millions more, however, requiring even more sophisticated apparatuses, particularly in the field of robotics, artificial intelligence, and tissue repair (surgical suturing). This is a particularly exciting and worthwhile challenge, namely of larger and safer endoscopic interventions, followed by seamless and scarless recovery. In synthesis, the future is widely open for those who use together intelligence and creativity to develop new prototypes, new accessories and new techniques. Yet there are many challenges in the path of endoscopic surgery. In this new era of robotic endoscopy, one will likely need a virtual simulator to train and assess the performance of younger doctors. More evidence will be essential in multiple evolving fields, particularly to elucidate whether more ambitious and complex pathways, such as intrathoracic and intraperitoneal surgery via natural orifice transluminal endoscopic surgery (NOTES), are superior or not to conventional techniques. PMID:24628672

  8. The Use of Biological Meshes in Diaphragmatic Defects – An Evidence-Based Review of the Literature

    PubMed Central

    Antoniou, Stavros A.; Pointner, Rudolph; Granderath, Frank-Alexander; Köckerling, Ferdinand

    2015-01-01

    The widespread use of meshes for hiatal hernia repair has emerged in the era of laparoscopic surgery, although sporadic cases of mesh augmentation of traumatic diaphragmatic rupture have been reported. The indications for biologic meshes in diaphragmatic repair are ill defined. This systematic review aims to investigate the available evidence on the role of biologic meshes in diaphragmatic rupture and hiatal hernia repair. Limited data from sporadic case reports and case series have demonstrated that repair of traumatic diaphragmatic rupture with biologic mesh is safe technique in both the acute or chronic setting. High level evidence demonstrates short-term benefits of biologic mesh augmentation in hiatal hernia repair over primary repair, although adequate long-term data are not currently available. Long-term follow-up data suggest no benefit of hiatal hernia repair using porcine small intestine submucosa over suture repair. The effectiveness of different biologic mesh materials on hernia recurrence requires further investigation. PMID:26539439

  9. Symptomatic and quality of life outcomes after site-specific fascial reattachment for pelvic organ prolapse repair.

    PubMed

    Fayyad, Abdalla M; Redhead, Emma; Awan, Noveen; Kyrgiou, Maria; Prashar, Sanjeev; Hill, Simon R

    2008-02-01

    The aim of this study was to assess symptomatic and quality of life outcome scores following site specific fascial reattachment surgery for pelvic organ prolapse using the validated Prolapse Quality of Life (P-QOL) questionnaires. One hundred and ninety two women underwent surgery for pelvic organ prolapse; ninety four underwent anterior repair (thirty four of them had vaginal hysterectomy), and ninety eight had posterior repair. Patients filled P-QOL questionnaires 24 hours prior to surgery and a postal P-QOL questionnaire six months post operatively. Pre and post operative questionnaires were paired. Quality of life and symptoms scores were calculated using Wilcoxon signed rank test. One hundred and one women returned their questionnaires and were suitable to include in the study. Forty nine underwent anterior repair (fifteen had vaginal hysterectomy) and 52 underwent posterior repair. Quality of life scores showed significant improvement in the anterior and posterior repair groups with the exception of general health in the anterior repair group and general health and prolapse impact in the posterior repair group. Anterior repair significantly improved urinary voiding and storage symptoms. Posterior repair group showed significant improvement in defecatory symptoms. Both groups showed improvement in sexual function and general prolapse symptoms. Prolapse repair with site specific fascial reattachment results in significant improvement in quality of life scores six months after surgery. Anterior repair improves urinary voiding and storage symptoms and posterior repair improves defecatory dysfunction and urinary voiding. Sexual function improves following prolapse repair with site specific fascial reattachment. PMID:17874216

  10. Anti-reflux surgery

    MedlinePLUS

    ... a treatment for acid reflux, also known as GERD (gastroesophageal reflux disease). GERD is a condition in which food or stomach ... close tightly enough. A hiatal hernia can make GERD symptoms worse. It occurs when the stomach bulges ...

  11. SLAP Repairs With Combined Procedures Have Lower Failure Rate Than Isolated Repairs in a Military Population

    PubMed Central

    Waterman, Brian R.; Arroyo, William; Heida, Kenneth; Burks, Robert; Pallis, Mark

    2015-01-01

    Background: Injuries to the superior glenoid labrum represent a significant cause of shoulder pain among active patients. The physical requirements of military service may contribute to an increased risk of injury. Limited data are available regarding the success of superior labral anterior posterior (SLAP) repairs in an active military population. Purpose: To quantify the rate of clinical failure and surgical revision after isolated and combined SLAP repair. Study Design: Cohort study; Level of evidence, 3. Methods: All consecutive active-duty servicemembers undergoing arthroscopic repair of type II SLAP lesions at a single institution between 2006 and 2012 were identified. Patients with less than 2-year clinical follow-up and nonmilitary status were excluded. Demographic variables, surgical variables, and occupational outcomes were extracted from electronic medical records and confirmed with the US Army Physical Disability Agency database. Failure was defined as subsequent revision surgery or medical discharge with persistent shoulder complaints. Results: A total of 192 patients with SLAP repair were identified with a mean follow-up of 50.0 months (SD, 17.0 months). Isolated SLAP repair occurred in 31.3% (n = 60) versus 68.8% (n = 132) with concomitant procedures. At final follow-up, 37.0% (n = 71) of patients reported some subjective activity-related shoulder pain. Postoperative return to duty occurred in 79.6% (n = 153), and only 20.3% (n = 39) were discharged with continuing shoulder disability. The combined rotator cuff repair (96%; P = .023) and anteroinferior labral repair group (88%; P = .056) had a higher rate of functional return than isolated SLAP repair (70%). Thirty-one (16.1%) patients were classified as surgical failure and required revision. Of these, the majority of patients undergoing biceps tenodesis (76%) returned to active duty, as compared with revision SLAP repair (17%). Lower demand occupation and the presence of combined shoulder injuries (P = .011 and .016, respectively) were significantly associated with a lower risk of medical discharge and revision surgery, respectively. Conclusion: Favorable outcomes can be anticipated in the majority of military servicemembers after arthroscopic SLAP repair, particularly with combined shoulder injuries. Revision surgery occurred in 16% of patients after primary SLAP repair. Clinical Relevance: Isolated repair of unstable SLAP lesions and/or increased upper extremity demands are associated with higher failure rates in this population. PMID:26535389

  12. Minimally invasive robotic mitral valve surgery.

    PubMed

    Atluri, Pavan; Woo, Y Joseph

    2011-01-01

    Over the past two decades, significant advances have been made in mitral valve surgery. Cardiac surgeons have successfully repaired degenerative and ischemic regurgitant mitral valves via a traditional midline sternotomy. In recent years, alternate incisions have yielded minimally invasive approaches to the mitral valve. Technological advances have made robotically assisted minimally invasive mitral valve surgery feasible. Decreased pain, more rapid return to work, diminished blood loss and reduced length of hospitalization have been witnessed following robotic mitral valve surgery when compared with a traditional sternotomy. Equivalent long-term mortality and freedom from recurrent mitral regurgitation are evident between mitral valve repair performed via a traditional sternotomy and minimally invasive and robotic techniques. As a result, an increasing number of patients and referring cardiologists are seeking minimally invasive approaches to mitral valve surgery. PMID:21158546

  13. Unnecessary surgery.

    PubMed Central

    Leape, L L

    1989-01-01

    The extent of unnecessary surgery has been the object of considerable speculation and occasional wild accusation in recent years. Most evidence of the existence of unnecessary surgery, such as information from studies of geographic variations and the results of second surgical opinion programs, is circumstantial. However, results from the few studies that have measured unnecessary surgery directly indicate that for some highly controversial operations the fraction that are unwarranted could be as high as 30 percent. Most unnecessary surgery results from physician uncertainty about the effectiveness of an operation. Elimination of this uncertainty requires more efficient production and dissemination of scientific information about clinical effectiveness. In the absence of adequate data from scientific studies, the use of a consensus of expert opinion, disseminated by means of comprehensive practice guidelines, offers the best opportunity to identify and eliminate unnecessary surgery. PMID:2668237

  14. Rapid road repair vehicle

    DOEpatents

    Mara, Leo M. (Livermore, CA)

    1998-01-01

    Disclosed is a rapid road repair vehicle capable of moving over a surface to be repaired at near normal posted traffic speeds to scan for and find an the high rate of speed, imperfections in the pavement surface, prepare the surface imperfection for repair by air pressure and vacuum cleaning, applying a correct amount of the correct patching material to effect the repair, smooth the resulting repaired surface, and catalog the location and quality of the repairs for maintenance records of the road surface. The rapid road repair vehicle can repair surface imperfections at lower cost, improved quality, at a higher rate of speed than was was heretofor possible, with significantly reduced exposure to safety and health hazards associated with this kind of road repair activities in the past.

  15. Rapid road repair vehicle

    DOEpatents

    Mara, L.M.

    1998-05-05

    Disclosed is a rapid road repair vehicle capable of moving over a surface to be repaired at near normal posted traffic speeds to scan for and find at the high rate of speed, imperfections in the pavement surface, prepare the surface imperfection for repair by air pressure and vacuum cleaning, applying a correct amount of the correct patching material to effect the repair, smooth the resulting repaired surface, and catalog the location and quality of the repairs for maintenance records of the road surface. The rapid road repair vehicle can repair surface imperfections at lower cost, improved quality, at a higher rate of speed than was not heretofor possible, with significantly reduced exposure to safety and health hazards associated with this kind of road repair activities in the past. 2 figs.

  16. Animal models of cartilage repair

    PubMed Central

    Cook, J. L.; Hung, C. T.; Kuroki, K.; Stoker, A. M.; Cook, C. R.; Pfeiffer, F. M.; Sherman, S. L.; Stannard, J. P.

    2014-01-01

    Cartilage repair in terms of replacement, or regeneration of damaged or diseased articular cartilage with functional tissue, is the ‘holy grail’ of joint surgery. A wide spectrum of strategies for cartilage repair currently exists and several of these techniques have been reported to be associated with successful clinical outcomes for appropriately selected indications. However, based on respective advantages, disadvantages, and limitations, no single strategy, or even combination of strategies, provides surgeons with viable options for attaining successful long-term outcomes in the majority of patients. As such, development of novel techniques and optimisation of current techniques need to be, and are, the focus of a great deal of research from the basic science level to clinical trials. Translational research that bridges scientific discoveries to clinical application involves the use of animal models in order to assess safety and efficacy for regulatory approval for human use. This review article provides an overview of animal models for cartilage repair. Cite this article: Bone Joint Res 2014;4:89–94. PMID:24695750

  17. Valve Repair or Replacement

    MedlinePLUS

    ... valve surgery can be done using a robot. Robotic surgery does not require a large incision in ... The Texas Heart Institute has a robot. With robotic surgery, the surgeon has a control console, a ...

  18. Nationwide survey to evaluate medical utilization by patients with inguinal hernia and the risk of developing varicocele in Taiwan

    PubMed Central

    Liu, Wen-Liang; Chen, Yu-An; Lai, Yu-Wei; Hsueh, Thomas Y; Chen, Shiou-Sheng; Chiu, Allen W

    2014-01-01

    Background The purpose of this study was to analyze age, geographical and seasonal variations in medical service utilization by patients with inguinal hernia in Taiwan, and the influence of herniorrhaphy on development of ipsilateral varicocele in male patients. Methods Between 2001 and 2008, comprehensive data on the characteristics of medical service utilization by patients with inguinal hernia was evaluated via a retrospective nationwide population-based study. Data were obtained from the National Health Insurance Research Database in Taiwan. Parameters for comparison included newly diagnosed inguinal hernia cases, number of herniorrhaphies, and incidence rates every year, number of outpatient visits for inguinal hernia, and herniorrhaphy by age, season, and area of Taiwan. Results There was an average of 1,466 newly diagnosed inguinal hernia cases and 871.9 herniorrhaphies performed per year per million population during the study period. The male ratio for both newly diagnosed inguinal hernia cases and number of herniorrhaphies increased significantly by age. The number of newly diagnosed inguinal hernia cases and outpatient visits for inguinal hernia was highest during summer, followed by spring, autumn, and winter, and in the north of Taiwan, followed by the center, south, and east. Additionally, the incidence of developing ipsilateral varicocele after herniorrhaphy was low in male patients. Conclusion The number of newly diagnosed inguinal hernia cases and outpatient visits for inguinal hernia is highest during summer and lowest in eastern Taiwan. In addition, the incidence of developing ipsilateral varicocele after herniorrhaphy is higher in patients aged 10–19 years. PMID:24470759

  19. Surgical Sciences Cardiovascular Surgery, Thoracic Surgery ------------------------------------------------------

    E-print Network

    Miyashita, Yasushi

    38 Surgical Sciences Cardiovascular Surgery, Thoracic Surgery ------------------------------------------------------ http://ctstokyo.umin.ne.jp/ We are leading in Japan by annual surgery case volume of 700. New knowledge. ·Clinical research · Brain and spinal cord protection in thoracic aortic surgery · Minimally invasive

  20. Robotic and minimally invasive cardiac surgery.

    PubMed

    Vernick, William; Atluri, Pavan

    2013-06-01

    The transition of mitral valve surgery away from the traditional sternotomy approach toward more minimally invasive strategies continues to evolve. The use of telemanipulative robotic arms with near 3-dimensional valve visualization has allowed for near complete endoscopic robotic-assisted mitral valve surgery, providing increased patient satisfaction and cosmesis. Studies have shown rapid recovery times without sacrificing perioperative safety or the durability of surgical repair. Although a steep learning curve exists as well as high fixed and disposable costs, continued technological development fueled by increasing patient demand may allow for further expansion in the use of robotic-assisted minimal invasive surgery. PMID:23711646

  1. A case of acute mesentero-axial gastric volvulus in a patient with a diaphragmatic hernia: experience with a laparoscopic approach

    PubMed Central

    Al-Faraj, Dalal; Al-Haddad, Mohanned; Al-Hadeedi, Omar; Al-Subaie, Saud

    2015-01-01

    Gastric volvulus is an uncommon but serious surgical condition mandating an early diagnosis and surgical intervention. It may present either acutely or chronically with epigastric pain, retching and vomiting. There are two types of gastric volvulus: organo-axial and mesentero-axial. We report a case of a mesentero-axial gastric volvulus in a 49-year-old woman with a left-sided diaphragmatic hernia. She presented with a significant epigastric pain and vomiting. A flexible upper endoscopy, a barium meal and a contrast-enhanced computed tomography imaging had confirmed the diagnosis. She was treated with a laparoscopic mesh repair of the diaphragmatic defect followed by a gastropexy. She had an uneventful postoperative course and was asymptomatic thereafter. PMID:26391688

  2. Bariatric Surgery Procedures

    MedlinePLUS

    ... Surgery Procedures Who is a Candidate for Bariatric Surgery? Childhood and Adolescent Obesity Find a Provider Benefits of Bariatric Surgery ... Search Patient Learning Center Bariatric Surgery FAQs Bariatric Surgery ... and Adolescent Obesity 100 SW 75th Street, Suite 201, Gainesville, ...

  3. MRI using ultrasmall superparamagnetic particles of iron oxide in patients under surveillance for abdominal aortic aneurysms to predict rupture or surgical repair: MRI for abdominal aortic aneurysms to predict rupture or surgery—the MA3RS study

    PubMed Central

    McBride, Olivia M B; Berry, Colin; Burns, Paul; Chalmers, Roderick T A; Doyle, Barry; Forsythe, Rachael; Garden, O James; Goodman, Kirsteen; Graham, Catriona; Hoskins, Peter; Holdsworth, Richard; MacGillivray, Thomas J; McKillop, Graham; Murray, Gordon; Oatey, Katherine; Robson, Jennifer M J; Roditi, Giles; Semple, Scott; Stuart, Wesley; van Beek, Edwin J R; Vesey, Alex; Newby, David E

    2015-01-01

    Introduction Population screening for abdominal aortic aneurysms (AAA) halves the associated mortality and has led to the establishment of national screening programmes. Prediction of aneurysm growth and rupture is challenging and currently relies on serial diameter measurements with ultrasound. Recently, a novel MRI-based technique using ultrasmall superparamagnetic particles of iron oxide (USPIO) has demonstrated considerable promise as a method of identifying aneurysm inflammation and expansion. Methods and analysis The MA3RS study is a prospective observational multicentre cohort study of 350 patients with AAA in three centres across Scotland. All participants will undergo MRI with USPIO and aneurysm expansion will be measured over 2?years with CT in addition to standard clinical ultrasound surveillance. The relationship between mural USPIO uptake and subsequent clinical outcomes, including expansion, rupture and repair, will be evaluated and used to determine whether the technique augments standard risk prediction markers. To ensure adequate sensitivity to answer the primary question, we need to observe 130 events (composite of rupture or repair) with an estimated event rate of 41% over 2?years of follow-up. The MA3RS study is currently recruiting and expects to report in 2017. Discussion This is the first study to evaluate the use of USPIO-enhanced MRI to provide additional information to aid risk prediction models in patients with AAA. If successful, this study will lay the foundation for a large randomised controlled trial targeted at applying this technique to determine clinical management. Trial registration number Current Controlled Trials: ISRCTN76413758. PMID:25932334

  4. [Amyand's hernia--case presentation and a discussion about diagnosis problems and surgical treatment].

    PubMed

    Suliman, E; Popa, D; Palade, R; Simion, G

    2012-01-01

    We present the case of a 62 years old patient, with multiple associated tares, which was operated in emergency for an Amyand's hernia. The appendix was perforated and generated a big pussy collection (aprox. 200 ml) in the hernia sac. The impossibility of mobilization of the appendix, which was just 2/3 in the hernia sac, made us perform a median laparotomy for safety reasons. The position and fixation of the cecum made impossible the exteriorization of the appendix in the hernia sac. The postoperative evolution, under a complex supervision, was favorable. Due to the rarity of the clinical entity, of the specific issues and of the literature review, we decided to communicate the clinical observation. PMID:22844840

  5. Brain surgery

    MedlinePLUS

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  6. Thyroid Surgery

    MedlinePLUS

    ... thyroid surgery, requiring treatment with thyroid hormone (see Hypothyroidism brochure ). This is especially true if you had ... Radioactive Iodine Low Iodine Diet Thyroid Function Tests Hypothyroidism Hyperthyroidism Thyroid Disease and Complementary and Alternative Medicine ...

  7. Sinus Surgery

    MedlinePLUS

    ... sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected ... altered anatomical landmarks, or where a patient?s sinus anatomy is very unusual, making typical surgery difficult. Image ...

  8. Cataract Surgery

    MedlinePLUS

    ... Contact Lenses Colored Contact Lenses Eyeglasses IOLs Refractive Surgery & LASIK Sunglasses Living EyeSmart About Ophthalmologists Adults Under 40 Adults 40 to 60 Adults Over 60 Babies, Children & Teenagers Computer Usage Diabetes Diet & Nutrition Eye Injuries Eye ...

  9. Nose Surgery

    MedlinePLUS

    ... is as high a priority as appearance. Can Cosmetic Nasal Surgery Create A "Perfect" Nose? Aesthetic nasal ... be corrected with a surgical procedure called septoplasty. Cosmetic changes to the nose are often performed at ...

  10. Plastic Surgery

    MedlinePLUS

    ... appearance and self-image through both reconstructive and cosmetic procedures. Reconstructive procedures correct defects on the face ... a woman's breast after surgery for breast cancer. Cosmetic (also called aesthetic ) procedures alter a part of ...

  11. Lung surgery

    MedlinePLUS

    You will have several visits with your health care provider and undergo medical tests before your surgery. Your health care provider will: Do a complete physical exam Make sure other medical conditions you may have, such as ...

