Inguinal hernia repair with porcine small intestine submucosa: 3-year follow-up results of a randomized controlled trial of Lichtenstein's repair with polypropylene mesh versus Surgisis Inguinal Hernia Matrix

Background

The aim of this study was to evaluate the safety and efficacy of Lichtenstein's hernioplasty using Surgisis Inguinal Hernia Matrix (SIHM; Cook, Bloomington, Indiana) compared with polypropylene (PP; Angiologica, Pavia, Italy).

Methods

This was a prospective, randomized, double-blind trial comparing Lichtenstein's inguinal hernioplasty using SIHM versus PP.

Results

Seventy male patients underwent Lichtenstein's hernioplasty (n = 35 in the SIHM group and n = 35 in the PP group). At 3 years after surgery, there were 2 deaths (5.7%) in the PP group and 1 death (2.9%) in the SIHM group (not significant [NS]). Although the study was underpowered to evaluate the recurrence rate, only 1 recurrence (2.9%) was seen in the PP group (NS). Although a significant decrease in postsurgical pain incidence was never observed among patients in the SIHM group, a significantly lower degree of pain was detected at rest and on coughing at 1, 3, and 6 months and on movement at 1, 3, and 6 months and 1, 2, and 3 years. A significant decrease in postsurgical incidence and degree of discomfort when coughing and moving were observed among patients in the SIHM group at 3 and 6 months and at 1, 2, and 3 years after surgery.

Comments

SIHM hernioplasty seems to be a safe and effective procedure.     

Does type of mesh used have an impact on outcomes in laparoscopic inguinal hernia?

Background

Theoretically, a lighter and softer mesh may decrease nerve entrapment and chronic pain by creating less fibrosis and mesh contracture in laparoscopic inguinal hernia repair.

Methods

We performed a telephone survey of patients who underwent laparoscopic inguinal hernia surgery between 2001 and 2007. We recorded patient responses for chronic pain, foreign body sensation, recurrence, satisfaction, and return to work, and then studied the effect of type of mesh (polypropylene vs polyester) on these factors.

Results

Of 109 consecutive patients surveyed (mean age, 54.5 y), 67 eligible patients underwent 84 transabdominal extraperitoneal procedures and 2 transabdominal preperitoneal procedures. Patients with polypropylene mesh had a 3 times higher rate of chronic pain (P = .05), feeling of lump (P = .02), and foreign body perception (P = .05) than the polyester mesh group. Our overall 1-year recurrence rate was 5.9%. The recurrence rate was 9.3% for the polypropylene group and 2.9% for the polyester group (P = .26).

Conclusions

A lightweight polyester mesh has better long-term outcomes for chronic pain and foreign body sensation compared with a heavy polypropylene mesh in laparoscopic inguinal hernia repair. We also saw a trend toward higher recurrence in the polypropylene group.     

A prospective, randomized, controlled study comparing Gynemesh®, a synthetic mesh, and Pelvicol®, a biologic graft, in the surgical treatment of recurrent cystocele

We compared safety and efficacy of Gynemesh PS® and Pelvicol® for recurrent cystocele repair. One hundred ninety patients were randomly divided into Gynemesh PS® and Pelvicol® groups and underwent tension-free cystocele repair. The Chi-square test was used to compare categorical variables, the paired t test for continuous parametric variables, and the Mann–Whitney test for continuous nonparametric variables. Ninety-six Gynemesh PS® patients and 94 Pelvicol® patients were studied. Mesh erosions occurred in 6.3% of Gynemesh PS® patients. No erosions were observed in Pelvicol® patients (p?=?0.02). Objective cure was 71.9% for Gynemesh PS® and 56.4% for Pelvicol® (p?=?0.06). Subjective cure was the same in both groups except for better sexuality in the Pelvicol® group. At 24 months follow-up, only Gynemesh PS® patients had mesh erosions. Anatomical outcome was similar in the two groups. Pelvicol® gave a better impact on voiding and sexuality.     

