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Li J, Wu L, Shao X, Cheng T. Postoperative perineal hernia repair: what is the evidence? Surg Today 2023; 53:1105-1115. [PMID: 36720743 DOI: 10.1007/s00595-023-02654-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/27/2022] [Indexed: 02/02/2023]
Abstract
The present study determined the characteristics of perineal hernia treatment in the literature, and the incidence of postoperative recurrence was stratified according to repair techniques. A systematic search of the available literature on the treatment of postoperative perineal hernias was performed using a major database. The types of repair techniques and outcome were entered into an electronic database and a pooled analysis was performed. A total of 213 cases of postoperative perineal hernia repair were collected from 20 relevant articles in the literature after excluding case reports (n < 3). Synthetic mesh was the material used most frequently for perineal hernia repair (55.9%). The most frequently used approach in perineal hernia repair was the perineal approach (56.5%). The recurrence rate was highest with the use of biological mesh (40.4%) and the perineal approach (35.6%). The recurrence rate was lowest in the combined abdominal & perineal approach (0%), followed by the abdominal approach (8.8%) and the laparoscopic approach (11.8%). A number of different repair techniques have been described in the literature. The use of synthetic mesh via a combined abdominal-perineal approach or intraabdominal/laparoscopic approach was shown to be associated with a reduced postoperative recurrence rate.
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Affiliation(s)
- Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China.
| | - Lisheng Wu
- Department of Hernia and Bariatric SurgeryDivision of Life Science and MedicineAnhui Province, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, People's Republic of China
| | - Xiangyu Shao
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Tao Cheng
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
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Bhangu A, Nepogodiev D, Ives N, Magill L, Glasbey J, Forde C, Bisgaard T, Handley K, Mehta S, Morton D, Pinkney T, Mehta S, Handley K, Ives N, Bhangu A, Brown J, Forde C, Futaba K, Glasbey J, Handley K, Ives N, Khan S, Magill L, Mehta S, Morton D, Nepogodiev D, Pallan A, Patel A, Ashdown-Phillips S, Roberts T, Jowett S, Munetsi L, Pinkney T, Torrance A, Brown J, Handley K, Hilken N, Hill M, Hunter M, Ives N, Khan S, Leek S, Lilly H, Magill L, Mehta S, Sawant A, Vince A, Walters M, Bemelman W, Blussé M, Borstlap W, Busch ORC, Buskens C, Klaver C, Marsman H, van Ruler O, Tanis P, Westerduin E, Wicherts D, Das P, Essapen S, Frost V, Glennon A, Gray C, Hussain A, McNichol L, Nisar P, Scott H, Trickett J, Trivedi P, White D, Amarnath T, Ardley R, Gupta R, Hall E, Hodgkins K, Narula H, Sewell TA, Simms JM, Toms J, White T, Atkinson A, Beral D, Lancaster N, Mackenzie F, Wilson T, Cruttenden-Wood D, Gibbins J, Halls M, Hill D, Hogben K, Jones S, Lamparelli MJ, Lewis M, Moreton S, Ng P, Oglesby A, Orbell J, Stubbs B, Subramanian K, Talwar A, Wilsher S, Al-Rashedy M, Fensom C, Gok M, Hardstaff L, Malik K, Sadat M, Townley B, Wilkinson L, Cosier T, Mangam S, Rabie M, Broadley G, Canny J, Fallis S, Green N, Hawash A, Karandikar S, Mirza M, Rawstorne E, Reddan J, Richardson J, Thompson C, Waite K, Youssef H, Bisgaard T, De Nes L, Rosenstock S, Strandfelt P, Westen M, Aryal K, Kshatriya KS, Lal R, Velchuru V, Wilhelmsen E, Akbar A, Antoniou A, Clark S, Datt P, Goh J, Jenkins I, Kennedy R, Maeda Y, Nastro P, Owen H, Phillips RKS, Warusavitarne J, Bradley-Potts J, Charleston P, Clouston H, Duff S, Fatayer T, Gipson A, Heywood N, Junejo M, Kennedy J, Lalor H, Manning C, McCormick R, Parmar K, Preston S, Ramesh A, Sharma A, Telford K, Adeosun A, Hammond T, Smolen S, Topliffe J, Docherty JG, Lim M, Lim M, Macleod K, Monaghan E, Patience L, Thomas I, Walker KG, Walker M, Watson AJM, Burgess A, Ghanem Y, Glister G, Kapur S, Paily A, Pal A, Ravikumar R, Rosbergen M, Sargen K, Speakman C, Agarwal AK, Banerjee A, Borowski D, Garg D, Gill T, Johnston T, Kelsey S, Munipalle PC, Tabaqchali M, Wilson D, Acheson A, Cripps