  12. A Rare Complication of Biliary Stent Migration: Small Bowel Perforation in a Patient with Incisional Hernia

    PubMed Central

    Yilmaz, Özkan; Kiziltan, Remzi; Aydin, Oktay; Bayrak, Vedat; Kotan, Çetin

    2015-01-01

    Endoscopic biliary stents have been recently applied with increasing frequency as a palliative and curable method in several benign and malignant diseases. As a reminder, although most of the migrated stents pass through the intestinal tract without symptoms, a small portion can lead to complications. Herein, we present a case of intestinal perforation caused by a biliary stent in the hernia of a patient with a rarely encountered incarcerated incisional hernia. PMID:26273488

  13. [Morgagni-Larrey diaphragmatic hernia in a 3-month-old child affected by Marfan syndrome].

    PubMed

    Laumonerie, P; Mouttalib, S; Edouard, T; Galinier, P

    2015-11-01

    The authors report on a case of diaphragmatic hernia occurring in a 3-month-old child affected by Marfan syndrome. Diagnosis was made on a chest X-ray and cardiac ultrasounds, performed because of the association of poor general condition, failure to thrive, and signs of respiratory distress. As a reminder, we emphasize the association between Marfan disease and diaphragmatic hernias as well as the diagnostic approach to reach an appropriate diagnosis. PMID:26433576

  14. Posturing after macular hole surgery: a review.

    PubMed

    Chandra, Aman; Charteris, David G; Yorston, David

    2011-01-01

    Since the first reports on surgical repair of macular holes, postoperative face-down posturing (FDP) has been part of the management regime. However, prone positioning is unpleasant for patients, and has adverse effects. Over the last decade some vitreoretinal surgeons have reduced the duration of FDP, or even abandoned it altogether. There have been few non-randomised, and even fewer randomised trials addressing this controversy. With high success rates for macular hole surgery and multiple different surgical strategies such as internal limiting membrane peeling, combining macular hole and cataract surgery, and different durations of gas tamponade, analysing the effects of individual factors is difficult. This paper discusses the mechanisms of surgical repair as well as the role of postoperative FDP, and reviews the studies that have attempted to determine its effect on the success of macular hole surgery. PMID:21778774

  15. Strangulated internal hernia by giant Meckel diverticulum presented as acute appendicitis

    PubMed Central

    Fuentes-Diaz, Jhonny Mauricio; Trujillo-Vasquez, Camilo Andrés; Parra-Vargas, Ana María; Rovira-Chaves, Andrea Sofía; Tinoco-Guzman, Laura Viviana; Garcia-Garcia, Johana Marcela

    2015-01-01

    Introduction Internal hernia due to a Meckel diverticulum is a common presentation of bowel obstruction mostly seen in pediatric population. However, it has been stated that among 5% of the patients had a giant Meckel diverticulum (defined as a Meckel diverticulum with increased dimensions than the ones commonly found), being this condition very unusual. Presentation of case We presented a 19 year old male with acute abdominal pain suggestive of appendicitis. During appendectomy we discovered ischemic and necrotic signs in a bowel segment, leading us to perform a laparotomy that revealed a portion of ischemic and necrotic jejunum, and another bowel segment with a strong adherence to the mesentery root that created an internal hernia. The internal hernia was reduced and the injured bowel portions were resected. Necrotic bowel samples were sent to the pathology department who posteriorly reported a giant Meckel diverticulum. The patient had an excellent recovery after procedure. Discussion After searching in PubMed for a similar association between Meckel diverticulum and internal hernia, we found few cases that reported a giant Meckel diverticulum and a low occurrence with internal hernias making our case not so common to find. Conclusion We concluded that a giant Meckel diverticulum in association with mesenteric defects producing internal hernias are not common pathologies to find together in a patient as our research and case suggest. PMID:26117448

  16. Endovascular Repair of a Secondary Aorto-Appendiceal Fistula

    SciTech Connect

    Tse, Donald M. L.; Thompson, Andrew R. A.; Perkins, Jeremy; Bratby, Mark J.; Anthony, Susan; Uberoi, Raman

    2011-10-15

    Aortoenteric fistula (AEF) is an uncommon but serious complication occurring after aortic surgery and may occur at any site in the gastrointestinal tract, with the duodenum being the most common. Conventional surgical repair of secondary AEF has high mortality, whereas endovascular repair has emerged as an alternative treatment despite concerns about persistent or recurrent infection. We report the case of a 91-year old man who was admitted with rectal bleeding from an aorto-appendiceal fistula 9 years after open abdominal aortic aneurysm repair. This rare site for AEF was diagnosed on computed tomography, and we present the first case of endovascular treatment of this uncommon complication.

  17. Transcatheter repair of aortic leaflet perforation in a patient with prior surgical bicuspid aortic valve repair.

    PubMed

    Lim, Wayland; Smith, Thomas; Rogers, Jason H

    2015-11-15

    A 47-year-old male underwent surgery for functional bicuspid aortic valve severe regurgitation with a fused right and left coronary cusp. The patient presents nine years after surgical bicuspid aortic valve repair with symptomatic severe aortic regurgitation, diagnosed by TEE and MRI, caused primarily from a perforation located at the base of the surgically fused coronary cusps. The patient had a minimally dilated aortic root that did not yet necessitate surgical intervention. We present a novel percutaneous bicuspid aortic valve perforation repair that potentially decreases the number of surgical operations the patient must undergo during his lifetime. © 2015 Wiley Periodicals, Inc. PMID:25914034

  18. Velopharyngeal Insufficiency Rates After Delayed Cleft Palate Repair: Lessons Learned From Internationally Adopted Patients.

    PubMed

    Follmar, Keith E; Yuan, Nance; Pendleton, Courtney S; Dorafshar, Amir H; Kolk, Craig Vander; Redett, Richard J

    2015-09-01

    Most surgeons recommend cleft palate repair between 6 and 12 months of age. Internationally adopted patients often undergo delayed repair due to social circumstances. There are few outcomes studies on this population. We conducted a 13-year retrospective review of all patients undergoing primary cleft palate repair at a single tertiary-care academic medical center between 1993 and 2006. The primary outcome was velopharyngeal insufficiency, defined as the recommendation for corrective surgery after multiple formal speech assessments. Two hundred one patients (102 males and 99 females) were identified. One hundred eighty-three repairs were performed before 18 months of age (standard repair group). Eighteen repairs were performed after 18 months of age (delayed repair group), with international adoption being a circumstance in 16 cases. The delayed and standard repair groups were similar with regard to sex, presence of craniofacial syndrome, Veau class, cleft size and laterality, type of repair, and operating surgeon. Mean follow-up was 9.3 years, with minimum follow-up of 5.0 years. Six (33%) of 18 patients in the delayed repair group developed velopharyngeal insufficiency compared to 23 (13%) of 183 in the standard repair group (P = 0.03 by Fisher exact test). These data demonstrate that internationally adopted patients undergoing delayed palate repair suffer especially poor speech outcomes. Physiologic differences in patients undergoing late repair, as well as social factors including adaptation to a new language and culture, may be factors. Early repair should be performed when possible. PMID:25046662

  19. Advanced Nail Surgery

    PubMed Central

    Haneke, Eckart

    2011-01-01

    Six techniques not yet widely known or used in the dermatologic surgery of the nails are briefly described. Small-to-medium-sized tumours of the proximal nail fold (PNF) can be excised and the defect repaired with advancement or rotation flaps. A superficial biopsy technique of the matrix for the diagnosis of longitudinal brown streaks in the nail, which allows rapid histological diagnosis of the melanocyte focus to be performed, is described here. Because the excision is very shallow and leaves the morphogenetic connective tissue of the matrix intact, the defect heals without scarring. Laterally positioned nail tumours can be excised in the manner of a wide lateral longitudinal nail biopsy. The defect repair is performed with a bipedicled flap from the lateral aspect of the distal phalanx. Malignant tumours of the nail organ often require its complete ablation. These defects can be covered by a full-thickness skin graft, reversed dermal graft, or cross-finger flap. The surgical correction of a split nail is often difficult. The cicatricial tissue of the matrix and PNF have to be excised and the re-attachment of these wounds prevented. The matrix defect has to be excised and sutured or covered with a free matrix graft taken either from the neighbouring area or from the big toe nail. PMID:22279381

  20. Department of Surgery Colorectal Surgery Section

    E-print Network

    Department of Surgery Colorectal Surgery Section 200 Hawkins Drive, 4621 JCP Iowa City, IA 52242.uihealthcare.org Colorectal Surgery and General Gastrointestinal Surgery Education Topics Neoplastic Disease 1. Controversies. Management of the patient with Stage IV colorectal cancer: Role of surgery 5. Options in patients

  1. Carotid artery surgery

    MedlinePLUS

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  2. Wound surgery.

    PubMed

    Caldwell, Michael D

    2010-12-01

    The purpose of this article is to review the concepts behind, and practice of, wound surgery. The techniques of wound surgery, born of necessity in the art of military surgeons, have found their renaissance in the modern age of wound care driven by the economic and functional considerations inherent to the outcome-based management of chronic disease. Over 300 years of literature on wound healing has shown an innate ability of the wound (in the absence of infection and repeated trauma) to control its progress, largely through the local inflammatory cells. This article discusses several historical works on wound surgery and healing, topical wound therapy, minimal intervention, and emphasizes the closure of chronic wounds. PMID:21074031

  3. Surgery in a patient with liver disease.

    PubMed

    Rai, Rakesh; Nagral, Sanjay; Nagral, Aabha

    2012-09-01

    Surgery is often needed in patients with concurrent liver disease. The multiple physiological roles of the liver places these patients at an increased risk of morbidity and mortality. Diseases necessitating surgery like gallstones and hernia are more common in patients with cirrhosis. Assessment of severity of liver dysfunction before surgery is important and the risk benefit of the procedure needs to be carefully assessed. The disease severity may vary from mild transaminase rise to decompensated cirrhosis. Surgery should be avoided if possible in the emergency setting, in the setting of acute and alcoholic hepatitis, in a patient of cirrhosis who is child class C or has a MELD score more than 15 or any patient with significant extrahepatic organ dysfunction. In this subset of patients, all possible means to manage these patients conservatively should be attempted. Modified Child-Pugh scores and model for end-stage liver disease (MELD) scores can predict mortality after surgery fairly reliably including nonhepatic abdominal surgery. Pre-operative optimization would include control of ascites, correction of electrolyte imbalance, improving renal dysfunction, cardiorespiratory assessment, and correction of coagulation. Tests of global hemostasis like thromboelastography and thrombin generation time may be more predictive of the risk of bleeding compared with the conventional tests of coagulation in patients with cirrhosis. Correction of international normalized ratio with fresh frozen plasma does not necessarily mean reduction of bleeding risk and may increase the risk of volume overload and lung injury. International normalized ratio liver may better reflect the coagulation status. Recombinant factor VIIa in patients with cirrhosis needing surgery needs further study. Intra-operatively, safe anesthetic agents like isoflurane and propofol with avoidance of hypotension are advised. In general, nonsteroidal anti-inflammatory drug (NSAIDs) and benzodiazepines should not be used. Intra-abdominal surgery in a patient with cirrhosis becomes more challenging in the presence of ascites, portal hypertension, and hepatomegaly. Uncontrolled hemorrhage due to coagulopathy and portal hypertension, sepsis, renal dysfunction, and worsening of liver failure contribute to the morbidity and mortality in these patients. Steps to reduce ascitic leaks and infections need to be taken. Any patient with cirrhosis undergoing major surgery should be referred to a specialist center with experience in managing liver disease. PMID:25755440

  4. Fibronectin and craniofacial surgery.

    PubMed

    Al-Qattan, Mohammad M; AlShomer, Feras; Alqahtani, Abdullah; Alhadlg, Ahmad

    2014-12-01

    Fibronectin is an essential component of the extracellular matrix. The role of fibronectin in craniofacial surgery has not been previously reviewed. Fibronectin mediates bone differentiation and development of the skull. Studies have shown that normal development of the skull requires a specific pattern of expression around the epithelial-mesenchymal interface of the neurocranium. Fibronectin is also essential in mediating the migration of neural crest cells to form the facial skeleton. The calvaria of patients with Apert and Crouzon syndromes have an abnormally elevated collagen level. However, fibronectin levels are elevated in the former syndrome and decreased in the latter syndrome. The significance of this requires further research. Fibronectin gene expression is increased in port wine-derived fibroblasts in patients with Sturge-Weber syndrome. Normal palatogenesis also requires a specific pattern of expression of fibronectin around the maxillary process as well as the roof of the stomodeum, and several studies have linked the development of cleft lip/palate to an imbalance of fibronectin content of the extracellular matrix. Fibronectin mediates cell-to-cell attachment during repair of calvarial defects; hence, fibronectin has been used as a carrier for bone morphogenetic proteins to treat calvarial defects. Finally, fibronectin is now an essential component in stem cell technology related to craniofacial surgery. PMID:24322634

  5. Management of Aortic Aneurysms: Is Surgery of Historic Interest Only?

    PubMed

    Bacharach, J Michael; Wood, Emily A; Slovut, David P

    2015-11-01

    Since its advent in 1991, endovascular aortic aneurysm repair (EVAR) has become a mainstay of treatment for abdominal aortic aneurysms (AAA). Studies such as the comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR 1) trial, have demonstrated the effectiveness of EVAR in reducing perioperative mortality. Technological improvements in graft design and delivery account for an increasing utilization of endovascular repair. Newer branch and fenestrated graft designs have allowed for treatment of patients with complex aortic anatomy that previously could not be treated with EVAR. Endovascular repair, while dominant, is unlikely to eliminate the need for open repair or to relegate open surgery for AAA to historical interest only. The unprecedented adoption of EVAR has led to complications and modes of failure that were not seen with open repair. The rate of failure is markedly increased when endografts are used outside of the instructions for use (IFU). The long-term durability of fenestrated and investigational branch devices remains to be established. The demand for an endovascular approach by patients and the willingness of physicians to place endografts outside the anatomic IFU criteria may have resulted in the pendulum swinging too far away from open surgical management. The consequence of reduced open aortic surgeries is a concern for both patient care as well as training for vascular surgery fellows. Vascular surgery training programs will require innovative changes in training to assure that vascular surgery trainees will have the requisite skill and experience required to competently perform open surgical repair on what will undoubtedly be some of the most complex aortic pathology. PMID:26395644

  6. [Foreskin surgery].

    PubMed

    Kolehmainen, Maija; Taskinen, Seppo; Ossi, Lindell

    2010-01-01

    Balanitis, phimosis and foreskin adhesions are common indications for foreskin surgery during childhood. In phimosis, the foreskin cannot be drawn behind the glans penis because of the narrow external opening of the former. It is important to be able to distinguish between physiologic and pathologic phimosis, since their treatment is different. In adulthood, the need for surgery can be caused by phimosis, a difficult sequel of paraphimosis, recurrent inflammations of the glans penis and foreskin, diseases and cancers of the skin as well as difficulties at intercourse due to the shortness of the frenulum of the prepuce of the penis. PMID:20405611

  7. Ultra-minimally invasive cardiac surgery: robotic surgery and awake CABG.

    PubMed

    Ishikawa, Norihiko; Watanabe, Go

    2015-01-01

    The recognition of the significant advantages of minimizing surgical trauma has resulted in the development of minimally invasive surgical procedures. Endoscopic surgery confers the benefits of minimally invasive surgery upon patients, and surgical robots have enhanced the ability and precision of surgeons. Consequently, technological advances have facilitated totally endoscopic robotic cardiac surgery, which has allowed surgeons to operate endoscopically, rather than through a median sternotomy, during cardiac surgery. Thus, repairs for structural heart conditions, including mitral valve plasty, atrial septal defect closure, multivessel minimally invasive direct coronary artery bypass grafting and totally endoscopic coronary artery bypass graft surgery (CABG), can be totally endoscopic. On the other hand, general anesthesia remains a risk in patients who have severe carotid artery stenosis before surgery, as well as in those with a history of severe cerebral infarction or respiratory failure. In this study, the potential of a new awake CABG protocol using only epidural anesthesia was investigated for realizing day surgery and was found to be a promising modality for ultra-minimally invasive cardiac surgery. We herein review robot-assisted cardiac surgery and awake off-pump coronary artery bypass grafting as ultra-minimally invasive cardiac surgeries. PMID:25274467

  8. Diaphragm Repair with a Novel Cross-Linked Collagen Biomaterial in a Growing Rabbit Model

    PubMed Central

    Mayer, Steffi; Decaluwe, Herbert; Ruol, Michele; Manodoro, Stefano; Kramer, Manuel; Till, Holger; Deprest, Jan

    2015-01-01

    Background Neonates with congenital diaphragmatic hernia and large defects often require patch closure. Acellular collagen matrices (ACM) have been suggested as an alternative to synthetic durable patches as they are remodeled by the host or could also be used for tissue engineering purposes. Materials and Methods 2.0x1.0 cm diaphragmatic defects were created in 6-weeks old New-Zealand white rabbits. We compared reconstruction with a purpose-designed cross-linked ACM (Matricel) to 4-layer non-cross-linked small intestinal submucosa (SIS) and a 1-layer synthetic Dual Mesh (Gore-Tex). Unoperated animals or animals undergoing primary closure (4/0 polyglecaprone) served as age-matched controls. 60 (n = 25) resp. 90 (n = 17) days later, animals underwent chest x-ray and obduction for gross examination of explants, scoring of adhesion and inflammatory response. Also, uniaxial tensiometry was done, comparing explants to contralateral native diaphragmatic tissue. Results Overall weight nearly doubled from 1,554±242 g at surgery to 2,837±265 g at obduction (+84%). X-rays did show rare elevation of the left diaphragm (SIS = 1, Gore-Tex = 1, unoperated control = 1), but no herniation of abdominal organs. 56% of SIS and 10% of Matricel patches degraded with visceral bulging in four (SIS = 3, Matricel = 1). Adhesion scores were limited: 0.5 (Matricel) to 1 (SIS, Gore-Tex) to the left lung (p = 0.008) and 2.5 (Gore-Tex), 3 (SIS) and 4 (Matricel) to the liver (p<0.0001). Tensiometry revealed a reduced bursting strength but normal compliance for SIS. Compliance was reduced in Matricel and Gore-Tex (p<0.01). Inflammatory response was characterized by a more polymorphonuclear cell (SIS) resp. macrophage (Matricel) type of infiltrate (p<0.05). Fibrosis was similar for all groups, except there was less mature collagen deposited to Gore-Tex implants (p<0.05). Conclusions Matricel induced a macrophage-dominated inflammatory response, more adhesions, had appropriate strength but a lesser compliance compared to native tissue. The herein investigated ACM is not a viable option for CDH repair. PMID:26147985

  9. Deep gluteal grounding pad burn after abdominal aortic aneurysm repair.

    PubMed

    Sapienza, Paolo; Venturini, Luigi; Cigna, Emanuele; Sterpetti, Antonio V; Biacchi, Daniele; di Marzo, Luca

    2015-01-01

    Although skin burns at the site of grounding pad are a known risk of surgery, their exact incidence is unknown. We first report the case of a patient who presented a deep gluteal burn at the site of the grounding pad after an abdominal aortic aneurism repair, the etiology and the challenging treatment required to overcome this complication. PMID:26099000

  10. Rodding Surgery

    MedlinePLUS

    Rodding Surgery 804 W. Diamond Ave., Ste. 210 Gaithersburg, MD 20878 (800) 981-2663 (301) 947-0083 Fax: (301) 947-0456 Internet: www.oif.org ... osteogenesis imperfecta contact: Osteogenesis Imperfecta Foundation 804 W. Diamond Avenue, Suite 210, Gaithersburg, MD 20878 Tel: 800- ...

  11. Cosmetic surgery.

    PubMed Central

    Harris, D. L.

