Surgical options in the management of groin hernias.
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Inguinal and femoral hernias are the most common conditions for which primary care physicians refer patients for surgical management. Hernias usually present as swelling accompanied by pain or a dragging sensation in the groin. Most hernias can be diagnosed based on the history and clinical examination, but ultrasonography may be useful in differentiating a hernia from other causes of groin swelling. Surgical repair is usually advised because of the danger of incarceration and strangulation, particularly with femoral hernias. Three major types of open repair are currently used, and laparoscopic techniques are also employed. The choice of technique depends on several factors, including the type of hernia, anesthetic considerations, cost, period of postoperative disability and the surgeon's expertise. Following initial herniorrhaphy, complication and recurrence rates are generally low. Laparoscopic techniques make it possible for patients to return to normal activities more quickly, but they are more costly than open procedures. In addition, they require general anesthesia, and the long-term hernia recurrence rate with these procedures is unknown. (+info)
Histological changes in the rat common carotid artery induced by aneurysmal wrapping and coating materials.
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Histological changes in and around the arterial walls of rats were investigated following topical application of aneurysmal wrapping and coating materials, including a fibrin glue, a cyanoacrylate glue (Biobond), and cotton fibers (Bemsheet). Bilateral common carotid arteries were exposed using sterile techniques, and one of the test materials was applied to the right artery. The left artery was used as the control. Changes in arterial histology were evaluated at 2 weeks, 1 month, 2 months, and 3 months after surgery. The fibrin glue was surrounded by intense inflammation at 2 weeks after surgery. Both the fibrin glue and inflammation had disappeared at 2 months, but the glue had induced mild inflammation in the adventitia. Biobond caused chronic inflammation, necrosis of the media, and thickening of the arterial wall due to fibrosis in both the media and adventitia. Bemsheet produced chronic inflammation, progressive fibrosis, and granuloma. Connective tissue increased in the adventitia, but no major changes were observed in the media. The Bemsheet fibers remained unchanged, and adhered to the arterial wall. Although arterial stenoses were not observed in the present study, the results suggest that cyanoacrylate glue can cause the arterial occlusive lesions observed following aneurysm surgery. (+info)
Inguinal hernia repair: a survey of Canadian practice patterns.
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OBJECTIVE: To describe the preferences of general surgeons across Canada with respect to hernia repair technique. DESIGN: A survey by mailed questionnaire. PARTICIPANTS: All 1452 fellows of the Royal College of Physicians and Surgeons of Canada currently holding a certificate in general surgery. INTERVENTION: Two mailings of the survey: the first in December 1996, the second to nonrespondents in February 1997. MAIN OUTCOME MEASURES: Surgeons' preference of hernia repair technique for specified indications. This was analysed according to practice setting and geographic location. MAIN RESULTS: Based on 706 completed questionnaires, the preferred techniques for repair of primary inguinal hernias were as follows: 23% Bassini, 20% mesh plug, 16% Lichtenstein, 15% laparoscopic, 11% Shouldice and 11% McVay. Preference for laparoscopic repair increased to 34% for recurrent hernias and 35% for bilateral hernias. The Atlantic provinces had the lowest preference rates for laparoscopic repair and the highest rates for the mesh plug technique. CONCLUSIONS: Most surgeons select the type of repair on the basis of the clinical scenario. Large variations in practice exist between provinces. (+info)
Comparison of laparoscopic vs open modified Shouldice technique in inguinal hernia repair.
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Inguinal hernia repair has been a common procedure performed by general surgeons. Recently, a newly developed approach has been introduced using the pre-peritoneal laparoscopic repair. The laparoscopic approach allows patients to recover faster, with less pain, however, a disadvantage is the higher cost. We conducted a retrospective study of inguinal hernia repairs performed by one surgeon at the same institution, comparing the laparoscopic technique to the modified Shouldice procedure with regard to surgical time, postoperative recovery time, charge, and time to return to work and to activities. Patients undergoing laparoscopic hernia repairs were able to return to work and to activities sooner than patients undergoing the modified Shouldice procedure. The results obtained in this study showed a higher charge for the laparoscopic procedure, with longer surgical and recovery room time. The more rapid return to work and activities may outweigh the higher charge and longer surgical and recovery room time. (+info)
Mesh-and-glue technique to prevent leakage of cerebrospinal fluid after implantation of expanded polytetrafluoroethylene dura substitute--technical note.
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Expanded polytetrafluoroethylene (ePTFE) can be used as a dura substitute but is associated with leakage of cerebrospinal fluid (CSF) through the suture line. Fibrin glue alone may not prevent this problem. This new method for sealing the suture line in ePTFE membrane uses an absorbable polyglycoic acid mesh soaked with fibrinogen fluid placed on the suture line. Thrombin fluid is then slowly applied to the wet mesh, forming a large fibrin membrane reinforced by the mesh over the suture line. Only one of 33 patients in whom this technique was used had CSF leakage, whereas 12 of 59 patients in whom a dural defect was closed with ePTFE alone showed postoperative subcutaneous CSF collection (p < 0.05). Our clinical experiences clearly show the efficacy of the mesh-and-glue technique to prevent CSF leakage after artificial dural substitution. Mesh and glue can provide an adequate repair for small dural defect. The mesh-and-glue technique may also be used for arachnoid sealing in spinal surgery. (+info)
Transcatheter closure of secundum atrial septal defects with the new self-centering Amplatzer Septal Occluder.
