New technique for mesh repair of paracolostomy hernias

Paracolostomy hernias are common and require treatment when symptomatic. Traditional methods of repair have high recurrence rates. We describe a new technique using polytetrafluorethylene mesh, which offers preservation of stoma site, lack of recurrences, ease, and safety.     

Hiatal hernia repair with biologic mesh reinforcement reduces recurrence rate in small hiatal hernias

The utility of mesh reinforcement for small hiatal hernia found especially during antireflux surgery is unknown. Initial reports for the use of biological mesh for crural reinforcement during repair for defects greater than 5 cm have been shown to decrease recurrence rates. This study compares patients with small hiatal hernias who underwent onlay biologic mesh buttress repair versus those with suture cruroplasty alone. This is a single‐institution retrospective review of all patients undergoing repair of hiatal hernia measuring 1–5 cm between 2002 and 2009. The patients were evaluated based on surgical repair: one group undergoing crural reinforcement with onlay biologic mesh and other group with suture cruroplasty only. Seventy patients with hiatal hernia measuring 1–5 cm were identified. Thirty‐eight patients had hernia repair with biologic mesh, and 32 patients had repair with suture cruroplasty only. Recurrence rate at 1 year was 16% (5/32) in patients who had suture cruroplasty only and 0% (0/38) in the group with crural reinforcement with absorbable mesh (statistically significant, P = 0.017). Suture cruroplasty alone appears to be inadequate for hiatal hernias measuring 1?5 cm with significant recurrence rate and failure of antireflux surgery. Crural reinforcement with absorbable mesh may reduce hiatal hernia recurrence rate in small hiatal hernias.     

Repair of paracolostomy hernias with Marlex mesh

The author's limited experience with the use of Marlex mesh to repair large paracolostomy hernias on five patients supports the experiences of others who have used this method of repair. The use of synthetic material in the repair of these often troublesome hernias is by no means conclusive since it was used only in a small number of patients. However, it is encouraging enough to warrant further use.     

Total pelvic mesh repair

INTRODUCTION: This report describes our technique and experience in restoring the pelvic floor of females with pelvic organ prolapse. METHODS: Total pelvic mesh repair uses a strip of Marlex Mesh® secured between the perineal body and the sacrum. Two additional strips, attached to the first, are tunneled laterally to the pubis and support the vagina and bladder laterally. Candidates for the procedure have failed previous standard repair or manifest combined organ prolapse on physical and cystodefecography exams. RESULTS: From January 1990 to December 1999, 236 females had total pelvic mesh repair, and 205 (87 percent) were available for follow-up. Median age was 64 (range, 32–89) years, median parity 2 (range, 1–9); 63 percent had birth-related complications. Bladder protrusion, vaginal protrusion, or both were the predominant chief complaint (54 percent), followed by anorectal protrusion (48 percent). Findings on physical examination showed degrees of prolapse of rectum (74 percent) and vagina (57 percent), perineal descent (63 percent), enterocele (47 percent), and rectocele (44 percent). Mean procedure time and length of hospital stay were 3.2 (standard deviation 0.75) hours and 6 (standard deviation 2.2) days, respectively. Reoperation rate because of complications of the total pelvic mesh repair procedure was 10 percent. Marlex® erosion into rectum or vagina occurred in 5 percent of patients and constituted 46 percent of the complications requiring reoperation. Additional surgical procedures at various intervals subsequent to total pelvic mesh repair have been performed in 36 percent of patients to further improve bladder function and have been performed in 28 percent of patients to improve anorectal function. There has been no recurrence of rectal or vaginal prolapse to date. Reports of overall satisfaction for correction of primary symptoms for patients grouped into early (0.5–3 years), middle (>3–6 years) and late (>6 years) were 68 percent, 73 percent, and 74 percent respectively. CONCLUSION: Total pelvic mesh repair is a safe and effective operation for females with pelvic organ prolapse.Presented at the meeting of the American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 24 to 29, 2000.     