    1989-01-01

    The psychotherapeutic nature of cosmetic surgery is emphasised by outlining the range of symptoms from which patients suffer and by explaining the sequence of psychological reactions which cause them. The principles which govern the selection of patients are defined. A brief account of each of the main cosmetic operations is given together with notes on their limitations and risks. PMID:2589786

  12. Arthroscopic Surgery.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    Arthroscopic surgery (or microsurgery) is a significant breakthrough in treating knee injuries. Its applications range from basic diagnosis to arthroscopic menisectomy, although its use in some procedures is still highly controversial. Many surgeons perform the diagnostic procedure, but follow this with the conventional surgical approach.…

  13. Design of an Endonasal Graft Placement Tool for Repair of Skull Base Defects

    E-print Network

    Design of an Endonasal Graft Placement Tool for Repair of Skull Base Defects R. J. Hendrick, R. A Skull Base Surgery Causes of Skull Base Injury · Trauma · Inevitable during some, neurological deficits, or death1 Transnasal skull base surgery2 · Surgeon actuated

  14. Gallbladder Cancer: Surgery

    MedlinePLUS

    ... treated? Next Topic Radiation therapy for gallbladder cancer Surgery for gallbladder cancer There are 2 general types ... gallbladder: Potentially curative surgery Palliative surgery Potentially curative surgery is done when imaging tests or the results ...

  15. Tennis elbow surgery - discharge

    MedlinePLUS

    Lateral epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... Gosens T. Lateral and medical epicondylitis. In: Stanley D, Trail IA, eds. Operative Elbow Surgery . Philadelphia, PA: Elsevier; 2012:chap 35. ...

  16. Lung Carcinoid Tumor: Surgery

    MedlinePLUS

    ... for lung carcinoid tumor symptoms Surgery to treat lung carcinoid tumors Surgery is the main treatment for ... often be cured by surgery alone. Types of lung surgery Different operations can be used to treat ( ...

  17. Facial Cosmetic Surgery

    MedlinePLUS

    ... find out more. asc"} Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  18. Dental Implant Surgery

    MedlinePLUS

    ... find out more. asc"} Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  19. Corrective Jaw Surgery

    MedlinePLUS Videos and Cool Tools

    ... find out more. asc"} Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  20. Prenatal diagnosis of an ectopic intrathoracic kidney in right-sided congenital diaphragmatic hernia using color Doppler ultrasonography.

    PubMed

    Masturzo, B; Kalache, K D; Cockell, A; Pierro, A; Rodeck, C H

    2001-08-01

    The prenatal sonographic features of a fetus with right-sided congenital diaphragmatic hernia diagnosed at 33 weeks are presented. Color Doppler demonstrated an abnormal course of the right renal artery, arising from the aorta and feeding the intrathoracic right kidney. This case report stresses the role of color Doppler in defining which organs have herniated in fetuses with diaphragmatic hernia. PMID:11530002

  1. Platelet rich plasma and knee surgery.

    PubMed

    Sánchez, Mikel; Delgado, Diego; Sánchez, Pello; Fiz, Nicolás; Azofra, Juan; Orive, Gorka; Anitua, Eduardo; Padilla, Sabino

    2014-01-01

    In orthopaedic surgery and sports medicine, the knee joint has traditionally been considered the workhorse. The reconstruction of every damaged element in this joint is crucial in achieving the surgeon's goal to restore the knee function and prevent degeneration towards osteoarthritis. In the last fifteen years, the field of regenerative medicine is witnessing a boost of autologous blood-derived platelet rich plasma products (PRPs) application to effectively mimic and accelerate the tissue healing process. The scientific rationale behind PRPs is the delivery of growth factors, cytokines, and adhesive proteins present in platelets and plasma, as well as other biologically active proteins conveyed by the plasma such as fibrinogen, prothrombin, and fibronectin; with this biological engineering approach, new perspectives in knee surgery were opened. This work describes the use of PRP to construct and repair every single anatomical structure involved in knee surgery, detailing the process conducted in ligament, meniscal, and chondral surgery. PMID:25302310

  2. Prenatal tetrandrine treatment can reverse the abnormal conditions in the lung of newborn with congenital diaphragmatic hernia.

    PubMed

    Xu, Chang; Liu, Wenying; Wang, Yuanxiang; Chen, Zhongxian; Ji, Yi; Luo, Miao; Wang, Xuejun

    2009-05-01

    Pulmonary hypoplasia and persistent pulmonary hypertension are the most important reasons for the high morbidity and mortality of congenital diaphragmatic hernia (CDH). Despite surgical advances and advances in neonatal intensive care, the mortality still remains high. Then the research on how to improve prenatal fetal lung growth has become a focus. Some researches involved in fetal surgery, tracheal occlusion, prenatal use of corticosteroids etc., have been carried out in CDH animal models and humans. But the results either showed no benefit for the outcome of CDH or were unproved. Tetrandrine is a bisbenzylisoquinoline alkaloid isolated from the root of Stephania tetrandra. It has been used in traditional Chinese medicine for several decades to treat patients with silicosis, asthma and pulmonary hypertension etc. Some researches showed that prenatal tetrandrine administration can improve the lung development in CDH rat models. We hypothesize that prenatal treatment with tetrandrine can reverse the abnormal condition in the lung of newborn with CDH, and thus decrease the mortality. PMID:19193494

  3. [Endovascular surgery in the war].

    PubMed

    Reva, V A; Samokhvalov, I M

    2015-01-01

    Rapid growth of medical technologies has led to implementation of endovascular methods of diagnosis and treatment into rapidly developing battlefield surgery. This work based on analysing all available current publications generalizes the data on using endovascular surgery in combat vascular injury. During the Korean war (1950-1953) American surgeons for the first time performed endovascular balloon occlusion of the aorta - the first intravascular intervention carried out in a zone of combat operations. Half a century thereafter, with the beginning of the war in Afghanistan (2001) and in Iraq (2003) surgeons of central hospitals of the USA Armed Forces began performing delayed endovascular operations to the wounded. The development of technologies, advent of mobile angiographs made it possible to later on implement high-tech endovascular interventions in a zone of combat operations. At first, more often they performed implantation of cava filters, somewhat afterward - angioembolization of damaged accessory vessels, stenting and endovascular repair of major arteries. The first in the theatre of war endovascular prosthetic repair of the thoracic aorta for severe closed injury was performed in 2008. Russian experience of using endovascular surgery in combat injuries is limited to diagnostic angiography and regional intraarterial perfusion. Despite the advent of stationary angiographs in large hospitals of the RF Ministry of Defence in the early 1990s, endovascular operations for combat vascular injury are casuistic. Foreign experience in active implementation of endovascular technologies to treatment of war-time injuries has substantiated feasibility of using intravascular interventions in tertiary care military hospitals. Carrying out basic training courses on endovascular surgery should become an organic part of preparing multimodality general battlefield surgeons rendering care on the theatre of combat operations. PMID:26035580

  4. Repairs of composite structures

    NASA Astrophysics Data System (ADS)

    Roh, Hee Seok

    Repair on damaged composite panels was conducted. To better understand adhesively bonded repair, the study investigates the effect of design parameters on the joint strength. The design parameters include bondline length, thickness of adherend and type of adhesive. Adhesives considered in this study were tested to measure their tensile material properties. Three types of adhesively bonded joints, single strap, double strap, and single lap joint were considered under changing bondline lengths, thickness of adherend and type of adhesive. Based on lessons learned from bonded joints, a one-sided patch repair method for composite structures was conducted. The composite patch was bonded to the damaged panel by either film adhesive FM-73M or paste adhesive EA-9394 and the residual strengths of the repaired specimens were compared under varying patch sizes. A new repair method using attachments has been suggested to enhance the residual strength. Results obtained through experiments were analyzed using finite element analysis to provide a better repair design and explain the experimental results. It was observed that the residual strength of the repaired specimen was affected by patch length. Method for rapid repairs of damaged composite structures was investigated. The damage was represented by a circular hole in a composite laminated plate. Pre-cured composite patches were bonded with a quick-curing commercial adhesive near (rather than over) the hole. Tensile tests were conducted on specimens repaired with various patch geometries. The test results showed that, among the methods investigated, the best repair method restored over 90% of the original strength of an undamaged panel. The interfacial stresses in the adhesive zone for different patches were calculated in order to understand the efficiencies of the designs of these patch repairs. It was found that the composite patch that yielded the best strength had the lowest interfacial peel stress between the patch and the host composite structure.

  5. Studies of Bone Morphogenetic Protein based Surgical Repair

    PubMed Central

    Lo, Kevin W.-H.; Ulery, Bret D.; Ashe, Keshia M.; Laurencin, Cato T.

    2012-01-01

    Over the past several decades, recombinant human bone morphogenetic proteins (rhBMPs) have been the most extensively studied and widely used osteoinductive agents for clinical bone repair. Since rhBMP-2 and rhBMP-7 were approved by the U.S. Food and Drug Administration for certain clinical uses, millions of patients worldwide have been treated with rhBMPs for various musculoskeletal disorders. Current clinical applications include treatment of long bone fracture non-unions, spinal surgeries, and oral maxillofacial surgeries. Considering the growing number of recent publications related to clincal research of rhBMPs, there exists enormous promise for these proteins to be used in bone regenerative medicine. The authors take this opportunity to review the rhBMP literature paying specific attention to the current applications of rhBMPs in bone repair and spine surgery. The prospective future of rhBMPs delivered in combination with tissue engineered scaffolds is also reviewed. PMID:22512928

  6. Relationship of a hiatal hernia to the function of the body of the esophagus and the gastroesophageal junction

    SciTech Connect

    DeMeester, T.R.; Lafontaine, E.; Joelsson, B.E.; Skinner, D.B.; Ryan, J.W.; O'Sullivan, G.C.; Brunsden, B.S.; Johnson, L.F.

    1981-10-01

    One hundred two patients referred to our Esophageal Function Laboratory without endoscopic evidence of esophagitis were divided into two groups on the basis of the presence of a hiatal hernia on endoscopic examination. Fifty-three patients had a hiatal hernia and 49 did not. Both groups and 30 normal volunteer subjects had esophageal manometry and 24 hour esophageal pH monitoring. The incompetency of the cardia in patients with a hiatal hernia was dependent upon loss of components responsible for the antireflux mechanism, mainly a decrease in distal esophageal sphincter pressure and a decrease in the length of the sphincter exposed to the positive-pressure environment of the abdomen. These deficiencies were not related to the presence of a hiatal hernia and were similar to those of patients with an incompetent cardia without a hiatal hernia. Patients with a hiatal hernia and an incompetent cardia had significantly more esophageal exposure to refluxed acid than without a hiatal hernia. On the basis of the number of reflux episodes that lasted 5 minutes or longer and radioisotope transit studies, this increased acid exposure was due to both a loss of competency of the cardia and poor esophageal clearance secondary to the presence of a hiatal hernia. Reduction of the hernia and anchoring the distal esophagus into the abdomen not only may improve the antireflux mechanism, but corrects the clearance abnormality as well. The presence of a hiatal hernia has a detrimental effect on the clearance function of the body of the esophagus and may aggravate the effects of gastroesophageal reflux due to an incompetent cardia.

  7. Identifying Neonatal and Pediatric Cardiac and Congenital Diaphragmatic Hernia Extracorporeal Membrane Oxygenation Patients at Increased Mortality Risk

    PubMed Central

    Grist, Gary; Whittaker, Carrie; Merrigan, Kellie; Fenton, Jason; Pallotto, Eugenia; Molitor-Kirsch, Erica; Ostlie, Daniel; O’Brien, James; Lofland, Gary

    2010-01-01

    Abstract: A previous review from our institution established clinically measured cut-points that defined the late implementation of extracorporeal membrane oxygenation (ECMO) correlating to increased mortality in neonatal and pediatric respiratory patients. Using the same methods, this review evaluates pediatric and neonatal cardiac and congenital diaphragmatic hernia (CDH) patients to determine if the same cut-points exist in this higher risk patient population. Neonatal and pediatric cardiac and CDH patients placed on ECMO between November 1989 and December 2008 were retrospectively reviewed to determine the first adjusted anion gap (AGc), the first venoarterial carbon dioxide (CO2) gradient (p[v-a]CO2), and the first Viability Index (AGc + p[v-a]CO2 = INDEX) on ECMO. These markers were then analyzed to identify the presence of specific cut-points that marked an increased risk of mortality. The timing of surgery was also reviewed to assess the surgical morbidity on survival. The review of neonatal and pediatric cardiac and CDH patients (n = 205) with an overall survival of 46% showed that all three markers were elevated to varying degrees in the expired patients (n = 110). Histograms identified the following specific cut-points for increased mortality: the AGc ? 23 mEq/L, the p[v-a]CO2 ? 16 mmHg, and the INDEX ? 28. An elevated AGc and INDEX correlated with a significantly higher risk for mortality (p < .05), survival to discharge being 20% or less. Patients under the cut-points had survival rates of 51% or higher. The timing of surgery (before or after ECMO initiation) did not significantly impact survival in the combined cardiac and CDH group. An INDEX ? 28 correlates with non-survival. We speculate that the late implementation of ECMO may lead to reperfusion injury, which causes reduced survival, and that ECMO intervention prior to reaching the cut-points may improve survival in neonatal and pediatric cardiac and CDH patients. PMID:21114220

  8. Snowmobile Repair. Teacher Edition.

    ERIC Educational Resources Information Center

    Hennessy, Stephen S.; Conrad, Rex

    This teacher's guide contains 14 units on snowmobile repair: (1) introduction to snowmobile repair; (2) skis, front suspension, and steering; (3) drive clutch; (4) drive belts; (5) driven clutch; (6) chain drives; (7) jackshafts and axles; (8) rear suspension; (9) tracks; (10) shock absorbers; (11) brakes; (12) engines; (13) ignition and…

  9. LAPAROSCOPIC GASTROPEXY FOR CORRECTION OF A HIATAL HERNIA IN A NORTHERN ELEPHANT SEAL (MIROUNGA ANGUSTIROSTRIS).

    PubMed

    Greene, Rebecca; Van Bonn, William G; Dennison, Sophie E; Greig, Denise J; Gulland, Frances M D

    2015-06-01

    A female northern elephant seal (Mirounga angustirostris) weaned pup presented with malnutrition. During rehabilitation, the seal developed regurgitation and reduced lung sounds on auscultation. Radiographs and endoscopy performed under sedation suggested a diaphragmatic hernia. A Type I (or sliding) hiatal hernia was confirmed with a positive contrast upper gastrointestinal study, revealing varying degrees of herniation of the gastric fundus through the diaphragm into the caudal thorax as well as esophageal reflux. The animal was treated preoperatively with an H2 antagonist and antinausea medication. A laparoscopic gastropexy was performed under general anesthesia. The animal recovered well postoperatively and resolution of clinical signs was achieved. The animal was released back into the wild 21 kg above admit weight. To our knowledge, we report here the first surgical correction of a hiatal hernia in a marine mammal. PMID:26056907

  10. Department of Surgery Acute Care Surgery Service

    E-print Network

    Department of Surgery Acute Care Surgery Service 200 Hawkins Drive Iowa City, Iowa 52242-1086 319-356-2902 Clinic Scheduling 319-356-7892 Administrative Support 319-356-3392 Fax www.uihealthcare.org/surgery Acute Care Surgery Education Topics Burns: 1. Acute Burn Resuscitation 2. Necrotizing Acute Soft Tissue

  11. Department of Surgery Colorectal Surgery Section

    E-print Network

    Department of Surgery Colorectal Surgery Section 200 Hawkins Drive, 4621 JCP Iowa City, IA 52242.uihealthcare.org Minimally Invasive Surgery Education Topics Foregut 1. Controversies in Rx of achalasia: Botox versus time to consider surgery? 3. GERD and Nissen fundoplication. Are we under diagnosing this disorder? 4

  12. Lung eicosanoids in perinatal rats with congenital diaphragmatic hernia

    PubMed Central

    Ijsselstijn, H.; Zijlstra, F. J.; Van Dijk, J. P. M.; De Jongste, J. C.

    1997-01-01

    Abnormal levels of pulmonary eicosanoids have been reported in infants with persistent pulmonary hypertension (PPH) and congenital diaphragmatic hernia (CDH). We hypothesized that a dysbalance of vasoconstrictive and vasodilatory eicosanoids is involved in PPH in CDH patients. The levels of several eicosanoids in lung homogenates and in bronchoalveolar lavage fluid of controls and rats with CDH were measured after caesarean section or spontaneous birth. In controls the concentration of the stable metabolite of prostacyclin (6-keto-PGF1?), thromboxane A2 (TxB2), prostaglandin E2 (PGE2), and leukotriene B4 (LTB4) decreased after spontaneous birth. CDH pups showed respiratory insufficiency directly after birth. Their lungs had higher levels of 6- keto-PGF1?, reflecting the pulmonary vasodilator prostacyclin (PGI2), than those of controls. We conclude that in CDH abnormal lung eicosanoid levels are present perinatally. The elevated levels of 6-keto-PGF1? in CDH may reflect a compensation mechanism for increased vascular resistance. PMID:18472832

  13. The role of two-stage repair in modern hypospadiology

    PubMed Central

    Bracka, Aivar

    2008-01-01

    Hypospadias surgery continues to evolve. The enthusiasm for flap-based urethroplasty is waning and instead there is an increasing preference for urethroplasty that uses either the urethral plate alone or in combination with grafts. From the vast armamentarium of hypospadias repairs that are still in use, the author suggests a simple protocol of just three closely related procedures with which we can now repair almost all hypospadias. The tubularised incised plate (TIP) repair and the ‘Snodgraft’ modification of the TIP principle are simple and effective one-stage solutions when partial circumference urethroplasty is required. Conversely, the Bracka two-stage graft repair remains an ideal and versatile solution when a full circumference urethroplasty is required. It is particularly appropriate for severe primary hypospadias associated with a poor plate and marked chordee and also to replace a scarred, hairy or balanitis xerotica obliterans diseased urethra in re-operative salvage hypospadias. PMID:19468400

  14. INTERNAL REPAIR OF PIPELINES

    SciTech Connect

    Bill Bruce; Nancy Porter; George Ritter; Matt Boring; Mark Lozev; Ian Harris; Bill Mohr; Dennis Harwig; Robin Gordon; Chris Neary; Mike Sullivan

    2005-07-20

    The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas transmission industry pipeline operators can be summarized in terms of the following performance requirements for internal repair: (1) Use of internal repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway crossings. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) The most common size range for 80% to 90% of operators surveyed is 508 mm (20 in.) to 762 mm (30 in.), with 95% using 558.8 mm (22 in.) pipe. Evaluation trials were conducted on pipe sections with simulated corrosion damage repaired with glass fiber-reinforced composite liners, carbon fiber-reinforced composite liners, and weld deposition. Additional un-repaired pipe sections were evaluated in the virgin condition and with simulated damage. Hydrostatic failure pressures for pipe sections repaired with glass fiber-reinforced composite liner were only marginally greater than that of pipe sections without liners, indicating that this type of liner is only marginally effective at restoring the pressure containing capabilities of pipelines. Failure pressures for larger diameter pipe repaired with a semi-circular patch of carbon fiber-reinforced composite lines were also marginally greater than that of a pipe section with un-repaired simulated damage without a liner. These results indicate that fiber reinforced composite liners have the potential to increase the burst pressure of pipe sections with external damage Carbon fiber based liners are viewed as more promising than glass fiber based liners because of the potential for more closely matching the mechanical properties of steel. Pipe repaired with weld deposition failed at pressures lower than that of un-repaired pipe in both the virgin and damaged conditions, indicating that this repair technology is less effective at restoring the pressure containing capability of pipe than a carbon fiber-reinforced liner repair. Physical testing indicates that carbon fiber-reinforced liner repair is the most promising technology evaluated to-date. In lieu of a field installation on an abandoned pipeline, a preliminary nondestructive testing protocol is being developed to determine the success or failure of the fiber-reinforced liner pipeline repairs. Optimization and validation activities for carbon-fiber repair methods are ongoing.

