共查询到20条相似文献，搜索用时 15 毫秒
1.
Colin G. DeLong Justin A. Doble Amber L. Schilling Eric M. Pauli David I. Soybel 《American journal of surgery》2018,215(4):610-617
Background
After open complex ventral hernia repair (cVHR), chronic pain has a significant impact on quality of life and processes of care.Methods
Records of 177 patients undergoing cVHR were reviewed in order to characterize the burden of managing postoperative pain in the first post-operative year following open cVHR.Results
In this cohort, 91 patients initiated at least one unsolicited complaint of pain, though phone call (37), unscheduled clinic visit (45) or evaluation in the emergency room (9); among these an actionable diagnosis was found in 38 (41.8%). Among 41 patients who initiated additional unsolicited complaints of pain, an actionable diagnosis was found in only 3 patients. Risk factors for such complaints included pre-operative pain and the use of synthetic mesh.Conclusions
Even in the absence of an actionable diagnosis, significant resources are utilized in evaluation and management of unsolicited complaints of pain in the first year after cVHR. 相似文献2.
Background
Consensus lacks concerning management of ventral hernia in women who are, or might become pregnant. The aim of this systematic review was to examine the risk of recurrence following pre-pregnancy ventral hernia repair, and secondly the prevalence of ventral hernia during pregnancy and the risk of surgical repair pre- and post-partum.Data sources
PubMed, Embase, CINAHL, Cochrane Library and Web of Science were systematically searched for randomized controlled trials, case-control, cohort studies and larger case-series on ventral (umbilical, epigastric or incisional) hernia repair in relation to pregnancy.Conclusions
If possible, elective ventral repair should be postponed until after last pregnancy. A non-mesh repair seems appropriate for smaller primary ventral hernia in women who plan future pregnancies. Umbilical hernia during pregnancy seems very rare and seldom requires repair pre- and post-partum. Routine practice of umbilical hernia repair in combination with cesarean section cannot be recommended. PROSPERO: CRD42017073736. 相似文献3.
Theadore Hufford Jean-Francois Tremblay Mohammad Taha Mustafa Sheikh Slawomir Marecik John Park Ina Zamfirova Kunal Kochar 《American journal of surgery》2018,215(1):88-90
Purpose
The goal of this study was to evaluate the efficacy, morbidity and safety of local parastomal hernia repair using biological mesh.Patients and methods
A retrospective analysis of a prospectively maintained database was performed for parastomal hernia repairs. All patients who underwent local parastomal hernia repair with biological mesh between July 2006 and July 2015 were included in the study. Non-local (laparoscopic or midline incision) procedures were excluded. The type of repair, incision used, mesh placement and morbidity were analyzed. Time to recurrence was measured as an independent variable.Results
58 procedures with a median follow up of 3.8 years were analyzed. The majority (91%) of repairs were performed on an elective basis. Underlay technique was used in 24 patients (39%), overlay in 4 (7%) and both overlay and underlay (sandwich technique) in 33 (54%) of the cases. Overall, 11 patients (18.1%) experienced recurrence. Recurrence occurred in 8 patients in the underlay group (33%), 1 in the overlay group (25%), with 2 recurrences identified in the sandwich technique group (6%; p = 0.02). There was one occurrence of 30-day morbidity in our study population (0.016%). No difference was observed for recurrence or morbidity according to the type of biologic mesh used (human, bovine, or porcine).Conclusion
Our results demonstrate that local parastomal hernia repairs are associated with moderate recurrence rates, very low morbidity and consistent with the current literature. The sandwich technique was found to have a significantly lower recurrence rate compared to underlay or overlay techniques. Keyhole incisions were associated with less recurrence than traditional circular incisions. Our findings further reveal biologic mesh type was not associated with any difference in outcomes. Local parastomal hernia repair with biologic mesh is a safe procedure with very low morbidity and acceptable recurrence rate, especially using the sandwich repair technique. 相似文献4.
