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Cochetti G, Barillaro F, Cottini E, D'Amico F, Pansadoro A, Pohja S, Boni A, Cirocchi R, Grassi V, Mancuso R, Silvi E, Ioannidou K, Egidi MG, Poli G, Mearini E. Pneumoscrotum: report of two different cases and review of the literature. Ther Clin Risk Manag 2015; 11:581-7. [PMID: 25914539 PMCID: PMC4399391 DOI: 10.2147/tcrm.s77326] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pneumoscrotum is the term used to describe the presence of air within the scrotum and includes scrotal emphysema as well as pneumatocele. The etiology varies; in some cases, pneumoscrotum may be due to life-threatening disease like pneumothorax or Fournier gangrene. Despite this, pneumoscrotum is a rarely debated issue. We present two different cases of pneumoscrotum and a review of the literature. The first case report is about a 29 year old male patient affected by Duchenne syndrome who showed pneumoscrotum after cardiopulmonary resuscitation that was performed for asphyxic crisis and cardiovascular arrest. We carried out local puncture with an 18-gauge needle, and the pneumoscrotum was successfully solved. The second case report is about a 56 year old male with pneumoscrotum due to Fournier gangrene who underwent radical exeresis of all necrotic tissues and drainage. This is why most of the scrotal skin and all of the penis skin were removed; as a result, the testicles, epididymis, and cavernosa corpora were externalized. On postoperative day one, the patient was feverless and underwent hyperbaric chamber therapy. No postoperative complications occurred. Accurate evaluation of the pneumoscrotum is always needed. Despite the benign course of most of the clinically evident pneumoscrotum cases, this condition should never be underestimated.
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Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Francesco Barillaro
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Emanuele Cottini
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Francesco D'Amico
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Alberto Pansadoro
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Solajd Pohja
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Roberto Cirocchi
- Department of Surgical Sciences, University of Perugia, Terni, Italy
| | - Veronica Grassi
- Department of Surgical Sciences, University of Perugia, Terni, Italy
| | - Rosa Mancuso
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Elisa Silvi
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Katifenia Ioannidou
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Maria Giulia Egidi
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Giulia Poli
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
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Pneumoscrotum as complication of blunt thoracic trauma: a case report. Case Rep Surg 2013; 2013:392869. [PMID: 23401836 PMCID: PMC3557629 DOI: 10.1155/2013/392869] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 12/27/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction. Pneumoscrotum is a rare clinical entity. It presents with swollen scrotal sac and sometimes with palpable crepitus. It has many etiologies. One of them is due to blunt trauma of the thoracic cage, causing pneumothorax and/or pneumomediastinum. Case Presentation. We report the case of an 82-year-old male who was transferred to the Emergency Department with signs of respiratory distress after a blunt chest trauma. A CT scan was obtained, and bilateral pneumothoraces with four broken ribs were disclosed. Subcutaneous emphysema expanding from the eyelids to the scrotum was observed, and a chest tube was inserted on the right side with immediate improvement of the vital signs of the patient. Discussion. Pneumoscrotum has three major etiologies: (a) local introduction of air or infection from gas-producing bacteria, (b) pneumoperitoneum, and (c) air accumulation from lungs, mediastinum, or retroperitoneum. These sources account for most of the cases described in the literature. Treatment should be individualized, and surgical consultation should be obtained in all cases. Conclusion. Although pneumoscrotum itself is a benign entity, the process by which air accumulates in the scrotum must be clarified, and treatment must target the primary cause.
