改良充填式无张力股疝修补术20例报告

目的探讨改良充填式无张力股疝修补的效果。方法回顾性分析我院2002年1月至2008年6月使用网塞及平片行改良充填式无张力股疝修补术20例,均经腹股沟切口,高位游离疝囊,网塞充填于股环上方薄弱的腹膜前间隙内,常规使用平片并与陷窝韧带、耻骨梳韧带固定。结果20例手术顺利,恢复良好,随访6~36月均无复发。结论经改进的充填式无张力股疝修补术可有效避免压迫股静脉,防止股疝复发,预防直疝和斜疝新发,为股疝治疗合理手术方式之一。     

平片式修补与疝环充填式修补在腹股沟疝无张力疝修补术中的选择探讨

目的探讨平片式修补与疝环充填式修补两种术式在无张力疝修补术中的适用范围。方法493例次腹股沟疝患者依据不同的疝类型,分别选择疝环充填式修补术(巴德网塞补片)及平片修补术(戈尔软组织补片、贝朗平片及巴德平片)。对手术方法、手术指征、术后疼痛、并发症及复发率等进行观察。结果男性初发性腹股沟疝(疝环2.5 cm)、女性腹股沟疝、复发性疝、嵌顿性腹股沟疝选用平片修补术,仅1例术后6个月出现迟发性感染。男性初发性腹股沟疝(疝环2.5 cm)、尤其是直疝选用疝环充填式修补术,未见术后并发症及复发病例。结论采用疝环充填式修补与平片修补的无张力疝修补术具有安全、创伤小、恢复快的优点,但应依据疝的类型选择术式及补片材料。     

55例成人腹股沟疝传统修补术后复发原因分析

目的 分析成人传统腹股沟疝修补手术后复发的原因.方法 对513例成人传统腹股沟疝修补手术后复发的55例行再次修补手术,采用疝环充填式无张力疝修补术35例,Marlex补片修补11例,9例行Shouldice修补术.结果 随访6个月~5 a,无1例再复发.结论 腹股沟疝术后复发的原因很多,疝环充填式无张力疝修补术可有效降...     

再论疝环充填式无张力疝修补术后复发和预防

目的 探讨疝环充填式无张力疝修补术后的复发原因及预防.方法 回顾性分析41例疝环充填式无张力疝修补术治疗腹股沟疝的术后复发病例,并探讨预防的方法. 男性38例,女性3例.前次手术属Ⅱ型4例,Ⅲ型30例,Ⅳ型7例.复发入院时临床检查斜疝30例,直疝8例,股疝3例.复发时间自术后5 d～8个月.结果 再次手术发现疝囊未找到,网塞置于疝囊下方或疝囊旁3例;网塞自疝环口下滑14例;疝内容物自网塞旁疝环口脱出5例;疝内容物通过二个网塞间自疝环口脱出3例;网片位置过高,疝内容物自网片下方脱出5例;网片卷曲和移位,疝内容物自网片下方脱出8例;疝内容物从自制网塞圆椎体中央脱出1例;未认识到滑动疝1例;复发原因不明1例.结论 疝环充填式无张力疝修补术后复发的主要原因是医生操作不当,规范化手术操作是重要的.     

疝环充填式与平片无张力疝修补近期随访研究

目的：研究疝环式充填式与平片无张力疝修补的手术效果。方法：用平片无张力疝修补术修补腹股沟疝369例，用疝环充填式疝修补术修补腹股沟疝62例，对此两种术式的手术时间，术后复发率，术后并发症等进行随访研究。结果：平片无张力疝修补组平均时间38min，术后复发7例；疝环充填式修补组平均手术时间50min，术后复发1例。结论：近期随访表明，疝环充填式与平片无张力疝修补能明显降低术后复发主，疝环充填式疝修补的疗效较平片无张力疝修补更好。     

高位腹膜前股疝无张力修补(附28例报告)

目的探讨高位腹膜前股疝无张力修补的临床效果。方法1999年10月~2006年4月使用聚丙烯网塞及平片治疗股疝28例。术中旷置股环,游离疝囊,不做高位结扎,游离疝囊颈部以上平面的腹膜前间隙,疝囊推入腹腔,将聚丙烯网塞展平置入腹膜前间隙内,平片置入子宫圆韧带或精索后方。重点加强股环上方的腹壁缺损区。结果28例手术顺利,恢复良好,随访0.5~4年无复发。结论行疝修补术时应该重新正确认识股疝的解剖结构,最大限度地恢复局部正常解剖,避免压迫股血管。     

