The effectiveness of surgical correction of uterine prolapse: cervical amputation with uterosacral ligament plication (modified Manchester) versus vaginal hysterectomy with high uterosacral ligament plication

Introduction and hypothesis  

The objective of this study is to evaluate cervical amputation with uterosacral ligament plication (modified Manchester) and compare it to vaginal hysterectomy with high uterosacral ligament plication procedure with special regard to the middle compartment.     

A preliminary anatomical basis for dual (uterosacral and sacrospinous ligaments) vaginal vault support at colporrhaphy

Introduction and hypothesis

This study aims to assess anatomically the likely effects of dual vaginal vault support using the uterosacral (USL) and sacrospinous ligaments (SSL) at colporrhaphy.

Methods

Observations were made from 13 formalinized cadaver hemipelves to determine the vaginal vault support likely to be provided by traction on the (a) USLs and (b) the posterior vaginal vault towards the SSL.

Results

Traction on the USLs and SSLs both appeared to create a posterior and superior vector of vaginal vault tension, though that on the USLs appeared to be mainly on the anterior vaginal vault (and wall) with that on the SSL seemingly mostly on the posterior vaginal vault (and wall).

Conclusions

Concomitant USL and SSL traction on the vaginal vault, now technically possible, appears, from these preliminary findings, to give complementary support to the anterior and posterior aspects of the vaginal vault and walls in a similar posterior and superior vector.     

Technique of anterior colporrhaphy: a Dutch evaluation

Introduction and hypothesis  

To evaluate the variation in techniques of anterior colporrhaphy among members of the Dutch Urogynecologic Society.     

Laparoscopic gastric plication: Technical report

BackgroundLaparoscopic gastric plication is an emerging restrictive bariatric procedure but still lacks standardization of the technique. The aim of this study was to apply a standardized, modified 3-port approach to laparoscopic gastric plication to improve outcomes.MethodsThe modified laparoscopic gastric plication technique was applied for 63 morbidly obese patients between March 2010 and January 2013. There were 9 men and 54 women, with a mean age of 34.2 years (range 20–48 years) and a mean body mass index of 38.9 kg/m² (range 32–65 kg/m²).ResultsThere were no deaths, no conversion to laparotomy, no reoperation, and no readmission. Percent excess weight loss was 41%, 52%, and 60% at 3, 6, and 12 months, respectively. There were no major complications reported in our study, but prolonged early postoperative nausea and vomiting occurred in 3 of 63 (4.8%) patients who had been successfully treated with proton pump inhibitors and antiemetics.ConclusionsOur initial experience showed that the 4-bite technique starting 2 cm below the angle of His with tight calibration of the gastric tube for obese patients is feasible, effective, and well tolerated, with a low frequency of major problems.     

Rehabilitation for anterior instability of the knee: preliminary report

Anterior instability of the knee and its associated rotatory components is recognized as a common disabling knee problem in athletes and nonathletes. The spectrum of anterior instability begins with injury to the anterior cruciate ligament as an isolated event or as part of an injury complex. Within the genera classification of anterior instability are straight, anteromedial, anterolateral, and combined. The type of instability is recognized in relation to the relative movement of the tibia on the femur and the rotational position of the tibia relative to the femur when an anteriorly directed force is applied to the tibia. The status of the static stabilizers of the knee dictates the type of instability. Treatment following anterior cruciate injury depends upon the extent of injury. Where significant disability and instability exist, reconstructive surgery utilizing intracapsular and/or extracapsular repairs can be performed. Rehabilitation begins at the time of injury and continues throughout life. The rehabilitation program should attempt to: 1) minimize risks of reinjury; 2) educate the patient; 3) reinforce stability with exercise based on biomechanical principles; 4) prevent or prolong the subsequent onset of degenerative changes; and 5) reinstate the previous performance level. J Orthop Sports Phys Ther 1982;3(3):121-128.     

CDH: preliminary report on a new anterior spinal instrumentation

Summary CDH (Cotrel-Dubousset-Hopf) instrumentation was developed with the aim of improving stability in ventral operation procedure and facilitating treatment of all anterior spinal diseases. The implantation of anterior plates and drawers, the use of a double-rod fixation within the implant in nonparallel directions, which provide an automatic locking mechanism against displacement, the prevention of dislocation of the cancellous bone srews, and the crosslink principle are its main characteristics. The device can be applied to the spine in accordance with its three-dimensional anatomy by any kind of force (distraction, compression, and rotation). Additional posterior instrumentation and postoperative external support are unnecessary in most cases because of improved stability. No reoperation was necessary following the mono- and multisegmental application of this method in 60 patients (28 with scoliosis, 12 with spondylodiscitis, 8 with primary tumors or isolated metastasis, 6 with fractures, 3 with failed back syndrome, 1 with kyphotic deformity, 1 with spondylolisthesis on two levels, and 1 with loss of correction after the dislocation of another posterior spinal instrumentation). Average blood loss was 950 ml; the average operating time was 3 h. In all, 16 monosegmental and 44 multisegmental procedures were carried out. In 25 patients, in particular those with paralytic scoliosis, a double-stage anterior and posterior spondylodesis was done.     