基于FAERS数据库对复发缓解型多发性硬化症一线治疗口服药物不良事件的挖掘与分析

目的:对复发缓解型多发性硬化症(relapsing remitting multiple sclerosis,RRMS)一线治疗口服药物芬戈莫德、特立氟胺、富马酸二甲酯和西尼莫德的不良事件(adverse events,AE)报告进行分析,挖掘不良反应(adverse drug reaction,ADR)风险信号,对比其差异性,为临床合理用药提供参考。方法:采用比值失衡法对报告系统收录的4种RRMS一线治疗药物的AE报告进行信号挖掘。结果:检索到芬戈莫德AE报告55634份,特立氟胺21533份,富马酸二甲酯74501份,西尼莫德4018份,女性多于男性;主要上报国家是美国;发生严重AE的结局占10.78%~16.25%。4种目标药物均累及神经系统疾病,包括多发性硬化症复发、头痛和步态障碍等。另外,芬戈莫德出现脂溢性角化病、皮肤血管瘤和淋巴细胞计数减少等风险信号;特立氟胺出现膀胱疾病、肌肉无力和腹泻等信号、富马酸二甲酯需关注胃病、核磁共振成像异常和淋巴细胞计数减少等信号;西尼莫德出现黄斑水肿、心率下降和淋巴细胞计数减少等信号。结论:ADR风险信号与累及系统基本与说明书一致,证明研究的可靠性。RRMS一线治疗口服药物的风险信号有所差异,可为临床用药提供参考。     

丙酚替诺福韦对比替诺福韦酯治疗HBeAg阳性乙肝患者的成本-效果分析

目的:对比丙酚替诺福韦和替诺福韦酯治疗HBeAg阳性乙肝患者的治疗效果和成本,进行成本-效果分析,优选治疗方案。方法:收集2020年1月至2021年12月石家庄市第五医院收治确诊为HBeAg阳性的慢性乙型肝炎、应用丙酚替诺福韦和替诺福韦酯进行抗病毒治疗的患者临床资料,筛选后共252例入组,根据使用药物分为丙酚替诺福韦组和替诺福韦酯组,规范治疗48周。对2组患者治疗48周时HBV-DNA阴转率进行统计分析,比较治疗效果;同时统计患者的治疗成本(药品费用、检查费用、住院费用),进行成本-效果分析,比较2组药物治疗的经济性。结果:2组患者在治疗48周时,治疗效果对比无统计学意义。治疗过程中,2组中重症患者的住院例数(占比)分别为16/29(55.17%)和11/38(28.95%),对比具有统计学意义(χ²=4.70,P=0.03)。在非住院患者中,成本-效果分析显示替诺福韦酯组优于丙酚替诺福韦组,增量成本-效果比为418.64;在住院患者中,成本-效果分析显示替诺福韦酯组劣于丙酚替诺福韦组,增量成本-效果比为-157.53。结论:2组药物的治疗效果无明显差异。对非住院治疗的患者来说,替诺福韦酯为优选方案,建议优先选用;但对于住院治疗的重症患者来说,建议选用丙酚替诺福韦以降低住院率,减轻患者经济负担。     

补片修补巨大腹壁切口疝16例报告

目的总结聚丙烯网片补片修补巨大腹壁切口疝的临床经验。方法回顾性分析2003年4月-2008年10月亳州市人民医院普外科治疗16例巨大腹壁切口疝患者的临床资料。结果手术操作、缝合方式、放置引流管、预防性抗生素应用及术前提高腹壁顺应性为影响愈合的主要因素。16例患者均痊愈出院,无严重并发症出现。结论应用补片法修补腹壁巨大切口疝效果良好,手术损伤小,术后恢复快,围手术期处理妥善可避免术后并发症发生。     

HIF and fumarate hydratase in renal cancer

Hereditary leiomyomatosis and renal cell cancer is a recently described hereditary cancer syndrome in which affected individuals are predisposed to the development of leiomyomas of the skin and uterus. In addition, this clinical entity also can result in the development of biologically aggressive kidney cancer. Affected individuals harbour a germline mutation of the fumarate hydratase (FH) gene, which encodes an enzyme that catalyses conversion of fumarate to malate in the Kreb's cycle. Thus far, proposed mechanisms for carcinogeneis associated with this syndrome include aberrant apoptosis, oxidative stress, and pseudohypoxic drive. At this time, the majority of accumulating data support a role for pseudohypoxic drive in tumour development. The link between FH mutation and pseudohypoxic drive may reside in the biochemical alterations resulting from diminished/absent FH activity. These biochemical derangements may interfere with oxygen homeostasis and result in a cellular environment conducive to tumour formation.     