  15. Endovascular Aneurysm Repair: Current and Future Status

    SciTech Connect

    Hinchliffe, R. J. Ivancev, K.

    2008-05-15

    Endovascular aneurysm repair has rapidly expanded since its introduction in the early 1990s. Early experiences were associated with high rates of complications including conversion to open repair. Perioperative morbidity and mortality results have improved but these concerns have been replaced by questions about long-term durability. Gradually, too, these problems have been addressed. Challenges of today include the ability to roll out the endovascular technique to patients with adverse aneurysm morphology. Fenestrated and branch stent-graft technology is in its infancy. Only now are we beginning to fully understand the advantages, limitations, and complications of such technology. This paper outlines some of the concepts and discusses the controversies and challenges facing clinicians involved in endovascular aneurysm surgery today and in the future.

  16. A hybrid repair of a superior mesenteric artery pseudoaneurysm using open mesenteric bypass and endovascular exclusion.

    PubMed

    Cumbie, Todd A; Kedora, John C; Pearl, Gregory J; Shutze, William P

    2015-07-01

    Superior mesenteric artery (SMA) aneurysms and pseudoaneurysms are uncommonly encountered in vascular surgery practice, but they typically require repair. Historically, they have been repaired with open aneurysmorrhaphy, bypass and exclusion, or simple ligation. More recently, endovascular repair with coil embolization and stent graft exclusion have been advocated. We present a repair of an SMA pseudoaneurysm via a hybrid approach with common hepatic artery to SMA bypass, exclusion of the pseudoaneurysm with ligation of the SMA proximal to the bypass, plug occlusion of the proximal SMA, and coil embolization of the pseudoaneurysm. PMID:26130888

  17. A hybrid repair of a superior mesenteric artery pseudoaneurysm using open mesenteric bypass and endovascular exclusion

    PubMed Central

    Cumbie, Todd A.; Kedora, John C.; Pearl, Gregory J.

    2015-01-01

    Superior mesenteric artery (SMA) aneurysms and pseudoaneurysms are uncommonly encountered in vascular surgery practice, but they typically require repair. Historically, they have been repaired with open aneurysmorrhaphy, bypass and exclusion, or simple ligation. More recently, endovascular repair with coil embolization and stent graft exclusion have been advocated. We present a repair of an SMA pseudoaneurysm via a hybrid approach with common hepatic artery to SMA bypass, exclusion of the pseudoaneurysm with ligation of the SMA proximal to the bypass, plug occlusion of the proximal SMA, and coil embolization of the pseudoaneurysm. PMID:26130888

  18. Two-Stage Endovascular Repair for Concurrent Penetrating Atherosclerotic Ulcers of the Thoracic and Abdominal Aorta

    PubMed Central

    Baek, Kang Seok; Kwun, Woo Hyung; Kim, Young Hwan; Kim, Duk-Sil; Kim, Sung-Wan

    2013-01-01

    We report a case of concurrent saccular aneurysms caused by a penetrating atherosclerotic ulcer of the thoracic and abdominal aorta that were successfully treated by staged endovascular repair. Even though surgical open repair or endovascular repair is the treatment option, use of endovascular repair is now accepted as an alternative treatment to surgery in selected patients. To prevent contrast medium-induced nephropathy and spinal cord ischemia caused by a simultaneous endovascular procedure, a saccular aneurysm of the descending thoracic aorta was excluded by stent graft, followed by the placement of a bifurcated stent graft in the infrarenal abdominal aorta one month later. PMID:24175273

  19. Anti-reflux surgery - children

    MedlinePLUS

    Kane TD1, Brown MF, Chen MK; Members of the APSA New Technology Committee.Position paper on laparoscopic ... Philadelphia, PA: Elsevier Saunders; 2011:chap 315. Petersen RP, Pellegrini CA Oelschlager BK.. Hiatal Hernia and Gastroesophageal ...

  20. Delayed Traumatic Diaphragm Hernia after Thoracolumbar Fracture in a Patient with Ankylosing Spondylitis

    PubMed Central

    Lee, Hyoun-Ho; Kim, Sang Woo; Jung, Young Jin

    2015-01-01

    Traumatic diaphragm hernia can occur in rare cases and generally accompanies thoracic or abdominal injuries. When suffering from ankylosing spondylitis, a small force can develop into vertebral fracture and an adjacent structural injury, and lead to diaphragm hernia without accompanying concomitant thoracoabdominal injury. A high level of suspicion may be a most reliable diagnostic tool in the detection of a diaphragm injury, and we need to keep in mind a possibility in a patient with ankylosing spondylitis and a thoracolumbar fracture, even in the case of minor trauma. PMID:25733996

  1. INTERNAL REPAIR OF PIPELINES

    SciTech Connect

    Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; George Ritter; Bill Mohr; Matt Boring; Nancy Porter; Mike Sullivan; Chris Neary

    2004-12-31

    The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas transmission industry pipeline operators can be summarized in terms of the following performance requirements for internal repair: (1) Use of internal repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway crossings. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) The most common size range for 80% to 90% of operators surveyed is 508 mm (20 in.) to 762 mm (30 in.), with 95% using 558.8 mm (22 in.) pipe. Evaluation trials were conducted on pipe sections with simulated corrosion damage repaired with glass fiber-reinforced composite liners, carbon fiber-reinforced composite liners, and weld deposition. Additional un-repaired pipe sections were evaluated in the virgin condition and with simulated damage. Hydrostatic failure pressures for pipe sections repaired with glass fiber-reinforced composite liner were only marginally greater than that of pipe sections without liners, indicating that this type of liner is only marginally effective at restoring the pressure containing capabilities of pipelines. Failure pressures for larger diameter pipe repaired with a semi-circular patch of carbon fiber-reinforced composite lines were also marginally greater than that of a pipe section with un-repaired simulated damage without a liner. These results indicate that fiber reinforced composite liners have the potential to increase the burst pressure of pipe sections with external damage Carbon fiber based liners are viewed as more promising than glass fiber based liners because of the potential for more closely matching the mechanical properties of steel. Pipe repaired with weld deposition failed at pressures lower than that of un-repaired pipe in both the virgin and damaged conditions, indicating that this repair technology is less effective at restoring the pressure containing capability of pipe than a carbon fiber-reinforced liner repair. Physical testing indicates that carbon fiber-reinforced liner repair is the most promising technology evaluated to-date. The first round of optimization and validation activities for carbon-fiber repairs are complete. Development of a comprehensive test plan for this process is recommended for use in the field trial portion of this program.

  2. INTERNAL REPAIR OF PIPELINES

    SciTech Connect

    Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; George Ritter; Bill Mohr; Matt Boring; Nancy Porter; Mike Sullivan; Chris Neary

    2004-08-17

    The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas transmission industry pipeline operators can be summarized in terms of the following performance requirements for internal repair: (1) Use of internal repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) The most common size range for 80% to 90% of operators surveyed is 508 mm (20 in.) to 762 mm (30 in.), with 95% using 558.8 mm (22 in.) pipe. Evaluation trials were conducted on pipe sections with simulated corrosion damage repaired with glass fiber-reinforced composite liners, carbon fiber-reinforced composite liners, and weld deposition. Additional un-repaired pipe sections were evaluated in the virgin condition and with simulated damage. Hydrostatic failure pressures for pipe sections repaired with glass fiber-reinforced composite liner were only marginally greater than that of pipe sections without liners, indicating that this type of liner is only marginally effective at restoring the pressure containing capabilities of pipelines. Failure pressures for larger diameter pipe repaired with a semi-circular patch of carbon fiber-reinforced composite lines were also marginally greater than that of a pipe section with un-repaired simulated damage without a liner. These results indicate that fiber reinforced composite liners have the potential to increase the burst pressure of pipe sections with external damage Carbon fiber based liners are viewed as more promising than glass fiber based liners because of the potential for more closely matching the mechanical properties of steel. Pipe repaired with weld deposition failed at pressures lower than that of un-repaired pipe in both the virgin and damaged conditions, indicating that this repair technology is less effective at restoring the pressure containing capability of pipe than a carbon fiber-reinforced liner repair. Physical testing indicates that carbon fiber-reinforced liner repair is the most promising technology evaluated to-date. Development of a comprehensive test plan for this process is recommended for use in the field trial portion of this program.

  3. DEHN SURGERY SIDDHARTHA GADGIL

    E-print Network

    Gadgil, Siddhartha

    DEHN SURGERY SIDDHARTHA GADGIL Contents 1. Introduction 1 2. Co-ordinates for surgery 1 3. Some algebraic topology 2 4. The theorem of Lickorish and Wallace 3 5. Surgeries and Cobordisms 4 6. The Kirby Calculus 5 7. Constructing knots using surgery 5 8. Surgeries about knots 5 References 6 1. Introduction

  4. Rapid road repair vehicle

    DOEpatents

    Mara, Leo M. (Livermore, CA)

    1999-01-01

    Disclosed are improvments to a rapid road repair vehicle comprising an improved cleaning device arrangement, two dispensing arrays for filling defects more rapidly and efficiently, an array of pre-heaters to heat the road way surface in order to help the repair material better bond to the repaired surface, a means for detecting, measuring, and computing the number, location and volume of each of the detected surface imperfection, and a computer means schema for controlling the operation of the plurality of vehicle subsystems. The improved vehicle is, therefore, better able to perform its intended function of filling surface imperfections while moving over those surfaces at near normal traffic speeds.

  5. ASSOCIATED NON DIAPHRAGMATIC ANOMALIES AMONG CASES WITH CONGENITAL DIAPHRAGMATIC HERNIA.

    PubMed

    Stoll, C; Alembik, Y; Dott, B; Roth, M P

    2015-01-01

    Cases with congenital diaphragmatic hernia (CDH) often have other associated anomalies. The purpose of this investigation was to assess the prevalence and the types of associated anomalies in CDH in a defined population. The anomalies associated with CDH were collected in all live births, stillbirths and terminations of pregnancy during 29 years in 386,088 consecutive pregnancies of known outcome in the area covered by our population based registry of congenital anomalies. Of the 139 cases with CDH born during this period (total prevalence of 3.60 per 10,000), 85 (61.2%) had associated major anomalies. There were 25 (18.0%) cases with chromosomal abnormalities including 12 trisomies 18, and 24 (17.3%) nonchromosomal recognized dysmorphic conditions. There were no predominant recognized dysmorphic conditions, but Fryns syndrome. However, other recognized dysmorphic conditions were registered including fetal alcohol syndrome, de Lange syndrome, sequences (laterality sequence and ectopia cordis), and complexes (limb body wall complex). Thirty six (25.9%) of the cases had non syndromic multiple congenital anomalies (MCA). Anomalies of the cardiovascular system (n = 53, 27.5%), the urogenital system (n = 34, 17.6%), the musculoskeletal system (n = 29, 15.0%), and the central nervous system (n = 19, 9.8%) were the most common other congenital anomalies. We observed specific patterns of anomalies associated with CDH which emphasizes the need to evaluate all patients with CDH for possible associated malformations. In conclusion the overall prevalence of associated anomalies, which was close to two in three infants, emphasizes the need for a thorough investigation of cases with CDH. A routine screening for other anomalies may be considered in infants and in fetuses with CDH. One should be aware that the anomalies associated with CDH can be classified into a recognizable anomaly, syndrome or pattern in more than one out of two cases with CDH. PMID:26625659

  6. Complex Abdominal Wall Repair

    MedlinePLUS

    ... bowel and underwent placement of Veritas in an inlay. And as we talked about during the case, ... repair either utilizing an underlay technique or an inlay technique. I would not recommend placing this in ...

  7. Rotator Cuff Repair

    MedlinePLUS Videos and Cool Tools

    ... REPAIR DOCTORS HOSPITAL CENTER FOR ORTHOPEDICS AND SPORTS MEDICINE CORAL GABLES, FLORIDA June 18, 2008 00:00: ... Gables, Florida. I'm Dr. John Zvijac, sports medicine and shoulder surgeon here at Doctors Hospital, and ...

  8. INTERNAL REPAIR OF PIPELINES

    SciTech Connect

    Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; Nancy Porter; Mike Sullivan; Chris Neary

    2004-04-12

    The two broad categories of deposited weld metal repair and fiber-reinforced composite liner repair technologies were reviewed for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Preliminary test programs were developed for both deposited weld metal repair and for fiber-reinforced composite liner repair. Evaluation trials have been conducted using a modified fiber-reinforced composite liner provided by RolaTube and pipe sections without liners. All pipe section specimens failed in areas of simulated damage. Pipe sections containing fiber-reinforced composite liners failed at pressures marginally greater than the pipe sections without liners. The next step is to evaluate a liner material with a modulus of elasticity approximately 95% of the modulus of elasticity for steel. Preliminary welding parameters were developed for deposited weld metal repair in preparation of the receipt of Pacific Gas & Electric's internal pipeline welding repair system (that was designed specifically for 559 mm (22 in.) diameter pipe) and the receipt of 559 mm (22 in.) pipe sections from Panhandle Eastern. The next steps are to transfer welding parameters to the PG&E system and to pressure test repaired pipe sections to failure. A survey of pipeline operators was conducted to better understand the needs and performance requirements of the natural gas transmission industry regarding internal repair. Completed surveys contained the following principal conclusions: (1) Use of internal weld repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway crossings. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling (HDD) when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) Pipe diameter sizes range from 50.8 mm (2 in.) through 1,219.2 mm (48 in.). The most common size range for 80% to 90% of operators surveyed is 508 mm to 762 mm (20 in. to 30 in.), with 95% using 558.8 mm (22 in.) pipe. An evaluation of potential repair methods clearly indicates that the project should continue to focus on the development of a repair process involving the use of GMAW welding and on the development of a repair process involving the use of fiber-reinforced composite liners.

  9. Laser surgery - skin

    MedlinePLUS

    Surgery using a laser ... used is directly related to the type of surgery being performed and the color of the tissue ... Laser surgery can be used to: Close small blood vessels to reduce blood loss Remove warts , moles , sunspots, and ...

  10. Coronary Artery Bypass Surgery

    MedlinePLUS

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  11. Joint Replacement Surgery

    MedlinePLUS

    ... a Clinical Trial Journal Articles Arthritis July 2014 Joint Replacement Surgery: Health Information Basics for You and Your Family What Is Joint Replacement Surgery? Joint replacement surgery is removing a ...

  12. Types of Heart Surgery

    MedlinePLUS

    ... heart surgery that is becoming more common is robotic-assisted surgery. For this surgery, a surgeon uses a computer to control surgical tools on thin robotic arms. The tools are inserted through small incisions ...

  13. Cameron Ulcer Causing Severe Anemia in a Patient with Diaphragmatic Hernia.

    PubMed

    Gupta, Prashant; Suryadevara, Madhu; Das, Avash; Falterman, James

    2015-01-01

    BACKGROUND Cameron lesions are linear gastric erosions on the mucosal folds at the diaphragmatic impressions found in patients with large hiatal hernias. While usually asymptomatic, hiatal hernias can result in serious sequelae, as this case report will clearly illustrate. Cameron lesions are clinically significant because of their ability to cause significant acute, chronic, or obscure gastrointestinal bleeding, often requiring blood transfusions. CASE REPORT In this report, we present the case of a 51-year-old white woman who originally presented to the Emergency Department with complaints of a runny nose, dry cough, generalized weakness, and muscle cramping ascribed to a viral infection. However, closer examination revealed substantial pallor with pale conjunctiva prompting further workup that revealed substantial anaemia. Upon further inquiry of her past medical history, she revealed the need for previous blood transfusions, and meticulous review of her medical record indicated a previous diagnosis of hiatal hernia with the presence of Cameron lesions based on esophagogastroduodenoscopy 2 years prior. CONCLUSIONS This case emphasizes the need for a high index of suspicion for Cameron lesions as a causative agent of substantial blood loss in patients with hiatal hernias after other common causes of gastrointestinal bleeding have been ruled out. PMID:26467083

  14. Cameron Ulcer Causing Severe Anemia in a Patient with Diaphragmatic Hernia

    PubMed Central

    Gupta, Prashant; Suryadevara, Madhu; Das, Avash; Falterman, James

    2015-01-01

    Patient: Female, 51 Final Diagnosis: Cameron’s ulcer Symptoms: — Medication: — Clinical Procedure: Endoscopy Specialty: Gastroenterology and Hepatology Objective: Rare co-existance of disease or pathology Background: Cameron lesions are linear gastric erosions on the mucosal folds at the diaphragmatic impressions found in patients with large hiatal hernias. While usually asymptomatic, hiatal hernias can result in serious sequelae, as this case report will clearly illustrate. Cameron lesions are clinically significant because of their ability to cause significant acute, chronic, or obscure gastrointestinal bleeding, often requiring blood transfusions. Case Report: In this report, we present the case of a 51-year-old white woman who originally presented to the Emergency Department with complaints of a runny nose, dry cough, generalized weakness, and muscle cramping ascribed to a viral infection. However, closer examination revealed substantial pallor with pale conjunctiva prompting further workup that revealed substantial anaemia. Upon further inquiry of her past medical history, she revealed the need for previous blood transfusions, and meticulous review of her medical record indicated a previous diagnosis of hiatal hernia with the presence of Cameron lesions based on esophagogastroduodenoscopy 2 years prior. Conclusions: This case emphasizes the need for a high index of suspicion for Cameron lesions as a causative agent of substantial blood loss in patients with hiatal hernias after other common causes of gastrointestinal bleeding have been ruled out. PMID:26467083

  15. Diaphragmatic hernia and right-sided heart enlargement in a Florida manatee (Trichechus manatus latirostris).

    PubMed

    Gerlach, Trevor J; de Wit, Martine; Landolfi, Jennifer A

    2012-10-01

    Postmortem evaluation of a Florida manatee (Trichechus manatus latirostris) revealed cold stress lesions and previous watercraft trauma that included broken ribs, a diaphragmatic hernia, an enlarged vena cava, and right-sided cardiomegaly. We discuss these findings and present a possible pathogenesis for the cardiomegaly. PMID:23060518

  16. Randomized Prospective Trial on the Occurrence of Laparoscopic Trocar Site Hernias

    ClinicalTrials.gov

    2010-11-12

    The Aim of the Study is to Analyze the Incidence of Trocar Site Hernia (TSH); in Orifices Created by Trocars Measuring ?10 mm in Diameter,; and to Determine Whether Closure of the External Fascial Layer Prevents; TSH and Potential Related Complications.

