Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A

Abstract

In 2014, the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias.” Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature.

Methods

For the development of the original guidelines, all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based Medicine. For the present update, all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne), the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included.

Results

Due to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques—minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite insufficient evidence with respect to these new techniques, it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields.

Conclusion

Guidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initial guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.

Effect of Two Matrix Metalloproteinase Inhibitors on the Color Stability of a Nanofilled Resin Composite

Objectives

This in vitro study evaluated the effect of two matrix metalloproteinase (MMP) inhibitors on the color stability of two shades of a nanofilled resin composite.

Methods and Materials

A total of 60 sound human molars were used in this study. Flat dentin surfaces were obtained by wet grinding the occlusal surfaces. Following acid etching, the molars were divided into three equal groups according to the MMP inhibitor used: Group 1: no inhibitor (control group), group 2: chlorhexidine digluconate based (CHX; Consepsis, Ultradent, South Jordan, UT, USA); group 3: doxycycline based (MTAD; Biopure, Dentsply TulsaDental, Johnson, TN, USA). Adper Single Bond 2 Adhesive (3M ESPE, St Paul, MN, USA) was applied to the treated dentin surfaces. Each group was then subdivided into two equal subgroups of 10 molars each, according to the shade of the resin composite (Filtek Z350 XT, 3M ESPE) used, either B1 or A3. The color was assessed for each subgroup at three times: baseline (after 24 hours); after aging using a total energy of 600 kJ/m2 (Weather-Ometer Ci35A, Atlas Electronic Devices Company, Chicago, IL, USA); and then after a second period of aging, for a total energy of 1200 kJ/m2. Color assessment was carried out using a spectrophotometer. Color change (ΔE) was calculated according to the Commission Internationale de l'Eclairage L*a* b* color scale, comparing each aging period with the baseline color measurement. Data were analyzed using repeated measures analysis of variance and Tukey post hoc test.

Results

All tested subgroups showed greater discoloration than the clinically acceptable level (3.3). MTAD induced the highest statistically significant color change, followed by CHX, whereas the control groups showed the lowest statistical ΔE values with both tested shades. Shade B1 subgroups showed higher ΔE values when compared with shade A3 subgroups.

Conclusion

Accelerated aging caused color change in a nanofilled resin composite regardless of MMP inhibitor used. Furthermore, lighter shades showed less color stability when compared with darker shades.

Problem-based learning at the University of Southern California School of Dentistry

Responding to the recent Institute of Medicine report on dental education, the Center for Craniofacial Molecular Biology (CCMB) of the University of Southern California School of Dentistry has developed a parallel track program in dental education leading to the D.D.S. degree. This program was proposed in May of 1995, and the first class of twelve students was admitted in September of that year. Currently two classes are enrolled and plans to admit a further twelve students (Class of 2001) are in place. The educational strategy for this program is totally problem-based. Students work in groups of six with a faculty facilitator, not necessarily a content expert. Facilitators are largely drawn from the multidisciplinary pool of research faculty at the center. All learning is mediated through biomedical and biodental problem cases. No formal lectures or classes are scheduled. The learning of clinical dental skills is promoted through focussed dental patient simulations in which students review clinical charts, radiographs, medical reports and then explore identified, hands-on learning needs using patient simulators in a clinical context. Early patient exposure is obtained through dental office visits and other special patient clinics. Initial experience with this program suggests that the problem-based learning (PBL) students learn as well (if not better) than their traditional program peers and develop excellent group and cognitive analytical skills. The absence of a pool of dentally related biomedical cases suitable for a PBL program has necessitated the use of innovative approaches to their development and presentation. It is believed that this educational approach will produce dental clinicians equipped with the self-motivated, life-long learning skills required in the ever-changing world of bio-dental sciences in the twenty-first century.

Helminth infections of sheep in North Sumatra, Indonesia

Gastrointestinal tracts of 73 indigenous sheep were obtained from the Medan abattoir in North Sumatra, Indonesia, and examined for the presence of helminths. A total of 13 species of helminths, eight nematodes, one cestode and four trematodes were encountered. All sheep were infected by more than one species of nematodes. Trichostrongylus colubriformis, T. axei and Haemonchus contortus were the most common species. The intensity of the nematode infections was very high: the average burden was over 7500 worms. Trichostrongylus spp. accounted, on average, for 81.5% of the total nematode burden. No influence of age on total nematode burden could be shown. Eurytrema pancreaticum and Schistosoma spindale were found in 23.3% and 4.1% of the examined sheep, respectively. The results are discussed in relation to common management and helminth control systems.