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51.
Luigi Bonavina Davide Bona Greta Saino Claudio Clemente 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(5):653-656
Background Benign esophageal pseudoachalasia is a rare condition.
Discussion We report the case of a 70-year-old man who complained of severe dysphagia after laparoscopic Nissen fundoplication and crural
mesh repair performed for long-standing gastroesophageal reflux disease. Severe dysphagia and nocturnal aspiration developed
soon after the operation. A marked dilatation of the esophageal body and a manometric pattern resembling achalasia was documented.
Results Endoscopic balloon dilatation was ineffective. Five months after the initial operation, the patient underwent revisional laparoscopic
surgery that consisted of Nissen’s wrap takedown, enlargement of the hiatus with partial resection of the mesh, Heller myotomy,
and Dor fundoplication. After a 2-year follow-up, the patient is doing well and is free of symptoms. 相似文献
52.
Background: Abdominal lipectomy is becoming an increasingly common surgical procedure in patients with esthetic deformities
resulting from massive weight loss induced by bariatric surgery. Sometimes a midline incisional hernia coexists with the pendulus
abdomen. Herein presented is a technique to perform a retromuscular mesh repair of the incisional hernia while sparing the
umbilicus.
Methods: The abdominal lipectomy with concomitant retro-muscular mesh repair of a midline incisional hernia is done sparing
the vascular supply of the umbilicus on one side only.
Results: 5 consecutive women with pendulus abdomen resulting from bariatric surgery-induced massive weight loss and concomitant
midline incisional hernia underwent abdominal lipectomy and incisional hernia mesh repair. Mean BMI was 28.6 kg/m2 (range 26–35), one patient was a smoker, and another had type 2 diabetes requiring oral hypoglycemic agents. Two patients
had had a previous incisional hernia repair with intraperitoneal mesh. One patient had partial necrosis of the umbilicus and
another experienced necrosis of only the epidermis that recovered fully.
Conclusions: The umbilicus can be safely spared during abdominal lipectomy with concomitant midline incisional hernia mesh
repair. Recurrent incisional hernia and common risk factors for wound healing such as diabetes and obesity increase the risk
of umbilical necrosis. 相似文献
53.
54.
Abstract
Background. The EU Hernia Trialists Collaboration was established to provide reliable evaluation of newer methods of groin hernia repair.
It involved 70 investigators in 20 countries.
Materials and methods. Twenty eligible trials (5016 participants) of open mesh vs. non-mesh groin hernia repair were identified. Meta-analysis was
performed using raw individual patient data where possible.
Results. Fewer hernia recurrences were reported after mesh repair. There were no clear differences between mesh and non-mesh groups
in complications. Overall, those in the mesh groups had a shorter hospital stay, quicker return to usual activities and less
frequent persisting pain, but individual trial results varied.
Conclusions. The review provides strong evidence that open mesh repair is associated with a reduction in the risk of recurrence of between
50% and 75%. There is also some evidence of quicker recovery and of lower rates of persisting pain following open mesh repair.
Electronic Publication 相似文献
55.
Entero-colocutaneous fistula: a late consequence of polypropylene mesh abdominal wall repair: case report and review of the literature 总被引:3,自引:6,他引:3
Background. The underlying risk associated with visceral mesh erosion is the close opposition of adjacent intestines to the prosthetic
graft. This highly morbid condition has been described with most types and techniques of abdominal wall mesh repair.
Patient. We report the case of a 52-year-old man who presented with an entero-colocutaneous fistula 10 years after prosthetic mesh
repair of an incisional hernia. The fistula was excised and the abdominal wall defect repaired with a tissue-impervious composite.
Conclusions. The use of a tissue-impervious barrier avoids development of enteric fistula when a prosthesis is placed directly over the
viscera.
Electronic Publication 相似文献
56.
Abstract
Background. To avoid the adverse consequences of abdominal compartment syndrome and to reduce the high mortality the celiotomy wound
in patients with abdominal sepsis was closed without tension using prosthetic mesh. This produces a semiopen situation that
permits staged reinterventions together with the functional reconstitution of the continuity of the abdominal wall.
Material and Methods. Twenty-five patients with intra-abdominal sepsis of various causes were evaluated retrospectively to assess the results of
semiopen management of the septic abdomen and reoperations on demand in severe peritonitis. All of the patients were in a
state of neglected peritonitis, and had at least one failing organ system. The Mannheim Peritonitis Index (MPI) scoring system
was used for stratification of abdominal sepsis.
Results. The mean MPI score of 25 patients was 24, ranging 10 to 33. Eight (32%) patients were reexplored (MPI=21). There were overall
9 (36%) complications in patients with mean MPI score of 23. Six (24%) mesh-related complications (infection and enterocutaneous
fistulas) developed (MPI=19). The mean MPI score of patients without complications was 24. Four (16%) patients died with index
MPI score of 26 due to fulminant hepatitis, myocardial infarction, and multiple organ failure. The admission period averaged
63 days.