  17. Flexible transinguinal laparoscopy to assess the contralateral ring in pediatric inguinal hernias.

    PubMed

    Pavlovich, C P; Gmyrek, G A; Gardner, T A; Poppas, D P; Mininberg, D T

    1998-09-01

    The incidence of contralateral patent processus vaginalis (CPPV) is >50% in infants with clinical unilateral inguinal hernia (CUIH) and decreases only slowly with advancing age. Laparoscopy through the hernia sac (transinguinal laparoscopy) to detect suspected CPPV is a safe and efficient way to minimize routine contralateral inguinal exploration, but can be technically difficult. We used flexible urologic instruments and/or angled cystoscopic lenses to make transinguinal laparoscopy easier. Over a 3-year period, 37 patients (34 boys and 3 girls) ranging in age from 4 months to 12 years (mean age 59 months) with CUIH underwent ipsilateral groin exploration and diagnostic transinguinal laparoscopy. Laparoscopy was performed with flexible 17F cystoscopes (26 cases), flexible 9F ureteroscopes (2 cases), and rigid 70 degrees cystoscope lenses (9 cases). We detected eight CPPV (22%) in our series of 20 right and 17 left inguinal hernias, in a mean transinguinal laparoscopy time of 4.5 minutes. At 26-month mean follow-up, no patient whose contralateral inguinal ring was deemed closed had developed a hernia. Flexible fiberoptic urologic scopes and/or angled cystoscope lenses make transinguinal laparoscopy easy and efficacious in the pediatric population. Our series represents the longest longitudinal study of transinguinal laparoscopy for the diagnosis of CPPV. PMID:9800892

  18. DEVELOPMENTAL TOXICITY OF 2-CHLORO-2'-DEOXYADENOSINE IN THE RAT: INDUCTION OF LUMBAR HERNIA

    EPA Science Inventory

    DEVELOPMENTAL TOXICITY OF 2-CHLORO-2'DEOXYADENOSINE IN THE RAT: INDUCTION OF LUMBAR HERNIA. C. Lau1, M.G. Narotsky1, D. Lui1, D. Best1, R.W. Setzer2, T.B. Knudsen3. 1Reprod. Tox. Div., 2Exp. Tox. Div., NHEERL, US EPA, Research Triangle Park, NC, USA, 3Dept. Path. Anat. Cell Bio...

  19. Use of ultrasonographic and nuclear imaging to diagnose scrotal hernia in a dog.

    PubMed

    Mitchener, K L; Toal, R L; Held, J P; Dorn, A S

    1990-06-01

    Ultrasonography and nuclear imaging were used in the diagnosis of scrotal hernia in a dog. Both techniques were useful as aids in the differential diagnosis of scrotal enlargement. Nuclear imaging was useful in ruling out testicular torsion; ultrasonography revealed a normal-appearing testis amid fluid and portions of omentum. PMID:2190960

  20. A novel reconstruction method for giant incisional hernia: Hybrid laparoscopic technique

    PubMed Central

    Ozturk, G; Malya, FU; Ersavas, C; Ozdenkaya, Y; Bektasoglu, H; Cipe, G; Citgez, B; Karatepe, O

    2015-01-01

    BACKGROUND AND OBJECTIVES: Laparoscopic reconstruction of ventral hernia is a popular technique today. Patients with large defects have various difficulties of laparoscopic approach. In this study, we aimed to present a new reconstruction technique that combines laparoscopic and open approach in giant incisional hernias. MATERIALS AND METHODS: Between January 2006 and August 2012, 28 patients who were operated consequently for incisional hernia with defect size over 10 cm included in this study and separated into two groups. Group 1 (n = 12) identifies patients operated with standard laparoscopic approach, whereas group 2 (n = 16) labels laparoscopic technique combined with open approach. Patients were evaluated in terms of age, gender, body mass index (BMI), mean operation time, length of hospital stay, surgical site infection (SSI) and recurrence rate. RESULTS: There are 12 patients in group 1 and 16 patients in group 2. Mean length of hospital stay and SSI rates are similar in both groups. Postoperative seroma formation was observed in six patients for group 1 and in only 1 patient for group 2. Group 1 had 1 patient who suffered from recurrence where group 2 had no recurrence. DISCUSSION: Laparoscopic technique combined with open approach may safely be used as an alternative method for reconstruction of giant incisional hernias.

  1. Proximal Hamstring Repair Strength

    PubMed Central

    Harvey, Margaret Ann; Singh, Hardeep; Obopilwe, Elifho; Charette, Ryan; Miller, Suzanne

    2015-01-01

    Background: Proximal hamstring repair for complete ruptures has become a common treatment. There is no consensus in the literature about postoperative rehabilitation protocols following proximal hamstring repair. Some protocols describe bracing to prevent hip flexion or knee extension while others describe no immobilization. There are currently no biomechanical studies evaluating proximal hamstring repairs; nor are there any studies evaluating the effect of different hip flexion angles on these repairs. Hypothesis: As hip flexion increases from 0° to 90°, there will be a greater gap with cyclical loading. Study Design: Controlled laboratory study. Methods: Proximal hamstring insertions were detached from the ischial tuberosity in 24 cadavers and were repaired with 3 single-loaded suture anchors in the hamstring footprint with a Krakow suture technique. Cyclic loading from 10 to 125 N at 1 Hz was then performed for 0°, 45°, and 90° of hip flexion for 1500 cycles. Gap formation, stiffness, yield load, ultimate load, and energy to ultimate load were compared between groups using paired t tests. Results: Cyclic loading demonstrated the least amount of gap formation (P < .05) at 0° of hip flexion (2.39 mm) and most at 90° of hip flexion (4.19 mm). There was no significant difference in ultimate load between hip flexion angles (326, 309, and 338 N at 0°, 45°, and 90°, respectively). The most common mode of failure occurred with knot/suture failure (n = 17). Conclusion: Increasing hip flexion from 0° to 90° increases the displacement across proximal hamstring repairs. Postoperative bracing that limits hip flexion should be considered. Clinical Relevance: Repetitive motion involving hip flexion after a proximal hamstring repair may cause compromise of the repair.

  2. Celebrating DNA's Repair Crew.

    PubMed

    Kunkel, Thomas A

    2015-12-01

    This year, the Nobel Prize in Chemistry has been awarded to Tomas Lindahl, Aziz Sancar, and Paul Modrich for their seminal studies of the mechanisms by which cells from bacteria to man repair DNA damage that is generated by normal cellular metabolism and stress from the environment. These studies beautifully illustrate the remarkable power of DNA repair to influence life from evolution through disease susceptibility. PMID:26638062

  3. [Lay emphasis on the application of negative pressure wound therapy technique in burn surgery].

    PubMed

    Chai, Jiake; Shen, Chuanan

    2015-04-01

    In recent years, negative pressure wound therapy (NPWT) technique has been widely used in burn surgery, including wound repair, skin grafting, and cosmetic procedures, showing promising clinical results. Based on the literature and clinical experience, the mechanism of NPWT and its clinical application in burn surgery are briefly iterated herewith. PMID:26320309

  4. Abstract--Robotic cardiac catheters have the potential to revolutionize heart surgery by extending minimally invasive

    E-print Network

    allow clinicians to interact with heart tissue with the same level of skill as in open heart surgeryAbstract--Robotic cardiac catheters have the potential to revolutionize heart surgery by extending minimally invasive techniques to complex surgical repairs inside the heart. However, catheter technologies

  5. Candidate genes for congenital diaphragmatic hernia from animalmodels: sequencing of fog2 and pdgfra reveals rare variants indiaphragmatic hernia patients

    SciTech Connect

    Bleyl, S.B.; Moshrefi, A.; Shaw, G.M.; Saijoh, Y.; Schoenwolf,G.C.; Pennacchio, L.A.; Slavotinek, A.M.

    2007-05-11

    Congenital diaphragmatic hernia (CDH) is a common, lifethreatening birth defect. Although there is strong evidence implicatinggenetic factors in its pathogenesis, few causative genes have beenidentified, and in isolated CDH, only one de novo, nonsense mutation hasbeen reported in FOG2 in a female with posterior diaphragmaticeventration. We report here that the homozygous null mouse for the Pdgfragene has posterolateral diaphragmatic defects and thus is a model forhuman CDH. We hypothesized that mutations in this gene could cause humanCDH. We sequenced PDGFRa and FOG2 in 96 patients with CDH, of which 53had isolated CDH (55.2 percent), 36 had CDH and additional anomalies(37.5 percent), and 7 had CDH and known chromosome aberrations (7.3percent). For FOG2, we identified novel sequence alterations predictingp.M703L and p.T843A in two patients with isolated CDH that were absent in526 and 564 control chromosomes respectively. These altered amino acidswere highly conserved. However, due to the lack of available parental DNAsamples we were not able to determine if the sequence alterations were denovo. For PDGFRa, we found a single variant predicting p.L967V in apatient with CDH and multiple anomalies that was absent in 768 controlchromosomes. This patient also had one cell with trisomy 15 on skinfibroblast culture, a finding of uncertain significance. Although ourstudy identified sequence variants in FOG2 and PDGFRa, we have notdefinitively established the variants as mutations and we found noevidence that CDH commonly results from mutations in thesegenes.

  6. Cosmetic Plastic Surgery Statistics

    MedlinePLUS

    2014 Cosmetic Plastic Surgery Statistics Cosmetic Procedure Trends 2014 Plastic Surgery Statistics Report Please credit the AMERICAN SOCIETY OF PLASTIC SURGEONS when citing statistical data or using ...

  7. Laboratory Reptile Surgery: Principles and Techniques

    PubMed Central

    Alworth, Leanne C; Hernandez, Sonia M; Divers, Stephen J

    2011-01-01

    Reptiles used for research and instruction may require surgical procedures, including biopsy, coelomic device implantation, ovariectomy, orchidectomy, and esophogostomy tube placement, to accomplish research goals. Providing veterinary care for unanticipated clinical problems may require surgical techniques such as amputation, bone or shell fracture repair, and coeliotomy. Although many principles of surgery are common between mammals and reptiles, important differences in anatomy and physiology exist. Veterinarians who provide care for these species should be aware of these differences. Most reptiles undergoing surgery are small and require specific instrumentation and positioning. In addition, because of the wide variety of unique physiologic and anatomic characteristics among snakes, chelonians, and lizards, different techniques may be necessary for different reptiles. This overview describes many common reptile surgery techniques and their application for research purposes or to provide medical care to research subjects. PMID:21333158

  8. Video-assisted Port-Access mitral valve surgery: from debut to routine surgery. Will Trocar-Port-Access cardiac surgery ultimately lead to robotic cardiac surgery?

    PubMed

    Vanermen, H; Wellens, F; De Geest, R; Degrieck, I; Van Praet, F

    1999-07-01

    A right thoracotomy is a well-known alternative for midsternotomy to have access to the left atrium. The Port-Access (Heartport, Inc, Redwood City, CA) approach is an invaluable option to avoid cracking of ribs and cartilage. EndoCPB (Heartport, Inc) and Endo-Aortic Clamp (Heartport, Inc) allows installation of the extracorporeal circulation and cardiac arrest from the groin. Videoassistance and shafted instruments help the surgeon to perform the surgery through a 5 x 2-cm port and fulfill the main goals of minimally invasive cardiac surgery, comfort, cosmesis, and fast rehabilitation. From February 1997 to November 1998, 75 patients (40 men/35 women) had either Port-Access mitral valve repair (n = 41) or replacement (n = 33) for a variety of reasons: myxoid degeneration (n = 45), rheumatic disease (n = 21), chronic endocarditis (n = 4), annular dilatation (n = 2), and sclerotic disease (n = 2). One valve was replaced because of an ingrowing myxoma. There was one closure of a paravalvular leak. The mean age was 59.3 years of age (range, 32 to 83 years). Most patients had normal ejection fractions but different grades of mitral valve insufficiency and were in NYHA class II. One 71-year-old patient died after reoperation on postoperative day 1 for failed repair. Two patients had conversion to sternotomy and conventional ECC for repair of a dissected aorta. One patient died, one patient suffered a minor cerebrovascular deficit. Three patients had prolonged intensive care unit (ICU) stays for respiratory insufficiency, 5 patients underwent revision for bleeding. Mean ICU stay was 2.5 days; and mean hospital stay, 9 days (range, 4 to 36). A significant difference between the first 30 and last 38 patients in terms of length of stay in the ICU and the hospital was noticed. Two late mitral valve replacements for chronic endocarditis after repair occurred. One patient had medical therapy for endocarditis after mitral valve replacement. The debut of Port-Access mitral valve surgery may be nerve-racking; the routine is a smooth and sure surgery with maximum comfort, a very discrete scar, and a fast rehabilitation. There were no paravalvular leakages nor myocardial infarctions. Cerebrovascular accidents owing to thromboembolic phenomena, vascular lower limb or wound complications were not seen. Port-Access mitral valve surgery is a very important investment in the future of cardiac surgery. Some learning curve pitfalls were associated with the process of starting this revolutionary technique. PMID:10451253

  9. Robotic Catheters for Beating Heart Surgery A dissertation presented

    E-print Network

    minimally invasive repair on the fast-moving structures inside the heart, like the mitral valve annulus tissue structure stiffness of approximately 0.1 N/mm while interacting with the mitral valve annulusRobotic Catheters for Beating Heart Surgery A dissertation presented by Samuel Benjamin Kesner

  10. Pyloro-duodenal hernia with formation of enterocutaneous fistula in a buffalo calf following a dog attack

    PubMed Central

    Kamalakar, G.; Prasad, V. Devi; Devaratnam, J.; Ganeshan, A.

    2015-01-01

    A body wall hernia entrapping abomasum and concurrent duodenal fistula in a buffalo calf aged about 8 months, secondary to a dog bite was successfully treated by closure of fistulous orifice and ventro lateral herniorrhaphy. PMID:26623378

  11. Muscle atrophy and fatty infiltration after an acute rotator cuff repair in a sheep model

    PubMed Central

    Luan, Tammy; Liu, Xuhui; Easley, Jeremiah T.; Ravishankar, Bharat; Puttlitz, Christian; Feeley, Brian T.

    2015-01-01

    Summary Introduction rotator cuff tears (RCTs) are the most common tendon injury seen in orthopedic patients. Muscle atrophy and fatty infiltration of the muscle are crucial factors that dictate the outcome following rotator cuff surgery. Though less studied in humans, rotator cuff muscle fibrosis has been seen in animal models as well and may influence outcomes as well. The purpose of this study was to determine if the rotator cuff would develop muscle changes even in the setting of an acute repair in a sheep model. We hypothesized that fatty infiltration and fibrosis would be present even after an acute repair six months after initial surgery. Methods twelve female adult sheep underwent an acute rotator cuff tear and immediate repair on the right shoulder. The left shoulder served as a control and did not undergo a tear or a repair. Six months following acute rotator cuff repairs, sheep muscles were harvested to study atrophy, fatty infiltration, and fibrosis by histological analysis, western blotting, and reverse transcription polymerase chain reaction (RT-PCR). Results the repair group demonstrated an increase expression of muscle atrophy, fatty infiltration, and fibrosis related genes. Significantly increased adipocytes, muscle fatty infiltration, and collagen deposition was observed in rotator cuff muscles in the tendon repair group compared to the control group. Conclusions rotator cuff muscle undergoes degradation changes including fatty infiltration and fibrosis even after the tendons are repair immediately after rupture. Level of Evidence Basic Science Study. PMID:26261789

  12. The METEOR trial: no rush to repair a torn meniscus.

    PubMed

    Hwang, Yong Gil; Kwoh, C Kent

    2014-04-01

    It is uncertain whether arthroscopic partial meniscectomy is better than physical therapy in patients who have a symptomatic torn meniscus on top of osteoarthritis of the knee. The Meniscal Repair in Osteoarthritis Research (METEOR) trial concluded that physical therapy is acceptable at first, and that surgery is not routinely needed. In patients assigned to physical therapy who eventually needed surgery, the delay resulting from a trial of conservative management did not impair outcomes at 12 months from the initial presentation. Here, we analyze the background, design, findings, and clinical implications of the METEOR trial. PMID:24692441

  13. LCD testing and repair

    NASA Astrophysics Data System (ADS)

    Waters, Rodney L.; Pothoven, Floyd R.; Branst, Lee

    1994-04-01

    Active-matrix liquid crystal displays (AMLCD) have come into increasing use in a variety of applications. As the size of the displays has gotten larger, their proper testing and repair has become critical. Quite simply, it is too costly to discard displays that fail to pass initial tests. Schemes have been devised that test AMLCDs as to whether they are operating or not, i.e., test that merely indicate whether the display will work, or not, once it is assembled. That is no longer enough. Manufacturers must know why a device is inoperable and whether it can be repaired. Since AMLCDs are basically large integrated circuits, a number of test and repair techniques have been borrowed from the semiconductor industry. This paper describes a method by which AMLCDs, especially large area devices, can be tested and repaired. This method primarily involves the incorporation of electrical probing to test individual lines and pixels. Once the defects have been located, lasers are used to effect the required repairs via material removal and deposition.

  14. Staged Biventricular Repair-Oriented Strategy in Borderline Biventricular Repair Candidates with Ventricular Septal Defect.

    PubMed

    Nakamura, Yuki; Hagino, Ikuo; Nakajima, Hiromichi; Aoki, Mitsuru

    2015-12-01

    Although borderline biventricular repair (BVR) candidates unsuitable for primary BVR are often subjected to single-ventricle repair (SVR), some of them reach BVR by staged strategy. We evaluated our staged BVR-oriented strategy in borderline BVR candidates with ventricular septal defect (VSD) in whom a BVR/SVR decision was deferred beyond the neonatal period. Forty-two patients were treated with the approach between 1991 and 2012. They had been followed toward BVR until it was judged impossible. Outcomes, time course toward definitive repair (DR: BVR, SVR, or 1 + 1/2 ventricle repair), and hemodynamics were reviewed. A total of 57 palliative surgeries were performed before BVR or bidirectional Glenn (BDG), namely procedures to control pulmonary blood flow in 40, to improve mixing in 5, and to promote left ventricle (LV) growth in 5. LV growth was achieved in four patients. There were three cardiac deaths. Except for four awaiting patients, 19 reached BVR (50 %), 11 patients were converted to other than BVR, and 28 patients achieved DR (74 %) at the median age of 30.9 months. Cardiac cath before BVR or BDG performed at the median age of 22.5 months revealed well-preserved pulmonary vasculature with the median pulmonary artery pressure of 14 mmHg, except three patients unsuitable for SVR. In conclusion, our staged BVR-oriented strategy required longer time course and more complex palliative surgeries compared with a simple SVR strategy. Leaving open the possibility of a late crossover to an SVR pathway is mandatory when adopting staged BVR-oriented strategy in these complex patients. PMID:26099174

  15. Short term and long term health related quality of life after congenital anorectal malformations and congenital diaphragmatic hernia

    PubMed Central

    Poley, M; Stolk, E; Tibboel, D; Molenaar, J; Busschbach, J

    2004-01-01

    Aims: To examine short term and long term health related quality of life (HRQoL) of survivors of congenital anorectal malformations (ARM) and congenital diaphragmatic hernia (CDH), and to compare these patients' HRQoL with that of the general population. Methods: HRQoL was measured in 286 ARM patients and 111 CDH patients. All patients were administered a symptom checklist and a generic HRQoL measure. For the youngest children (aged 1–4) the TAIQOL (a preliminary version of the TAPQOL) was used, for the other children (aged 5–15) the TACQOL questionnaire, and for adults (aged >16) the SF-36. Results: As appeared from the symptom checklists, many patients remained symptomatic into adulthood. In the youngest ARM patients (aged 1–4 years), generic HRQoL was severely affected, but the older ARM patients showed better HRQoL. In the CDH patients, the influence of symptoms on HRQoL seemed less profound. The instruments we used revealed little difference between adults treated for ARM or CDH and the general population. Conclusions: These results show that for two neonatal surgical procedures, improved survival does not come at the expense of poor HRQoL in adults. Even though there is considerable suffering in terms of both morbidity and mortality in the youngest group, the ultimate prognosis of survivors of the two studied congenital malformations is favourable. This finding can be used to reassure parents of patients in need of neonatal surgery for one of these conditions about the prospects for their child. PMID:15321860