H, El-Sharkawy A, Ng O, Sharma P, Ward K, Chandler D, Courtney E, Bunni J, Butcher K, Dalton S, Flindall I, Katebe J, Roy P, Tate J, Vincent T, Williamson MER, Wood J, Bignell M, Branagan G, Broardhurst J, Chave H, Dean H, D'Souza N, Foster G, Sleight S, Sutaria R, Ahmed I, Budhoo MR, Colley J, Cruickshank N, Gill K, Hayes A, Joy H, Kamabjha C, Plowright J, Radley S, Rea M, Thumbe V, Torrance A, Varghese P, Wilkin R, Zulueta E, Allsop L, Atkari B, Badrinath K, Daliya P, Dube M, Heeley C, Hind R, Nash D, Palfreman A, Peacock O, Watson N, Blodwell M, Javaid A, Mohamad A, Muhammad K, Qureshi N, Ridgway S, Siddiqui K, Solkar M, Vere J, Wordie A, Chang J, Elgaddal S, Green M, Hollyman M, Mirza N, Rankin J, Williams G, Ali W, Hardwick A, Mohamed Z, Navid A, Netherton K, Obreja M, Rao M, Stringer J, Tennakoon A, Bullen T, Butt M, Dawson R, Dawson S, Farmer M, Garimella V, Gates Z, Wilkings L, Yeomans N, Adedeji O, Alalawi R, Al Araimi A, Ashraf S, Bach S, Beggs A, Cagigas C, Dattani M, Dimitriou N, Futaba K, Ghods-Ghorbani M, Glasbey J, Gourevitch D, Haydon G, Ismail T, Keh C, Morton DG, Narewal M, Nepogodiev D, Papettas T, Pinkney T, Poh A, Ranstorne E, Royle TJ, Shah T, Singh J, Smart C, Suggett N, Tayyab M, Vijayan D, Vohra R, Wairaich N, Yeung D, Bamford R, Chambers J, Cotton D, Houlihan R, Kynaston J, Longman R, Lowe A, Messenger D, Owais A, Phillpott C, Shabbir J, Baragwanath P, El-Sayed C, Gaunt A, Khatri C, McCullough P, Patel A, Ward S, Wilkin R, Obukofe R, Stroud R, Mason D, Williams N, Wong LS, Chaudhri S, Cooke J, Cunha M, Fairey H, Norwood M, Singh B, Thomasset S, Abbott S, Addison S, Archer J, Bhangu A, Church R, Holford E, Lenehan F, Odogwu S, Richardson L, Sidebotham J, Swan E, Tilley A, Wagstaff L, Amey I, Baird Y, Cripps N, Greenslade S, Harris G, Levy B, Mckenzie P, Misselbrook A, Moore S, Skull A, Nicol D, Reddy B, Thrush J, Iglesias Vecchio M, Dunn Y, Williams C, Furtado S, Gill M, Gilmore L, Goldsmith P, Kocialkowski C, Loganathan S, Nath R, Paraoan M, Taylor T, Allison A, Allison J, Curtis N, Dalton R, D'Costa C, Dennison G, Foster J, Francis N, Gibbons J, Hamdan M, Lewis A, Ockrim J, Sharma R, Spurdle K, Varadharajan S, Aghahoseini A, Alexander DJ, Bandyopadhyay D, Bradford I, Chitsabesan P, Coleman Z, Gibson A, Lasithiotakis K, Panagiotou D, Polyzois K, Stojkovic S, Woodcock N, Wright M, Hargest R, Jackson R, Rajesh A, Ogunbiyi O, Slater A, Yu LM. Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial. Lancet 2020; 395:417-426. [PMID: 32035551 PMCID: PMC7016509 DOI: 10.1016/s0140-6736(19)32637-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. METHODS In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. FINDINGS Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43-0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26-0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60-1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54-1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. INTERPRETATION Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. FUNDING National Institute for Health Research Research for Patient Benefit and Allergan.
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Abstract
In the following article, we present the key trends in emergency surgical care in the Russian Federation between 2000 and 2017. The study used data from federal statistical observations and a survey of state medical institutions in 80 regions encompassing 99.3% of the country's population. We discovered a change in the correlation between acute abdominal diseases, particularly a significant reduction in the occurrence of acute appendicitis and perforated peptic ulcer. Reduction in the number of emergency surgeries by 27.8% annually was also observed. Mortality rate decreased in cases of strangulated hernia, acute cholecystitis and acute pancreatitis, while it is stable for bowel obstruction and acute appendicitis and increasing in perforated peptic ulcer cases. The total annual number of lethal outcomes due to acute abdominal diseases was decreased by 1900 cases. Significant changes were observed in mortality rate and minimally invasive surgeries proportions between federal districts and individual regions of the country. The range of administrative measures was proposed.
