Differences in the outcomes of scrotal vs. lateral vs. medial inguinal hernias: a multivariable analysis of registry data

Hernia - There are hardly any studies on the outcome of scrotal compared with medial and lateral inguinal hernias. Therefore, this present multivariable analysis of data from the Herniamed Registry...     

Laparoscopic surgery for the cure of colorectal cancer

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic surgery for the cure of colorectal cancer with emphasis on oncologic follow-up in particular. METHODS: A study was performed of patients with colorectal cancer treated by laparoscopy in five German centers between May 1991 and September 1997. Surgical and pathologic data were recorded in an anonymous registry database and analyzed by type of resection. Standard procedures were sigmoid or left colectomy, anterior resection, abdominoperineal resection, and right hemicolectomy. Follow-up information included incidence of local, distant, and port site recurrence and cancer-related death. RESULTS: A total of 399 patients (212 females) with a mean age of 66.6 years underwent laparoscopic curative resections (sigmoid resection, 89; left colectomy, 11; anterior resection, 157; abdominoperineal resection, 102; right hemicolectomy, 40). Conversion was necessary in 6.3 percent (n=25). Complications requiring reoperation occurred in 9 percent (n=35). Complications that were treated conservatively occurred in 27.6 percent (n=110). Thirty-day mortality was 1.8 percent (n=7). First bowel movements resumed on the third postoperative day; patients did not use analgesics after a mean of five days. Mean postoperative hospitalization was two weeks. According to International Union Against Cancer classification, 147 patients had Stage I cancer, 35 had Stage II cancer, and 217 underwent curative resection for Stage III cancer. Mean number of lymph nodes resected was 12.1. At a mean follow-up of 30 months, one port site recurrence was documented. No local recurrence was observed after curative resection of Stage I colorectal cancer. Of 399 patients, local recurrence occurred in 6 patients (Stage II, 2; Stage III, 4), and distant metastases were documented in 25 patients (Stage I, 3; Stage II, 3; Stage III, 19). The highest incidence of cancer-related death occurred after abdominoperineal resection (4.9 percent). CONCLUSION: To assess the role of laparoscopic colorectal surgery for the cure of cancer objectively, prospective randomized trials are necessary.Read at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998.     

Finite element analysis of customized implant in mandibular reconstruction after tumor resection with and without using customized surgical osteotomy guide

Objectives

The aim of this work was to compare different 12 cases (3 patients * 4 cases = 12 cases) with varying gaps between implant and bone by analyzing the effect of these gaps on implant and screws using FEM.

Methods

In each patient's case 1 using CSOG and in case 2, 3, and 4 without using CSOG tumor cutting was done. Hence in each patient zero gaps at case 1 and overcutting at case 2, 3, and 4 have obtained at different locations.

Results

FEM results reveal that in each patient's case 4 (maximum gap) was more susceptible to loosening of the screws due to higher strains (37%) and implant failure due to higher stress (28%) concentration under the same loading conditions when compared with case 1 (zero gap).

Conclusions

The study reveals that mandibular reconstruction with implant placement using CSOG can significantly enhance the stability and safety of the implant.     

Evidence of Thromboembolism Prophylaxis in Bariatric Surgery—Results of a Quality Assurance Trial in Bariatric Surgery in Germany from 2005 to 2007 and Review of the Literature

Background  Since January 1st, 2005, the current situation for bariatric surgery has been examined by means of a voluntary quality assurance study in Germany with a multicenter design in which 38 hospitals and surgical departments participated. The data are registered in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany). Methods  Data describing peri-interventional characteristics were prospectively documented in an internet online data registry. All primary bariatric procedures performed since January 1st, 2005, were registered. In addition, reoperations in patients who had previously undergone primary surgical intervention were included. As a representative excerpt from the overall prospective multicenter observational study on obesity surgery, data on the type, regimen, and time course of deep venous thrombosis (DVT) prophylaxis were documented. From the number and spectrum of complications, the incidences of clinically manifest DVT or pulmonary embolism (PE) were derived during the in-hospital course and follow-up in conjunction with the type of surgical procedure and body mass index (BMI). Results  Overall, 3,122 bariatric procedures were performed at 38 German hospitals between January 2005 and December 2007. These procedures were subdivided into 2,869 primary operations and 253 revisions (sex ratio, male to female = 25.6:74.4%). The average BMI of all patients was 48.5 kg/m2 in 2005, 48.4 kg/m2 in 2006, and 48.0 kg/m2 in 2007. In 2005 and 2006, gastric banding (GB) was the most commonly performed operation, followed by Roux-en-Y gastric bypass (RYGBP). In 2007, RYGBP was carried out in 42.1% of all bariatric procedures. Interestingly, the incidence of deep venous thrombosis (DVT) was only 0.06%, whereas PE occurred in 0.06% of patients only after hospital discharge. The DVT prophylaxis protocol used has been changed for the last 2 years: the majority of patients with a BMI above 50 kg/m2 received low-molecular-weight heparin twice a day. Conclusion  In Germany, a trend from GB to sleeve gastrectomy (SG) and malabsorptive approach has been evaluated. This trend is associated with differences of the DVT prophylaxis regimen in the profile of bariatric surgical patients depending on BMI and the type of bariatric procedure. Despite the low incidence of DVT and pulmonary embolism (PE) detected, there is a lack of evidence on a reasonable regimen for sufficient DVT prophylaxis in bariatric surgery; instead, there are only recommendations from the guidelines and statements of a specific medical society. Therefore, prospective studies are necessary to determine the optimal DVT prophylaxis for bariatric surgical patients as well as obese patients undergoing surgery.     