John Kuckelman Riyad Karmy-Jones Elizabeth Windell Seth Izenberg Jean-Stephane David William Long Matthew J. Martin 《American journal of surgery》2018,215(5):794-800
Background
Traumatic Rib Cage Hernias (TRCH) requiring operative repair are rare and there is currently no literature to guiding surgical management.Methods
Perioperative review of TRCH over 32 years. Five operative grades were developed based on extent of tissue/bone damage, size, and location.Results
Twenty-four patients (20 blunt, 4 penetrating) underwent operative repair. Lung was the herniated organ in 88% with a median of 4 rib fractures and average size of 60.25?cm. Types of operation were well clustered by assigned TRCH grade. The majority required mesh (75%) and/or rib plating (79%). Complex tissue flap reconstruction was required in 10%. Full range-of-motion was maintained in 88% with79% returning to pre-injury activity levels. Five patients had continued pain at final follow up (mean?=?7months).Conclusion
The size and degree of injury has important implications in the optimal surgical management of TRCHs. These operative grades effectively direct surgical care for these rare and complex injuries. 相似文献5.
G. Damiano V.D. Palumbo S. Fazzotta S. Buscemi S. Ficarella A. Maffongelli G. Buscemi A.I. Lo Monte 《Transplantation proceedings》2019,51(1):215-219
Background
Incisional hernia in renal transplant patients is a complication that negatively affects the global outcome of transplant and quality of life. The repair of this condition was classically made by open repair with mesh. Increasing evidence suggests that laparoscopic repair could be advocated as the technique of choice in these patients with optimal results. However, the fixation of mesh should be performed by a mixed combination of fibrin sealant (lateral margin of wall defect) and tacks (medial margin). The tacks fixation of the mesh along the lateral margin of the wall defect, close to the graft, is generally difficult for the small size of the remaining aponeurotic plane and dangerous for the underlying presence of the graft.Materials and Methods
A case of incisional hernia in a kidney transplant recipient was repaired by laparoscopic mesh technique. The polypropylene-polyglycolic acid composite mesh was fastened with a mixed technique of absorbable tacks for medial margin of the defect and fibrin sealant for the lateral side in contiguity with graft surface.Results
The patient was discharged after 4 days. The 6-month follow-up did not show mesh displacement or recurrence of hernia.Conclusions
The laparoscopic mesh repair may become the criterion standard for kidney transplant patients affected by incisional hernia. The difficulties of mesh fixation close to the graft can be overcome by the combination of fibrin sealant glue and absorbable tacks at different margins of the wall defect. This technique may offer advantages for this population of patients. 相似文献6.
Jill Smolevitz Richard Jacobson Milot Thaqi Samantha Millikan Keith W. Millikan 《American journal of surgery》2018,215(3):458-461
Background
Consensus guidelines recommend against elective ventral hernia repair (VHR) in patients with BMI >30 kg/m2 without preoperative weight loss intervention. We aim to compare hernia recurrence and perioperative complications in VHR utilizing anterior component separation (CS) in patients with class III obesity (BMI >40 kg/m2).Methods
A retrospective review of patients undergoing VHR with CS was performed. The primary endpoint was hernia recurrence; secondary endpoints were wound complications, postoperative medical complications, mortality and length of stay.Results
185 consecutive patients were identified from 2008 to 2016. There were no significant differences between groups: hernia recurrence (6.9% BMI >40 kg/m2, 2.4% BMI <39.9 kg/m2, p = 0.21), wound complications (58.6% BMI >40 kg/m2, 47.2% BMI <39.9 kg/m2, p = 0.16), postoperative complications (39.7% BMI >40 kg/m2, 26% BMI <39.9 kg/m2, p = 0.08), mortality (1.6% BMI >40 kg/m2, 3.4% BMI <39.9 kg/m2, p = 0.59), and length of stay (10.6 days BMI >40 kg/m2, 11.2 days BMI <39.9 kg/m2, p = 0.5).Conclusion
This study demonstrates similar outcomes in class III obesity patients undergoing elective VHR compared to patients with BMI <39.9 kg/m2. 相似文献7.