平片式和疝环充填式无张力疝修补术疗效比较

尤张力蛳修补术是治疗腹股沟疝的常用方法,目前有疝环充填式无张力疝修补术和平片式无张力疝修补术。收集我院2005年3月-2009年3月采用平片式与疝环充填式无张力疝修补术治疗的161例腹股沟疝患者,对其临床资料进行回顾性分析．比较两种于术方法的临床疗效。     

无张力腹股沟疝修补术后疝复发的临床分析

目的　探讨无张力腹股沟疝修补术后疝复发的原因、预防及治疗。方法　结合 11例无张力腹股沟疝修补术后复发疝的临床资料 ,分析其复发的原因 ,并提出改进手术的方法及对复发疝的治疗。结果　本组 10例 ,其中疝环充填式无张力疝修补术后复发 6例 ,平片修补术后复发 4例。复发原因为平片修补术后因补片过小复发 1例 ,补片卷曲、移位 1例 ,补片精索孔留得过大 2例 ,疝环充填式无张力疝修补术后充填之网塞未牢靠固定在疝环口周围的坚韧组织上复发 2例 ,疝环口过大 ,与充填之网塞不匹配 2例 ,充填的 2个网塞之间未固定 ,留有间隙 1例 ,网塞间断缝合固定 ,但网片未固定 1例。结论　无张力腹股沟疝修补术后复发疝的原因主要是术中操作失误即对网塞和补片的置入和固定不当 ,其治疗方法仍为开放的无张力腹股沟疝修补术 ,主要是疝环充填式无张力疝修补术。     

腹股沟疝无张力修补术后复发的外科治疗

目的探讨无张力疝修补术后复发性腹股沟疝的外科手术治疗方法。方法67例复发性腹股沟疝中,使用人工材料行无张力疝修补手术后复发者有13例(19.4%),均再次手术治疗,采用Kugel补片1例、PHS补片修补3例和疝环充填式无张力修补9例。结果术后发生伤口积液1例,阴囊水肿1例,无切口感染,术后随防3～63个月,未见复发。结论无张力疝修补术后亦难免复发,再手术时宜根据术中所见选用不同的疝修补方式,但网塞疝环充填法仍然是一种简单、有效的治疗方法。     

女性腹股沟疝无张力修补术原则探讨

目的通过三种无张力疝修补术疗效分析探讨女性腹股沟疝无张力修补术的原则。方法选取我院2001年1月至2007年5月行腹股沟斜疝或直疝无张力修补术的女性患者54例进行回顾性分析,应用Lichtenstein平片无张力修补术16例,应用疝修补装置(PHS)无张力修补术20例,应用疝环充填式(Mesh plug)无张力修补术18例。结果应用疝装置修补术效果好,无复发及遗漏疝病例,平片无张力修补术及网塞修补术较疝修补装置,遗漏股疝的发生率高。结论女性腹股沟疝应当选用全耻骨肌孔修补的无张力修补术式。     

Structural alterations of prosthetic meshes in humans

The use of prosthetic mesh in abdominal wall hernia surgery is a well-accepted practice. What is not settled, however, is the type of prosthesis that best suits the purpose. The narrow choice today means a prosthesis of polyester or polypropylene. These are available in many designs, configuration of weave, thickness of weave and strand, and size of pore. There has been a pervasive feeling that these materials "shrink". To what extent they do has not been accurately defined. This study was designed to measure such "shrinkage". Interestingly, our measurements revealed that prosthetic meshes could "expand" as well as "shrink". The extent to which they do varies between –40% and 58.5%. Whereas it was felt that fibrocyte activity and its eventual scar formation accounted for the "shrinkage" of the mesh, we have discovered that structural alterations in the size of the mesh pores can be affected by distilled water, saline, blood, formalin, bleach, as well as in vivo implantation. Prosthetic meshes are, therefore, not the inert materials they are claimed to be and can expand as well as shrink. We have, unfortunately, not been able to correlate the degree or direction of change to any known parameter. Electronic Publication     

Classification of biomaterials and their related complications in abdominal wall hernia surgery

