1
|
Furlan FC, Hosokawa JA, Essu FF, Andrade-Silva FB, Silva JDS, Kojima KE. FUNCTIONAL OUTCOME OF TREATMENT OF DEVIATED OLECRANON FRACTURE (MAYO 2A) BY AN INTRAMEDULLARY SCREW WITH TENSION BAND COMPARED TO CLASSIC TENSION BAND - A PROSPECTIVE RANDOMIZED STUDY. Acta Ortop Bras 2022; 30:e256894. [PMID: 36506855 PMCID: PMC9721414 DOI: 10.1590/1413-785220223002e256894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/03/2021] [Indexed: 12/05/2022]
Abstract
Objective evaluate the functional treatment outcome of deviated transverse olecranon fractures (Mayo 2A) after treatment with tension-banded intramedullary screw (PIBT) compared to classical tension band (BTC). Methods Prospectively collect all deviated transverse olecranon fractures from 2012 to 2016 and randomize them into PIBT and BTC groups. Range of motion (ROM) was measured after 2 and 5 weeks, 3 and 6 months, and 1 and 2 years. Functional assessments (DASH, Oxford Elbow Score, and Mayo Elbow Performance Index) were performed after 3 and 6 months and 1 and 2 years. Complications were collected up to 2 years of follow-up. Results 22 patients were included, 11 in each group. The mean age was 47.9 years, and the left side was injured in 13 (59.0%) patients. All patients completed the 2-year follow-up. There was no ROM difference at any time between the two groups (p> 0.005). Flexion and extension gain was maximum at three months and remained unchanged until two years. Neither flexion nor extension returned to normal, missing around 10°. Pronation and supination returned to normal. All three functional scores showed almost complete recovery of elbow function after three months postoperatively, with no difference between the groups. No group had complications, no reoperation, and no implant removal. Conclusion PIBT had similar results in ROM and functional score compared to BTC. Both had low complication rates and no need for implant removal. Level of evidence I; Randomized Trial .
Collapse
Affiliation(s)
- Fernando Cesar Furlan
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Jacqueline Alves Hosokawa
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Felipe Futema Essu
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Fernando Brandao Andrade-Silva
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Jorge dos Santos Silva
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Kodi Edson Kojima
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| |
Collapse
|
2
|
Kato JM, Iuamoto LR, Suguita FY, Essu FF, Meyer A, Andraus W. IMPACT OF OBESITY AND SURGICAL SKILLS IN LAPAROSCOPIC TOTALLY EXTRAPERITONEAL HERNIOPLASTY. Arq Bras Cir Dig 2018; 30:169-172. [PMID: 29019555 PMCID: PMC5630207 DOI: 10.1590/0102-6720201700030002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/06/2017] [Indexed: 11/21/2022]
Abstract
Background: Laparoscopic totally extraperitoneal (TEP) hernia repair is a technically demanding procedure. Recent studies have identified BMI as an independent factor for technical difficulty in the learning period. Aim: To analyze the effect of overweight and obesity on the technical difficulties of TEP. Method: Prospective study on patients who underwent a symptomatic inguinal hernia by means of the TEP technique. Were analyzed gender, BMI, previous surgery, hernia type, operative time and complications. Technical difficulty was defined by operative time, major complications and recurrence. Patients were classified into four groups: 1) underweight, if less than 18,5 kg/m²; 2) normal range if BMI between 18,5 and 24,9 kg/m²; 3) overweight if BMI between 25-29,9 kg/m²; and 4) obese if BMI≥30 kg/m². Results: The cohort had a total of 190 patients, 185 men and 5 women. BMI values ranged from 16-36 kg/m² (average 26 kg/m²). Average operating time was 55.4 min in bilateral hernia (15-150) and 37.8 min in unilateral (13-150). Time of surgery was statistically correlated with increased BMI in the first 93 patients (p=0.049). Conclusion: High BMI and prolonged operative time are undoubtedly correlated. However, this relationship may be statistically significant only in the learning period. Although several clinical features can influence surgical time, upon reaching an experienced level, surgeons appear to easily handle the challenges.
Collapse
Affiliation(s)
| | | | | | | | - Alberto Meyer
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo Medical School.,Abdominal Wall Repair Center, Samaritano Hospital, São Paulo, SP, Brazil
| | - Wellington Andraus
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo Medical School
| |
Collapse
|
3
|
Oliveira LT, Essu FF, de Mesquita GHA, Jardim YJ, Iuamoto LR, Suguita FY, Martines DR, Nii F, Waisberg DR, Meyer A, Andraus W, D'Albuquerque LAC. Component separation of abdominal wall with intraoperative botulinum A presents satisfactory outcomes in large incisional hernias: a case report. Int J Surg Case Rep 2017; 41:99-104. [PMID: 29055880 PMCID: PMC5651546 DOI: 10.1016/j.ijscr.2017.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Transplantation patients have a series of associated risk factors that make appearance of incisional hernia (IH) more likely. A number of aspects of the closure of large defects remain controversial. In this manuscript, we present the repair of a large IH following liver transplantation through the technique of posterior components separation combined with the anterior, together with the intraoperative use of botulinum toxin A and the placement of mesh. As a secondary objective, we analyze the incidence of IH following liver transplantation in our service. METHODS Between the years 2013 and 2016, 247 patients underwent liver transplantation in the Liver Transplantation Service at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. We analyzed the incidence of IH in these patients. One of these cases operated in March 2017 presented a defect in the abdominal wall of 22×16.6×6.4cm in the median and paramedian regions. We present the details of this innovative surgical technique. RESULTS The total operating time was 470min. During the postoperative phase the patient presented ileus paralysis, without systemic repercussions. Resumption of an oral diet on the fifth postoperative day, without incident. Hospital discharge occurred on the 12th postoperative day, with outpatient follow up. CONCLUSION In our service, the incidence of incisional hernias following liver transplantation is 14.5%. We described a successful approach for selected patient group for whom there is no established standard treatment. Given the complexity of such cases, however, more studies are necessary.