In Geol Ho Kyong Ihn Eun-Jung Koo Eun Young Chang Jung-Tak Oh 《Journal of pediatric surgery》2018,53(10):2008-2012
Purpose
This study aimed to evaluate the usefulness of laparoscopic repair of inguinal hernia (LR) in infants in comparison with open hernia repair (OR).Methods
We retrospectively analyzed the clinical data of 465 infants treated for inguinal hernia from January 2006 to December 2015. Among them, 124 underwent LR and 341 underwent OR.Results
In the OR group, 16.1% (55/341) primarily underwent bilateral inguinal hernia repair and 13.6% (42/308) subsequently developed metachronous contralateral inguinal hernia during follow-up. In the LR group, 75.8% (94/124) underwent primary bilateral inguinal hernia repair and only 1.6% (2/123) developed metachronous contralateral inguinal hernia. The mean operation times of unilateral inguinal hernia repair showed no statistical differences between LR and OR. However, the mean operation times of bilateral inguinal hernia repair were shorter in LR (39.8 ± 10.4 vs. 51.1 ± 14.4 min, p < 0.001). Postoperative recurrence and wound infection showed no statistical differences between the groups, but postoperative scrotal swelling was more common in OR (0.0% vs. 4.0%, p = 0.006).Conclusion
LR in infants showed a lower incidence of metachronous hernia, shorter operation times, and better postoperative course than OR. LR could be considered the primary operation method in infants with inguinal hernia.Levels of Evidence
Prognosis Study, Retrospective Study, Level III. 相似文献8.
Brian C Gulack Rachel Greenberg Reese H Clark Marie Lynn Miranda Martin L Blakely Henry E Rice Obinna O Adibe Elisabeth T Tracy P Brian Smith 《Journal of pediatric surgery》2018,53(4):784-788
Purpose
Inguinal hernias are common in premature infants, but there is substantial variation with regards to timing of repair. We sought to quantify and explain this variation.Methods
Cohort study of infants < 34 weeks gestation diagnosed with an inguinal hernia and discharged from one of 329 neonatal intensive units between 1998 and 2012. Multivariable logistic regression clustered by site was used to evaluate demographic, clinical, maternal, and socioeconomic variables associated with pre-discharge repair.Results
A total of 8037 infants met study criteria, and 3230 (40%) received a pre-discharge repair. The frequency of pre-discharge repair varied by site from 9% to 84%, and increased over the study period from 20% in 1998 to 45% in 2012. Concurrent gastrostomy or fundoplication and lower socioeconomic status were associated with an increased odds of receiving a pre-discharge repair.Conclusion
There is substantial variation with regards to the timing of repair of inguinal hernias in premature infants, with an increasing number of infants receiving repair prior to hospital discharge over time. Concurrent gastrostomy or fundoplication and socioeconomic status are associated with timing of repair.Level of evidence
IV. 相似文献9.
Alberto M. Leopaldi Krzysztof Wrobel Giovanni Speziali Sjoerd van Tuijl Agne Drasutiene W. Randolph Chitwood 《The Journal of thoracic and cardiovascular surgery》2018,155(1):147-155
Objective
Previously, cardiac surgeons and cardiologists learned to operate new clinical devices for the first time in the operating room or catheterization laboratory. We describe a biosimulator that recapitulates normal heart valve physiology with associated real-time hemodynamic performance.Methods
To highlight the advantages of this simulation platform, transventricular extruded polytetrafluoroethylene artificial chordae were attached to repair flail or prolapsing mitral valve leaflets. Guidance for key repair steps was by 2-dimensional/3-dimensional echocardiography and simultaneous intracardiac videoscopy.Results
Multiple surgeons have assessed the use of this biosimulator during artificial chordae implantations. This simulation platform recapitulates normal and pathologic mitral valve function with associated hemodynamic changes. Clinical situations were replicated in the simulator and echocardiography was used for navigation, followed by videoscopic confirmation.Conclusions
This beating heart biosimulator reproduces prolapsing mitral leaflet pathology. It may be the ideal platform for surgeon and cardiologist training on many transcatheter and beating heart procedures. 相似文献10.