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Affiliation(s)
- A Sh Revishvili
- Vishnevsky National medical research center of surgery of Ministry of Health of Russia, Moscow, Russia
| | - A V Fedorov
- Vishnevsky National medical research center of surgery of Ministry of Health of Russia, Moscow, Russia
| | - V P Sazhin
- Pavlov Ryazan State Medical University of Ministry of Health of Russia, Ryazan, Russia
| | - V E Olovyannyi
- Vishnevsky National medical research center of surgery of Ministry of Health of Russia, Moscow, Russia
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Kyle-Leinhase I, Köckerling F, Jørgensen LN, Montgomery A, Gillion JF, Rodriguez JAP, Hope W, Muysoms F. Comparison of hernia registries: the CORE project. Hernia 2018; 22:561-575. [PMID: 29307057 PMCID: PMC6061062 DOI: 10.1007/s10029-017-1724-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/27/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The aim of the international CORE project was to explore the databases of the existing hernia registries and compare them in content and outcome variables. METHODS The CORE project was initiated with representatives from all established hernia registries (Danish Hernia Database, Swedish Hernia Registry, Herniamed, EuraHS, Club Hernie, EVEREG, AHSQC) in March 2015 in Berlin. The following categories were used to compare the registries: initiation and funding, data collection and use for certification of hernia centers, patient data and data protection, operative data, registration of complications and follow-up data. RESULTS The Danish Hernia Database is the only one to qualify as a genuine national registry where participation is compulsory for entry of all procedures by all surgeons performing a hernia operation. All other registries have to be considered as voluntary and completeness of data depends upon the participating hospitals and surgeons. Only the Danish Hernia Database and the Swedish Hernia Registry are publicly funded. All other registries are reliant on financial support from the medical technology industry. As an incentive for voluntary participation in a hernia registry, hospitals or surgeons are issued a certificate confirming that they are taking part in a quality assurance study for hernia surgery. Due to data protection and privacy regulations, most registries are obliged or have chosen to enter their patient data anonymously or coded. The Danish Hernia Database and Swedish Hernia Registry utilize a national personal patient code. In the Herniamed Registry, patient data are saved in a coded and anonymous format after obtaining the patient's informed consent. CONCLUSION Despite the differences in the way data are collected for each of the listed hernia registries, the data are indispensable in clinical research.
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Affiliation(s)
- I Kyle-Leinhase
- EuraHS and Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - F Köckerling
- HERNIAMED and Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital Spandau, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - L N Jørgensen
- DANISH HERNIA DATABASE and Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Montgomery
- SWEDISH HERNIA REGISTRY and Department of Clinical Sciences, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - J F Gillion
- CLUB HERNIE and Unité de Chirurgie Viscérale et Digestive, Hôpital Privé d'Antony, Antony, France
| | | | - W Hope
- AHSQC and New Hanover Regional Medical Center, Wilmington, USA
| | - F Muysoms
- EuraHS and Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
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Pathak V, Suwal K. Postoperative Outcome in Patients with Pulmonary Hypertension Undergoing Elective Non-Cardiac Surgery. JNMA J Nepal Med Assoc 2017; 56:438-441. [PMID: 29453476] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION The impact of pulmonary artery hypertension on post-operative outcome in elective, non-cardiac surgery is incompletely understood. This study was designed to evaluate the post-operative outcome of patients undergoing elective, non-cardiac surgery with and without pulmonary hypertension. METHODS The study was conducted in an inner-city hospital in Bronx, New York. A retrospective chart review was conducted on all patients who underwent elective, non- cardiac surgery from January 2000 to December 2010 and had echocardiogram within 30 days of surgery. Patients with systolic pressure of ≥35mm of Hg as estimated by echocardiogram were enrolled. Case matched peers with normal pulmonary pressures served as controls. Post-operative outcomes were compared between the two groups. RESULTS A total of 66 patients were analysed, 33 cases and 33 controls. All patients were followed up to 30-day post-surgery. Heart failure, myocardial infarction, arrhythmia, stroke, delayed extubation and deaths were measured in both the groups. There were two deaths in the control group while there were three deaths in pulmonary hypertension group (statistically not significant, P >0.05). A total of three patients in pulmonary hypertension group had adverse outcome (one had a major arrhythmia, one had delayed extubation (>24 hours) and one had stroke). Whereas two patients in control group had adverse outcome (one had delayed extubation (>24 hours) and one had major arrhythmia). CONCLUSIONS Pulmonary hypertension does not affect the post-operative outcome in the first 30 days for elective non-cardiac surgery.