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Subwongcharoen S, Udompornmongkol V. A Randomized Control Trial of Levobupivacaine, Bupivacaine Versus Placebo Extraperitoneal Infusion in Totally Extraperitoneal Laparoscopic Inguinal Hernioplasty. J Surg Res 2010; 162:279-83. [DOI: 10.1016/j.jss.2009.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 12/30/2008] [Accepted: 01/20/2009] [Indexed: 11/24/2022]
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Losi P, Burchielli S, Spiller D, Finotti V, Kull S, Briganti E, Soldani G. Cyanoacrylate surgical glue as an alternative to suture threads for mesh fixation in hernia repair. J Surg Res 2010; 163:e53-8. [PMID: 20691995 DOI: 10.1016/j.jss.2010.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 04/21/2010] [Accepted: 05/04/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND In recent years, the use of synthetic glues has become an established practice in several areas of surgical treatment. For example, they are used in open and laparoscopic surgery and in digestive tract endoscopy, interventional radiology, and vascular neuroradiology. The experiments in this study were aimed at elucidating that suture-based permanent mesh fixation can be replaced by fixation with N-butyl 2-cyanoacrylate glue (Glubran2) for surgical repair of abdominal wall hernias. MATERIALS AND METHODS In 25 Wistar rats, two hernia defects (1.5 cm in diameter) per animal were created bilaterally in the midline of the abdominal wall. The peritoneum was spared. The lesions were left untreated for 10 d to achieve a chronic condition. Then the defects were covered with TiMESH extralight (2 × 2 cm) and fixed by 30 μL of Glubran2 or traditional suture. The time points of sacrifice were 17 and 28 d, 3, 4, and 5 mo. At autopsy, histology and immunohistochemistry were performed to evaluate the inflammatory response and the presence of apoptotic cells respectively. RESULTS Mesh fixation was excellent in all samples at each time point. At application sites, the inflammatory reaction was mild with a small number of macrophages and vascularized connective tissue presence around glue and mesh threads. Glue residues were observed in histologic sections at each time point. No presence of apoptotic cells was found. CONCLUSIONS This study demonstrated that Glubran2 can effectively replace traditional suture in mesh fixation without affecting tissue healing and determining a physiological inflammatory reaction at the abdominal wall site.
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Affiliation(s)
- Paola Losi
- Laboratory for Biomaterials & Graft Technology, Institute of Clinical Physiology CNR, Massa, Italy.
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Mirilas P, Mentessidou A, Skandalakis JE. Secondary internal inguinal ring and associated surgical planes: surgical anatomy, embryology, applications. J Am Coll Surg 2008; 206:561-70. [PMID: 18308229 DOI: 10.1016/j.jamcollsurg.2007.09.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 09/26/2007] [Accepted: 09/28/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Petros Mirilas
- Centers for Surgical Anatomy and Technique, Emory University School of Medicine, Atlanta, GA, USA
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Topgül K, Anadol AZ, Güngör B, Malazgirt Z. Laparoscopic bilateral hernia repair using fibrin sealant: technical report of two cases. J Laparoendosc Adv Surg Tech A 2006; 15:638-41. [PMID: 16366875 DOI: 10.1089/lap.2005.15.638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Minimally invasive surgery is widely used in hernia repair given its advantages such as minimal disturbance to the surrounding tissues, shorter hospital stay, and promising long-term results. Efforts are still being made to make this minimally invasive procedure even more minimal. New tissue adhesives avoid the use of foreign materials and the postoperative pain that might be attributed to staples. We present the first two cases of bilateral inguinal hernia repair performed with a totally extraperitoneal procedure using fibrin sealant instead of staples for the fixation of the mesh.
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Affiliation(s)
- Koray Topgül
- Department of Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey.
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Fernández-Lobato R, Tartas-Ruiz A, Jiménez-Miramón FJ, Marín-Lucas FJ, de Adana-Belbel JCR, Esteban ML. Stoppa procedure in bilateral inguinal hernia. Hernia 2006; 10:179-83. [PMID: 16432642 DOI: 10.1007/s10029-005-0061-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Accepted: 09/08/2005] [Indexed: 11/25/2022]
Abstract
The Stoppa procedure is a very safe repair of bilateral inguinal hernia, but it requires a learning period to achieve optimal results. We present a study with our experience and learning curve for this technique. Two hundred and ten patients with bilateral inguinal hernia (420 hernias) were repaired with Stoppa procedure from January 1995 to December 2003 with an average age of 57.2 years (range 28-89 years), with 8 women and 202 men (96%). Emergency surgery was performed for incarcerated hernia in six cases (2.8%). The rates of recurrent hernias, concomitant disease and associated surgical techniques were similar in all the years. Operative time decreased from 100 min (1995) to 61-66 min (2001-2003). Drain remained in place in 100% (1995), and 0% (2003). Regional anaesthesia was performed in 25% (1995) and 80-90% in the last years; hospital stay decreased from 5.1 to 1.2 days (2003), and morbidity from 50% (1995) to 12-16% (P<0.0001). There were three recurrences, two in the first 30 cases (6.6%), and one in the remaining 180 (0.5%) (4-92 months follow-up). The procedure was introduced in 1995 by one surgeon, performing 100% of cases, being accepted progressively by other surgeons. The first 25-30 cases of a surgical technique are the learning curve, with the highest rate of morbidity, time, technical and operative difficulties, and long hospital stay. As a result of the first surgeon's experience, some modifications of the technique are developed and results improved.