Summary The value of the use of biomaterials for the repair of abdominal wall hernias is gaining increasing recognition. The use of synthetic mesh to achieve a tension-free repair has resulted in a significant reduction in postoperative pain, in length of the recovery period, and in the number of recurrences. However, certain physical properties of biomaterials can lead to undesirable consequences. These include increased risk of infection, seroma formation, biomaterial-related intestinal obstruction, and fistula formation and failure of repair due to shrinkage of the mesh. The purpose of this paper is to discuss the mechanism of these problems with special emphasis on pore size, molecular permeation and shrinkage of biomaterials and their effects on infection, seroma formation, and recurrence of mesh repair of abdominal wall hernias.     

The open tension-free mesh repair of inguinal hernia Analysis of 1,235 cases

Summary 1235 outpatient repairs of inguinal hernias under local anesthesia with IV sedation were performed between September 1993 and June 1997. The average age was 63. Twelve percent were recurrent repairs. All indirect hernias and all focal diverticular type V direct defects were treated with a cone-shaped polypropylene plug plus an overlay mesh strip. All broad fusiform type IV direct defects were repaired either by the same plug method or in the manner of a Lichtenstein repair. Mortality was zero. There were 3 recurrences, 5 superficial hematomas, 5 seromas, 1 questionable neuralgia, 1 dysejaculation, 1 ischemie orchitis, 1 flare-up of gout and 1 TIA, for a complication rate of 1.46%. Infection rate was zero. Recurrence rate thus far is only 0.24%, 0.16% for primary repair and 0.67% for recurrent repair.     

Spanish transcultural adaptation of the Leuven Itch Scale

Itching is one of the most frequent symptoms, and most resistant to treatment, relating to scar formation after burns. The Leuven Itch Scale is a questionnaire which has been validated for use in burns, analysing different clinical dimensions of pruritus. However, until now there was no Spanish version available for use with Spanish-speaking patients.     

Characterization of the structure and properties of authentic and counterfeit polypropylene surgical meshes

A counterfeit version of the Ethicon Prolene polypropylene mesh was distributed to hospitals and clinics and unintentionally implanted into patients undergoing tension-free hernia repair. On December 19, 2003, the Food and Drug Administration (FDA) issued a public health web notification indicating that the counterfeit mesh was not sterile or safe to use. To develop safety recommendations for patients with the counterfeit mesh implant, we compared the counterfeit’s structural, physical, chemical and mechanical properties with polypropylene meshes previously cleared by FDA. The mesh fibers for all the products tested were found to have similar chemical and physical properties. The mechanical properties were directly related to the knitted structure (loop size, repeat distance, fabric tightness) and the porosity. Extracts from the counterfeit mesh passed cytotoxicity screening tests. The FDA further recommended that if the mesh had been inadvertently implanted, then those patients should be monitored as would be the practice for any patient with an implanted surgical mesh.     

Measurement of itching: validation of the Leuven Itch Scale

Objective

To develop the Leuven Itch Scale (LIS), which measures itching through evaluation of the dimensions of the itch experience; and to provide evidence of the validity, reliability, and responsiveness of the LIS.

Materials and methods

A clinimetric study using a longitudinal design. Patients with burns (n = 46), atopic dermatitis (n = 63), or chronic urticaria (n = 41) were included. Evidence for validity (based on test content, relations with other variables and internal structure), reliability and responsiveness of the LIS was evaluated.

Results

Validity evidence based on test content was demonstrated by very low percentages of invalid scores for most items. Validity evidence based on relations with other variables was found, because all hypotheses that were put forward could be accepted. With respect to validity evidence on internal structure, a significant moderate positive correlation was found between itch frequency and itch distress, and between itch frequency and severity. As hypothesized, itch severity and distress were strongly correlated. Test-retest reliability showed a moderate to almost perfect agreement for about half of the items. However, the remaining items could be subject to changes in the itch, rather than reflecting instability of the Leuven Itch Scale. In terms of responsiveness, the Leuven Itch Scale did not suffer from floor or ceiling effects and could detect changes in itch frequency in patients with burns.

Conclusion

The Leuven Itch Scale is a useful and clinimetrically sound instrument to measure pruritus in different patient populations affected by itching.     