Laparoscopic giant parastomal hernia repair with prosthetic mesh

Laparoscopy is being increasingly used in colorectal surgery interventions. Herein, we present a patient with giant parastomal hernia who underwent laparoscopic repair. A70-year-old man who had undergone abdominoperineal resection and end colostomy for carcinoma of rectum was admitted to our clinic with a giant parastomal hernia. The parastomal hernia was repaired by laparoscopic approach using prosthetic material. The patient was discharged uneventfully on postoperative day 4. Laparoscopic approach is a rational alternative to conventional repair techniques of parastomal hernia and may be a reliable and easily applicable method with the classic benefits of laparoscopic surgery. Received: 14 May 2002 / Accepted: 24 August 2002     

New endoscopic and surgical treatment options for early esophageal adenocarcinoma

Although the outcome for advanced stage esophageal cancer is poor, the early detection and treatment of early stage disease is usually associated with a much better outcome. Until recently, esophagectomy has been the treatment of choice in fit patients. However, morbidity is significant, and this has encouraged the development of newer endoscopic treatments that preserve the esophagus. These techniques include ablation and mucosal resection. Promising results are described, and endoscopic methods might provide a reasonable alternative for the treatment of early esophageal cancer. However, follow‐up remains short and endoscopic treatment does not deal with potential lymphatic spread. Hence, careful selection is required. Minimally invasive techniques for esophageal resection have also been shown to be feasible, although there is only limited evidence that they reduce postoperative morbidity. Better data are still required to demonstrate improved outcomes from endoscopic treatment and minimally invasive esophagectomy.     

Update on the natural orifice transluminal endoscopic surgery for gallbladder preserving gallstones therapy: A review

Cholecystectomy remains the “gold standard” for the management of symptomatic gallstones. Minimally invasive laparoscopic cholecystectomy has been the treatment of choice for the past 3 decades. However, the technique of natural orifice transluminal endoscopic surgery cholecystolithotomy is evolving, with some experts advocating gallbladder stone removal without gallbladder excision in order to preserve gallbladder function and eliminate post-cholecystectomy syndromes, including complications of the surgical incision, bile duct injury, functional gastrointestinal, and psychological conditions, and possibly an increase in colon cancer. In addition, transluminal endoscopic cholecystolithotomy is an option for elderly patients who are not suitable candidates for open surgery and those who desire scar-free minimally invasive surgery with organ preservation. This article summarizes the established pure natural orifice transluminal endoscopic surgery gallbladder preserving gallstone removal techniques and highlights the pros and cons of different popular available endoscopic approaches to gallstone therapy and how flexible endoscopic surgery via the natural orifice is compared to the well-established cholecystectomy.     

Laparoscopic mesh repair antireflux surgery for treatment of large hiatal hernia

SUMMARY: One of the most frequently occurring anatomic failures after laparoscopic fundoplication is migration of the wrap into the chest, with or without disruption. This so-called 'slipped' Nissen fundoplication may be the result of inadequate closure of the diaphragmatic crura or rupture of the sutures or disruption of the muscle fibers approached. From January 2000 to December 2002, a total of seven patients (four male) with a mean age of 56 years (range 22-72 years), were considered for laparoscopic antireflux procedure using DACRON mash to reinforce the crural hiatal closure. The patients were operated under general anesthesia; laparoscopy was performed by classical approach with five trocars. The mean operative time was 120 minutes (range 40-240 min). There were no deaths. The average of postoperative hospital stay was 3.5 days (range, 3-5). Patients returned to normal activities usually on postoperative day 10 (range, 7-15). The follow-up time was at least 2 years. There was only one late complication related to the use of DACRON mesh at the hiatus, due to migration of the mesh into the esophageal lumen causing disphagia. In conclusion the mesh repair antireflux surgery is a good alternative for closing the diaphragmatic defect in large hiatal hernias or to correct this problem in case of recurrence or Barrett's esophagus.     