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Golash V. Technique of suturing the mesh in laparoscopic total extra peritoneal (TEP) repair of inguinal hernia. Surgeon 2004; 2:264-72. [PMID: 15570845 DOI: 10.1016/s1479-666x(04)80095-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE OF STUDY For laparoscopic repair of inguinal hernia, total extraperitoneal approach is the procedure of choice. The insertion of a mesh in laparoscopic total extraperitoneal repair (TEP) of an inguinal hernia with proper orientation and spreading it without wrinkles and folds in the preperitoneal space, however, is difficult to learn and carry out. Prolene mesh is also known to shrink and sometimes get displaced in the preperitoneal space giving rise to recurrences. We describe here an easy innovative technique of insertion of mesh and suture fixation. The surgeon has full control over the mesh and placement is accurate. METHOD AND RESULTS One hundred hernias in 78 male patients were repaired. The same technique was used in all the patients and by one surgeon. In the technique, three midline ports were used. A dissection balloon and Tackers were not used. The mesh was fixed by sutures at the anatomical line joining the two anterior superior iliac spines with the help of suture hooks. There were no recurrences in 24 months of follow-up. There were no intraoperative complications. Mean operative time was 35 minutes. There was no conversion to an open or intraperitoneal approach. There was no incidence of mesh or wound infection. CONCLUSION Many surgeons believe that the recurrence rate will increase when the mesh is not fixed. My technique of fixing the mesh is easily reproducible and economical. TEP with suturing the mesh is now my standard approach for inguinal hernia repair.
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Affiliation(s)
- V Golash
- Department of Surgery, Sultan Qaboos Hospital, PO. Box 98, Salalah, Pin Code 211, Sultanate of Oman.
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Bar-Dayan A, Natour M, Bar-Zakai B, Zmora O, Shabtai M, Ayalon A, Kuriansky J. Preperitoneal bupivacaine attenuates pain following laparoscopic inguinal hernia repair. Surg Endosc 2004; 18:1079-81. [PMID: 15156393 DOI: 10.1007/s00464-003-8214-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2003] [Accepted: 11/11/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Laparoscopic preperitoneal inguinal hernia repair is associated with a short hospital stay and an early return to normal activity. Therefore, early postoperative pain control is important. The aim of this study was to evaluate the effect of preperitoneal Bupivacaine instilled into the preperitoneal cavity on pain following laparoscopic mesh repair of inguinal hernia. METHODS After institutional review board approval, 44 patients undergoing elective laparoscopic inguinal hernia repair were prospectively randomized into two groups. Upon completion of the Prolene mesh repair, group A received 80 mg of Bupivacaine in 25 cc of saline installed into the preperitoneal space, whereas group B received normal saline installed into the preperitoneal space. Pain was assessed using a visual analog scale at fixed time intervals; the amount of analgesics required was also recorded. RESULTS Twenty-two patients were included in each group. The demographic characteristics and type of surgery (unilateral vs bilateral) did not significantly differ between the two groups. The average pain levels were significantly attenuated in group A compared to group B at 1 (4.0 vs 5.0, respectively; p = 0.0038), 2 (4.0 vs 5.9, respectively; p = 0.0015), and 4 (4.3 vs 5.8, respectively; p = 0.0038) h after surgery. Furthermore, the analgesic intake was significantly decreased in group A compared to group B. CONCLUSION Preperitoneal Bupivacaine attenuates pain following laparoscopic inguinal hernia repair and should be considered in these cases.
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Affiliation(s)
- A Bar-Dayan
- Department of Surgery, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel.