Transurethral resection of tension-free vaginal tape under tactile traction

Urethral erosion is a rare complication after the tension-free vaginal tape (TVT) procedure. Surgical management of this complication is challenging due to the potential for significant patient morbidity. A 50-year-old patient presented with lower urinary tract symptoms (LUTS) and incomplete voiding, 6 years after a TVT procedure performed for stress incontinence. An attempt at cystoscopy revealed an almost complete occlusion of the urethral lumen by a urethral erosion of the polypropylene mesh. A transurethral resection was performed under tactile traction. This procedure is a minimally invasive approach that avoids the need for a transvaginal procedure. Careful cystourethroscopy should be performed in patients presenting with new lower LUTS after TVT in order to avoid a delay in diagnosing a mesh erosion.     

Long-term result and current status of the Lichtenstein open tension-free hernioplasty

Summary The tension-free hernioplasty project began in 1984 at the Lichtenstein Hernia Institute. The method consists of complete reinforcement of the inguinal floor with a large sheet of mesh, with adequate mesh tissue interface beyond the boundary of the inguinal floor and creation of a new internal ring made of prosthesis. The preliminary report of this operation was published in 1989, with no recurrence at that point in time. Shortly after the submission of the report, several recurrences were encountered. Based on the lesson learned from those recurrences, the operation was slightly modified and reported in 1991 [Amid 1993]. Since then, the Lichtenstein technique has gained world-wide popularity. Outcome measures identical to ours and other authors have been achieved by even those surgeons who have no special interest or expertise in herniology. The purpose of this article is to report the current state of the open tension-free hernioplasty for the repair of primary and recurrent inguinal hernias.     

Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series

Background  Primary laparoscopic hiatal hernia repair is associated with up to a 42% recurrence rate. This has lead to the use of mesh for crural repair, which has resulted in an improved recurrence rate (0–24%). However, mesh complications have been observed. Methods  We compiled two cases, and our senior author contacted other experienced esophageal surgeons who provided 26 additional cases with mesh-related complications. Care was taken to retrieve technical operative details concerning mesh size and shape and implantation technique used. Results  Twenty-six patients underwent laparoscopic and two patients open surgery for large hiatal hernia (n = 28). Twenty-five patients had a concomitant Nissen fundoplication, two a Toupet fundoplication, and one a Watson fundoplication. Mesh types placed were polypropylene (n = 8), polytetrafluoroethylene (PTFE) (n = 12), biological mesh (n = 7), and dual mesh (n = 1). Presenting symptoms associated with mesh complications were dysphagia (n = 22), heartburn (n = 10), chest pain (n = 14), fever (n = 1), epigastric pain (n = 2), and weight loss (n = 4). Main reoperative findings were intraluminal mesh erosion (n = 17), esophageal stenosis (n = 6), and dense fibrosis (n = 5). Six patients required esophagectomy, two patients had partial gastrectomy, and 1 patient had total gastrectomy. Five patients did not require surgery. In this group one patient had mesh removal by endoscopy. There was no immediate postoperative mortality, however one patient has severe gastroparesis and five patients are dependent on tube feeding. Two patients died 3 months postoperatively of unknown cause. There is no apparent relationship between mesh type and configuration with the complications encountered. Conclusion  Complications related to synthetic mesh placement at the esophageal hiatus are more common than previously reported. Multicenter prospective studies are needed to determine the best method and type of mesh for implantation.     

Open mesh-plug repair for primary inguinal hernia (826 cases)

Summary The authors report their experience with open mesh-plug repair in the treatment of adult primary inguinal hernias from 1992 to 1998. Eight hundred and twenty-six cases, i.e.: 71% of all repairs for primary hernias, were operated using this procedure. 65.3% of all this operations were performed under local anesthesia (LA). The following complications were observed: wound infection 1.7%, haematoma 1.6%; orchitis 0.9%, recurrence 0.8%. The results were consistent with those of large series in the literature. Complications increased when anesthesia other than LA was used, in obese and in elderly patients. No patients required prosthesis removal due to pain or infection. We also discuss the various prostheses and our results favour polypropylene as opposed to Dacron. Several types of polypropylene mesh are discussed, comparing thickness, thread and pore size and their physical properties. The results suggest that a single thread close knit with controlled memory stiffness for the mesh and a looser and thinner version for the plug give the best results.