Collapse
Affiliation(s)
| | - Felipe Futema Essu
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Yuri Justi Jardim
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Fábio Yuji Suguita
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Fernanda Nii
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Daniel Reis Waisberg
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alberto Meyer
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Wellington Andraus
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | |
Collapse
|
4
|
de Mesquita GHA, Iuamoto LR, Suguita FY, Essu FF, Oliveira LT, Torsani MB, Meyer A, Andraus W. Simple technique of subxiphoid hernia correction carries a low rate of early recurrence: A retrospective study. BMC Surg 2017; 17:51. [PMID: 28476113 PMCID: PMC5420125 DOI: 10.1186/s12893-017-0249-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Subxiphoid incisional hernia occurs as a complication following median sternotomy and are difficult to repair. We present recent data of a standardized technique for correction of subxiphoid incisional hernias, and discuss possible anatomical and surgical factors related to recurrence of the hernia. METHODS A retrospective study with medical records analysis of patients submitted to surgical correction of subxiphoid incisional hernias through standardized treatment between July 2014 and September 2016. All procedures were carried out using the same standardized technique, surgical materials (threads and meshes) and pre- and post-operative care. RESULTS All of the surgical procedures carried out were elective. The hernia defect varied between 5 cm and 16 cm (mean of 7.4 cm); the procedure lasted between 32 and 75 min; the mean time of hospital stay was 2.2 days (range from 1 to 5 days). In five patients the correction of subxiphoid incisional hernia was carried out concurrently with another procedure. No death occurred as a result of the operations. Five patients had minor postoperative complications. Follow up time was between 7 and 33 months, with a recurrence rate of 0% at the time of writing. CONCLUSIONS Despite the limitations of a short follow up period, the surgical technique described presented low rates of early recurrence by closing the hernia defect, using relaxing incisions in the musculature and aponeurosis and surgical mesh.
Collapse
Affiliation(s)
- Gustavo Heluani Antunes de Mesquita
- Department of Gastroenterology, University Of São Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - Leandro Ryuchi Iuamoto
- Department of Gastroenterology, University Of São Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Fabio Yuji Suguita
- Department of Gastroenterology, University Of São Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Felipe Futema Essu
- Department of Gastroenterology, University Of São Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Lucas Torres Oliveira
- Department of Gastroenterology, University Of São Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Matheus Belloni Torsani
- Department of Gastroenterology, University Of São Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Alberto Meyer
- Department of Gastroenterology, University Of São Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, 01246-903, Brazil.,Abdominal Wall Repair Center, Samaritano Hospital, São Paulo, Brazil.,Division Chief, General and Gastrointestinal Surgery, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - Wellington Andraus
- Department of Gastroenterology, University Of São Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| |
Collapse
|
5
|
Iuamoto LR, Franco AS, Suguita FY, Essu FF, Oliveira LT, Kato JM, Torsani MB, Meyer A, Andraus W, Chaib E, D'Albuquerque LAC. Human islet xenotransplantation in rodents: A literature review of experimental model trends. Clinics (Sao Paulo) 2017; 72:238-243. [PMID: 28492724 PMCID: PMC5401612 DOI: 10.6061/clinics/2017(04)08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/16/2016] [Indexed: 01/19/2023] Open
Abstract
Among the innovations for the treatment of type 1 diabetes, islet transplantation is a less invasive method of treatment, although it is still in development. One of the greatest barriers to this technique is the low number of pancreas donors and the low number of pancreases that are available for transplantation. Rodent models have been chosen in most studies of islet rejection and type 1 diabetes prevention to evaluate the quality and function of isolated human islets and to identify alternative solutions to the problem of islet scarcity. The purpose of this study is to conduct a review of islet xenotransplantation experiments from humans to rodents, to organize and analyze the parameters of these experiments, to describe trends in experimental modeling and to assess the viability of this procedure. In this study, we reviewed recently published research regarding islet xenotransplantation from humans to rodents, and we summarized the findings and organized the relevant data. The included studies were recent reports that involved xenotransplantation using human islets in a rodent model. We excluded the studies that related to isotransplantation, autotransplantation and allotransplantation. A total of 34 studies that related to xenotransplantation were selected for review based on their relevance and current data. Advances in the use of different graft sites may overcome autoimmunity and rejection after transplantation, which may solve the problem of the scarcity of islet donors in patients with type 1 diabetes.
Collapse
Affiliation(s)
- Leandro Ryuchi Iuamoto
- Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | | | | | | | | | | | | | - Alberto Meyer
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Wellington Andraus
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Eleazar Chaib
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | |
Collapse
|