  16. Bariatric Surgery

    PubMed Central

    2005-01-01

    Executive Summary Objective To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of bariatric surgery. Background Obesity is defined as a body mass index (BMI) of at last 30 kg/m2.1 Morbid obesity is defined as a BMI of at least 40 kg/m2 or at least 35 kg/m2 with comorbid conditions. Comorbid conditions associated with obesity include diabetes, hypertension, dyslipidemias, obstructive sleep apnea, weight-related arthropathies, and stress urinary incontinence. It is also associated with depression, and cancers of the breast, uterus, prostate, and colon, and is an independent risk factor for cardiovascular disease. Obesity is also associated with higher all-cause mortality at any age, even after adjusting for potential confounding factors like smoking. A person with a BMI of 30 kg/m2 has about a 50% higher risk of dying than does someone with a healthy BMI. The risk more than doubles at a BMI of 35 kg/m2. An expert estimated that about 160,000 people are morbidly obese in Ontario. In the United States, the prevalence of morbid obesity is 4.7% (1999–2000). In Ontario, the 2004 Chief Medical Officer of Health Report said that in 2003, almost one-half of Ontario adults were overweight (BMI 25–29.9 kg/m2) or obese (BMI ? 30 kg/m2). About 57% of Ontario men and 42% of Ontario women were overweight or obese. The proportion of the population that was overweight or obese increased gradually from 44% in 1990 to 49% in 2000, and it appears to have stabilized at 49% in 2003. The report also noted that the tendency to be overweight and obese increases with age up to 64 years. BMI should be used cautiously for people aged 65 years and older, because the “normal” range may begin at slightly above 18.5 kg/m2 and extend into the “overweight” range. The Chief Medical Officer of Health cautioned that these data may underestimate the true extent of the problem, because they were based on self reports, and people tend to over-report their height and under-report their weight. The actual number of Ontario adults who are overweight or obese may be higher. Diet, exercise, and behavioural therapy are used to help people lose weight. The goals of behavioural therapy are to identify, monitor, and alter behaviour that does not help weight loss. Techniques include self-monitoring of eating habits and physical activity, stress management, stimulus control, problem solving, cognitive restructuring, contingency management, and identifying and using social support. Relapse, when people resume old, unhealthy behaviour and then regain the weight, can be problematic. Drugs (including gastrointestinal lipase inhibitors, serotonin norepinephrine reuptake inhibitors, and appetite suppressants) may be used if behavioural interventions fail. However, estimates of efficacy may be confounded by high rates of noncompliance, in part owing to the side effects of the drugs. In addition, the drugs have not been approved for indefinite use, despite the chronic nature of obesity. The Technology Morbidly obese people may be eligible for bariatric surgery. Bariatric surgery for morbid obesity is considered an intervention of last resort for patients who have attempted first-line forms of medical management, such as diet, increased physical activity, behavioural modification, and drugs. There are various bariatric surgical procedures and several different variations for each of these procedures. The surgical interventions can be divided into 2 general types: malabsorptive (bypassing parts of the gastrointestinal tract to limit the absorption of food), and restrictive (decreasing the size of the stomach so that the patient is satiated with less food). All of these may be performed as either open surgery or laparoscopically. An example of a malabsorptive technique is Roux-en-Y gastric bypass (RYGB). Examples of restrictive techniques are vertical banded gastroplasty (VBG) and adjustable gastric banding (AGB). The Ontario Health Insurance Plan (OHIP) Schedule of Benefits for Physician Services includ

  17. Long Term Maturation of Congenital Diaphragmatic Hernia Treatment Results: Toward Development of a Severity-Specific Treatment Algorithm

    PubMed Central

    Kays, David W.; Islam, Saleem; Larson, Shawn D.; Perkins, Joy; Talbert, James L.

    2015-01-01

    Objective To assess the impact of varying approaches to CDH repair timing on survival and need for ECMO when controlled for anatomic and physiologic disease severity in a large consecutive series of CDH patients. Summary Background Data Our publication of 60 consecutive CDH patients in 1999 showed that survival is significantly improved by limiting lung inflation pressures and eliminating hyperventilation. Methods We retrospectively reviewed 268 consecutive CDH patients, combining 208 new patients with the 60 previously reported. Management and ventilator strategy were highly consistent throughout. Varying approaches to surgical timing were applied as the series matured. Results Patients with anatomically less-severe left liver-down CDH had significantly increased need for ECMO if repaired in the first 48 hours, while patients with more-severe left liver-up CDH survived at a higher rate when repair was performed before ECMO. Overall survival of 268 patients was 78%. For those without lethal associated anomalies, survival was 88%. Of these, 99% of left liver-down CDH survived, 91% of right CDH survived. and 76% of left liver-up CDH survived. Conclusions This study shows that patients with anatomically less severe CDH benefit from delayed surgery while patients with anatomically more severe CDH may benefit from a more aggressive surgical approach. These findings show that patients respond differently across the CDH anatomic severity spectrum, and lay the foundation for the development of risk specific treatment protocols for patients with CDH. PMID:23989050

  18. Outcomes of chronic macular hole surgical repair

    PubMed Central

    Shukla, Shripaad Y; Afshar, Armin R; Kiernan, Daniel F; Hariprasad, Seenu M

    2014-01-01

    Purpose: To report visual and anatomic outcomes of chronic macular hole surgery, with analysis of pre-operative OCT-based hole size and post-operative closure type. Settings and Design: An IRB-approved, retrospective case series of 26 eyes of 24 patients who underwent surgery for stage 3 or 4 idiopathic chronic macular holes at a tertiary care referral center. Statistical Analysis: Student's t-test. Results: Nineteen of 26 eyes (73%) had visual improvement after surgery on most recent exam. Twenty-one of 26 eyes (81%) achieved anatomic closure; 16 of 26 eyes (62%) achieved type 1, and five of 26 eyes (19%) achieved type 2 closure. Post-operative LogMAR VA for type 1 closure holes (0.49) was significantly greater than for type 2 closure and open holes (1.26, P < 0.003 and 1.10, P < 0.005, respectively), despite similar pre-operative VA (P = 0.51 and 0.68, respectively). Mean pre-operative hole diameter for eyes with type 1 closure, type 2 closure, and holes that remained open were 554, 929, and 1205 microns, respectively. Mean pre-operative hole diameter was significantly larger in eyes that remained open as compared to eyes with type 1 closure (P = 0.015). Conclusion: Vitrectomy to repair chronic macular holes can improve vision and achieve long-term closure. Holes of greater than 3.4 years duration were associated with a greater incidence of remaining open and type 2 closure. Larger holes (mean diameter of 1205 microns) were more likely to remain open after repair. PMID:25116773

  19. Base Excision Repair

    PubMed Central

    Krokan, Hans E.; Bjørås, Magnar

    2013-01-01

    Base excision repair (BER) corrects DNA damage from oxidation, deamination and alkylation. Such base lesions cause little distortion to the DNA helix structure. BER is initiated by a DNA glycosylase that recognizes and removes the damaged base, leaving an abasic site that is further processed by short-patch repair or long-patch repair that largely uses different proteins to complete BER. At least 11 distinct mammalian DNA glycosylases are known, each recognizing a few related lesions, frequently with some overlap in specificities. Impressively, the damaged bases are rapidly identified in a vast excess of normal bases, without a supply of energy. BER protects against cancer, aging, and neurodegeneration and takes place both in nuclei and mitochondria. More recently, an important role of uracil-DNA glycosylase UNG2 in adaptive immunity was revealed. Furthermore, other DNA glycosylases may have important roles in epigenetics, thus expanding the repertoire of BER proteins. PMID:23545420

  20. Endovascular repair of mitroaortic intervalvular fibrosa aneurysm after bentall surgery.

    PubMed

    Vola, Marco; Gerbay, Antoine; Campisi, Salvatore; Duprey, Ambroise; Heller, Fabien; Patoir, Arnaud; Albertini, Jean Noel; Fuzellier, Jean Francois; Isaaz, Karl; Favre, Jean Pierre

    2015-02-01

    We report the first case of a successful transapical transcatheter treatment of a giant pseudoaneurysm originating from a rupture of the mitroaortic fibrosa that occurred 3 months after a Bentall procedure in a 81-year-old male patient. Because of the age of the patient and the location of the leak at the mitroaortic fibrosa, the risk of a conventional ascending aorta reoperation was considered too high, and a transcatheter approach was chosen. A transapical puncture was performed with a left minithoracotomy followed by a catheterization of the pseudoaneurysm neck and an 8-mm Amplatzer (St. Jude Medical, Saint Paul, MN, USA) device was delivered, resulting in a successful complete endovascular exclusion of the pseudo-aneurysmal sac. PMID:25639415

  1. Rescheduling with iterative repair

    NASA Technical Reports Server (NTRS)

    Zweben, Monte; Davis, Eugene; Daun, Brian; Deale, Michael

    1992-01-01

    This paper presents a new approach to rescheduling called constraint-based iterative repair. This approach gives our system the ability to satisfy domain constraints, address optimization concerns, minimize perturbation to the original schedule, and produce modified schedules quickly. The system begins with an initial, flawed schedule and then iteratively repairs constraint violations until a conflict-free schedule is produced. In an empirical demonstration, we vary the importance of minimizing perturbation and report how fast the system is able to resolve conflicts in a given time bound. These experiments were performed within the domain of Space Shuttle ground processing.

  2. Rescheduling with iterative repair

    NASA Technical Reports Server (NTRS)

    Zweben, Monte; Davis, Eugene; Daun, Brian; Deale, Michael

    1992-01-01

    This paper presents a new approach to rescheduling called constraint-based iterative repair. This approach gives our system the ability to satisfy domain constraints, address optimization concerns, minimize perturbation to the original schedule, produce modified schedules, quickly, and exhibits 'anytime' behavior. The system begins with an initial, flawed schedule and then iteratively repairs constraint violations until a conflict-free schedule is produced. In an empirical demonstration, we vary the importance of minimizing perturbation and report how fast the system is able to resolve conflicts in a given time bound. We also show the anytime characteristics of the system. These experiments were performed within the domain of Space Shuttle ground processing.

  3. 46 CFR Sec. 19 - Ship Repair Summaries.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 8 2012-10-01 2012-10-01 false Ship Repair Summaries. Sec. 19 Section 19 Shipping...SUM REPAIR CONTRACT-NSA-LUMPSUMREP Sec. 19 Ship Repair Summaries. (a) Ship Repair Summaries shall be prepared on Form...

  4. 46 CFR Sec. 19 - Ship Repair Summaries.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 8 2014-10-01 2014-10-01 false Ship Repair Summaries. Sec. 19 Section 19 Shipping...SUM REPAIR CONTRACT-NSA-LUMPSUMREP Sec. 19 Ship Repair Summaries. (a) Ship Repair Summaries shall be prepared on Form...

  5. A rare case of femoral herniation of female internal genitalia

    PubMed Central

    Ambedkar, Vivek; Singh, Abhilash; Bain, Jayanta; Singh, Lal Mani

    2015-01-01

    We report a rare case with herniation of the uterus, fallopian tube, and ovary in a femoral hernia. A female patient was admitted with complain of the painful lump in the left groin. Clinical examination indicated strangulated femoral hernia, which necessitated an emergency surgery. During surgical procedure, the uterine tube, left fallopian tube and left ovary, were observed as the contents of the hernia. The contents were reduced back into the pelvic cavity, and the hernia was repaired. The patient made good recovery postsurgery. PMID:26283851

  6. Electric motor model repair specifications

    SciTech Connect

    1995-08-01

    These model repair specifications list the minimum requirements for repair and overhaul of polyphase AC squireel cage induction motors. All power ranges, voltages, and speeds of squirrel cage motors are covered.

  7. Mass-spring systems for simulating mitral valve repair using 3D ultrasound images.

    PubMed

    Skornitzke, Stephan; Schummers, Georg; Schreckenberg, Marcus; Ender, Jörg; Eibel, Sarah; Bungartz, Hans-Joachim; Kauczor, Hans-Ulrich; Stiller, Wolfram

    2015-10-01

    Mitral valve (MV) diseases are among the most common types of heart diseases, while heart diseases are the most common cause of death worldwide. MV repair surgery is connected to higher survival rates and fewer complications than the total replacement of the MV, but MV repair requires extensive patient-specific therapy planning. The simulation of MV repair with a patient-specific model could help to optimize surgery results and make MV repair available to more patients. However, current patient-specific simulations are difficult to transfer to clinical application because of time-constraints or prohibitive requirements on the resolution of the image data. As one possible solution to the problem of patient-specific MV modeling, we present a mass-spring MV model based on 3D transesophageal echocardiographic (TEE) images already routinely acquired for MV repair therapy planning. Our novel approach to the rest-length estimation of springs allows us to model the global support of the MV leaflets through the chordae tendinae without the need for high-resolution image data. The model is used to simulate MV annuloplasty for five patients undergoing MV repair, and the simulated results are compared to post-surgical TEE images. The comparison shows that our model is able to provide a qualitative estimate of annuloplasty surgery. In addition, the data suggests that the model might also be applied to simulating the implantation of artificial chordae. PMID:26241162

  8. Scar remodeling after strabismus surgery.

    PubMed Central

    Ludwig, I H

    1999-01-01

    PURPOSE: Patients with overcorrected strabismus (and several patients with undercorrection after extraocular muscle resection) underwent exploration of previously operated muscles, with the intention of advancing their tendons to prevent the need for surgery on additional muscles. Unexpectedly, it was found that, in many cases, an elongated scar segment of variable length was interposed between the muscle and its insertion site on the sclera. Laboratory investigations were carried out to elucidate the underlying mechanism(s) and to create an animal model of the disorder. METHODS: Lengthened scars were repaired on 198 muscles during 134 procedures performed on 123 patients. The scars consisted of amorphous connective tissue interposed between the globe and normal tendon. Repair was accomplished by excision of the scar and reattachment of the muscle to sclera, using absorbable sutures in 64 cases and nonabsorbable sutures in 70 cases. Histopathologic examination was performed on 82 clinical specimens, and tissue culture studies were performed on 7 specimens. To develop an animal model, 10 New Zealand white rabbits underwent bilateral superior rectus resection. Half of the eyes received sub-Tenon's injections of collagenase over the operative site during weeks 2, 3, 5, and 6 postoperatively; the other half received saline solution injections on the same schedule. At 10 weeks, half the sites were studied histologically, and the other half underwent collagen creep analysis. In a second study, the use of absorbable versus nonabsorbable sutures was compared in the rabbit model. RESULTS: In the clinical cases, the mean length of the elongated scar segments was 4.2 mm. A total of 105 of the 134 repair procedures were judged successful. Thirty-one procedures resulted in recurrence of the original overcorrection; 7 of these had documented restretches. Factors that distinguished patients with stretched scars from patients with classic slipped muscles included minimal or no limitation of versions, less separation of the tendons from sclera, and thicker appearance of the scar segments. The use of nonabsorbable sutures in the repair procedure reduced the recurrence rate. Histologic examination of the clinical stretched scar specimens showed dense connective tissue that was less well organized compared with normal tendon. In the tissue culture studies, cells cultured from the stretched scar specimens grew rapidly and were irregularly shaped. A high-molecular-weight protein was identified in the culture medium. By contrast, cells cultured from normal tendon (controls) grew more slowly and regularly, stopped growing at 4 days, and produced less total protein than cultured stretched scar specimens. In the animal model studies, the collagenase-treated sites showed elongated scars with increased collagen between the muscle and the sclera, as well as increased collagen creep rates, compared with the saline-treated controls. The use of nonabsorbable sutures in collagenase-treated animal model surgery sites was associated with shorter, thicker scars compared with similar sites sutured with absorbable sutures. CONCLUSIONS: A lengthened or stretched, remodeled scar between an operated muscle tendon and sclera is a common occurrence and is a factor contributing to the variability of outcome after strabismus repair, even years later. This abnormality may be revealed by careful exploration of previously operated muscles. Definitive repair requires firm reattachment of tendon to sclera with nonabsorbable suture support. Images FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 FIGURE 7 FIGURE 8 FIGURE 9 FIGURE 10 FIGURE 11 FIGURE 12 FIGURE 13 FIGURE 14 FIGURE 15 FIGURE 16 FIGURE 17 FIGURE 18 FIGURE 19 FIGURE 20 FIGURE 21 FIGURE 22 FIGURE 23 FIGURE 24 FIGURE 25 FIGURE 26 FIGURE 27 FIGURE 28 FIGURE 29 FIGURE 30 FIGURE 31 FIGURE 32 FIGURE 33 FIGURE 34 FIGURE 35 FIGURE 36 FIGURE 37 FIGURE 38 FIGURE 39 FIGURE 40 FIGURE 41 FIGURE 42 FIGURE 43 FIGURE 44 FIGURE 45 FIGURE 46 FIGURE 52 FIGURE 53 FIGURE 54 FIGURE 55 FIGURE 58 FIGURE 59 FIGURE 60 FIGURE 61 FIGURE 62 FIGURE 63

  9. Protein methylation and DNA repair.

    PubMed

    Lake, Aimee N; Bedford, Mark T

    2007-05-01

    DNA is under constant attack from intracellular and external mutagens. Sites of DNA damage need to be pinpointed so that the DNA repair machinery can be mobilized to the proper location. The identification of damaged sites, recruitment of repair factors, and assembly of repair "factories" is orchestrated by posttranslational modifications (PTMs). These PTMs include phosphorylation, ubiquitination, sumoylation, acetylation, and methylation. Here we discuss recent data surrounding the roles of arginine and lysine methylation in DNA repair processes. PMID:17306845

  10. Automotive Engine Maintenance and Repair.

    ERIC Educational Resources Information Center

    Marine Corps Inst., Washington, DC.

    This correspondence course, originally developed for the Marine Corps, is designed to provide students with an understanding of automotive engine maintenance and repair. The course contains six study units covering automotive engine maintenance and repair; design classification; engine malfunction, diagnosis, and repair; engine disassembly; engine…

  11. Laboratory For Telerobotic Repair

    NASA Technical Reports Server (NTRS)

    Fiorini, Paolo; Bejczy, Antal K.; Das, Hari; Zak, Haya

    1993-01-01

    Laboratory telerobotic system performs such complicated tasks as picking up tools, removing thermal blanket, and replacing screws. Human operator in control room operates remote robot with aid of video monitors, torque and force displays, and force feedback. System used to perform research and to develop telerobotic-repair capabilities equal to those of human operator.

  12. Automotive Body Repair Competencies.

    ERIC Educational Resources Information Center

    D'Armond, Jack; And Others

    Designed to provide a model curriculum and guidelines, this manual presents tasks that were identified by employers, employees, and teachers as important in a postsecondary auto body repair curriculum. The tasks are divided into ten major component areas of instruction: metalworking and fiberglass, painting, frame and suspension, glass and trim,…

  13. Basic Book Repair Methods.

    ERIC Educational Resources Information Center

    Schechter, Abraham A.