Conclusions. In 25 critically ill patients with abdominal sepsis the mortality was lower than expected, relative to heterogeneous data
from the literature; also, major complications occurred less frequently although the mean MPI score was high. The authors
conclude that this approach is a reliable contribution to the complex treatment of these patients.
Electronic Publication 相似文献
57.
Michael A. Patterson William W. Hager Anil V. Rao 《Optimal control applications & methods.》2015,36(4):398-421
A mesh refinement method is described for solving a continuous‐time optimal control problem using collocation at Legendre–Gauss–Radau points. The method allows for changes in both the number of mesh intervals and the degree of the approximating polynomial within a mesh interval. First, a relative error estimate is derived based on the difference between the Lagrange polynomial approximation of the state and a Legendre–Gauss–Radau quadrature integration of the dynamics within a mesh interval. The derived relative error estimate is then used to decide if the degree of the approximating polynomial within a mesh should be increased or if the mesh interval should be divided into subintervals. The degree of the approximating polynomial within a mesh interval is increased if the polynomial degree estimated by the method remains below a maximum allowable degree. Otherwise, the mesh interval is divided into subintervals. The process of refining the mesh is repeated until a specified relative error tolerance is met. Three examples highlight various features of the method and show that the approach is more computationally efficient and produces significantly smaller mesh sizes for a given accuracy tolerance when compared with fixed‐order methods. Copyright © 2014 John Wiley & Sons, Ltd. 相似文献
58.
Ian RP Sunderland Glenn Edwards James Mainprize Oleh Antonyshyn 《CANADIAN JOURNAL OF PLASTIC SURGERY》2015,23(2):95-99
Prefabricated, patient-specific alloplastic implants for cranioplasty reduce surgical complexity, decrease operative times, minimize exposure and risk of contamination, and have resulted in improved aesthetic results. However, in creating a prefabricated custom implant using a patient’s computed tomography data, a stable, unalterable defect must be clearly defined before surgery. In the event that an intraoperative modification of an exiting skull defect is required, or in cases of tumour resection in which the size of the skull defect is unknown preoperatively, these prefabricated implants cannot be used. The ideal method for alloplastic cranioplasty would enable cost-effective creation of a patient-specific implant with the capacity for intraoperative modification.The present article describes a novel technique of cranioplasty that uses a patient’s computed tomography data to create a custom forming tool (ie, mold), enabling intraoperative creation of a patient-specific titanium mesh implant. The utility of these implants in creating a custom reconstructive solution in cases in which the size of the skull defect is unknown preoperatively will be demonstrated using two case presentations. 相似文献
59.
Aim: The method of mesh fixation remains an issue of argument in laparoscopic totally extraperitoneal inguinal hernia repair. Laparoscopic staplers, bioactive tissue glues and tacks had been used by various institutions for the same purpose. In the present article, we describe the percutaneous subcutaneous suture technique, which is an inexpensive method of mesh fixation in laparoscopic inguinal hernia repair. Methods: We carried out a retrospective case series review of cases with laparoscopic totally extraperitoneal inguinal hernia repair carried out in Pok Oi Hospital, Hong Kong from 19 November 2008 to 4 June 2009. Mesh fixation by percutaneous subcutaneous suture technique was carried out for patients with large hernial defects (≥ 4 cm), bilateral or recurrent hernias. Results: One out of 31 hernioplasties (3.2%) carried out with mesh fixation was complicated by recurrence up to 3 months of median follow up. Conclusion: We describe our alternative method of mesh fixation by percutaneous subcutaneous suture technique in laparoscopic totally extraperitoneal inguinal hernia repair. However, further clinical studies are required to elaborate the benefits and long-term results of this method. 相似文献
60.
Background Groin pain in athletes is caused by a wide range of musculoskeletal disorders. Occasionally, a palpable bulge at the external
ring or ultrasound may not demonstrate a hernia. When athletes do not respond to conservative treatment, a “sports” hernia
should be considered.
Methods A retrospective review of 750 laparoscopic preperitoneal hernias was performed. A sports hernia was defined as a tear in the
transversalis fascia that was not evident by preoperative physical exam. A 7 × 10-cm biologic mesh, Surgisis, was placed,
uncut, over the myopectinate orifice and fixed with five tacks or fibrin glue. Patients were followed up at 2 and 6 weeks,
6 months, and 1 year.
Results Ten professional and amateur athletes were found to have sports hernias. Operative time averaged 32 min. There were no major
complications. All athletes returned to full activities in 4 weeks. Only one patient did not show improvement in his symptoms.
No patient developed a recurrent hernia.
Conclusions Laparoscopic exploration should be considered in athletes with chronic groin pain that does not improve after conventional
treatments have failed. Furthermore, biologic mesh (Surgisis) should be considered for the repair of inguinal sports hernias. 相似文献