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Affiliation(s)
- Vikas Pathak
- Division of Pulmonary and Critical Care Medicine, WakeMed Health and Hospitals, USA
| | - Kriti Suwal
- Department of Medicine, Kathmandu Medical College, Kathmandu, Nepal
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Handojo K, Meylemans D, Devroe K, Vermeiren K, Aelvoet C, Tollens T. Initial Experience with a New Macroporous Partially Absorbable Mesh: Introducing Ultrapro® Advanced™. Surg Technol Int 2016; 28:125-130. [PMID: 27042785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The Ultrapro® Advanced™ mesh (Ethicon, Sommerville, NJ) is a new mesh design, using the best characteristics from the previous platform, while adding new, advanced features. Our centre, Imelda Hospital, Bonheiden, Belgium, was chosen as one of the first clinical testing sites. The aim of this study was to present our preliminary data on complication rate and patient satisfaction. MATERIALS AND METHODS From October 1, 2015 until January 31, 2016, we treated 57 patients, implementing 67 Ultrapro® Advanced™ meshes. One patient was excluded due to postoperative cerebral haemorrhage with aphasia. Only patients with more than one-month follow-up were included for further analysis, resulting in a population of 41 patients with 51 meshes. Of them, 35 were male and only 6 were female, with an average age of 61.4 years and an average BMI of 25.9. The indications were uni- and bilateral laparoscopic inguinal hernia repair (n = 23 and 10 respectively), open inguinal hernia repair (n = 3), and open incisional hernia repair (n = 5). Quality of life was measured preoperatively and at four weeks postoperatively, using the hernia specific Carolina Comfort Scale (CCS) questionnaire. RESULTS The primary endpoint was complication rate. Only two patients (4.8%) mentioned a mild scrotal hematoma and two patients (4.8%) demonstrated a seroma. There were no superficial wound infections nor early recurrent hernias. Our secondary endpoint was quality of life, measured by the CCS questionnaire, which differentiates between a symptomatic and an asymptomatic group. A total of 13 patients were asymptomatic, whilst 28 patients reported some sort of discomfort, ranging from mild (n = 25) to moderate and/or daily symptoms (n = 3). No patients were disabled by their symptoms. CONCLUSION The Ultrapro® Advanced™ is a sequel of the classic Ultrapro® mesh with similar characteristics: it is a "lightweight", macroporous, partially absorbable mesh built out of thin filaments, while maintaining sufficient strength. Its improvement is due to incorporation of evidence-based characteristics such as an increased mesh elasticity. Furthermore, the surgical manipulation is improved thanks to the increased mesh memory. Our prospective cohort study shows good initial and short-term results after implementation of the Ultrapro® Advanced™. However, further prospective research is mandatory on the long-term outcomes.
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Affiliation(s)
- Karen Handojo
- Department of Abdominal Surgery, Imelda Hospital, Bonheiden, Belgium
| | | | - Kurt Devroe
- Department of Abdominal Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Koen Vermeiren
- Department of Abdominal Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Chris Aelvoet
- Department of Abdominal Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Tim Tollens
- Department of Abdominal Surgery, Imelda Hospital, Bonheiden, Belgium
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Baugh KA, Weireter LJ, Collins JN. The trauma pan scan: what else do you find? Am Surg 2014; 80:855-859. [PMID: 25197870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objective of this study was to investigate the prevalence of incidental findings in pan-computed tomography (CT) scans of trauma patients and the communication of significant findings requiring follow-up to the patient. A retrospective chart review of adult trauma patients was performed during the period of January 1, 2011, to August 31, 2011. During that period, 990 patient charts were examined and 555 charts were selected based on the inclusion criteria of a pan-CT scan including the head, neck, abdomen/pelvis, and chest. Patient demographics such as age, gender, mechanism of injury, and Injury Severity Score were collected. Nontraumatic incidental findings were analyzed to establish the prevalence of incidental findings among trauma patients. Discharge summaries were also examined for follow-up instructions to determine the effectiveness of communication of the significant findings. Between the 555 pan-CT scans (1759 total scans), 1706 incidental findings were identified with an incidence of 3.1 incidental findings per patient and with the highest concentration of findings occurring in the abdomen/pelvis. The majority of findings were benign including simple renal cysts with a prevalence of 7.7 per cent. However, 282 significant findings were identified that were concerning for possible malignancy or those requiring further evaluation, the most common of which were lung nodules, which accounted for 21.6 per cent of significant findings. However, only 32.6 per cent of significant findings were documented as reported to the patient. With the use of pan scans on trauma patients, many incidental findings have been identified to the benefit of the patient. The majority of these are clinically insignificant; however, only 32.6 per cent of potentially significant findings were communicated to the patient. The advantage of early detection comes from proper communication and this study demonstrates that there could be improvement in conveying findings to the patient.
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Althouse BM, Allem JP, Childers MA, Dredze M, Ayers JW. Population health concerns during the United States' Great Recession. Am J Prev Med 2014; 46:166-70. [PMID: 24439350 DOI: 10.1016/j.amepre.2013.10.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/31/2013] [Accepted: 10/14/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Associations between economic conditions and health are usually derived from cost-intensive surveys that are intermittently collected with nonspecific measures (i.e., self-rated health). PURPOSE This study identified how precise health concerns changed during the U.S. Great Recession analyzing Google search queries to identify the concern by the query content and their prevalence by the query volume. METHODS Excess health concerns were estimated during the Great Recession (December 2008 through 2011) by comparing the cumulative difference between observed and expected (based on linear projections from pre-existing trends) query volume for hundreds of individual terms. As performed in 2013, the 100 queries with the greatest excess were ranked and then clustered into themes based on query content. RESULTS The specific queries with the greatest relative excess were stomach ulcer symptoms and headache symptoms, respectively, 228% (95% CI=35, 363) and 193% (95% CI=60, 275) greater than expected. Queries typically involved symptomology (i.e., gas symptoms) and diagnostics (i.e., heart monitor) naturally coalescing into themes. Among top themes, headache queries were 41% (95% CI=3, 148); hernia 37% (95% CI=16, 142); chest pain 35% (95% CI=6, 313); and arrhythmia 32% (95% CI=3, 149) greater than expected. Pain was common with back, gastric, joint, and tooth foci, with the latter 19% (95% CI=4, 46) higher. Among just the top 100, there were roughly 205 million excess health concern queries during the Great Recession. CONCLUSIONS Google queries indicate that the Great Recession coincided with substantial increases in health concerns, hinting at how population health specifically changed during that time.