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Lange JF, Rooijens PPGM, Koppert S, Kleinrensink GJ. The preperitoneal tissue dilemma in totally extraperitoneal (TEP) laparoscopic hernia repair: an anatomo-surgical study. Surg Endosc 2002; 16:927-30. [PMID: 12163956 DOI: 10.1007/s004640090107] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2000] [Accepted: 05/17/2001] [Indexed: 11/26/2022]
Abstract
BACKGROUND One of the a main reasons for the long learning curve associated with totally extraperitoneal (TEP) laparoscopic hernia repair is an insufficient understanding of the dissection of the proper preperitoneal space. In this study, we investigated the conditions required for the correct anatomical approach to the preperitoneal space. METHODS The anatomo-surgical conditions for dissection of the correct preperitoneal space were evaluated in 10 video studies of TEP repairs. In addition, we also investigated the preperitoneal tissue layers in 10 embalmed human bodies. RESULTS The proper preperitoneal space can only be approached after cleavage of the ventral component of a bilaminar preperitoneal fascia complex, also known as the posterior lamina of the transversalis fascia. The cleavage can be accomplished spontaneously by a fully expanded balloon correctly introduced into the plane between the rectus muscle and the posterior lamina of the transversalis fascia. CONCLUSIONS The anatomy of the preperitoneal tissues in the inguinal region is complex. To gain expertise in laparoscopic totally extraperitoneal (TEP) hernia repair, the presence of a bilaminar fascia complex and the importance of the cleavage of the posterior lamina of transversalis fascia must be appreciated.
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Affiliation(s)
- J F Lange
- Department of Anatomy, The Lowlands Institute of Surgical and Applied Anatomy, Faculty of Medicin and Health Sciences, Erasmus University Rotterdam, Dr. Molewaterplein 50, 3015 GE Rotterdam, TheNetherlands.
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Losanoff JE, Jones JW. Re: Laparoscopic Repair of Inguinal Hernias with Higher Risk for Recurrence: Independent Assessment of Results from 121 Repairs. Am Surg 2002. [DOI: 10.1177/000313480206800125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Julian E. Losanoff
- Department of Surgery University of Missouri-Columbia School of Medicine Columbia, MO 65212
| | - James W. Jones
- Department of Surgery University of Missouri-Columbia School of Medicine Columbia, MO 65212
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Bringman S, Ek A, Haglind E, Heikkinen T, Kald A, Kylberg F, Ramel S, Wallon C, Anderberg B. Surg Laparosc Endosc Percutan Tech 2001; 11:322-326. [DOI: 10.1097/00019509-200110000-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bringman S, Ek A, Haglind E, Heikkinen TJ, Kald A, Kylberg F, Ramel S, Wallon C, Anderberg B. Is a dissection balloon beneficial in bilateral, totally extraperitoneal, endoscopic hernioplasty? A randomized, prospective, multicenter study. Surg Laparosc Endosc Percutan Tech 2001; 11:322-6. [PMID: 11668230 DOI: 10.1097/00129689-200110000-00007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to gain the initial working space in totally extraperitoneal endoscopic (TEP) hernioplasty, but this increases its cost. Forty-four men with bilateral, primary or recurrent inguinal hernias were randomized to undergo TEP with or without dissection balloon. There were two conversions to transabdominal preperitoneal hernioplasty, or open herniorrhaphy, in the group with balloon and four in the group without balloon. There was no difference in the postoperative morbidity or operation time between the two groups, and there were no major complications in either group. The recurrence rate was 4.3% in the group with the balloon and 7.1% in the group without the balloon. There were no statistically significant differences between the groups. Although our study population is too small to detect small differences between the groups, it seems that the use of a dissection balloon is not beneficial in a bilateral TEP.
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Affiliation(s)
- S Bringman
- Department of Surgery K53, Karolinska Institutet at Huddinge University Hospital, S-141 86 Stockholm, Sweden.
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Bringman S, Ek A, Haglind E, Heikkinen T, Kald A, Kylberg F, Ramel S, Wallon C, Anderberg B. Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty (TEP)? A randomized prospective multicenter study. Surg Endosc 2001; 15:266-70. [PMID: 11344426 DOI: 10.1007/s004640000367] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2000] [Accepted: 09/28/2000] [Indexed: 10/28/2022]
Abstract
BACKGROUND Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to facilitate the creation of the initial working space in totally extraperitoneal endoscopic hernioplasty (TEP), but their use adds to the cost of the operation. METHODS A total of 322 men with unilateral, primary, or recurrent inguinal hernias were randomized to undergo TEP with or without a dissection balloon. RESULTS In the group with the balloon, three of 161 patients (2.5%) required conversion to transabdominal preperitoneal hernioplasty (TAPP), or open herniorraphy, whereas 17 of 161 patients (10.6%) were converted to TAPP or open herniorraphy in the group without the balloon (p = 0.002). The mean operation time was 55 min in the group with the balloon and 63 min in the group without the balloon (p = 0.004). There was no difference between them in postoperative morbidity, and there were no major complications in either group. The recurrence rate was 3.1% in the group with the balloon and 3.7 % in the group without the balloon (p = 0.8). CONCLUSION The use of a dissection balloon in TEP reduces the conversion rate and may be especially beneficial early in the learning curve.
