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61.
Is parastomal hernia repair with polypropylene mesh safe? 总被引:13,自引:0,他引:13
BACKGROUND: Concern over the safety of polypropylene mesh in parastomal hernia repairs has led some to avoid its use. We reviewed our rate of complications and outcomes with polypropylene mesh. METHODS: From January 1988 through May 2002, 58 patients underwent parastomal hernia repair with polypropylene mesh. After closure of the fascia, the stoma was pulled through the center of the mesh, which was placed either above or below the fascia. Multivariate analysis was performed to determine independent predictors for the development of complications. RESULTS: There were 31 end colostomies, 24 end ileostomies, and 3 loop transverse colostomies. Mean follow-up with 50.6 months. Overall complications related to the polypropylene mesh was 36% (recurrence 26%, surgical bowel obstruction 9%, prolapse 3%, wound infection 3%, fistula 3%, and mesh erosion 2%). None of the patients had extirpation of their mesh. Complications were significantly associated with younger age (59.6 versus 67 years, P = 0.04). Cancer patients with stomas had fewer complications (P = 0.02, odds ratio 0.34). Inflammatory bowel disease, stomal type, mesh location, urgent procedures, steroid use, and surgical approaches were not significantly associated with an increased complication rate. Of the 15 patients with recurrence, 7 underwent successful repair for an overall success rate of 86%. CONCLUSIONS: Parastomal hernia repair with polypropylene mesh is safe and effective. 相似文献
62.
Imai M Kondo Y Masuko H Okada K Osawa S Ishizu H Nishida Y Hata T Uemura K Kina M Honda S Ishiyama G Takahashi T Hino A 《Surgery today》2003,33(11):864-866
A case of distant metastasis to mesh-plug prosthesis in gastrointestinal cancer is presented herein. An 88-year-old man had received mesh-plug repair with high ligation for a recurrence of a right inguinal hernia. Six months later, advanced gastric cancer and advanced transverse colon cancer were detected, and therefore a distal gastrectomy and partial colectomy were performed. Two weeks after the operation, the patient complained of right groin tenderness, and the mesh-plug prosthesis was removed to control any infection. A histopathological investigation demonstrated adenocarcinoma in the plug prosthesis. The patient died of carcinomatosis peritonei 45 days after the last operation. 相似文献
63.
Comparison of PTFE,pericardium bovine and fascia lata for repair of incisional hernia in rat model,experimental study 总被引:3,自引:0,他引:3
Incisional hernia is a frequent complication of abdominal surgery developing in 11–20 % of patients undergoing an abdominal
operation. Regarding morbidity and loss of manpower, incisional hernias continue to be a fundamental problem for surgeons.
In this experimental study, three commonly used mesh materials (Goretex PTFE; Tutoplast Fascia lata; Tutopatch Pericardium
bovine) were compared according to effectiveness, strength, adhesion formation, histological changes, and early complications.
Three groups, each consisting of 14 rats, have been formed as group A: polytetrafluoroethylene (PTFE), group B: pericardium
bovine and group C: fascia lata. Evaluations were achieved at the end of the first and second postoperative week, respectively.
Adhesion formation, wound maturation, bursting pressure, and tensile strength were evaluated. No statistically significant
difference regarding adhesion formation was observed between groups although adhesion formation was less significant in PTFE
and pericardium bovine groups than in the fascia lata group. Bursting pressure and tensile strength values were significantly
higher in PTFE group than in the fascia lata group (P <0.05). No statistically significant difference was observed between groups regarding wound maturation. In this experimental
model, PTFE and pericardium bovine were found to be superior to fascia lata in abdominal wall repair.
Electronic Publication 相似文献
64.
This paper describes a simplified technique for the repair of incisional hernias. The previous scar is resected, and the peritoneal sac is carefully dissected until it is completely exposed. The sac is opened to liberate structures adherent to the sac or to the area immediately surrounding the defect. The peritoneum is closed and invaginated to form a sac bed underlying the entire extent of the defect, and the mesh is laid on this sac bed. The mesh is then fixed with "U" stitches, reinforcing these by inserting a second line from the edge of the defect to the mesh. Suture material used is polypropylene 1/0 or 2/0. This procedure has been carried out on 15 patients, and after 1 year of follow-up, there has been no recurrence of the hernia. Operating time was reduced, and the surgical technique was found to be easier. Placing a mesh prosthesis inside the hernia sac and fixing it to the abdominal wall with two lines of suturing simplifies the repair procedure, reduces operating time, and is effective in the repair of all incisional hernias. A study is required to compare this outcome with the different mesh repair techniques. 相似文献
65.
目的:总结评价疝环充填式无张力疝修补术的经验、优点。方法:采用网片修补腹股沟疝18例。结果:18例患者近期无复发,无术后明显疼痛和牵扯感,无伤口感染和阴囊水种。结论:本手术简化了腹股沟疝修补术的步骤,减轻了患者的痛苦,而且没有改变生理解剖关系,减少了复发的发生。 相似文献
66.
Brigitte Fatton Peter L. Dwyer Chahin Achtari P. K. Tan 《International urogynecology journal》2009,20(4):427-434
Introduction and hypothesis The objective of this study is to assess anatomical and functional results of the extraperitoneal uterosacral ligament suspension
(USL) in women with post-hysterectomy vaginal vault prolapse.
Methods One hundred and twenty-three consecutive women were included. Concurrent procedures were anterior colporraphy with fascial
repair (20%) and mesh reinforcement (49%), posterior colporraphy with fascial repair (38%) and mesh reinforcement (56%) and
a sling procedure (29%). Women were assessed using Baden and Walker and pelvic organ prolapse quantification classification
pre- and post-operatively.