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Affiliation(s)
| | - Jon-Patrick Allem
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Matthew A Childers
- School of Public and International Affairs, University of Georgia, Athens, Georgia
| | - Mark Dredze
- Human Language Technology Center of Excellence, Johns Hopkins University Baltimore, Maryland
| | - John W Ayers
- Graduate School of Public Health, San Diego State University, San Diego, California.
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Abunnaja S, Cuviello A, Dhamija A, Nguyen B, Richi A, Macaron S. Do routine postoperative upper gastrointestinal studies following laparoscopic gastric bypass affect clinical outcomes? Conn Med 2013; 77:395-398. [PMID: 24195176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Laparoscopic gastric bypass surgery has become a popular form of treatment for individuals suffering from obesity. As such, many institutions routinely employ an upper gastrointestinal (UGI) study on postoperative day one to assess for surgical complications, including anastomotic leaks. In this study, retrospective case analysis was used to determine whether UGI studies prove useful in detecting a gastrointestinal leak. Seventy-five in-hospital case reports were analyzed, of which 55 cases received an UGI study routinely on postoperative day one. Twenty cases received intraoperative anastomotic analysis and an UGI study was completed only if clinically indicated. All UGI studies obtained were negative; however, other complications were noted, including anastomotic stricture and internal hernia. Our study found that routine UGI studies after laparoscopic Roux-En-Ygastric bypass did not contribute significantly to patient care. UGI studies should therefore be employed on a selective basis given the clinical signs and symptoms of the patient.
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Affiliation(s)
- Salim Abunnaja
- Stanley Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, USA.
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Jørgensen LN, Friis-Andersen H, Bay-Nielsen M, Kehlet H. [Danish Hernia Database]. Ugeskr Laeger 2012; 174:2522. [PMID: 23079425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Baraff LJ, Byyny RL, Probst MA, Salamon N, Linetsky M, Mower WR. Prevalence of herniation and intracranial shift on cranial tomography in patients with subarachnoid hemorrhage and a normal neurologic examination. Acad Emerg Med 2010; 17:423-8. [PMID: 20370782 DOI: 10.1111/j.1553-2712.2010.00704.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Patients frequently present to the emergency department (ED) with headache. Those with sudden severe headache are often evaluated for spontaneous subarachnoid hemorrhage (SAH) with noncontrast cranial computed tomography (CT) followed by lumbar puncture (LP). The authors postulated that in patients without neurologic symptoms or signs, physicians could forgo noncontrast cranial CT and proceed directly to LP. The authors sought to define the safety of this option by having senior neuroradiologists rereview all cranial CTs in a group of such patients for evidence of brain herniation or midline shift. METHODS This was a retrospective study that included all patients with a normal neurologic examination and nontraumatic SAH diagnosed by CT presenting to a tertiary care medical center from August 1, 2001, to December 31, 2004. Two neuroradiologists, blinded to clinical information and outcomes, rereviewed the initial ED head CT for evidence of herniation or midline shift. RESULTS Of the 172 patients who presented to the ED with spontaneous SAH diagnoses by cranial CT, 78 had normal neurologic examinations. Of these, 73 had initial ED CTs available for review. Four of the 73 (5%; 95% confidence interval [CI] = 2% to 13%) had evidence of brain herniation or midline shift, including three (4%; 95% CI = 1% to 12%) with herniation. In only one of these patients was herniation or shift noted on the initial radiology report. CONCLUSIONS Awake and alert patients with a normal neurologic examination and SAH may have brain herniation and/or midline shift. Therefore, cranial CT should be obtained before LP in all patients with suspected SAH.
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Affiliation(s)
- Larry J Baraff
- University of California Los Angeles Emergency Medicine Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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12
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Savoye-Collet C, Savoye G, Koning E, Leroi AM, Dacher JN. Gender influence on defecographic abnormalities in patients with posterior pelvic floor disorders. World J Gastroenterol 2010; 16:462-6. [PMID: 20101772 PMCID: PMC2811799 DOI: 10.3748/wjg.v16.i4.462] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 10/07/2009] [Accepted: 10/15/2009] [Indexed: 02/06/2023] Open
Abstract
AIM To compare defecographic abnormalities in symptomatic men and women and to analyze differences between men and age- and symptom-matched women. METHODS Sixty-six men (mean age: 55.4 years, range: 20-81 years) who complained of constipation and/or fecal incontinence and/or pelvic pain underwent defecography after intake of a barium meal. Radiographs were analyzed for the diagnosis of rectocele, enterocele, intussusception and perineal descent. They were compared with age- and symptom-matched women (n = 198) who underwent defecography during the same period. RESULTS Normal defecography was observed in 22.7% of men vs 5.5% of women (P < 0.001). Defecography in men compared with women showed 4.5% vs 44.4% (P < 0.001) rectocele, and 10.6% vs 29.8% (P < 0.001) enterocele, respectively. No difference was observed for the diagnosis of intussusception (57.6% vs 44.9%). Perineal descent at rest was more frequent in women (P < 0.005). CONCLUSION For the same complaint, diagnosis of defecographic abnormalities was different in men than in women: rectocele, enterocele and perineal descent at rest were observed less frequently in men than in women.
