Combined surgical treatment with prosthesis of recurrent ventral and inguinal hernias

The presence of associated incisional and groin hernias is relatively rare and it represents an important problem in surgical treatment. The authors here report their experience of three patients treated with no reabsorbable prostheses placed according to Rives' technique for incisional hernias, and according to Stoppa's for inguinal hernias.     

The surgical treatment of a large postoperative ventral hernia in patients over 60

Breech presentation occurs in 3-5% of deliveries and can be managed by either a trial of vaginal breech delivery (TOVBD), external cephalic version (ECV) or Caesarean section. A postal questionnaire was completed by 82% of Scottish consultant obstetricians and revealed wide variations in practice. Eighteen percent never offered ECV. Among those who did consensus was lacking on some contraindications. One-quarter sometimes performed ECV before 37 weeks gestations despite the possibility of spontaneous version. Only 70% restricted ECV to one or more designated operators thereby maintaining levels of expertise. Variations were demonstrated in the use of tocolytics, and pre and post procedure investigations. Following failed ECV 28% considered a repeat attempt and 56% a TOVBD. TOVBD was not offered as first line management by one-fifth of respondents. Those who did varied in the pre-procedure investigations performed. Guidelines are required to ensure safe, consistent practice and avoid unnecessary Caesarean sections.     

Prevention of abdominal compartment syndrome by absorbable mesh prosthesis closure

OBJECTIVE: To determine whether prevention of the abdominal compartment syndrome after celiotomy for trauma justifies the use of absorbable mesh prosthesis closure in severely injured patients. DESIGN: Retrospective analysis of case series from July 1, 1989, to July 31, 1996. SETTING: University-based level I trauma center. PATIENTS: Seventy-three consecutive trauma patients requiring celiotomy who received absorbable mesh prosthesis closure and 73 control patients matched for injury severity and trauma type who received celiotomy without a mesh prosthesis closure. INTERVENTIONS: Absorbable mesh prosthesis closure was used in cases of excessive fascial tension, abdominal compartment syndrome, necrotizing fasciitis, traumatic defect, or planned reoperation. MAIN OUTCOME MEASURES: Demographics, Injury Severity Score, Abdominal Trauma Index, highest abdominal Abbreviated Injury Scale score, number of abdominal/pelvic injuries, highest head Abbreviated Injury Scale score, shock, indication for mesh closure, complications, number of operations and time required for closure, days in the intensive care unit, length of stay, and mortality were determined. The highest abdominal Abbreviated Injury Scale score was multiplied by the number of abdominal/pelvic injuries to calculate the abdominal pelvic trauma score. RESULTS: Group 1 consisted of 47 patients who received mesh at initial celiotomy, and group 2, 26 patients who received mesh at a subsequent celiotomy. These 2 groups were statistically similar in demographics, injury severity, and mortality. However, group 2 had a significantly higher incidence of postoperative abdominal compartment syndrome (35% vs 0%), necrotizing fasciitis (39% vs 0%), intra-abdominal abscess/peritonitis (35% vs 4%), and enterocutaneous fistula (23% vs 11%) compared with group 1 (P < .001). Group 1 patients with preoperative abdominal compartment syndrome had more abdominal/ pelvic injuries and higher abdominal trauma index than matched controls (P < .05). There was a trend toward higher abdominal pelvic trauma score in patients who developed abdominal compartment syndrome. The Pearson coefficient of correlation between the abdominal trauma index and the more easily calculated abdominal pelvic trauma score was 0.91 (P < .001). CONCLUSION: The use of absorbable mesh prosthesis closure in severely injured patients undergoing celiotomy was effective in treating and preventing the abdominal compartment syndrome.     

Laparoscopic ventral hernia repair: a community hospital experience

OBJECTIVE: To study the suitable age for intraocular lens (IOL) implantation in children. METHODS: 240 (240 eyes) normal children aged 3-13 years old were selected. Their corneal refraction, anterior chamber depth, lens thickness and ocular axial length were measured with Roden-Stock Keratometer C-MES and Eyescan Model 55 separately. RESULTS: The corneal refraction of 3-year-old children, the anterior chamber depth and lens thickness after 5 years old, and the ocular axial length after 9 years old approach the adult magnitude. CONCLUSIONS: A 3-year-old child has been qualified with IOL implantation, the child younger than 9 years old should be implanted with a normal adult IOL and then corrected with glasses, and a child after 10 years old should be directly implanted with a proper dioptric IOL.     