Results One hundred and ten patients (89%) were available for follow-up. Mean follow-up was 2 years. Objective success rate regarding
the vaginal cuff is 95.4%. Global anatomical success rate was 85.5%. Urinary, coital and bowel symptoms were improved following
surgery. Mesh exposure rate was 19.3%, with all cases managed conservatively or with minor interventions.
Conclusion Bilateral extraperitoneal USL is an effective operation to restore apical support with low morbidity, which avoids potential
risks associated with opening the peritoneal cavity. 相似文献
67.
Utility of a new soft non-woven polypropylene mesh for the transabdominal extraperitoneal laparoscopic hernia repair: preliminary results 总被引:1,自引:0,他引:1
SummaryAims Tension-free mesh reinforcement is the mainstay of laparoscopic hernia repair. Problems with current prostheses include shrinkage, migration, patient discomfort and neuralgias. We prospectively analyzed the short-term utility of a soft, non-woven mesh (Biomesh W/NK®, Cousin Biotech) in the TAPP repair.Methods During surgery, ease of insertion, unrolling, positioning and fixation of the mesh were evaluated. Postoperatively, all patients were followed up at 8 and 30 days.Results Forty-five hernias were repaired in 32 patients. Hernias were classified as Nyhus I-2; II-5; Nyhus III-33; Nyhus IV-5. Mean mesh size for unilateral hernias was 14,4 × 12.8 × 9 cm. All meshes were inserted without difficulty, and unrolled into the correct space with minimal trouble. Once in position, moving the mesh was more difficult than with a conventional woven mesh. Fixing was relatively straightforward. The mesh was noted to mould to tissues, assisting with hemostasis. At follow-up, there were no complications noted, specifically no neuralgias or seromas.Discussion Woven or knitted polypropylene mesh is commonly used for laparoscopic hernia repair, due to its ease of manipulation. However, the stiffness of such mesh probably contributes to its well-recognized complications. The Biomesh is much softer, lighter and more pliable, and can potentially reduce complications related to mesh stiffness. We have demonstrated the ease of insertion and fixation of the mesh, and the absence of short-term complications related to its use. In light of our experience, we believe that, in selected cases, the Biomesh offers an attractive alternative to traditional mesh. 相似文献
68.
Axel Meissner Marc van Bracht Max-Olav Schrage Martin Christ Hans-Joachim Trappe Petra Maagh Christian-Andreas Perings Thomas Butz Gunnar Plehn 《Journal of interventional cardiac electrophysiology》2009,25(3):183-192
Objective As opposed to fundamental investigations into the nature of atrial fibrillation (AF) current clinical studies of AF ablation
techniques sometimes only contain sparse information about the underlying electrophysiological properties. The purpose of
this prospective, pilot study was to evaluate acute therapeutic success and clinical outcome after 6 month of segmental ostial
ablation (SOA) using the High Density Mesh Mapper catheter (HDMM, BARD Electrophysiology, Lowell, MA, USA) for an electrophysiological
guided approach. The HDMM is a novel, single expandable basket electrode catheter for high resolution recordings at the left
atrium/pulmonary vein (PV) junction.
Methods SOA was performed by irrigated radiofrequency (RF) application around the HDMM. Entry- and exit conduction block, as well
as decreased local electrode amplitude, were endpoints for short-term successful ablation.
Results Seventy-two patients with highly symptomatic paroxysmal AF (PAF; 47, 65.2%), persistent AF (12, 16.7%) and permanent AF (13,
18.1%) were studied. Entrance conduction block was obtained in 93%, exit conduction block in 81% of all PV. After 6 month
no PV stenosis was observed, 62 patients (86.1%) improved clinically, whereas 52 patients (72.2%) were free from arrhythmias
and sinus rhythm was present favoring patients with PAF.
Conclusions In this first prospective study of PV isolation using the HDMM, our findings suggest, that this method is safe and yields
good primary success rates and favourable clinical outcome at 6 month. The new technology based on high resolution recordings,
offers beside good anatomical orientation a direct electrophysiological control for monitoring of bidirectional conduction
block. 相似文献
69.
BACKGROUND: Parastomal hernias can be prevented or repaired using synthetic mesh; however, reported complications include infection, fibrosis and potential bowel erosion. The study aim was to assess the safety, feasibility and potential efficacy of using a prophylactic collagen implant. METHODS: Twenty patients undergoing defunctioning stomas were randomised to a conventional procedure or reinforcement with the implant. Follow-up included regular symptom questionnaires, clinical examination, stoma site ultrasound, and serum inflammatory markers. RESULTS: Ten patients (four males; mean BMI 26.3) had a conventional stoma, and ten (three males; mean BMI 26.3) received the implant. At a median of 6.5 months follow-up, a parastomal hernia was clinically evident in three of ten patients without the implant, and in none of ten patients with the implant. There were no clinical complications, ultrasound evidence of chronic seromas or serological evidence of a systemic inflammatory response. CONCLUSIONS: Xenogeneic collagen has been demonstrated to aid soft tissue reinforcement. In this study, in contrast to published data relating to the use of conventional synthetic mesh, there were no complications related to infection or the implant's proximity to the bowel. This trial demonstrates that the implant is safe, feasible to use and has the potential to prevent parastomal herniation. 相似文献
70.
Persistent or recurrent gastro-oesophageal reflux (GOR) following Nissen fundoplication occurs in up to one in five cases,
especially if the child is neurologically impaired. We advocate the use of mesh hiatal reinforcement for patients undergoing
reoperation for GOR or if the diaphragmatic crura are thought to require reinforcement at the time of the original surgery.
Accepted: 16 May 2000 相似文献