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Abstract
This paper describes 130 patients with enteroceles and their treatment. It includes analysis of all cases with enterocele over a 17-month period in a pelvic floor dysfunction database. Procedures performed included the Moschcowitz procedure with suspension of the vaginal vault to the sacrum in 13 patients (10%), colposacrosuspension (CSS) (mesh from the upper posterior half of the vagina to the sacrum with mobilisation and fixation of the rectum to the mesh) in 39 patients (30%), perineocolposacrosuspension (PCSS) (similar to CSS, but the mesh is inserted further down to the perineum) in 48 patients (37%) and perineopubo-colposacrosuspension (PPCSS) (as PCSS, but with a second mesh between the bladder and vagina extending to the sacrum) in 30 patients (23%). An additional modified Burch colposuspension was performed in 87 patients (67%). A failure was defined as a recurrent vaginal prolapse of Grade II or more, or urinary incontinence requiring surgical correction. The patients' mean age was 60.5 years, their mean parity 3.3 and 92.3% were white. Preoperatively, 33.8% of the patients complained of constipation, 33.1% of difficulty in defaecation and 77% had bladder symptoms, suggesting urinary stress incontinence or detrusor instability. In 74.6% of the patients part of the vagina protruded through the vaginal introitus. The mean period of follow-up was 7.4 months (range 1-26) with only 13 patients (10%) not followed. Only two patients (1.5%) developed Grade II vaginal prolapse (both cystoceles and both from the PCSS group). Urinary stress incontinence in need of further treatment developed in 13 patients (10%). The failure rate, therefore, was 11.5%. In six patients (4.6%) the mesh had to be removed due to mesh reaction. In all cases the mesh was unabsorbable. Vaginal suspension procedures with mobilisation of the rectum provided satisfactory results for severe enterocele over the short term.
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Affiliation(s)
- H S Cronjé
- Department of Obstetrics and Gynaecology, University of Free State, Bloemfontein, South Africa.
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Small CM, DeCaro JJ, Terrell ML, Dominguez C, Cameron LL, Wirth J, Marcus M. Maternal exposure to a brominated flame retardant and genitourinary conditions in male offspring. Environ Health Perspect 2009; 117:1175-9. [PMID: 19654930 PMCID: PMC2717147 DOI: 10.1289/ehp.0800058] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 02/27/2009] [Indexed: 05/03/2023]
Abstract
BACKGROUND The upward trend in industrial nations in the incidence of male genitourinary (GU) conditions may be attributed to increased exposure to endocrine disruptors. Polybrominated biphenyl (PBB), a brominated flame retardant, is one such suspected endocrine disruptor. OBJECTIVE We investigated the relationship between maternal serum levels of PBBs and GU conditions among male offspring exposed in utero. METHODS In this cohort study of sons born to women accidentally exposed to PBBs during 1973-1974, we examined self-reported data on GU conditions among male offspring in relation to maternal serum PBB levels. We used generalized estimating equations to calculate odds ratios (ORs), controlling for gestational age at birth. RESULTS Of 464 sons, 33 reported any GU condition (13 hernias, 10 hydroceles, 9 cryptorchidism, 5 hypospadias, and 1 varicocele). Four reported both hernia and hydrocele, and one both hernia and cryptorchidism. After adjustment for gestational age at birth, sons of highly exposed women (> 5 ppb) were twice as likely to report any GU condition compared with sons of the least exposed women [< or =1 ppb; OR = 2.0; 95% confidence interval (CI), 0.8-5.1]. This risk was increased when we excluded sons born after the exposure but before the mother's serum PBB measurement (OR = 3.1; 95% CI, 1.0-9.1). We found evidence of a 3-fold increase in reported hernia or hydrocele among sons with higher PBB exposure (test of trend p-value = 0.04). Neither hypospadias nor cryptorchidism was individually associated with PBB exposure. CONCLUSIONS Although cryptorchidism and hypospadias were not associated with in utero PBB exposure, this study suggests that other GU conditions may be associated with exposure to endocrine-disrupting chemicals during development.
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Affiliation(s)
- Chanley M Small
- Department of Epidemiology, Emory University, Atlanta, Georgia 30322, USA.