Midline fascial plication under continuous digital transrectal control: which factors determine anatomic outcome?

Introduction and hypothesis  

The aim of the study was to report anatomic and functional outcome of midline fascial plication under continuous digital transrectal control and to identify predictors of anatomic failure.     

RCT of vaginal extraperitoneal uterosacral ligament suspension (VEULS) with anterior mesh versus sacrocolpopexy: 4-year outcome

Introduction and hypothesis

This study assessed the safety and efficacy of vaginal extraperitoneal uterosacral ligament suspension (VEULS) with anterior overlay mesh versus sacrocolpopexy (SCP) for posthysterectomy vault prolapse.

Methods

This was a multicenter randomized trial of women with posthysterectomy vault prolapse stage >2 according to the Pelvic Organ Prolapse Quantification (POP-Q) system. Primary outcome was a composite of no vaginal bulge symptoms, no anatomical recurrence in the anterior or apical compartment at or beyond the hymenal ring, and no surgical retreatment for prolapse 12 months postsurgery. Secondary outcomes were peri- and postoperative complications, changes in prolapse, and urogenital and sexual symptoms at 12, 24, and 48 months based on the Pelvic Floor Distress Inventory (PFDI)-20.

Results

Between 2006 and 2011, 82 eligible women were randomized: 39 received VEULS and 43 received SCP. Primary composite outcome at 12 months for success was 41% for VEULS and 65% for SCP [odds ratio (OR 2.68, p?=?0.03)]. Perioperative complications were more common in the SCP group. C-point was higher for SCP (?6.0 VEULS vs ?8.0 SCP, p?=?0.005) and total vaginal length (TVL) was longer for SCP (8.0 VEULS vs 9.0 SCP, p?=?0.05). Cumulative mesh exposure rate at 4 years was similar between the uterosacral [4/39 (10.3%)] and sacrocolpopexy [4/43 (9.3%)] groups, bearing in mind that not all patients were examined at 4 years. Subjective outcomes derived from three domains of the PFDI-20 were similar at 12, 24, 48 months. Postoperative Pelvic Organ Prolapse Distress Inventory (POPDI) score improved similarly for both groups at all timepoints, with the minimally important difference of at least 21 reached for both groups.

Conclusions

Composite outcome of success was better for SCP at 12 months, but subjective outcomes for prolapse at all timepoints over 4 years for VEULS and SCP were not significantly different.

     

Minilaparoscopy-assisted transrectal low anterior resection (LAR): a preliminary study

Background

Natural orifice translumenal endoscopic surgery (NOTES) represents the evolution of surgery towards less invasive procedures. The feasibility of NOTES transrectal approach has increased its clinical applicability. This report describes a first series of minilaparoscopy-assisted transrectal low anterior resection with double purse-string end-to-end circular stapler anastomoses.

Methods

Between March and April 2012 three selected patients underwent transrectal minilaparoscopy-assisted natural orifice surgery total mesorectal excision for rectal cancer. All the oncologic principles of open/laparoscopic low anterior resection for rectal cancer were strictly fulfilled. Two patients underwent neoadjuvant treatment. Laparoscopic visualization and assistance was provided through one 10-mm umbilical port and two ports, one of which was used as stoma site (5 mm) and the other as a drain site (2 mm needle port). The specimen was transected transanally followed by the confection of double purse-string lateral/end-to-end anastomoses. There were no intraoperative complications.

Results

Mean operative time was 143 min. Oral intake was initiated on the second postoperative day. Patients were discharged home by day 5. The pathology unit confirmed that distal and circumferential margins were free of tumor invasion, and quality of mesorectum resection was reported satisfactory. One patient had to be readmitted because of severe dehydration due to increased ileostomy output. The patient was discharged at the third day after the readmission without renal failure.

Conclusions

In this preliminary report, transrectal minilaparoscopy-assisted low anterior resection was feasible and safe. Lateral/end-to-end anastomoses can be considered an interesting alternative to the double-stapling technique. However, it is necessary to further study and develop these procedures, along with careful patient selection, before transrectal low anterior resection may be considered for routine clinical use.     