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Affiliation(s)
- S Bringman
- Department of Surgery, Karolinska Institute, Huddinge University Hospital, S-141 86 Stockholm, Sweden.
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Katkhouda N, Mavor E, Friedlander MH, Mason RJ, Kiyabu M, Grant SW, Achanta K, Kirkman EL, Narayanan K, Essani R. Use of fibrin sealant for prosthetic mesh fixation in laparoscopic extraperitoneal inguinal hernia repair. Ann Surg 2001; 233:18-25. [PMID: 11141220 PMCID: PMC1421161 DOI: 10.1097/00000658-200101000-00004] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of mesh fixation with fibrin sealant (FS) in laparoscopic preperitoneal inguinal hernia repair and to compare it with stapled fixation. SUMMARY BACKGROUND DATA Laparoscopic hernia repair involves the fixation of the prosthetic mesh in the preperitoneal space with staples to avoid displacement leading to recurrence. The use of staples is associated with a small but significant number of complications, mainly nerve injury and hematomas. FS (Tisseel) is a biodegradable adhesive obtained by a combination of human-derived fibrinogen and thrombin, duplicating the last step of the coagulation cascade. It can be used as an alternative method of fixation. METHODS A prosthetic mesh was placed laparoscopically into the preperitoneal space in both groins in 25 female pigs and fixed with either FS or staples or left without fixation. The method of fixation was chosen by randomization. The pigs were killed after 12 days to assess early graft incorporation. The following outcome measures were evaluated: macroscopic findings, including graft alignment and motion, tensile strength between the grafts and surrounding tissues, and histologic findings (fibrous reaction and inflammatory response). RESULTS The procedures were completed laparoscopically in 49 sites. Eighteen grafts were fixed with FS and 16 with staples; 15 were not fixed. There was no significant difference in graft motion between the FS and stapled groups, but the nonfixed mesh had significantly more graft motion than in either of the fixed groups. There was no significant difference in median tensile strength between the FS and stapled groups. The tensile strength in the nonfixed group was significantly lower than the other two groups. FS triggered a significantly stronger fibrous reaction and inflammatory response than in the stapled and control groups. No infection related to method of fixation was observed in any group. CONCLUSION An adequate mesh fixation in the extraperitoneal inguinal area can be accomplished using FS. This method is mechanically equivalent to the fixation achieved by staples and superior to nonfixed grafts. Biologic soft fixation with FS will prevent early graft migration and will avoid the complications associated with staple use.
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Affiliation(s)
- N Katkhouda
- Division of Emergency Nontrauma and Minimally Invasive Surgery, Department of Surgery, University of Southern California School of Medicine, Los Angeles, California 90033, USA.
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Gainant A, Geballa R, Bouvier S, Cubertafond P, Mathonnet M. [Prosthetic treatment of bilateral inguinal hernias via laparoscopic approach or Stoppa procedure]. ANNALES DE CHIRURGIE 2000; 125:560-5. [PMID: 10986768 DOI: 10.1016/s0003-3944(00)00241-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM OF THE STUDY The aim of this prospective non-randomized study was to compare Stoppa's technique to laparoscopic approach in totally extraperitoneal repair of bilateral inguinal hernia. PATIENTS AND METHOD From December 1996 to December 1998, 117 consecutive patients with 234 hernias underwent either Stoppa's technique (74 patients) or a totally extraperitoneal laparoscopic approach (43 patients). Patients were randomized in two groups according to the surgeon to whom they were referred. All patients were reviewed in December 1999. RESULTS There was no mortality. Complications occurred in 3% of patients after Stoppa's technique (group S) and in 4% of patients in the laparoscopic group (group L). The conversion rate was 7% (3 cases). Postoperative analgesia use, hospital stay, and duration of disability were significantly shorter in group L, the cost was lower, but the operating time was significantly longer than in group S. Recurrence rates were similar in the two groups: 2% in group S, 1.1% in group L. CONCLUSION The laparoscopic approach appears to be preferable to Stoppa's technique in the treatment of bilateral inguinal hernia.
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Affiliation(s)
- A Gainant
- Service de chirurgie digestive, endocrinienne et générale, CHRU Dupuytren, France
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LiteratureWatch. J Laparoendosc Adv Surg Tech A 2000; 10:127-9. [PMID: 10794219 DOI: 10.1089/lap.2000.10.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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