Mesh size may not affect recurrence in laparoscopic totally extraperitoneal repair of inguinal hernias

A mesh is usually employed to cover defects when performing laparoscopic totally extraperitoneal repair (TEP) of inguinal hernias. However, there is insufficient evidence for an appropriate mesh size. Therefore, we aimed to compare the recurrence rate between large- and medium-mesh laparoscopic TEP. Patients who underwent laparoscopic TEP for primary inguinal hernias from January 2012 to March 2020 were included. We retrospectively reviewed electric medical records. The primary outcome was the difference in recurrence rate between the large and medium meshes. The large mesh was 10.3 × 15.7 cm, and the medium mesh was 7.9 × 13.4 cm or 9 × 13 cm. In total, 446 patients were included in the study. Of these patients, 177 were in the large-mesh group, and 269 were in the medium-mesh group. The average ages of the large- and medium-mesh groups were 58.4 and 56.9 years, respectively (P = .361). In both groups (large vs medium), males were dominant (93.2% vs 93.6%, P = .850), and indirect hernias (87.0% vs 88.1%, P = .740) were dominant. There was no difference in body mass index (P = .883) or hernia side (P = .770). Peritoneal tearing as an intraoperative complication occurred frequently in the large-mesh group (13.6% vs 3.3%, P < .001). During the mean follow-up period of 28 months, recurrence occurred in 3 (1.7%) and 13 (4.8%) patients in the large- and medium-mesh groups, respectively. However, there was no statistical significance (P = .262). Mesh size may not affect recurrence after laparoscopic TEP of primary inguinal hernias.     

Mini-access open arch repair

BackgroundThe use of minimally invasive approaches is scarce in open aortic arch repair because of its perceived high operative risk and technical difficulty.MethodsThis study enrolled 59 consecutive patients (aged 58.2±13.2 years) undergoing elective arch replacement either through upper hemi-sternotomy (n=58) or mini-thoracotomy (n=1) between 2015 and 2020. Of these, 44 underwent hemiarch replacement and 15 underwent total arch replacement. Moderate hypothermic circulatory arrest was used for all patients while antegrade cerebral perfusion was selectively used for total arch repair. For more efficient distal aortic anastomosis in limited spaces, inverted graft anastomosis was utilized whenever possible.ResultsHemi-sternotomy involved upper sternal separation down to the second, third, and fourth intercostal spaces in 1 (1.7%), 30 (50.8%), and 27 (45.8%) patients, respectively. Concomitant cardiac procedures included root replacement in 19 patients (32.2%) and aortic valve replacement in 21 patients (35.6%). Circulatory arrest, cardiac ischemic, cardiopulmonary bypass, and total procedural times were 8.9±3.4, 91.1±31.1, 114.6±46.2, and 250.3±79.5 min, respectively for total arch repair, and 25.0±12.1, 72.3±16.6, 106.0±16.9, and 249.1±41.7 min, respectively for hemiarch repair. Conversion to full-sternotomy was required in 1 patient (1.7%) due to bleeding. There was one case of mortality (1.7%) attributable to low-cardiac output syndrome following hemiarch repair concomitantly with Bentall procedure. Major complications included requirement for mechanical support in 1 (1.7%), temporary neurologic deficit in 1 (1.7%), newly initiated dialysis in 3 (5.1%), and re-exploration due to bleeding in 2 (3.4%).ConclusionsMini-access open arch repair is technically feasible and achieved excellent early outcomes.     

生物补片在腹腔镜下食管裂孔疝修补术的临床疗效分析

目的探讨生物补片在腹腔镜下食管裂孔疝修补术治疗食管裂孔疝的临床疗效。 方法回顾性收集自2014年5月至2017年3月在新疆维吾尔自治区人民医院住院治疗并使用生物补片行腹腔镜下食管裂孔疝修补术患者12例临床资料,总结上述患者术前及术后12个月反流情况及术后并发症等。 结果12例患者均手术顺利无中转术式等情况,术后患者反流症状均较术前明显改善,术前反流时间、反流次数、DeMeester评分、GERD-Q量表评分等比术后明显降低,差异有统计学意义(P<0.05),术后出现早期吞咽困难2例,随访过程中无严重并发症发生,无复发。 结论使用生物补片进行腔镜食管裂孔疝修补联合胃底折叠术是治疗食管裂孔疝的有效方法,短期随访结果说明生物补片加强修补食管裂孔疝是安全、有效的,长期疗效需进一步研究证实。     

