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31.
Open mesh versus non-mesh repair of groin hernia meta-analysis of randomized trials leased on individual patient data 总被引:1,自引:1,他引:0
Abstract
Background. The EU Hernia Trialists Collaboration was established to provide reliable evaluation of newer methods of groin hernia repair.
It involved 70 investigators in 20 countries.
Materials and methods. Twenty eligible trials (5016 participants) of open mesh vs. non-mesh groin hernia repair were identified. Meta-analysis was
performed using raw individual patient data where possible.
Results. Fewer hernia recurrences were reported after mesh repair. There were no clear differences between mesh and non-mesh groups
in complications. Overall, those in the mesh groups had a shorter hospital stay, quicker return to usual activities and less
frequent persisting pain, but individual trial results varied.
Conclusions. The review provides strong evidence that open mesh repair is associated with a reduction in the risk of recurrence of between
50% and 75%. There is also some evidence of quicker recovery and of lower rates of persisting pain following open mesh repair.
Electronic Publication 相似文献
32.
Preliminary experience with new bioactive prosthetic material for repair of hernias in infected fields 总被引:15,自引:5,他引:10
Surgisis (Cook Surgical, Bloomington, Ind., USA) is a new four-ply bioactive, prosthetic mesh for hernia repair derived from
porcine small-intestinal submucosa. It is a naturally occurring extracellular matrix which is easily absorbed, supports early
and abundant new vessel growth, and serves as a template for the constructive remodeling of many tissues. As such, we believe
that Surgisis mesh is ideal for use in contaminated or potentially contaminated fields in which ventral, incisional, or inguinal
hernia repairs are required. From November 2000 through May 2002, 25 patients (11 male, 14 female) underwent placement of
Surgisis mesh for a variety of different hernia repairs. A total of 25 hernia repairs were performed in our patient population.
Fourteen procedures (56%) were performed in a potentially contaminated setting (i.e. with incarcerated/strangulated bowel
within the hernia or coincident with a laparoscopic cholecystectomy/colectomy). Eleven repairs (44%) were performed in a grossly
contaminated field, including one in which an infected polypropylene mesh from a previous inguinal hernia repair was replaced
with Surgisis and one in which necrotic bowel was discovered within the hernial sac. Median follow-up was 15 months with a
range of 1–20 months. Of the 25 total repairs, there was one wound infection complicated by enterocutaneous fistula in a patient
originally operated on for ischemic bowel. The fistula was in a location independent of the Surgisis mesh. There were no mesh-related
complications or recurrent hernias in our early postoperative follow-up period. Surgisis mesh appears to be a promising new
prosthetic material for hernia repair, especially in contaminated or potentially contaminated fields. Obviously, long-term
follow-up is still required.
Electronic Publication 相似文献
33.
The use of three different mesh materials in the treatment of abdominal wall defects 总被引:1,自引:1,他引:0
N. Deligiannidis I. Papavasiliou K. Sapalidis I. Kesisoglou S. Papavramidis O. Gamvros 《Hernia》2002,6(2):51-55
Abstract
Abstract. Various prosthetic materials have been proposed for the repair of abdominal wall defects. These materials offer tension-free
repair and significantly lower recurrence rate. Their respective properties are related to such complications as seroma, infection,
fistula formation, intestinal adhesions and removal. We compared the final outcome in treating abdominal wall defects in 56
patients with three different prosthetic materials: conventional polypropylene in a preperitoneal location, expanded polytetrafluoroethylene
mesh, and hydrophilic membrane coated polyester mesh in an intraperitoneal location. The hydrophilic coated polyester group
exhibited the lowest complication rate and the polypropylene group the highest.
Electronic Publication 相似文献
34.
E. Freud A. Blumenfeld M. Zer J. Sandbank G. Horev S. Giler 《Pediatric surgery international》1996,11(8):539-543
Circular esophageal myotomy (CEM) is currently a well-accepted technique for elongation of the upper esophageal pouch in cases of long-gap esophageal atresia (EA). Esophageal pseudodiverticulum is a frequent and perhaps underreported sequela of this technique, characterized by ballooning or outpouching of the esophageal mucosa in the myotomized area. The present study was designed to seek a supplement for the CEM technique in order to avoid possible pseudodiverticulum formation in the myotomized area. We created an animal model to simulate the anatomic conditions present after primary repair of EA facilitated by CEM. Three groups of dogs underwent either cervical (1 group) or thoracic (2 groups) esophageal myectomy. In the cervical and first thoracic groups, the denuded mucosa was left without any support. In the second thoracic group, the denuded mucosal area was wrapped with polyglactin 910 (Vicryl) mesh. In all three groups the esophagus was narrowed by a Marlex mesh ring 3 cm distal to the myectomized zone, simulating a condition resulting from anastomotic narrowing. The dogs underwent barium swallows under fluoroscopy at different postoperative periods and were killed 4 or 6 months after surgery. The esophagi were removed for gross and radiologic investigation under maximal insufflation as well as for histologic assessment. The proposed canine model proved to be useful for study of the myectomized esophagus, mimicking the anatomy and conditions after CEM in long-gap EA repair. Wrapping the denuded mucosa with Vicryl mesh fortified the weakened esophageal wall, thus diminishing the likelihood of future pseudodiverticulum development. In light of the simplicity of the technique and the absence of any evident risk or complications, we recommend that the use of Vicryl mesh wrap be considered during CEM to reinforce the esophageal wall.Supported by the Slezak Fund for Experimental Surgery (Grant #01370791) 相似文献
35.
