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Background
Large-scale data for the optimal inguinal hernia repair in younger men with an indirect hernia is not available. We analysed nationwide data for risk of reoperation in younger men after a primary repair using a Lichtenstein operation or a conventional non-mesh hernia repair. 相似文献3.
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Zarins CK Wolf YG Lee WA Hill BB Olcott C IV Harris EJ Dalman RL Fogarty TJ 《Annals of surgery》2000,232(4):501-507
OBJECTIVE: To evaluate of the impact of endovascular aneurysm repair on the rate of open surgical repair and on the overall treatment of abdominal aortic aneurysms (AAAs). METHODS: All patients with AAA who were treated during two consecutive 40-month periods were reviewed. During the first period, only open surgical repair was performed; during the subsequent 40 months, endovascular repair and open surgical repair were treatment options. RESULTS: A total of 727 patients with AAA were treated during the entire period. During the initial 40 months, 268 patients were treated with open surgical repair, including 216 infrarenal (81%), 43 complex (16%), and 9 ruptured (3%) aortic aneurysms. During the subsequent 40 months, 459 patients with AAA were treated (71% increase). There was no significant change in the number of patients undergoing open surgical repair and no significant difference in the rate of infrarenal (238 [77%]) and complex (51 [16%]) repairs. A total of 353 patients were referred for endovascular repair. Of these, 190 (54%) were considered candidates for endovascular repair based on computed tomography or arteriographic morphologic criteria. Analyzing a subgroup of 123 patients, the most common primary reasons for ineligibility for endovascular repair were related to morphology of the neck in 80 patients (65%) and of the iliac arteries in 35 patients (28%). A total of 149 patients underwent endovascular repair. Of these, the procedure was successful in 147 (99%), and 2 (1%) patients underwent surgical conversion. The hospital death rate was 0%, and the 30-day death rate was 1%. During a follow-up period of 1 to 39 months (mean 12 +/- 9), 21 secondary procedures to treat endoleak (20) or to maintain graft limb patency (1) were performed in 17 patients (11%). There were no aneurysm ruptures or aneurysm-related deaths. CONCLUSIONS: Endovascular repair appears to have augmented treatment options rather than replaced open surgical repair for patients with AAA. Patients who previously were not candidates for repair because of medical comorbidity may now be safely treated with endovascular repair. 相似文献
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Progress of peripheral nerve repair 总被引:2,自引:0,他引:2
陈峥嵘 《中华创伤杂志(英文版)》2002,5(6):323-325
Study on repair of peripheral nerve injury has been proceeding over a long period of time.With the use of microsurgery technique since 1960s, the quality of nerve repair has been greatly improved.In the past 40 years,with the continuous increase of surgical repair methods,more progress has been made on the basic research of peripheral nerve repair. 相似文献
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Wright BE Beckerman J Cohen M Cumming JK Rodriguez JL 《American journal of surgery》2002,184(6):505-8; discussion 508-9
BACKGROUND: Laparoscopic mesh repair has been advocated as treatment of choice for ventral hernias. The term "ventral hernia" refers to a variety of abdominal wall defects and laparoscopic papers have not reported defect specific analysis. The purpose of this study was to determine any advantages to laparoscopic mesh repair of umbilical hernias. METHODS: A retrospective review (January 1998 to April 2001) was made of patients undergoing umbilical hernia repair. Patients were categorized into three groups: laparoscopic repair with mesh, open repair with mesh, and open repair without mesh. Comparative analysis was performed. RESULTS: One-hundred and sixteen umbilical hernia repairs were performed in 112 patients: 30 laparoscopic mesh repairs, 20 open mesh repairs, and 66 open nonmesh repairs. The laparoscopic technique was used for larger defects and took more time with a trend toward fewer postoperative complications and recurrences. CONCLUSIONS: Laparoscopic umbilical hernia repair with mesh presents a reasonable alternative to conventional methods of repair. 相似文献
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INTRODUCTION
The concept of using a mesh to repair hernias was introduced over 50 years ago. Mesh repair is now standard in most countries and widely accepted as superior to primary suture repair. As a result, there has been a rapid growth in the variety of meshes available and choosing the appropriate one can be difficult. This article outlines the general properties of meshes and factors to be considered when selecting one.MATERIALS AND METHODS
We performed a search of the medical literature from 1950 to 1 May 2009, as indexed by Medline, using the PubMed search engine (<http://www.pubmed.gov>). To capture all potentially relevant articles with the highest degree of sensitivity, the search terms were intentionally broad. We used the following terms: ‘mesh, pore size, strength, recurrence, complications, lightweight, properties’. We also hand-searched the bibliographies of relevant articles and product literature to identify additional pertinent reports.RESULTS AND CONCLUSIONS
The most important properties of meshes were found to be the type of filament, tensile strength and porosity. These determine the weight of the mesh and its biocompatibility. The tensile strength required is much less than originally presumed and light-weight meshes are thought to be superior due to their increased flexibility and reduction in discomfort. Large pores are also associated with a reduced risk of infection and shrinkage. For meshes placed in the peritoneal cavity, consideration should also be given to the risk of adhesion formation. A variety of composite meshes have been promoted to address this, but none appears superior to the others. Finally, biomaterials such as acellular dermis have a place for use in infected fields but have yet to prove their worth in routine hernia repair. 相似文献11.