Michael Derickson Cody Phillips Morgan Barron John Kuckelman Matthew Martin Mia DeBarros 《American journal of surgery》2018,215(5):887-890
Introduction
Bariatric surgery results in massive weight loss, leaving many patients with redundant skin that can cause significant physical and psychosocial limitations. We sought to identify variables associated with postoperative complications and adjuncts associated with the mitigation of postoperative complications.Methods
A retrospective review was performed of all post-bariatric surgery patients who underwent panniculectomy over a 10-year period.Results
Total 706 patients included. Overall complication rate was 56%: dehiscence (24%), surgical site infection (22%), seroma (18%), and post-operative bleeding (5%). Return to operating room rate was 12%. Significant factors were: BMI >26 (p?<?0.01), fleur-de-lis panniculectomy (p?<?0.01), concomitant hernia repair (p?<?0.01). Multivariate regression analysis demonstrated ASA class >2 (OR 1.97, p?<?0.05) and incision type (OR 1.64, p?<?0.05) to be independent predictors of morbidity.Conclusion
High morbidity for post-bariatric panniculectomy is primarily local wound complications. Potentially modifiable factors that increase the complication risk profile include higher BMI, higher ASA class, and the use of fleur-de-lis incision. 相似文献11.
Purpose
Anterior cruciate ligament (ACL) repair was first described in the mid 1900's. However, due to poorly selected patients led to unsatisfactory early results. We aim to study the outcome of ACL repair in a carefully selected cohort.Methods
Thirteen consecutive patients of acute Type 1 (proximal ACL avulsion) were treated with arthroscopic ACL repair using a suture pull out technique. At the latest follow-up the patients were evaluated for Lysholm score, KT-1000 measurement and clinical assessment for any laxity.Results
At a mean follow-up of 31.3 months, none of the patients had any subjective laxity. The mean Lysholm score was 95 and instrumented laxity measurement did not reveal any significant laxity compared to the opposite knee.Conclusion
The proximal ACL avulsion has healing potential similar to proximal MCL injuries. Performing microfracture of the lateral wall of the notch optimizes the healing environment by negating the effects of the synovial fluid. Performing ACL repair in a carefully selected patient leads to good short term results and saves the patient of a reconstruction procedure, at least in the immediate future. 相似文献12.
Background
The global rise in infectious disease has led the Center for Disease Control and Prevention and the World Health Organization to release new guidelines for the prevention of surgical site infection.Methods
In this article, we summarize current recommendations based on level of evidence, review unresolved and unaddressed issues, and supplement them with new literature.Results
Although the guidelines discuss major issues in reducing surgical site infection, many questions remain unanswered.Conclusion
These guidelines will hopefully help in setting a standard of care based on best evidence available and focus investigators on areas where evidence is lacking. 相似文献13.
Background
De novo gastric cancer is a rare complication of liver transplantation.Methods
Surgical treatments of 16 cases with different outcomes were reported in the English literature.Results
De novo gastric cancer (stage II) was diagnosed as the result of epi-gastric discomfort in a recipient 10 years after liver transplantation. The patient received chemotherapy alone and remained well for 26 months.Conclusions
De novo gastric cancer of liver transplantation recipients is a severe complication; early detection and relevant intervention will benefit these recipients. 相似文献14.