    This book addresses some common preservation techniques that invariably become necessary in library and archival collections of any size. The procedures are described in chronological sequence, and photographs show the techniques from the viewpoint of the person actually doing the work. The recommended repair methods can be accomplished using…

  14. Comprehensive Small Engine Repair.

    ERIC Educational Resources Information Center

    Hires, Bill; And Others

    This curriculum guide contains the basic information needed to repair all two- and four-stroke cycle engines. The curriculum covers four areas, each consisting of one or more units of instruction that include performance objectives, suggested activities for teacher and students, information sheets, assignment sheets, job sheets, visual aids,…

  15. Hiatal hernia uptake of iodine-131 mimicking mediastinal metastasis of papillary thyroid carcinoma.

    PubMed

    Haghighatafshar, Mahdi; Khajehrahimi, Farnaz

    2015-01-01

    There are a few case reports of hiatal hernia demonstrating thoracic uptake on I-131 scintigraphy. In this case, high thyroglobulin levels in combination with misinterpretation of I-131 uptake in the mediastinum, leaded to mismanagement of the patient. Here we present a case of focal I-131 uptake within a hiatal hernia initially mimicking an isolated mediastinal metastasis. There are many potential causes of false-positive I-131 scan result. In this case, adjunctive chest computed tomography and gastroesophageal barium study helped to elucidate the true nature of this I-131 uptake. False-positive findings may be caused by a wide variety of nonthyroidal carcinomas, which can concentrate radioiodine or from skin contamination. Several organs, such as the gastric, salivary glands, renal cyst, pericardial effusion, and ovarian can accumulate I-131. It should be borne in mind as a potential source of false-positive whole-body I-131 imaging. PMID:26430323

  16. Randomised controlled trial of early discharge for inguinal hernia and varicose veins.

    PubMed Central

    Adler, M W; Waller, J J; Creese, A; Thorne, S C

    1978-01-01

    A randomised controlled trial has been conducted into the effects of discharging patients from hospital either 48 hours or six to seven days after operations for inguinal hernia and varicose veins. There was no statistically significant difference in major postoperative complications between the two lengths of stay for either of the two conditions. Similarly there was no difference between the two groups of hernia patients in relation to eventual recurrences. There was no significant difference in length of convalescence between long-stay and short-stay patients in full-time occupations. The savings to the statutory services of discharging patients early were estimated at 25.72 pounds per patient. Patients appeared to approve of the type of care they experienced, regardless of length of stay. However, the families of short-stay patients were significantly less enthusiastic in their attitudes towards the policy of early discharge than the families of long-stay patients. PMID:98548

  17. Intestinal perforation in a parastomal hernia by a migrated plastic biliary stent.

    PubMed

    Levey, J M

    2002-11-01

    Organ perforation is a well-described complication of plastic biliary stent placement [1, 2, 3, 4, 5, 6, 7, 8, 9, 10][1-10]. Most commonly, a stent will cause duodenal perforation while still in the area of the biliary system. This often occurs in the setting of a periampullary diverticulum. Less frequently, a perforation occurs as a result of stent migration into the distal lumenal gastrointestinal tract. These cases have involved a migrated stent impacting at the level of the ileum or a sigmoid colon diverticulum. A plastic biliary stent causing perforation inside an incarcerated small bowel hernia sac has been reported [10]. We describe the first reported case of a plastic biliary stent causing perforation inside a parastomal hernia. PMID:12085152

  18. A case of extraperitoneal stoma-associated internal hernia after abdominoperineal resection.

    PubMed

    Yokoyama, Yuichiro; Kawai, Kazushige; Kazama, Shinsuke; Yoneyama, Satomi; Tanaka, Junichiro; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Nozawa, Hiroaki; Kanazawa, Takamitsu; Yamaguchi, Hironori; Ishihara, Soichiro; Sunami, Eiji; Kitayama, Joji; Watanabe, Toshiaki

    2014-01-01

    Published reports concerning internal hernias after extraperitoneal stoma construction are scarce. In our present report, we describe the case of a 56-year-old man who was referred to our hospital for the treatment of rectal cancer. He underwent abdominoperineal resection of the rectum with sigmoidostomy using an extraperitoneal route. On the ninth postoperative day, the patient experienced sudden and intense abdominal pain and was diagnosed with strangulation of the small intestine due to a stoma-associated internal hernia. Therefore, an emergency laparotomy was performed. The surgical findings showed that the small intestine protruded through the space between the sigmoid colon loop and the abdominal wall in a cranial-to-caudal direction. The strangulated portion of the small intestine was recovered, and the orifice of herniation was closed. No recurrence of internal herniation was observed during the follow-up period. PMID:24886644

  19. The “Flying Swan” Technique: A Novel Method for Anterior Labral Repair Using a Tensioned Suture Bridge

    PubMed Central

    Alexander, Susan; Wallace, Andrew L.

    2014-01-01

    Arthroscopic labral repair is an effective technique for most cases of traumatic shoulder instability. However, patients with anterior labroligamentous periosteal sleeve avulsion lesions frequently have multiple episodes of subluxation or dislocation and a high recurrence rate after surgery, even with modern methods of labral repair. One reason may be failure of biological healing of the labrum due to an inadequate “footprint” of contact between the capsulolabral tissue and the glenoid bone. We have developed a technique that facilitates a tensioned suture bridge between suture anchors that may improve the results of labral repair in patients with anterior labroligamentous periosteal sleeve avulsion lesions. PMID:24749030

  20. Repair of Post-Infarction Ventricular Free Wall Rupture With TachoSil®

    PubMed Central

    Gholampour-Dehaki, Maziar; Javadikasgari, Hoda; Zare, Asghar; Madani, Mohsen

    2015-01-01

    Introduction: Left ventricular free wall rupture (LVFWR) is a frequent cause of death after acute myocardial infarction, and its repair remains a surgical challenge. Case Presentation: TachoSil® is a ready-to-use equine collagen patch which has been successfully used for hemostasis in cardiovascular surgery. However, a limited number of studies have reported its application for LVFWR repair. In this study, we describe our initial experience using TachoSil® for LVFWR repair. Conclusions: A hemodynamic study was acceptable at a 12-month follow-up, and no complication was seen. PMID:26528448

  1. Hernia of cecum and ascending colon through the foramen of Winslow?

    PubMed Central

    Puig, Carlos A.; Lillegard, Joseph B.; Fisher, James E.; Schiller, Henry J.

    2013-01-01

    INTRODUCTION Internal hernias through the foramen of Winslow are rare events and constitute 8% of internal hernias but only 0.1% of all abdominal hernias. PRESENTATION OF CASE A 62-year-old man presented with upper abdominal pain, distention and vomiting, and was shown on CT scan to have the right colon and cecum herniating into the lesser sac through the foramen of Winslow. This diagnosis was confirmed at laparotomy as well as a midgut volvulus and right hemicolectomy was performed because of ischemic changes of the cecum. DISCUSSION Six developmental abnormalities may result in internal herniation of bowel contents in the abdomen: (i) abnormal retroperitoneal fixation of the mesentery resulting in anomalous positioning of the intestine; (ii) incomplete mesenteric surfaces with the presence of abnormal opening through which the intestine herniates, (iii) abnormally large internal foramina or fossae (e.g. foramen of Winslow); (iv) abnormally long small-bowel mesentery; (v) an elongated right hepatic lobe thought to guide bowel into the foramen of Winslow, and (vi) persistence of the ascending mesocolon allowing marked mobility of the right colon. CONCLUSION We believe that hypermobile cecum was responsible for the internal herniation through the foramen of Winslow and that this served as the lead point allowing for the midgut volvulus. There is no consensus on the surgical management of internal hernias through the Foramen of Winslow when the herniated contents are grossly viable. The literature in this regard is scarce and surgical decision making is based on surgeon preference and the viability of the herniated intraabdominal contents. PMID:23973900

  2. Laparoscopic herniorrhaphy in children.

    PubMed

    Bertozzi, Mirko; Marchesini, Laura; Tesoro, Simonetta; Appignani, Antonino

    2015-01-01

    The authors report their experience in laparoscopic repair of inguinal hernias in children. From May 2010 to November 2013, 122 patients with inguinal hernia underwent laparoscopic herniorrhaphy (92 males and 30 females). Telescope used was 5 mm, while trocars for the operative instruments were 3 or 2 mm. After introducing the camera at the umbilical level and trocars in triangulation, a 4-0 nonabsorbable monofilament suture was inserted directly through the abdominal wall. The internal inguinal ring was then closed by N or double N suture. All operations were performed in one-day surgery setting. In the case of association of inguinal and umbilical hernia an original technique was performed for positioning and fixing the umbilical trocar and for the primary closure of the abdominal wall defect. The postoperative follow-up consisted of outpatient visits at 1 week and 1, 3, and 6 months. The mean age of patients was 38.5 months. Of all patients, 26 were also suffering from umbilical hernia (19 males and 7 females). A total of 160 herniorrhaphies were performed; 84 were unilateral (66 inguinal hernia, 18 inguinal hernia associated with umbilical hernia), 38 bilateral (30 inguinal hernia, 8 inguinal hernia associated with umbilical hernia). Nine of 122 patients (6 males and 3 females) were operated in emergency for incarcerated hernia. A pre-operative diagnosis of unilateral inguinal hernia was performed in 106 cases. Of these patients, laparoscopy revealed a controlateral open internal inguinal ring in 22 cases (20.7%). The mean operative time was 29.9±15.9 min for the monolateral herniorrhaphies, while in case of bilateral repair the mean operative time was 41.5±10.4 min. The mean operative time for the repair of unilateral inguinal hernia associated with umbilical hernia was 30.1±7.4 while for the correction of bilateral inguinal hernia associated with umbilical hernia 39.5±10.6 min. There were 3 recurrences (1.8%): 2 cases in unilateral repair and 1 case a unilateral recurrence in a bilateral repair. No other complications were seen. Laparoscopic repair of inguinal hernia in children performed in this experience resulted a safe and effective procedure. PMID:26429119

  3. Assessment of the canine model of rotator cuff injury and repair

    PubMed Central

    Derwin, Kathleen A; Baker, Andrew R; Codsi, Michael J; Iannotti, Joseph P

    2007-01-01

    Animal shoulder models are used to systematically investigate the factors influencing rotator cuff injury and repair. Each model has advantages and disadvantages that must be considered in the context of the specific research questions being asked. Herein we evaluate the utility of the canine model for studies of acute, full-thickness rotator cuff tendon injury and repair. We found that time zero failure load is dependent on the suture type and configuration used for repair. Acute, full-width tendon repairs fail anatomically within the first days after surgery in the canine model, regardless of suture type, suture configuration or post-operative protocol. Robust scar tissue forms in the gap between the failed tendon end and the humerus, which can be visually, mechanically and histologically misconstrued as tendon if an objective test of repair connectivity is not performed. We conclude that a full-width injury and repair model in the canine will provide a rigorous test of whether a new repair strategy or post-operative protocol (such as casting or temporary muscle paralysis) can maintain repair integrity in a high load environment. Alternatively, a partial-width tendon injury model allows loads to be shared between the tendon repair and the remaining intact portion of the infraspinatus tendon and prohibits complete tendon retraction. Thus a partial-width injury in the canine may model the mechanical environment of many single tendon tears in the human injury condition and warrants further investigation. PMID:17560802

  4. Comparative and targeted proteomic analyses of urinary microparticles from bladder cancer and hernia patients.

    PubMed

    Chen, Chien-Lun; Lai, Yue-Fan; Tang, Petrus; Chien, Kun-Yi; Yu, Jau-Song; Tsai, Cheng-Han; Chen, Hsiao-Wei; Wu, Chih-Ching; Chung, Ting; Hsu, Chia-Wei; Chen, Chi-De; Chang, Yu-Sun; Chang, Phei-Lang; Chen, Yi-Ting

    2012-12-01

    Bladder cancer is a common urologic cancer whose incidence continues to rise annually. Urinary microparticles are an attractive material for noninvasive bladder cancer biomarker discovery. In this study, we applied isotopic dimethylation labeling coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS) to discover bladder cancer biomarkers in urinary microparticles isolated from hernia (control) and bladder cancer patients. This approach identified 2964 proteins based on more than two distinct peptides, of which 2058 had not previously been reported as constituents of human urine exosomes/microparticles. A total of 107 differentially expressed proteins were identified as candidate biomarkers. Differences in the concentrations of 29 proteins (41 signature peptides) were precisely quantified by LC-MRM/MS in 48 urine samples of bladder cancer, hernia, and urinary tract infection/hematuria. Concentrations of 24 proteins changed significantly (p<0.05) between bladder cancer (n=28) and hernia (n=12), with area-under-the-curve values ranging from 0.702 to 0.896. Finally, we quantified tumor-associated calcium-signal transducer 2 (TACSTD2) in raw urine specimens (n=221) using a commercial ELISA and confirmed its potential value for diagnosis of bladder cancer. Our study reveals a strong association of TACSTD2 with bladder cancer and highlights the potential of human urinary microparticles in the noninvasive diagnosis of bladder cancer. PMID:23082778

  5. Gene Therapy for Cartilage Repair

    PubMed Central

    Madry, Henning; Orth, Patrick; Cucchiarini, Magali

    2011-01-01

    The concept of using gene transfer strategies for cartilage repair originates from the idea of transferring genes encoding therapeutic factors into the repair tissue, resulting in a temporarily and spatially defined delivery of therapeutic molecules to sites of cartilage damage. This review focuses on the potential benefits of using gene therapy approaches for the repair of articular cartilage and meniscal fibrocartilage, including articular cartilage defects resulting from acute trauma, osteochondritis dissecans, osteonecrosis, and osteoarthritis. Possible applications for meniscal repair comprise meniscal lesions, meniscal sutures, and meniscal transplantation. Recent studies in both small and large animal models have demonstrated the applicability of gene-based approaches for cartilage repair. Chondrogenic pathways were stimulated in the repair tissue and in osteoarthritic cartilage using genes for polypeptide growth factors and transcription factors. Although encouraging data have been generated, a successful translation of gene therapy for cartilage repair will require an ongoing combined effort of orthopedic surgeons and of basic scientists. PMID:26069580

  6. Imaging in gynecologic surgery.

    PubMed

    Mettler, Liselotte; Sammur, Wael; Alkatout, Ibrahim; Schollmeyer, Thoralf

    2011-03-01

    The technical development of instruments for endoscopic surgery started in the field of gynecology. In the early 1970s, with the improvement of optics and instruments for laparoscopic surgery, gyne-endoscopic surgery developed and set milestones for all other surgical fields. However, the general surgeons propagated the advantages of 2D or 3D imaging surgery much better than the conservative gynecologists. Surgery on a 2D screen without direct vision is regarded as more advantageous than open surgery and has achieved wide acceptance. Several schools of gynecologic endoscopy in Europe (in Kiel, Giessen, Clermont Ferrand and Strasbourg) have set guidelines for gyne-endoscopic surgery. Our catalog of indications in the areas of gyne-endoscopic surgery, published in 2002, reveals the broad application of these techniques today. 3D vision, robotic instruments and systems, such as the da Vinci(®) Surgical System from Intuitive Surgical, Inc. (CA, USA), round up the picture of endoscopic surgery. The advantages of endoscopic surgery over open surgery (more precision, less trauma, less postoperative pain, shorter hospital stays and a faster recovery period) are becoming more accepted. The present healthcare systems and hospital administrations understand the challenges of imaging in surgery, particularly in endoscopic surgery. PMID:21410349

  7. The Results of All-Inside Meniscus Repair Using the Viper Repair System Simultaneously with Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kang, Hong Je; Kim, Kwang Mee; Cho, Hang Hwan; Espinosa, Johnsel C.

    2015-01-01

    Background Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction. Methods Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning's classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing. Results The clinical success rate was 95.4% and the HSS scores were 93.9 ± 5.4 at the final follow-up. According to Henning's classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present. Conclusions The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair System is an effective treatment method when it is performed simultaneously with ACL reconstruction. PMID:26217463

  8. Weight Loss Surgery

    MedlinePLUS

    Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you cannot lose weight ... obesity. There are different types of weight loss surgery. They often limit the amount of food you ...

  9. Cataract surgery - series (image)

    MedlinePLUS

    Cataract surgery usually works very well. The operation has few risks, the pain and recovery period are short, ... improved. Ninety-five percent or more of all cataract surgeries result in improved vision.

  10. Gastric bypass surgery

    MedlinePLUS

    ... your belly. The surgery is called laparoscopy . The scope allows the surgeon to see inside your belly. ... to 6 small cuts in your belly. The scope and instruments needed to perform the surgery are ...

  11. Ear Plastic Surgery

    MedlinePLUS

    ... Meeting Calendar Find an ENT Doctor Near You Ear Plastic Surgery Ear Plastic Surgery Patient Health Information ... they may improve appearance and self-confidence. Can Ear Deformities Be Corrected? Formation of the ear during ...

  12. Complications of Sinus Surgery

    MedlinePLUS

    ... further intracranial surgeries. Impaired sense of taste or smell : The sense of smell usually improves after the procedure because airflow is ... in their voice after sinus surgery. Impairment of smell or taste: (see above) Infection: The most common ...

  13. Blood donation before surgery

    MedlinePLUS

    ... you, if you need blood transfusion after surgery. Blood from these donors must be collected at least a few days ... blood bank before your surgery to have directed donor blood. It is important to note that there is ...

  14. Gum Graft Surgery

    MedlinePLUS

    ... Augmentation Ridge Modification Periodontal Pocket Reduction Procedures Periodontal Plastic Surgery Procedures Love the Gums You're With Member ... Augmentation Ridge Modification Periodontal Pocket Reduction Procedures Periodontal Plastic Surgery Procedures Love the Gums You're With Find ...

  15. Cosmetic breast surgery - discharge

    MedlinePLUS

    ... Higdon KK. Reduction mammoplasty. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier; 2013:chap 8. ... Gabriel A. Breast augmentation. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier; 2013:chap 2.

  16. Minimal invasive single-site surgery in colorectal procedures: Current state of the art

    PubMed Central

    Diana, Michele; Dhumane, Parag; Cahill, R A; Mortensen, N; Leroy, Joel; Marescaux, Jacques

    2011-01-01

    BACKGROUND: Minimally invasive single-site (MISS) surgery has recently been applied to colorectal surgery. We aimed to assess the current state of the art and the adequacy of preliminary oncological results. METHODS: We performed a systematic review of the literature using Pubmed, Medline, SCOPUS and Web of Science databases. Keywords used were “Single Port” or “Single-Incision” or “LaparoEndoscopic Single Site” or “SILS™” and “Colon” or “Colorectal” and “Surgery”. RESULTS: Twenty-nine articles on colorectal MISS surgery have been published from July 2008 to July 2010, presenting data on 149 patients. One study reported analgesic requirement. The final incision length ranged from 2.5 to 8 cm. Only two studies reported fascial incision length. There were two port site hernias in a series of 13 patients (15.38%). Two “fully laparoscopic” MISS procedures with preparation and achievement of the anastomosis completely intracorporeally are reported. Future site of ileostomy was used as the sole access for the procedures in three studies. Lymph node harvesting, resection margins and length of specimen were sufficient in oncological cases. CONCLUSIONS: MISS colorectal surgery is a challenging procedure that seems to be safe and feasible, but the existing clinical evidence is limited. In selected cases, and especially when an ileostomy is planned, colorectal surgery may be an ideal indication for MISS surgery leading to a no-scar surgery. Despite preliminary oncological results showing the feasibility of MISS surgery, we want to stress the need to standardize the technique and carefully evaluate its application in oncosurgery under ethical committee control. PMID:21197243

  17. Prokaryotic Nucleotide Excision Repair

    PubMed Central

    Kisker, Caroline; Kuper, Jochen; Van Houten, Bennett

    2013-01-01

    Nucleotide excision repair (NER) has allowed bacteria to flourish in many different niches around the globe that inflict harsh environmental damage to their genetic material. NER is remarkable because of its diverse substrate repertoire, which differs greatly in chemical composition and structure. Recent advances in structural biology and single-molecule studies have given great insight into the structure and function of NER components. This ensemble of proteins orchestrates faithful removal of toxic DNA lesions through a multistep process. The damaged nucleotide is recognized by dynamic probing of the DNA structure that is then verified and marked for dual incisions followed by excision of the damage and surrounding nucleotides. The opposite DNA strand serves as a template for repair, which is completed after resynthesis and ligation. PMID:23457260

  18. Robotic liver surgery

    PubMed Central

    Leung, Universe

    2014-01-01

    Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented. PMID:25392840

  19. Brain surgery - discharge

    MedlinePLUS

    Craniotomy - discharge; Surgery - brain - discharge; Neurosurgery - discharge; Craniectomy - discharge; Stereotactic craniotomy - discharge; Stereotactic brain biopsy - discharge; Endoscopic craniotomy - discharge

  20. [Ambulatory emergency surgery].