目的:针对目前小儿颅骨缺损的多种治疗观念及课题组前期研究提出的“滑行理论”,利用幼龄SD大鼠模型探究颅骨缺损及钛网修补后对其颅骨生长和智力发育的影响。方法:将3周幼龄SD大鼠随机分成假手术对照组(SOC)、颅骨缺损组(SD)和钛网修补组(TMR),术前排除组间差异,术后同环境下饲养至性成熟进行旷场实验和Morris水迷宫实验后处死,测量体质量、颅骨径线、颅骨厚度、缺损内径和脑容积等指标。结果:术前体质量及颅骨径线显示三组间差异无统计学意义(P>0.05),具有可比性;性成熟时体质量、颅骨径线、脑容积三组间均无差异(P>0.05),仅SOC组平均颅骨厚度较大(P<0.05);缺损内径方面SD组与TMR组无差异(P>0.05),且与术前相比均呈狭长形变;旷场实验中总路程、平均速度和静止时间及部分区域数据方面SD组与其他组有差异(P<0.05);Morris水迷宫实验显示第5天逃避潜伏期、首次穿越平台时间和目标象限时间占比等SD组与其他组均有差异(P<0.05)。结论:颅骨缺损未行修补对幼龄大鼠颅骨的正常生长无明显影响,但可能影响其智力发育;钛网修补并不会... 相似文献
36.
目的探讨头皮合并颅骨缺损的修复方法。方法对2000年至2007年治疗的6例头皮合并颅骨缺损患者,采用皮肤扩张术修复头皮,钛网修补颅骨缺损。结果6例患者中,1例患者出现皮瓣下积液,经抽吸、加压包扎后愈合;其余病例未出现感染、血肿及皮瓣坏死等并发症,外观满意。结论皮肤扩张术和钛网联合应用是修复头皮合并颅骨缺损的较好方法。 相似文献
37.
38.
L. N. Ivanova V. A. Lavrinenko A. V. Babina I. I. Khegay 《Bulletin of experimental biology and medicine》2008,146(5):642-646
Endoprostheses made from knitted fabric of 3 loop types were used for hernioplasty in rats. Biocompatibility of implanted
textile constructions was evaluated after 6 months. The intensity of inflammatory reaction and types of complications in animals
depended on the loop type and method of finishing of the mesh endoprosthesis tissue.
__________
Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 145, No. 5, pp. 582–587, May, 2008 相似文献
39.
40.
《The Journal of arthroplasty》2021,36(9):3141-3147
BackgroundThe 2-octyl cyanoacrylate topical adhesive with flexible self-adhesive polyester mesh (Dermabond Prineo) is becoming widely used in many surgical fields. However, no prior studies have tested the efficacy and safety of this topical adhesive compared with subcuticular suture in the same patient. The purpose of this study was to compare the efficacy and safety between Dermabond Prineo and subcuticular suture for skin closure in patients undergoing same-day bilateral total knee arthroplasties (TKAs).Materials and MethodsA prospective, double-blind randomized controlled trial was performed in 51 patients scheduled to undergo same-day bilateral TKAs. One knee was randomly assigned to the Dermabond Prineo and the other knee was allocated to the subcuticular suture. As primary outcomes, Vancouver scar scale was evaluated at 6 months and Patient and Observer Scar Assessment Scale was evaluated at 2 weeks, 6 weeks, 3 months, and 6 months. Secondary outcomes included cosmesis efficacy (Hollander wound evaluation scale [HWES] and cosmesis visual analog scale [VAS]), time and pain efficiency (skin suture time, stitch out time, and stitch out pain VAS), and safety (wound complications during the 6-month follow-up period). The primary and secondary outcome measures were compared between groups.ResultsThere were no significant differences in Vancouver scar scale and Patient and Observer Scar Assessment Scale at 6 months. Although there were no significant differences in HWES at 2 weeks, the Dermabond Prineo group showed better step-off border item of HWES. There was also no difference in cosmesis VAS at 6 months. The Dermabond Prineo group showed superior results in terms of time (suture time: Dermabond Prineo = 191 second (sec) ± 60.1 sec, subcuticular suture = 356.8 sec ± 92.3 sec; stitch out time: Dermabond Prineo = 4 sec ± 1.3 sec, subcuticular suture = 26.6 sec ± 4.2 sec, all P < .001) without significant differences in pain scale (P = .823) or wound complications (all P > .05).ConclusionComparing cosmetic efficacy, time efficiency, and safety, Dermabond Prineo provided quicker wound closure, shorter stitch out time, and better wound margin coaptation in the early postoperative period but similar cosmetic efficacy compared with subcuticular suture. Based on our study, Dermabond Prineo is a useful alternative to subcuticular suture in patients undergoing TKA.Level of EvidenceTherapeutic level 1. 相似文献