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15
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Abstract
BACKGROUND Self-injury, sleep problems and health problems are commonly reported in Cornelia de Lange Syndrome (CdLS) but there are no comparisons with appropriately matched participants. The relationship between these areas and comparison to a control group is warranted. METHOD 54 individuals with CdLS were compared with 46 participants with intellectual disability (ID) of mixed aetiology who were similar in terms of degree of ID, mobility, age and gender using informant-based measures of health problems, sleep and self-injury. RESULTS Participants with CdLS experienced significantly more current and lifetime health problems with eye problems and gastrointestinal disorders prominent. Although 55% of those with CdLS experienced sleep problems this prevalence was not different from the comparison group. Sleep disorder was not associated with self-injury in the CdLS group, skin problems were associated with severity of self-injury but not presence. DISCUSSION People with CdLS experience a range of significant health problems and have more health concerns than others with the same degree of ID. Although this has been well documented in the past, the current high prevalence of health concerns indicates the need for regular health assessment and appropriate intervention.
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Affiliation(s)
- S S Hall
- Department of Psychiatry and Behavioral Science, Stanford University, California, USA
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16
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Abstract
Peritoneal dialysis is an established form of renal replacement therapy. With its increasing popularity, we are now encountering a variety of complications. Noninfectious complications are usually less common as compared with infectious complications. In this review, we discuss some of the common noninfectious complications of peritoneal dialysis such as hernias, hydrothorax, hemoperitoneum, pancreatitis, ischemic colitis and necrotizing enterocolitis, pneumoperitoneum, GERD, subcapsular steatosis and hypokalemia. The awareness of these complications will help in early diagnosis and treatment.
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Affiliation(s)
- Tapasi C Saha
- Section of Nephrology, Brody School of Medicine, East Carolina University, 2355 West Arlington Boulevard, Greenville, NC 27834, USA.
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17
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Takagi H, Sugimoto M, Kato T, Matsuno Y, Umemoto T. Postoperative Incision Hernia in Patients with Abdominal Aortic Aneurysm and Aortoiliac Occlusive Disease: A Systematic Review. Eur J Vasc Endovasc Surg 2007; 33:177-81. [PMID: 16934501 DOI: 10.1016/j.ejvs.2006.07.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Accepted: 07/11/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We conducted a systematic review to determine the incidence of postoperative incision hernia in patients with abdominal aortic aneurysm compared to those with aortoiliac occlusive disease. METHODS Studies which compared the incidence of postoperative incision hernia in patients with abdominal aortic aneurysm and aortoiliac occlusive disease undergoing midline incision for arterial reconstruction were identified. MEDLINE was searched for articles published between January 1966 and September 2005. RESULTS Our search identified seven studies including data on 1132 patients, 719 with abdominal aortic aneurysm and 413 with aortoiliac occlusive disease. Pooled analysis demonstrated that patients with abdominal aortic aneurysm had a 2.9-fold increased risk of inguinal hernia (odds ratio 2.85, 95% confidence interval 1.71-4.77, p<0.0001), and a 2.8-fold risk of incisional hernia (2.79, 1.88-4.13, p<0.0001). Adjusting for other known risk factors patients with aortic aneurysm had a 5-fold increased risk of incisional hernia (5.45, 2.48-11.94, p<0.0001). CONCLUSIONS Patients with abdominal aortic aneurysm appear to have an approximately 3-fold increased risk for both inguinal and postoperative incision hernia compared to patients with aortoiliac occlusive disease. A large multi-centre prospective study is needed to confirm the results of this review.
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Affiliation(s)
- H Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Centre, Shizuoka, Japan.
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Skiker H, Laghmari M, Boutimzine N, Ibrahimy W, Benharbit M, Ouazani B, Daoudi R. [Open globe injuries in children: retrospective study of 62 cases]. Bull Soc Belge Ophtalmol 2007:57-61. [PMID: 18251455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The open globe injuries in children are frequent and serious accidents. The purpose of this study is to investigate the epidemiologic and clinical characteristics and the visual outcomes of this accident. A retrospective study was conducted on 62 cases in the Ophthalmology department between January 2001 and December 2005. The mean age of admission was 7.5 years. Fifty-one patients were males and twelve were females. Open globe injuries occurred most frequently in the street. The wounds involved the cornea in 66.1% of the cases. There was iris hernia in 30 cases, hyphema in 20 cases and traumatic cataract in 15 cases; in 8% of the cases a foreign body was detected. Final visual acuity was 0.5 or better in 28%. This finding emphasizes that educative measures should be taken into consideration in order to prevent this accident.
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Affiliation(s)
- H Skiker
- Hôpital des spécialités Rabat, Maroc.