Laparoscopic ventral hernia repair: are there comparative advantages over traditional methods of repair? 总被引:5,自引:0,他引:5
Wright BE Niskanen BD Peterson DJ Ney AL Odland MD VanCamp J Zera RT Rodriguez JL 《The American surgeon》2002,68(3):291-5; discussion 295-6
Recent studies have noted advantages of laparoscopic over open repair of ventral hernias. Because few reports have involved comparison with traditional repair we report a comparison between laparoscopic and open approaches. We retrospectively reviewed the records of patients undergoing ventral hernia repair over a 28-month period. Patients were grouped into three categories: laparoscopic repair with mesh, open repair with mesh, and open repair without mesh. There were 295 ventral hernia repairs and there was no difference in age, gender, operative complications, or hospital stay between the groups. Mesh and defect size was greater in the laparoscopic group. The overall postoperative complication rate was greater in the open group with mesh. Yet when specific wound complications were analyzed there was no difference between the groups. Furthermore a death occurred in the laparoscopic group from an unrecognized bowel injury. The recurrence rate was greatest in the open repair without mesh group. Finally hospital cost was greatest in the laparoscopic group and third-party reimbursement was better for the open techniques. We were unable to demonstrate a significant advantage to laparoscopic ventral hernia repair. Although many patients with large fascial defects were well served with this approach it may not be a better option for these patients. 相似文献
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OBJECTIVE: To compare the function, complications and cosmesis after a modified Thiersch-Duplay and Mathieu unstented urethroplasty. PATIENTS AND METHODS: Over a 5-year period 381 consecutive patients (not randomized) with distal hypospadias were evaluated. A modified Thiersch-Duplay with dorsal incised urethral plate tubularization (group A) was undertaken in 170 (45%) and a parameatal based flip-flap Mathieu hypospadias repair (group B) in 211 (55%). No urinary diversion or stent was used in any of the 381 patients. RESULTS: In both groups the mean (sd) follow-up was 3.1 (1.4) years. All 381 patients voided spontaneously after surgery and none developed urinary retention needing catheterization. In groups A and B, respectively, the overall late complications were 12 (7.1%) and 32 (15.2%) (P=0.001), with urethrocutaneous fistula in six (3.5%) and 26 (12.3%; P=0.001); secondary surgery for fistula repair was successful in all boys in A and 89% in B. The glanular meatus was a vertical slit in all in group A and 86% in B (P=0.02). In both groups, 71% of the children who are now toilet-trained and standing to void have a good calibre, single and straight urinary stream in a forward direction. CONCLUSIONS: Stenting or urinary diversion is unnecessary after distal hypospadias surgery. The functional results were good in those standing to void. A more natural vertical slit-like glanular meatus was easily created using the modified Thiersch-Duplay urethroplasty, with a lower fistula rate. 相似文献
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Inguinal hernias: should we repair? 总被引:1,自引:0,他引:1
This review examines available data concerning the natural history of treated and untreated inguinal hernias. The incidence of complications with either treatment strategy is discussed using historical information from a time before herniorrhaphy became routine and contemporary data from two recently completed randomized controlled trials comparing routine repair using a tension-free technique with watchful waiting. 相似文献
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Banerjee A Beck C Narula VK Linn J Noria S Zagol B Mikami DJ 《Surgical endoscopy》2012,26(5):1264-1268
Background
The advent of laparoscopic ventral hernia repair (LVHR) not only reduced the morbidity associated with open repair but also led to a decrease in the hernia recurrence rate. However, the rate continues to remain significant. 相似文献15.
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Background Foramen of Morgagni’s hernia is an uncommon congenital diaphragmatic hernia. Repair is mostly performed through laparotomy.