Posterior approaches in groin hernia repair with prosthesis: open or closed

Laparoscopic herniorraphies have been used to reduce the pain and convalescence associated with open approaches. However, there is still not any consensus of the best approach. We compared open preperitoneal and laparoscopic total extraperitoneal approaches in groin hernia repair. METHODS: Thirty-two patients underwent open preperitoneal herniorraphy (Group I) and other 32 patients underwent total extraperitoneal repair (Group II). Time of surgery was noted. Visual Analogue Scale (VAS) was applied to evaluate the postoperative pain intensity. RESULTS: Operation time was 35 (20-65) minutes in Group I and 58 (40-85) minutes in Group II (p < 0.05). The difference of complication ratios between two groups was not significant. Laparoscopic approach was associated with less pain within postoperative 24 hours as compared to the open technique. However, after the first postoperative day, there was no longer statistically significant difference between both groups. No recurrence has yet been seen in follow-up period of 15 (4-24) months. CONCLUSION: Laparoscopic herniorraphy is associated with better results in term of postoperative pain within the first 24 hours as compared to open technique.     

A containing prosthesis in the treatment of dilated myocardiopathy

OBJECTIVE: The placebo-controlled, randomized, double-blind study was performed to investigate dose-related effects of oxymetazoline on olfactory function during the course of the spontaneously occurring cold. METHODS: Drug effects were assessed using olfactory/ trigeminal event-related potentials (ERPs) and psychophysical measures (intensity ratings, odor discrimination, butanol threshold); nasal volume was monitored by means of acoustic rhinometry. The investigation was performed in 36 subjects (mean age 24.6 years). The subjects were assigned to treatment groups A, B or C (three groups with 12 subjects each; six women and six men per group). All the subjects received placebo on the left side; on the right side, group A subjects received placebo and group B and C subjects received 0.25 mg x ml(-1) and 0.5 mg x ml(-1) oxymetazoline, respectively. After onset of the rhinitis (day 0) measurements were performed on days 2, 4, 6 and 35. RESULTS: Oxymetazoline clearly produced an increase in nasal volume. However, during the 2-h observation period, effects produced by the two dosages were not significantly different. Despite the increase in nasal volume, oxymetazoline produced only an increase of the overall intensity of H2S stimuli; it had no systematic effect on other measures of olfactory or trigeminal function. In addition, after all the subjects had recovered from the cold, oxymetazoline had no significant main effect on olfactory/trigeminally mediated sensations. CONCLUSIONS: Oxymetazoline appeared to have neither negative nor major positive effects on intranasal chemosensory function. It is hypothesized that oxymetazoline needs to be applied locally to the area of the olfactory cleft in order to significantly improve olfaction during the course of the common cold.     

Pannus resection through the tilting disc prosthesis: successful treatment preserving the prosthesis

A 59-year-old woman was admitted to our hospital because of heart failure. In 1988, she underwent aortic valve replacement with an Omnicarbon valve and mitral valve replacement with a bioprosthetic valve. She was doing well until July in 1996 when she developed heart failure. Echocardiography revealed massive mitral valve regurgitation, and cinefluoroscopy showed implanted Omnicarbon valve dysfunction with a leaflet opening angle of 35 degrees. At reoperation, it was revealed that pannus formation prevented the valve from functioning well. The pannus was resected through the major orifice, and the leaflet was rotated toward the right anterolateral orientation. The worn bioprosthetic valve was replaced with a mechanical one. Postoperative cinefluoroscopy of the rotated Ominicarbon valve showed the opening angle to be 61 degrees.     

In vitro characterization of a fluoropassivated gelatin-impregnated polyester mesh for hernia repair

The surgical management of abdominal hernias requires prosthetic grafting in situations where the defect is too large or the surrounding tissue is not available for repair. Flat patches made of different biomaterials have been used in textile or microporous forms. The present work describes the results of an in vitro study comparing the morphological, mechanical, and chemical characteristics of a new textile prototype, Fluoropassiv, made of polyester fibers treated with a fluoropolymer and impregnated with gelatin to those of seven existing commercial meshes and patches made from polypropylene, polyester, polytetrafluoroethylene (PTFE) yarns, and expanded microporous PTFE graft. The morphological study revealed a diversity of structures having a minimal relative porosity of 70%, high bursting, and suture retention strengths in comparison with natural muscular tissue. Elasticmoduli proved to depend more on the direction of the textile the rigidity was higher for those materials having tight structure, like the Fluoropassiv and the Surgipro meshes (> 30 MPa), whereas those with more open structures, such as the Marlex, Trelex, Lars, Bard Teflon, and GoreTex structures, showed lower elastic modulus (10 mPa). In addition, chemical analyses confirmed no irregularities in the polymers used in all prostheses and demonstrated that the fluoropolymer coating of the Fluoropassiv was uniformly distributed. The innovative aspects in the construction of the knitted fabric Fluoropassiv appears to make it suitable for repairing hernias, and the inclusion of both continuous fluoropolymer surface treatment of polyester fibers and gelatin impregnation appears to improve the healing process.     

Laparoscopic treatment of inguinal hernia

It is always important to treat conditions which may be cancerous with respect and, where there is suspicion, to take biopsies for histological examination. A hoarse voice may, in addition, be a sign of tuberculosis of the larynx, and the clinical appearance can be similar to a carcinoma. Preoperative chest x-ray (not always performed) and an awareness by the histologist of such a possibility are important now that this condition is increasing in frequency in parallel with conditions where immunological status is compromised.     