Application of the rapid prototyping technique to design a customized temporomandibular joint used to treat temporomandibular ankylosis

Anthropometric variations in humans make it difficult to replace a temporomandibular joint (TMJ), successfully using a standard “one-size-fits-all” prosthesis. The case report presents a unique concept of total TMJ replacement with customized and modified TMJ prosthesis, which is cost-effective and provides the best fit for the patient. The process involved in designing and modifications over the existing prosthesis are also described. A 12-year- old female who presented for treatment of left unilateral TMJ ankylosis underwent the surgery for total TMJ replacement. A three-dimensional computed tomography (CT) scan suggested features of bony ankylosis of left TMJ. CT images were converted to a sterolithographic model using CAD software and a rapid prototyping machine. A process of rapid manufacturing was then used to manufacture the customized prosthesis. Postoperative recovery was uneventful, with an improvement in mouth opening of 3.5 cm and painless jaw movements. Three years postsurgery, the patient is pain-free, has a mouth opening of about 4.0 cm and enjoys a normal diet. The postoperative radiographs concur with the excellent clinical results. The use of CAD/CAM technique to design the custom-made prosthesis, using orthopaedically proven structural materials, significantly improves the predictability and success rates of TMJ replacement surgery.     

Evaluation of the role of prophylactic antibiotics in elective laparoscopic cholecystectomy: a prospective randomized trial.

At present the use of prophylactic antibiotics in elective laparoscopic cholecystectomy is controversial. This prospective study was carried out to define the role of prophylactic antibiotics in elective laparoscopic cholecystectomy to prevent postoperative infection. Ninety three patients were randomly placed in two groups. Group A comprised of 40 while group B consisted of 53 patients. Patients in Group A received 1.5 grams of second generation cephalosporin (cefuroxime sodium) diluted in 100ml of normal saline, at the time of induction of anesthesia. Group B patients received an equal volume of normal saline only. A sample of gall bladder bile was collected by direct gall bladder puncture intra-operatively for aerobic and anaerobic culture. Age, sex, weight of the patient, American Society of Anesthesiologists classification grade, presence of diabetes mellitus, episodes of colic 30 days preceding surgery, intra-operative gall bladder rupture, stone and / or bile spillage, results of bile culture, gall bladder histology, length of hospital stay, and number of septic complications were recorded and analyzed. In group A, one patient (2.5%) had post operative wound infection and in group B, two patients (3.8%) had post operative infection which was statistically similar (p>0.1). There was no difference between the two groups in terms of demographic, intra operative and post operative denominators. Therefore the study concluded that prophylactic antibiotics did not have a significant role to play in prevention of postoperative wound infection in elective laparoscopic cholecystectomy.     

Use of rapid prototyping and three-dimensional reconstruction modeling in the management of complex fractures

Background

The production of a copy of the fracture or a deformity in a bone with a complex geometry can be one of the important applications of the integration between two modern computer-based technologies, reverse engineering (RE) and rapid prototyping (RP).

Methods

This article reviews recent development in this field and present a case series about the use of medical CT/MRI scanning, three-dimensional reconstruction, anatomical modeling, computer-aided design, RP and computer-aided implantation in treating a complex fracture of acetabulums, calcaneum, and medial condyle of femur (Hoffa's fracture).

Conclusion

The use of RP technology helped us to understand the fracture configuration and to achieve near anatomical reduction. With this we believe, this technology will reduce the surgical time as was observed in our cases. This consequently, will lower the requirement of an anesthetic dosage and decrease the intraoperative blood loss.In summary, the merging of computational analysis, modeling, designing, and fabrication will serve as important means to treat conditions and fractures around joints, spine, acetabulum, and craniofacial region.

Level of evidence

Level 4, case series.     

Pseudoaneurysm of the right subclavian artery-tracheostomy tube as a causative factor

The subclavian artery pseudoaneurysm developing in a patient of axonal head injury triggered a search for possible causative factor. Intimacy between the aneurysm and the tracheostomy tube suggested possibility of constant irritation of subclavian artery by the tube leading to pseudoaneurysm. The hypothesis is supported by the short neck, long uncuffed tube and constant posture of the neck with absence of any other causative factor. Pseudoaneurysm was repaired without reconstruction of subclavian artery considering well developed collaterals.     

Kombinierte endoskopische Versorgung der Spieghel-Hernie

Spigelian hernias are rare forms of abdominal hernia but can lead to severe complications. Besides conventional techniques there are only a few reports on the successful use of minimally invasive surgery (MIS) techniques. In this paper the combination of laparoscopy and TEP (total extraperitoneal patch plasty) technique without mesh fixation is presented. In our opinion laparoscopy ?C TEP ?C laparoscopy is a logical, safe and beneficial method for treatment of Spigelian hernias.