Prospective histologic evaluation of intra-abdominal prosthetics four months after implantation in a rabbit model

Background

Placement of an intraperitoneal prosthetic is required for laparoscopic ventral hernia repair. The biocompatibility of these prosthetics determines the host’s inflammatory response, scar plate formation, tissue ingrowth, and subsequent mesh performance, including prosthetic compliance and prevention of hernia recurrence. We evaluated the host response to intraperitoneal placement of several prosthetics currently used in clinical practice.

Methods

A 4-cm × 4-cm piece of mesh was implanted on intact peritoneum in New Zealand white rabbits. The mesh types included expanded polytetrafluoroethylene (ePTFE) (DualMesh^®), ePTFE and polypropylene (Composix^®, heavyweight polypropylene), polypropylene and oxidized regenerated cellulose (Proceed^®, midweight polypropylene), and polypropylene (Marlex^®, heavyweight polypropylene). At four months, standard hematoxylin and eosin and Milligan’s trichrome stains of the mesh-tissue interaction were analyzed by three observers blinded to the mesh types. Each specimen was evaluated for scar plate formation, inflammatory response, and tissue ingrowth. Each of these three categories was graded on a standard scale of 1–4 (1 = normal tissue and 4 = severe inflammatory response). The scores were analyzed using Wilcoxon rank sum test with p < 0.05 as significant.

Results

Ten samples of each mesh type were evaluated. There was no difference in tissue incorporation between the groups. The mean scar plate formation was greater in the heavyweight polypropylene meshes than for DualMesh (p = 0.04). With Proceed, the reduction in scar plate formation compared with that for Composix and Marlex approached statistical significance (p = 0.07). The mean number of inflammatory cells was greater around the ePTFE when compared with the midweight polypropylene (p = 0.02) but equal to the other meshes.

Conclusions

The four prosthetic materials evaluated in this study demonstrate comparable host biocompatibility as evidenced by the tissue ingrowth. Scar plate formation around DualMesh was significantly less than that around Composix and Marlex. Interestingly, more inflammatory cells were noted surrounding the DualMesh which was equal to that of the heavyweight meshes. Proceed, a midweight polypropylene mesh, has the potential for improved patient tolerance compared to heavyweight polypropylene meshes based on its favorable histologic findings.     

Does the degree of experience for the tension-free vaginal tape procedure influence the results of the suprapubic arc sling procedure during the learning phase?

Aim The object was to evaluate whether the degree of experience for the tension-free vaginal tape (TVT) procedures influenced the early results of the suprapubic arc (SPARC) sling procedure. Materials and methods We performed the TVT from March 1999 to May 2003 and SPARC from June to April 2004 by experienced surgeon (A) and inexperienced surgeon (B), respectively. Patients were divided as four subgroups: first 50 patients who underwent the TVT by surgeon A (TVT A); first 15 patients who underwent the TVT by surgeon B (TVT B); first 50 patients who underwent the SPARC by surgeon A (SPARC A); first 15 patients who underwent the SPARC by surgeon B (SPARC B). Results Bladder perforations were noted in 4 (8.5%) in the TVT A group and 2 (13.3%) in the TVT B group, respectively (P = 0.626). There was no bladder perforation occurred in the SPARC A and B groups. The rates of transient postoperative urinary retention were 6.4% in the TVT A group and 0.0% in the TVT B group, respectively (P = 1.000). No retention occurred in the SPARC A and B groups. Stress urinary incontinence was cured by 89.4% in the TVT A group and 80.0% in the TVT B group, respectively (P = 0.388). Similar success rates were found in the SPARC A (85.4%) and SPARC B (92.3%) group (P = 1.000). Conclusion Our findings suggest that the degree of experience for the TVT procedure does not influence the results of the SPARC procedure during the learning phase.