Late mesh rejection as a complication to transabdominal preperitoneal laparoscopic hernia repair

BACKGROUND: The use of a mesh in transabdominal preperitoneal laparoscopic hernia repair (TAPP) caries the risk of late rejection or infectious complications related to the mesh. The aim of this study was to describe the extent of these complications. METHODS: We performed a retrospective study of 500 consecutive patients with TAPP for inguinal hernia. Results: Late mesh rejection was observed in three patients at 5-19 months after surgery. The mesh was removed via a suprapubic midline incision. At 3-4 month's follow-up, none of the patients had recurrence of the hernia, even though no hernia repair had been done. CONCLUSION: Late mesh rejection is a potential complication of TAPP and has to be considered when choosing the surgical method of hernia repair.     

From Bassini to tension-free mesh hernia repair. Review of 1409 consecutive cases

The short and long-term results of traditional and tension-free inguinal hernia repairs have been assessed in three surgical units. In order to standardise the results, hernias were classified according with Nyhus. There were 109 type I, 311 type II, 854 type III, and 125 type IV hernias. Follow-up was possible in 1201 patients (1249 hernia repairs). Postoperative course, postoperative pain, and recurrences were analysed. Recurrences ranged from 0.7% up to 9.3%. The tension-free methods of repair provided the most important advantages in term of low recurrence rate and early return to work even if, in our series, recurrences resulted mainly related to the type of hernia than to the type of repair. The Authors conclude that any hernia repair should be sized to the type of hernia defect in order to avoid over-treatment and abusive placing of a foreign body such as polypropylene mesh.     

A modified suture in the surgical treatment of middle ventral hernias

Mechanical stability of the front abdominal wall median anatomic structure tissues has been examined in 49 experiments on cadavers. It was found that aponeurotic tissue of the edges of sheaths of the rectus abdominis is the most firm one. The article analyses different types of sutures used in hernioplasty. The authors propose original method of hernioplasty using the most stable anatomic structure, formation of narrow tissue duplication with a minimal amount of suture material. This method has been used in surgical treatment of 58 patients with umbilical, postoperative and linea alba hernias. There were no recurrences for 3 years.     

Fundoplication for the treatment of gastroesophageal reflux in hiatal hernia

Blood pressure (BP) levels were recorded in 2223 male and 2205 female children and adolescents ranging in age from 7 to 18 years. In addition, 521 male adults (soldiers) ranging in age from 21 to 25 years were included in the study. Children and adolescents who participated in the survey were selected at random the Elementary and High Schools. The results of the study showed that a gradual increase occurred in the systolic, as well as in the diastolic component of blood pressure from 7 to 18 years of age. By contrast, there was no increase with age in the systolic and diastolic blood pressure in the young male adult subjects, who had BP measurements comparable to those observed in children. A child was characterized as hypertensive according to the criteria outlined by Master et al. Children with BP between the 90th and the 95th percentile were considered as suspect hypertensive, whereas those with BP exceeding the 95th percentile were considered definitely hypertensive. The overall incidence of hypertension in children in this survey was 3.1%.     

Videolaparoscopic treatment of paraesophageal hiatal hernia

STUDY AIM: The aim of this prospective study was to report the results of videolaparoscopic repair in a series of ten patients with paraesophageal hernia. PATIENTS AND METHODS: From January 1982 to September 1998, ten patients (three men and seven women, mean age: 68 years [range: 42-87]) were operated on for paraesophageal hernia. An intrathoracic gastric volvulus was present in four patients, a severe anemia in four and two were asymptomatic. All interventions were performed laparoscopically and included sac resection, crura closure and realization of a posterior gastric valve on 270 degrees. RESULTS: There was one irruption of gastric juice in the bronchial tree at the beginning of the anesthesia which required assisted ventilation for 3 days. The mean follow-up was 17.5 months (range: 3-50). There was no postoperative diarrhea and no gas bloat syndrome. Eight patients complained of postoperative dysphagia which disappeared within 6 weeks, except in one patient with esophageal motility disorder postoperatively discovered. None of the patients had postoperative gastroesophageal reflux. A chest X-ray performed after 1 year detected no hernia recurrence in seven patients. There was no recurrent anemia after 6 months. CONCLUSION: The videolaparoscopic repair of paraesophageal hernias is feasible without any technical difficulties even in aged patients with precarious physical conditions. The results are good with a mean follow-up of 17.5 months.     

Dental prosthesis rehabilitation following oral carcinologic treatment

Following the different treatments applied on patients suffering of a mouth cancer, often these are confronted with a functional and esthetic handicap. Thanks to the prosthetic techniques and an eventual resort to implantation, it is possible to improve their quality of life. Different prosthetic reconstructions are considered.