    PubMed

    Triboulet, Jean-Pierre

    2014-03-01

    Development of outpatient cases in emergency is still a controversy. Ambulatory surgery is possible in ambulatory surgical unit (ASU), or in emergency surgical units (ESU). Quality of care and safety need to be associated to patients' ambulatory management without impairment of ASU and ESU organization. Patient eligibility concerns not only traumatic hand surgery but also general or visceral surgery. PMID:24530140

  1. Pediatric Surgery Gallengangatresie

    E-print Network

    Manstein, Dietmar J.

    1 Pediatric Surgery Gallengangatresie: eine seltene Erkrankung fällt durch die Maschen eines Versorgungsnetzes C. Petersen, B. M. Ure Pediatric Surgery Warum machen wir so viel Wirbel um eine seltene Surgery Die Gallengangatresie ist ein Problem! Seltene Erkrankung: ca. 1: 18.000 In Deutschland ca. 40

  2. Pediatric heart surgery

    MedlinePLUS

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... There are many kinds of heart defects. Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels ...

  3. Clinical Paper Orthognathic Surgery

    E-print Network

    Frey, Pascal

    . Stoelinga4,5 1 Department of Oral and Maxillofacial Surgery/Pathology, Academic Centre for Dentistry of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, Netherlands; 5 DepartmentClinical Paper Orthognathic Surgery Do the changes in muscle mass, muscle direction, and rotations

  4. Primary flexor tendon surgery: the search for a perfect result.

    PubMed

    Elliot, David; Giesen, Thomas

    2013-05-01

    Repair of the divided flexor tendon to achieve normal, or near normal, function is an unsolved problem, with each result still uncertain. The authors believe the way forward in primary flexor tendon surgery clinically is by use of strengthened but simpler sutures, appropriate venting of the pulley system, and maintaining early rehabilitation. However, there needs also be consideration of patient factors and other aspects. Research needs to continue more widely, in both the laboratory and the clinical environment, to find ways of better modifying adhesions after surgical repair of the tendon. PMID:23660055

  5. NOTES, hybrid NOTES, NOTES-assisted kidney surgery: what has been achieved so far?

    PubMed

    Clavijo, R; Ribal, Maria J; Sotelo, Rene; Fernández, G; Alcaraz, Antonio

    2012-04-01

    With improved technologies and the development of new techniques, has emerged the concept of "scarless surgery" in an attempt to treat certain diseases obviating the need for incisions to access the peritoneal cavity, resulting in direct benefit to patients and assuming an improvement in quality of life and offering an advantage over conventional laparoscopy. Laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) are evolutions of laparoscopy, and they are complementary techniques that should be included in this new concept. NOTES is an emerging surgical modality that uses endoscopic instruments through hollow viscera to enter the peritoneal cavity and allow surgical procedures without incisions. The NOTES procedure may provide additional benefits when compared with current minimally invasive procedures. Potential advantages include no skin incisions, improved cosmetic result, reduced postoperative pain, diminished risk of postoperative hernias, and earlier recovery. NOTES surgery has still some inconvenient regarding instrumentals, viewing orientation, control of complications. Attempts to overcome the current limitations of the technique have given rise to the concept of hybrid NOTES, which is performed with the assistance of transabdominal ports for the use of conventional laparoscopy equipment. NOTES is a very promising technique although further investigation is necessary until implementing NOTES surgery in the common clinical practice. PMID:22495281

  6. Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: A single center experience

    PubMed Central

    Ong, Marc; Guang, Tan Yu; Yang, Tan Kok

    2015-01-01

    AIM: To determine predisposing factors leading to surgical delay in elderly patients with acute abdominal conditions and its impact on surgical outcomes. METHODS: A retrospective review of a total of 144 patients aged 60 years and older who had undergone emergency abdominal surgery between 2010 and 2013 at a regional general hospital was analysed. The operations analysed were limited to perforated or gangrenous viscus and strangulated hernia. Patient demographic features, time taken to obtain a computed tomography scan, time taken to surgery and the impact on postoperative morbidity and mortality were analysed. RESULTS: The mean age was 70.5 ± 9.1 years and median time taken to surgery was 9 h. The overall mortality and complication rates (Clavien Dindo 3 and above) were 9% and 13.1% respectively. Diabetes mellitus was a significant predisposing factor which had an impact on surgical delays. Delays in surgery more than 24 h led to higher complication rates at 38.9% (P = 0.003), with multivariate analysis confirming it as an independent factor. Delays in obtaining a computed tomography (CT) scan was also shown to result in higher complication rates (Clavien Dindo 3 and above). CONCLUSION: Delays in performing emergency surgery in elderly lead to higher complication rates. Obtaining CT scans early also may facilitate prompt diagnosis of certain abdominal emergencies where presentation is more equivocal and this may lead to improved surgical outcomes. PMID:26425270

  7. Airway-Related Symptoms and Surgeries in Patients With Mucopolysaccharidosis I

    PubMed Central

    Bruce, Iain A.; Wraith, James E.; Travers, Helen; Fallet, Shari

    2015-01-01

    Objective: Mucopolysaccharidosis I (MPS I) is a progressive, debilitating, and life-threatening genetic disease, which, owing to the nonspecific nature of the early symptoms, is often unrecognized and associated with significant diagnostic delays. To improve early recognition leading to early diagnosis and initiation of treatment, we characterized the extent of airway-related symptoms and surgeries among patients with MPS I. Methods: Analysis of the frequency of airway-related symptoms and surgeries from 1041 patients enrolled in the MPS I Registry and correlation with other systemic manifestations of MPS I. Results: Airway-related symptoms (macroglossia, enlarged tonsils, reactive airway disease/asthma, or sleep disturbances) were reported for as many as 85% of Hurler, 83% of Hurler-Scheie, and 65% of Scheie patients—very often before the diagnosis of MPS I was established. Surgeries for an airway indication were reported in 39% of patients and many had at least 1 airway-related surgery before the diagnosis of MPS I was confirmed. The mean percentage of patients with airway-related symptoms for whom hernias and/or dysostosis multiplex were also reported was 84% and 54%, respectively. Conclusion: Airway-related symptoms and surgeries are common and often the earliest presenting feature in MPS I. Improved recognition of early MPS I disease manifestations may lead to earlier diagnosis and treatment. PMID:25214650

  8. Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease

    PubMed Central

    2015-01-01

    Degenerative diseases of the mitral valve (MV) are the most common cause of mitral regurgitation in the Western world and the most suitable pathology for MV repair. Several studies have shown excellent long-term durability of MV repair for degenerative diseases. The best follow-up results are obtained with isolated prolapse of the posterior leaflet, however even with isolated prolapse of the anterior leaflet or prolapse of both leaflets the results are gratifying, particularly in young patients. The freedom from reoperation on the MV at 15 years exceeds 90% for isolated prolapse of the posterior leaflet and it is around 70-85% for prolapse of the anterior leaflet or both leaflets. The degree of degenerative change in the MV also plays a role in durability of MV repair. Most studies have used freedom from reoperation to assess durability of the repair but some studies that examined valve function late after surgery suggest that recurrent mitral regurgitation is higher than estimated by freedom from reoperation. We can conclude that MV repair for degenerative mitral regurgitation is associated with low probability of reoperation for up to two decades after surgery. However, almost one-third of the patients develop recurrent moderate or severe mitral regurgitation suggesting that surgery does not arrest the degenerative process. PMID:26539345

  9. Design of an Endonasal Graft Placement Tool for Repair of Skull

    E-print Network

    Design of an Endonasal Graft Placement Tool for Repair of Skull Base Defects Richard J. Hendrick Vanderbilt University 1 Background Endonasal skull base surgery (see Fig. 1) has proven to be a safe deficits, brain hemorrhage, and death [1]. Figure 1: Sagittal head MRI revealing the skull base anatomy

  10. Is closure of the peritoneal layer necessary in the repair of midline surgical abdominal wounds?

    PubMed

    Hugh, T B; Nankivell, C; Meagher, A P; Li, B

    1990-01-01

    This study describes a prospective randomized controlled trial to evaluate whether suture of the peritoneal layer is necessary as a separate step in the closure of midline abdominal surgical wounds. Consecutive patients undergoing abdominal operation--elective and emergency surgery--through a midline abdominal wound were randomized to have the peritoneal layer closed with continuous catgut, or to have this step omitted. The linea alba was closed with interrupted stainless steel sutures, and the skin approximated with staples. Patients were evaluated for wound sepsis, wound dehiscence, and subsequent incisional hernia development. Postoperative pain was assessed by a self-administered visual analogue score, and by measuring narcotic requirements. There was no significant difference in narcotic requirements, pain scores, or wound complications between the 2 groups. Single-layer closure of the abdominal wall is quicker, less costly, and theoretically safer than layered closure, and it is recommended that separate suture of the peritoneum be abandoned. PMID:2139269

  11. The Existence of Myocardial Repair

    PubMed Central

    Schoenfeld, Matthew; Frishman, William H.; Leri, Annarosa; Kajstura, Jan; Anversa, Piero

    2014-01-01

    The lack of myocardial repair after myocardial infarction and the heart failure that eventually ensues was thought of as proof that myocardial cell regeneration and myocardial repair mechanisms do not exist. Recently, growing experimental and clinical evidence has proven this concept wrong. Cardiac stem cells and endogenous myocardial repair mechanisms do exist; however, they do not produce significant myocardial repair. Similarly, the preliminary results of stem cell therapy for myocardial repair have shown early promise but modest results. Preclinical studies are the key to understanding stem cell senescence and lack of cellular contact and vasculature in the infarcted region. Additional laboratory studies are sure to unlock the therapeutic mechanisms that will be required for significant myocardial repair. PMID:23568056

  12. A central role for vimentin in regulating repair function during healing of the lens epithelium.

    PubMed

    Menko, A S; Bleaken, B M; Libowitz, A A; Zhang, L; Stepp, M A; Walker, J L

    2014-03-01

    Mock cataract surgery provides a unique ex vivo model for studying wound repair in a clinically relevant setting. Here wound healing involves a classical collective migration of the lens epithelium, directed at the leading edge by an innate mesenchymal subpopulation of vimentin-rich repair cells. We report that vimentin is essential to the function of repair cells as the directors of the wound-healing process. Vimentin and not actin filaments are the predominant cytoskeletal elements in the lamellipodial extensions of the repair cells at the wound edge. These vimentin filaments link to paxillin-containing focal adhesions at the lamellipodial tips. Microtubules are involved in the extension of vimentin filaments in repair cells, the elaboration of vimentin-rich protrusions, and wound closure. The requirement for vimentin in repair cell function is revealed by both small interfering RNA vimentin knockdown and exposure to the vimentin-targeted drug withaferin A. Perturbation of vimentin impairs repair cell function and wound closure. Coimmunoprecipitation analysis reveals for the first time that myosin IIB is associated with vimentin, linking vimentin function in cell migration to myosin II motor proteins. These studies reveal a critical role for vimentin in repair cell function in regulating the collective movement of the epithelium in response to wounding. PMID:24478454

  13. General Surgery Resident Vascular Operative Experience in the Era of Endovascular Surgery and Vascular Fellowships.

    PubMed

    Yan, Huan; Maximus, Steven; Kim, Jerry J; Smith, Brian; Kim, Dennis; Koopmann, Matthew; DeVirgilio, Christian

    2015-10-01

    Advances in endovascular surgery have resulted in a decline in major open arterial reconstructions nationwide. Our objective is to investigate the effect of endovascular surgery on general surgery resident experience with open vascular surgery. Between 2004 and 2014, 112 residents graduated from two academic institutions in Southern California. Residents were separated into those who graduated in 2004 to 2008 (period 1) and in 2009 to 2014 (period 2). Case volumes of vascular procedures were compared using two-sample t test. A total of 43 residents were in period 1 and 59 residents were in period 2. In aggregate, there was no significant difference in open cases recorded between the two periods (84 vs 87, P = 0.194). Subgroup analysis showed period 2 recorded significantly fewer cases of open aneurysm repair (5 vs 3, P < 0.001), cerebrovascular (14 vs 10, P = 0.007), and peripheral obstructive procedures (16 vs 13, P = 0.017). Dialysis access procedures constituted the largest group of procedures and remained similar between the two periods (35 vs 42, P = 0.582). General surgery residents experienced a significant decline in several index open major arterial reconstruction cases. This decline was offset by maintenance of dialysis access procedures. If the trend continues, future general surgeons will not be proficient in open vascular procedures. PMID:26595111

  14. The role of multimodality imaging in the selection of patients for aortic valve repair.

    PubMed

    Regeer, Madelien V; Versteegh, Michel I M; Marsan, Nina Ajmone; Bax, Jeroen J; Delgado, Victoria

    2016-01-01

    Aortic valve sparing surgery for aortic regurgitation and/or aortopathy serves as an alternative to aortic valve and root replacement. One of the advantages of aortic valve sparing surgery over conventional replacement is that there is no need for life-long anticoagulation, which is particularly attractive in young patients who may receive a mechanical prosthesis otherwise. However, successful aortic valve repair requires high expertise. At present, reparability is determined intraoperatively by direct surgical inspection. Preoperative imaging techniques might improve the patient selection for aortic valve repair. The mechanism of aortic regurgitation, aortic valve morphology and calcification and aortic root dimensions are all of importance when aortic valve repair is considered. The present review focuses on the role of imaging techniques in determining aortic valve reparability. PMID:26536524

  15. [Catheter based mitral valve repair for severe mitral regurgitation: patient selection].

    PubMed

    Naegeli, Barbara; Franzen, Olaf

    2015-09-01

    The catheter-based mitral valve repair is a novel technology for the treatment of severe mitral regurgitation (MR). This technique is suitable for elderly patients with pronounced co-morbidities who are deemed to be high risk for conventional heart surgery. A meaningful reduction of mitral regurgitation leads to improvement of symptoms and quality of life. Studies also demonstrate reverse remodeling of the left ventricle. In heart failure patients with severe MR percutaneous repair reduces re-hospitalization rates>50% in comparison to optimal medical treatment. For degenerative MR conventional surgery is the gold standard, whereas for high surgical risk patients and for severe functional MR percutaneous repair is an alternative. PMID:26331203

  16. DNA repair in cultured keratinocytes

    SciTech Connect

    Liu, S.C.; Parsons, S.; Hanawalt, P.C.

    1983-07-01

    Most of our understanding of DNA repair mechanisms in human cells has come from the study of these processes in cultured fibroblasts. The unique properties of keratinocytes and their pattern of terminal differentiation led us to a comparative examination of their DNA repair properties. The relative repair capabilities of the basal cells and the differentiated epidermal keratinocytes as well as possible correlations of DNA repair capacity with respect to age of the donor have been examined. In addition, since portions of human skin are chronically exposed to sunlight, the repair response to ultraviolet (UV) irradiation (254 nm) when the cells are conditioned by chronic low-level UV irradiation has been assessed. The comparative studies of DNA repair in keratinocytes from infant and aged donors have revealed no significant age-related differences for repair of UV-induced damage to DNA. Sublethal UV conditioning of cells from infant skin had no appreciable effect on either the repair or normal replication response to higher, challenge doses of UVL. However, such conditioning resulted in attenuated repair in keratinocytes from adult skin after UV doses above 25 J/m2. In addition, a surprising enhancement in replication was seen in conditioned cells from adult following challenge UV doses.

  17. DNA excision repair at telomeres.

    PubMed

    Jia, Pingping; Her, Chengtao; Chai, Weihang

    2015-12-01

    DNA damage is caused by either endogenous cellular metabolic processes such as hydrolysis, oxidation, alkylation, and DNA base mismatches, or exogenous sources including ultraviolet (UV) light, ionizing radiation, and chemical agents. Damaged DNA that is not properly repaired can lead to genomic instability, driving tumorigenesis. To protect genomic stability, mammalian cells have evolved highly conserved DNA repair mechanisms to remove and repair DNA lesions. Telomeres are composed of long tandem TTAGGG repeats located at the ends of chromosomes. Maintenance of functional telomeres is critical for preventing genome instability. The telomeric sequence possesses unique features that predispose telomeres to a variety of DNA damage induced by environmental genotoxins. This review briefly describes the relevance of excision repair pathways in telomere maintenance, with the focus on base excision repair (BER), nucleotide excision repair (NER), and mismatch repair (MMR). By summarizing current knowledge on excision repair of telomere damage and outlining many unanswered questions, it is our hope to stimulate further interest in a better understanding of excision repair processes at telomeres and in how these processes contribute to telomere maintenance. PMID:26422132

  18. Tissue Engineering a Biological Repair Strategy for Lumbar Disc Herniation

    PubMed Central

    O'Connell, Grace D.; Leach, J. Kent; Klineberg, Eric O.

    2015-01-01

    Abstract The intervertebral disc is a critical part of the intersegmental soft tissue of the spinal column, providing flexibility and mobility, while absorbing large complex loads. Spinal disease, including disc herniation and degeneration, may be a significant contributor to low back pain. Clinically, disc herniations are treated with both nonoperative and operative methods. Operative treatment for disc herniation includes removal of the herniated material when neural compression occurs. While this strategy may have short-term advantages over nonoperative methods, the remaining disc material is not addressed and surgery for mild degeneration may have limited long-term advantage over nonoperative methods. Furthermore, disc herniation and surgery significantly alter the mechanical function of the disc joint, which may contribute to progression of degeneration in surrounding tissues. We reviewed recent advances in tissue engineering and regenerative medicine strategies that may have a significant impact on disc herniation repair. Our review on tissue engineering strategies focuses on cell-based and inductive methods, each commonly combined with material-based approaches. An ideal clinically relevant biological repair strategy will significantly reduce pain and repair and restore flexibility and motion of the spine. PMID:26634189

  19. Complications of Tendon Surgery in the Foot and Ankle.

    PubMed

    Barp, Eric A; Erickson, John G

    2016-01-01

    This article discusses four subsets of patients that have an increased risk of complications from tendon surgery in the foot and ankle: smokers, diabetics, and patients with peroneal or Achilles tendon pathology. Very little has been published on the complications of other tendon surgeries in the foot and ankle other than Achilles tendon repair. Data can be extrapolated from the general orthopedic literature and animal studies to help guide therapy and treatment options. The foot and ankle surgeon must take into account the entirety of the history and physical examination to develop a treatment plan that optimizes each patient's chance for a complication-free recovery. PMID:26590733

  20. Stimulating endogenous cardiac repair

    PubMed Central

    Finan, Amanda; Richard, Sylvain

    2015-01-01

    The healthy adult heart has a low turnover of cardiac myocytes. The renewal capacity, however, is augmented after cardiac injury. Participants in cardiac regeneration include cardiac myocytes themselves, cardiac progenitor cells, and peripheral stem cells, particularly from the bone marrow compartment. Cardiac progenitor cells and bone marrow stem cells are augmented after cardiac injury, migrate to the myocardium, and support regeneration. Depletion studies of these populations have demonstrated their necessary role in cardiac repair. However, the potential of these cells to completely regenerate the heart is limited. Efforts are now being focused on ways to augment these natural pathways to improve cardiac healing, primarily after ischemic injury but in other cardiac pathologies as well. Cell and gene therapy or pharmacological interventions are proposed mechanisms. Cell therapy has demonstrated modest results and has passed into clinical trials. However, the beneficial effects of cell therapy have primarily been their ability to produce paracrine effects on the cardiac tissue and recruit endogenous stem cell populations as opposed to direct cardiac regeneration. Gene therapy efforts have focused on prolonging or reactivating natural signaling pathways. Positive results have been demonstrated to activate the endogenous stem cell populations and are currently being tested in clinical trials. A potential new avenue may be to refine pharmacological treatments that are currently in place in the clinic. Evidence is mounting that drugs such as statins or beta blockers may alter endogenous stem cell activity. Understanding the effects of these drugs on stem cell repair while keeping in mind their primary function may strike a balance in myocardial healing. To maximize endogenous cardiac regeneration, a combination of these approaches could ameliorate the overall repair process to incorporate the participation of multiple cellular players. PMID:26484341