Tension-free hiatal hernia repair with biological mesh: A real-world experience

Laparoscopic Nissen fundoplication and esophagoplasty are the standards for gastroesophageal reflux disease (GERD) and hiatal hernia (HH) repair. Biologically derived mesh is also associated with reduced recurrence. This study attempted to evaluate the effectiveness of a biological mesh in the 4K laparoscopic repair of HH. This retrospective study reviewed patients with a severe GERD complicated with HH from August 2019 to August 2020. All patients underwent the HH repair using a biological mesh under a 4K laparoscope accompanying Nissen fundoplication. Up to 16 months postoperatively, GERD-health-related quality-of-life (GERD-HRQL) scale, radiologic studies on HH recurrence, and symptoms were recorded. The mean surgical time and postoperative hospital stay were 70.9 ± 8.72 min, 4.8 ± 0.76 days, respectively. The postoperative symptom relief rate was 96.5%, and no recurrence exhibited during follow-up. Dysphagia occurred in 10 (9.43%) patients. There were no intraoperative vagus nerve injury or postoperative complications, mesh infection, and reoperation for mesh. The tension-free repair of HH with the biological mesh is an option for clinical use, with effectiveness and few short-term complications being reported.     

Primary laparoscopic and open repair of paraesophageal hernias: a comparison of short-term outcomes

SUMMARY.   The choice of the optimal surgical approach for repairing paraesophaeal hernias (PEH) is debated. Our objective is to evaluate the short-term outcomes of primary laparoscopic and open repairs of PEH performed in the Calgary Health Region. A retrospective review of all patients undergoing repair of PEH between October 1999 and February 2005 was performed. The outcome measures evaluated included intra-operative parameters and post-operative variables, mortality rates, recurrence rates and patient satisfaction. A total of 93 patients underwent either a laparoscopic ( n  = 46) or open ( n  = 47) primary PEH repair. The laparoscopic approach was associated with a longer mean operative time (3.1 ± 1.2 hours vs. 2.5 ± 0.7 hours, P  = 0.005) but resulted in a shorter overall hospital stay (5 days [2–16 days] vs. 10 days [5–24 days]; P  < 0.001), and fewer post-operative complications (10/46 [22%] vs. 25/47 [53%] P  = 0.002). Although the follow-up was short (laparoscopic 16 months; open 18 months), a 9% recurrence rate was reported with both approaches. Patient satisfaction using the Gastroesophageal Disease Health-Related Quality Of Life questionnaire was similar in both groups ( P  = 0.861) with most patients reporting excellent outcomes (laparoscopic: 32/36 [89%]; open 27/35 [77%]). Our review suggests that the laparoscopic approach is safe with shorter hospital stay and recovery. Although early follow-up suggests that recurrence rates and patient satisfaction are similar, long-term follow-up is required to determine whether the laparoscopic approach will become the procedure of choice.     

Surgical outcomes of laparoscopic total extraperitoneal (TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study

Inguinal hernia repair is one of the most frequently performed surgery. The ideal procedure for inguinal hernia repair remains controversial. Open Lichtenstein tension-free mesh repair (LMR) is one of the most preferred open techniques with satisfactory outcomes. Laparoscopic approach in inguinal hernia surgery remains controversial, especially in comparison with open procedures. In this study, we have reported a comparison of laparoscopic total extraperitoneal (TEP) inguinal hernia repair with LMR. Postoperative pain, operative time, complications like seroma, wound infection, chronic groin pain, and recurrence rate were parameters to evaluate the outcome.One hundred seventy-four patients were included in the study by consecutive randomized prospective sampling. The patients were divided into 2 groups: group A, laparoscopic TEP inguinal hernia repair, and group B, LMR. The procedures were performed by experienced surgeons. The primary outcomes were evaluated based on postoperative pain and recurrence rate. Secondary outcomes considered for evaluation were operative time, complications like seroma, infection, and chronic groin pain.Severe pain was reported in group A (7.9%) compared to group B (15.1%), which was statistically significant (P < .001). Moderate pain was reported more in group B (70.9%) compared to group A (29.5%) (P < .001). The mean operative time in group A was 84.6 ± 32.2, which was significantly higher than that in group B, 59.2 ± 14.8. There was no major complication in both groups. The chronic pain postoperatively was significantly in higher number of patients in group B vs group A (22.09% vs 3.4%). The postoperative hospital stay period was significantly lesser for group A vs for group B (2.68 ± 1.52 vs 3.86 ± 6.16). Time duration taken to resume normal activities was significantly lower in group A (13.6 ± 6.8) vs (19.8 ± 4.6) in group B (P < .001).Although there is definite evidence of longer operative time and learning curve, laparoscopic TEP has added advantages like less postoperative pain, early resumption of normal activities, less chronic groin pain, and comparable recurrence rate compared to open Lichtenstein repair. Laparoscopic TEP can be performed with acceptable outcomes and less postoperative complications if performed by experienced hands.     