Midline anterior and posterior atlas clefts may simulate a Jefferson fracture:A report of 2 cases

A 9-year-old girl crashed into the wall of the pool while swimming. Because of immediate neck pain and stiffness she was brought to a local hospital where cervical spine films were interpreted as normal. Since the pain persisted, a CT examination was also performed and a fracture in the anterior arch together with a spina bifida of the posterior arch of the atlas were diagnosed.     

Techniques – Mini-incision and plication (MIP) cure hydrocele: A minimally invasive surgical variation

In this single-surgeon case series of 92 men, we present the mini-incision and plication (MIP) cure hydrocele technique for the treatment of idiopathic hydrocele. This minimally invasive, open surgical variant achieves the desired eversion and plication with minimal hydrocele manipulation, providing excellent results independent of hydrocele size, with fewer complications and a recurrence rate of <1%.     

Epineural sleeve neurorrhaphy: surgical technique and functional results--a preliminary report

This study was conducted to evaluate the effect of epineural sleeve neurorrhaphy on peripheral nerve regeneration. A total of 12 Lewis rats were divided in two groups of 6 rats each. In group 1, the rat sciatic nerve was transected and repaired using the conventional epineural technique with four sutures. In group 2, the epineural sleeve technique was introduced with two sutures only. Functional recovery was evaluated at 1, 2, 4, 8, and 12 weeks by walking track analysis (sciatic function index [SFI]), mean limb circumference ratio, and severity of toe contracture. Although the SFI at 12 weeks revealed no difference between the two groups (+/-88.39 +/- 10.75 conventional group, +/-77.35 +/- 17.06 epineural sleeve group), significant differences in SFIs were detected at 4 and 8 weeks, with better functional recovery in group 2 rats (4 weeks: 125.92 +/- 22.73 conventional group, +/-99.17 +/- 5.45 epineural sleeve group; 8 weeks: +/-96.65 +/- 4.73 conventional group, +/-72.82 +/- 17.11 epineural group; p < 0.05 for both time points). Mean limb circumference ratio was not significant at all time points. At 12 weeks, all animals in the conventional nerve repair group developed severe toe contractures whereas only 2 animals in epineural sleeve repair group had contracture (p < 0.05). In this study, the epineural sleeve technique demonstrated a faster functional recovery when compared with the conventional technique, as confirmed by SFI and toe contracture grading.     

腹腔镜肾折叠术治疗巨大肾积水(附12例报告)

目的　探讨腹腔镜肾折叠术治疗巨大肾积水的可行性及初步临床经验。　方法　巨大肾积水 12例。男 5例 ,女 7例。年龄 19～ 6 4岁 ,平均 4 3岁。左侧 7例 ,右侧 5例。输尿管上段结石4例 ,肾盂输尿管连接部 (UPJ)梗阻 2例 ,输尿管中段结石 2例 ,肾盂结石 3例 ,输尿管中段狭窄 1例。通过腹腔镜解除上尿路梗阻并于镜下用 2 0可吸收线“8”字缝合肾皮质 ,将肾脏中盏缝至上盏、下盏缝至中盏 ,折叠为拳头大小 ,并缝合肾周筋膜。　结果　 12例手术均取得成功。手术时间 75～ 2 10min ,术中出血 5 0～ 2 0 0ml。术后 1～ 4d肛门排气 ,1～ 3d拔除腹腔引流管 ,1周拔除导尿管并出院。术后 1个月于膀胱镜下拔除双J管 ,无尿漏 ,随访 3～ 18个月 ,无输尿管狭窄 ,IVU及经腹超声 (BUS)复查显示患肾积水明显减轻 ,核素电子断层扫描 (ECT)检查术侧肾脏肾小球滤过率 (GFR)好转 ,肾功能有不同程度恢复。　结论　腹腔镜肾折叠手术是巨大肾积水保肾手术的微创途径 ,不仅可以促进肾解剖和肾功能的恢复 ,加快尿囊内尿液排出 ,减少术后感染和结石的形成 ,创伤小、恢复快、痛苦少。     

AO纯钛带锁钢板在颈椎前路固定的初步报告

报告了对１５例颈椎疾患患者行颈前路减压植骨融合并采用ＡＯ颈椎纯钛带锁钢板固定。经６个月～８．２个月的随访，所有病例植骨均完全愈合，无一例发生钢板螺钉松动等并发症。颈椎带锁钢板可使固定节段有高度的内在稳定性，并具有操作简便、安全、并发症少、内固定材料生物相容性良好、无磁性等优点，尤其适用于颈椎外伤、肿瘤及退行性变的治疗。