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AIMS: The study was set up to find out whether a new self-centering prosthesis for transcatheter closure of secundum atrial septal defects could overcome the disadvantages of previously described devices. METHODS AND RESULTS: Fifty-two consecutive patients with a significant atrial septal defect were considered for transcatheter closure with the Amplatzer Septal Occluder. The device, made of a Nitinol and polyester fabric mesh, provides a different approach to defect occlusion by stenting the atrial septal defect up to a stretched diameter of 26 mm. Three infants whose large defects were demonstrated on a transthoracic echocardiogram were excluded from transcatheter treatment. On transoesophageal echocardiography, 49 defects ranged from 6-26 mm, in one adult the defect measured 28 mm and this patient was excluded from attempted transcatheter closure. At cardiac catheterization in five further patients, devices were not implanted, in two because the stretched diameter exceeded 26 mm and in three the device was withdrawn because it was unstable or compromised the mitral valve. Thus, device closure was performed in 43 patients. At follow-up after 3 months the complete closure rate was 97%. CONCLUSION: The self-centering Amplatzer Septal Occluder is very efficient and user-friendly and offers interventional closure in 83% of an unselected group of patients presented with an atrial septal defect. (+info)
Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair: a randomized multicenter trial (SCUR Hernia Repair Study).
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OBJECTIVE: To evaluate the influence of the laparoscopic technique in hernia repair regarding time to full recovery and return to work, complications, recurrence rate, and economic aspects. SUMMARY BACKGROUND DATA: Several studies have shown advantages in terms of less pain and faster recovery after laparoscopic hernia repair, whereas others have not, and the cost-effectiveness has been questioned. The laparoscopic technique must be thoroughly compared with the open procedures before its true place in hernia surgery can be defined. METHODS: Six hundred thirteen male patients aged 40 to 75 years were randomized to the conventional procedure, preperitoneal mesh placed by the open technique, or laparoscopic preperitoneal mesh (TAPP). Follow-up was after 7 days, 8 weeks, and 1 year. RESULTS: Of 613 patients undergoing surgery, 604 (98.5%) were followed for 1 year. Patients who underwent TAPP gained full recovery after 18.4 days, compared with 24.2 days for open mesh (p < 0.001) and 26.4 days for the conventional procedure (p < 0.001). Patients who underwent TAPP returned to work after 14.7 days, compared with 17.7 days for open mesh (p = 0.05) and 17.9 days for the conventional procedure (p = 0.04). They also had significantly less restriction in physical activities after 7 days. The TAPP procedure was more expensive, mainly as a result of longer surgical time and equipment costs, even after compensation for earlier return to work. Complications were more common in the TAPP group, with a varying pattern between the groups. Four recurrences in the conventional, 11 in the open mesh, and 4 in the TAPP group were recorded after 1 year (p = n.s.). CONCLUSION: The laparoscopic technique results in both shorter time to full recovery and shorter time to return to work, at the price of substantially increased costs. (+info)
The use of titanium surgical mesh-bone graft composite in the anterior thoracic or lumbar spine after complete or partial corpectomy.
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Various conditions such as fracture, dislocation, tumor, or infection adversely affect the vertebral body and lead to instability. Restoration of a stable anterior column is essential for normal spinal biomechanics. Various biological and mechanical spacers have been used to reconstruct the anterior column after corpectomy. In this retrospective review, the authors evaluated clinical charts and radiographs of 13 patients receiving titanium surgical mesh (TSM)-bone graft composite to reconstruct the anterior spinal column in the thoracic or lumbar region. The objective of this review was to evaluate the stability and efficacy of the TSM-bone graft composite in the anterior spine after a complete or partial corpectomy. Sixteen patients with involvement of the thoracic or lumbar vertebral column after trauma, tumor, or infection underwent partial or complete corpectomy. In all patients the anterior defect was reconstructed using a TSM-bone graft composite. Three patients died within 12 months postoperatively due to primary malignant process. Thirteen of 16 patient charts and radiographs were evaluated for anterior fusion status, settling of the TSM-bone graft composite, and hardware failure. No pseudoarthroses were noted. Evidence of solid anterior fusion was noted in all patients. The average settling of the TSM-bone graft construct was 3 mm. All patients presenting with only pain and no neurological symptoms (n = 9) experienced early pain relief. For patients presenting with neurological symptoms (n = 4), the recovery was complete in three and partial in one. No patient was made neurologically worse, and there were no vascular injuries intra- or postoperatively. The study suggests that TSM-bone graft composite offers excellent biomechanical stability in the immediate postoperative period, permitting progressive maturation of the fusion mass. (+info)