We prefer the transthoracic approach, which allows better and safer control during thoracic dissection, although it is considered
more painful and related to greater morbidity. In recent years we introduced the transxiphoid hand-assisted videothoracoscopic
approach, which combines the advantages of the thoracic route with a mini-invasive procedure facilitated by one hand inside
the chest.
Methods A retrospective review was performed over a 20-year period (1985–2005). Twenty-two patients who had a foramen of Morgagni’s
hernia repaired were identified and relevant data were collected. Average age was 57 ± 10 years and one half of the patients
were asymptomatic. Chest roentgenograms, chest computerized tomography, and barium enema were used as diagnostic utilities.
Posterolateral thoracotomy was performed in 17 (15 right-sided) patients, whereas in 5 (all right-sided) the defect was repaired
by transxiphoid hand-assisted videothoracoscopy. Operative time, pain scored by visual analog scale, hospital stay, and cosmetic
results by acceptance score were reviewed for every patient.
Results Hernial sac was present in all cases and contained only omentum (n = 13), omentum plus transverse colon (n = 7), omentum plus transverse colon and small bowel (n = 2). In 6 patients (2 videothoracoscopy) we repaired the large defects with polypropylene mesh. Videothoracoscopy achieved
significant good results compared to thoracotomy in operative time (85 ± 7.9 versus 110 ± 11.3 min, p < 0.01), 24-h visual analog scale (3.5 ± 1.1 versus 6.7 ± 3.9, p < 0.01), hospital stay (2.6 ± 0.5 versus 6.4 ± 1.2 days, p < 0.01), and acceptance score (4.3 ± 0.5 versus 3.1 ± 0.8, p < 0.05). Postoperative course was always uneventful. Patients were followed for an average period of 58.6 ± 14.7 and 109.7 ± 43.5
months, respectively: no recurrences were found in any group.
Conclusions We believe that the transthoracic approach is a safe and effective method for repairing Morgagni’s hernia. The videothoracoscopic
approach is a promising alternative and it may be facilitated by introducing a hand inside the chest.
This study has been carried out within the Research Fellowship Program Dottorato di Ricerca in Tecnologie e Terapie Avanzate
in Chirurgia, appointed by Tor Vergata University and was supported in part by the Ministry of Health (60%) 相似文献
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Rectocele repair: when and how? 总被引:1,自引:0,他引:1
Pelvic organ prolapse repair poses a unique challenge to the reconstructive pelvic surgeon. Traditional levator plication
has been promoted for the past century and has recently been shown to create unsatisfactory functional results, among them
dyspareunia. In an attempt to improve both functional and quality-of-life outcomes, new methods for posterior vaginal wall
defect repair have been developed and are now undergoing critical evaluation. We present a review of posterior vaginal wall
repair with a focus on new anatomic concepts and site-specific rectocele repair. 相似文献
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Eugene O. Dickens Ramachandra Kolachalam Anthony Gonzalez Christopher Richardson Lawrence D’Amico Jorge Rabaza Reza Gamagami 《Journal of robotic surgery》2018,12(4):713-718
Inguinal hernia repair (IHR) is performed through either an open or minimally invasive approach (MIS). MIS allows for exploration and potential repair of an occult contralateral hernia. The aim of this study is to evaluate complications associated with intraoperative contralateral exploration and repair through robotic-assisted (da Vinci®) IHR. 652 robotic-assisted inguinal hernia procedures were uniformly and retrospectively collected from seven surgeons. Incidental contralateral findings were evaluated and populations with and without contralateral findings were compared in terms of demographics, operative characteristics and complications. This case series includes the earliest cases in each surgeon’s robotic-assisted IHR experience. Seventy-one percent (71%) of patients presented with a unilateral hernia. Intraoperative/incidental contralateral (“occult”) hernias were found in 12.3% of patients with a unilateral diagnosis. For patients with and without contralateral findings, there were no significant differences in demographics and baseline health characteristics. Perioperative morbidity was statistically similar between groups: intraoperative complications (0 vs 0.5%, p?=?1.000), postoperative complications prior to discharge (0 vs 3.2%, p?=?0.38) and from discharge through 30 days (5.3 vs 4.0%, p?=?0.72), as well as readmissions and reoperations related to the repair within 30 days. Differences in setting of care, length of stay, rate of blood transfusions, concomitant procedures and conversions were nonsignificant. Mean operative time was longer in patients with a contralateral hernia by 19 min (p?<?0.0001). Intraoperative contralateral exploration and subsequent repair during robotic-assisted IHR does not compromise perioperative patient morbidity. These study results support the increasing evidence for repair of contralateral, incidentally discovered inguinal hernias.Clinicaltrials.Gov ID number: NCT02684448. 相似文献