Minimally invasive repair of pectus carinatum with a new steel bar

BackgroundCurrently, the anti-Nuss operation is widely used as standard surgery for pectus carinatum, but the installation and removal of the Nuss steel bars can be difficult, time-consuming and traumatic. To further simplify the procedure, we designed a new steel bar to facilitate minimally invasive surgical correction of pectus carinatum.MethodsFrom January 2018 to July 2021, 112 patients underwent minimally invasive repair of pectus carinatum (MIRPC) with the new steel bar in our centre. Two generations of bars were designed during our study period, and symmetric and asymmetric deformities were treated. After 2 years of follow-up, the bar and stabilizers were removed. The effects and complications of minimally invasive repair using the new bar to correct pectus carinatum were reviewed.ResultsThe mean patient age was 14.46 years. The mean operation duration was 67.74 minutes. The mean hospital length of stay was 3.64 days. The Haller index of the patients improved from 1.96 preoperatively to 2.78 postoperatively. The complications included pneumothorax, pleural effusion, wound infections, nickel allergy, screw loosening, wire breakdown, bar fraction and overcorrection leading to excavatum. Seventy-two patients (64.3%) underwent bar removal, with 63 patients (87.5%) achieving excellent or good results. The deformity recurred in 2 patients (2.8%) during follow-up.ConclusionsMIRPC with our newly designed steel bar can achieve good results and is effective in repairing both symmetric and asymmetric carinatum deformities.     

Cirrhosis and hernia repair in a cohort of 6352 patients in a tertiary hospital: Risk assessment and survival analysis

The prevalence of hernias in patient with cirrhosis can reach up to 40%. The pathophysiology of cirrhosis is closely linked to that of the umbilical hernia, but other types are also common in this population. The aim of this study is to evaluate factors that influence in the prognosis after hernia repair in patients with cirrhosis. A historical cohort of 6419 patients submitted to hernia repair was gathered. Clinical, epidemiological data and hernia characteristics were obtained. For patient with cirrhosis, data from exams, surgery and follow-up outcomes were also analyzed. Survival curves were constructed to assess the impact of clinical and surgical variables on survival. 342 of the 6352 herniated patients were cirrhotic. Patient with cirrhosis had a higher prevalence of umbilical hernia (67.5% × 24.2%, P < .001) and a lower prevalence of epigastric (1.8% × 9.0%, P < .001) and lumbar (0% × 0.18%, P = .022). There were no significant differences in relation to inguinal hernia (P = .609). Ascites was present in 70.1% of patient with cirrhosis and its prevalence was different in relation to the type of hernia (P < .001). The survival curve showed higher mortality for emergency surgery, MELD > 14 and ascites (HR 12.6 [3.79–41.65], 4.5 [2.00–10.34], and 6.1 [1.15–20.70], respectively, P < .05). Hernia correction surgery in patient with cirrhosis has a high mortality, especially when performed under urgent conditions associated with more severe clinical conditions of patients, such as the presence of ascites and elevated MELD.     

Efficacy of preemptive endoscopic submucosal dissection and surgery for synchronous colorectal neoplasms

Abstract

Background and aim

If patients with surgically resectable colorectal cancershave synchronous colorectal neoplasms that are difficult to remove by endoscopic mucosal resection, preemptive endoscopic submucosal dissection (ESD) can avoid excessive colorectal resection. The aim of this study was to evaluate the efficacy of the strategy of preemptive ESD and surgery for synchronous colorectal neoplasms.