Martha Godfrey Alexandra A. Rosser Carla M. Pugh Ajit K. Sachdeva Sarah Sullivan 《American journal of surgery》2019,217(2):382-386
Background
Given their variegated backgrounds, surgeons taking continuing medical education (CME) courses possess different learning needs. This study examines the relationship between surgeons’ levels of experience and the questions they asked in a simulation-based CME course.Methods
We analyzed transcribed audio-video data collected from surgeons participating in a simulated laparoscopic hernia repair CME course and identified four types of questions learners posed to their instructors. Linear regressions compared how often these questions were asked versus self-reported operative experience.Results
Both Requesting Guidance and Requesting Confirmation were inversely proportional to experience, whereas Asking About a Specific Case was directly proportional to experience. Requesting Instructor Preference exhibited no significant correlation with experience.Conclusion
Practicing surgeons with relatively less experience tend to ask for confirmation and guidance, whereas those with greater experience tend to focus on specific hypothetical scenarios. This data can be used to tailor instruction based on learners’ self-reported experience level. 相似文献15.
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S.-C. Kuo C.-C. Lin A. Elsarawy Y.-H. Lin S.-H. Wang Y.-J. Wu C.-L. Chen 《Transplantation proceedings》2017,49(8):1870-1874
Background
Ventral incisional hernia (VIH) is not uncommon following liver transplantation. Open repair was traditionally adopted for its management. Laparoscopic repair of VIH has been performed successfully in nontransplant patients with evidence of reduced recurrence rates and hospital stay. However, the application of VIH in post-transplantation patients has not been well established. Herein, we provide our initial experience with laparoscopic repair of post-transplantation VIH.Methods
From March 2015 to March 2016, 18 cases of post-transplantation VIH were subjected to laparoscopic repair (laparoscopy group). A historical control group of 17 patients who underwent conventional open repair (open group) from January 2013 to January 2015 were identified for comparison. The demographics and clinical outcomes were retrospectively compared.Results
There were no significant differences among basic demographics between the 2 groups. No conversion was recorded in the laparoscopy group. Recurrence of VIH up to the end of the study period was not noted. In the laparoscopy group, the minor complications were lower (16.7% vs 52.9%; P = .035), the length of hospital stay was shorter (3 d vs 7 d, P = .007), but the median operative time was longer (137.5 min vs 106 min; P = .003).Conclusions
Laparoscopic repair of post-transplantation VIH is a safe and feasible procedure with shorter length of hospital stay. 相似文献19.
Massimiliano M. Marrocco-Trischitta Hector W. de Beaufort Francesco Secchi Theodorus M. van Bakel Marco Ranucci Joost A. van Herwaarden Frans L. Moll Santi Trimarchi 《Journal of vascular surgery》2017,65(6):1584-1590
Objective
This study assessed whether the additional use of the aortic arch classification in type I, II, and III may complement Ishimaru's aortic arch map and provide valuable information on the geometry and suitability of proximal landing zones for thoracic endovascular aortic repair.Methods
Anonymized thoracic computed tomography scans of healthy aortas were reviewed and stratified according to the aortic arch classification, and 20 of each type of arch were selected. Further processing allowed calculation of angulation and tortuosity of each proximal landing zone. Data were described indicating both proximal landing zone and type of arch (eg, 0/I).Results
Angulation was severe (>60°) in 2/III and in 3/III. Comparisons among the types of arch showed an increase in proximal landing zones angulation (P < .001) and tortuosity (P = .009) depending on the type of arch. Comparisons within type of arch showed no change in angulation and tortuosity across proximal landing zones within type I arch (P = .349 and P = .409), and increases in angulation and tortuosity toward more distal proximal landing zones within type II (P = .003 and P = .043) and type III (P < .001 in both).Conclusions
The aortic arch classification is associated with a consistent geometric pattern of the aortic arch map, which identifies specific proximal landing zones with suboptimal angulation for stent graft deployment. Arches II and III also appear to have progressively less favorable anatomy for thoracic endovascular aortic repair compared with arch I. 相似文献20.
Suolin Li Xuelai Liu Kenneth K.Y. Wong Lin Liu Yingchao Li 《Journal of pediatric surgery》2018,53(12):2507-2510