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Boldó E, Perez de Lucia G, Aracil JP, Martin F, Escrig J, Martinez D, Miralles JM, Armelles A. Trocar site hernia after laparoscopic ventral hernia repair. Surg Endosc 2006; 21:798-800. [PMID: 17177087 DOI: 10.1007/s00464-006-9015-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 05/10/2006] [Accepted: 06/11/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of trocar site hernia (TSH) after laparoscopic ventral hernia repair (LVHR) is reported to be low. The present study investigates the associated risk factors, with a view to preventing this complication. METHODS A retrospective study was made of the incidence of TSH in a personal series of LVHR, recording anthropometric and clinical data on the patients. Risk factors were assessed by bivariate and multivariate analyses. The patients were subjected to clinical and telephone follow-up. RESULTS In a series of 27 LVHR, the incidence of TSH was 22% (6 patients). The use of meshes larger than 10 x 15 cm for LVHR was the only TSH risk factor to reach statistical significance. Female gender and diabetes showed a higher incidence in the TSH group. CONCLUSIONS The use of large meshes may be a risk factor for TSH. We believe this to be due to dilatation of the trocar orifice during introduction of the mesh, and also to postoperative retraction of the mesh.
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Affiliation(s)
- E Boldó
- Consorcio Hospitalario Provincial de Castellon, Avenida Ferrandis Salvador 50, 12100, Castellon, Spain.
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20
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Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL. Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg 2006; 118:1100-1109. [PMID: 17016173 DOI: 10.1097/01.prs.0000236898.87398.d6] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Reconstruction is an important adjunct to breast cancer management. This study evaluated the frequency of major and minor complications in the largest reported series of consecutive mastectomy patients treated with free tissue transfer for breast reconstruction. METHODS All patients treated with microvascular breast reconstruction at the University of California, Los Angeles, Medical Center over an 11-year period were identified using a retrospective analysis. Frequency of complications was assessed. RESULTS A total of 1195 breast reconstructions were performed in 952 patients. Transverse rectus abdominis musculocutaneous flaps were used in most cases (81.8 percent), whereas the superior gluteal musculocutaneous flap (10.1 percent) and other free flaps were used in the remaining patients. The overall complication rate was 27.9 percent and consisted primarily of minor complications (21.7 percent). Major complications were noted in 7.7 percent, including six total flap losses (0.5 percent). Obesity was a major predictor of complications. Smoking was not associated with increased rates of overall or microsurgical complications. Neoadjuvant chemotherapy was also an independent predictor of complications and was associated with wound-healing problems and fat necrosis. Prior abdominal surgery in transverse rectus abdominis musculocutaneous flap patients increased the risk of partial flap loss, fat necrosis, and donor-site complications. CONCLUSIONS Microsurgical breast reconstruction is a safe and highly effective technique. Complications tend to be minor and do not affect postreconstruction adjuvant therapy. Obesity is a major predictor of flap and donor-site complications, and these patients should be appropriately counseled. Similarly, neoadjuvant preoperative chemotherapy and prior abdominal surgery increase the rates of minor complications.
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Affiliation(s)
- Babak J Mehrara
- Los Angeles, Calif.; and New York, N.Y. From the Division of Plastic and Reconstructive Surgery and Department of Surgery, University of California, Los Angeles, Medical Center
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Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is associated with a relatively high incidence of internal hernias (IH) when compared to the open operation. METHODS A search in PubMed MEDLINE from January 1994 through January 2006 was performed (keywords: obesity, laparoscopy, gastric bypass and internal hernia). RESULTS 26 studies with a total of 11,918 patients were considered. 300 cases of IH occurred (rate 2.51%). IH occurred 116 times at the level of the transverse colon mesentery (69%), 30 at the Petersen's space (18%), and 22 at the entero-enterostomy site (13%). 142 re-operations were performed laparoscopically (85.6%), and 24 by laparotomy (14.4%). Bowel resection was done in 5 cases (4.7%). Mortality was 1.17%. CONCLUSIONS IH after LRYGBP has an incidence of 2.51%. Closure of mesenteric defects with non-absorbable running suture and antecolic Roux limb are recommended. Surgical exploration for suspicion of IH after LRYGBP should be first done by laparoscopy.
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Affiliation(s)
- Antonio Iannelli
- Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet, Nice, France.
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22
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Abstract
PURPOSE Perineal hernias are infrequent complications of abdominoperineal operations with estimated historic prevalences (from the era where the perineal wound was left open) ranging from 0.6 to 7 percent. The purpose of this study was to identify the modern prevalence of postoperative perineal hernias, factors that may contribute to their development, and examine the methods of repair. METHODS The Mayo Clinic patient database (1990-2000) was interrogated for the following data identifiers: incisional hernia, perineal hernia, abdominoperineal resection, proctocolectomy, and partial or total pelvic exenteration. All surviving patients were followed up to December 2005. The retrieved patient data was retrospectively analyzed. RESULTS Of a total of 3,761 patients who underwent abdominoperineal resection (including nonrestorative proctocolectomy and pelvic exenteration) during the study period, 8 developed a perineal hernia (5 females). The median age at hernia presentation was 76 (range, 69-84) years, representing a median interval of 22 (range, 1-60) months from the original operation. All were smokers (> or =15 pack years) and five had received chemoradiotherapy for their original diagnosis. The commonest prevalence was found in patients who had undergone abdominoperineal resection (5/1,266) or pelvic exenteration (2/1,334). Only 1 of 1,161 patients developed a perineal hernia after proctocolectomy despite most being on perioperative immunosuppression for inflammatory bowel disease. Abdominal exploration and repair was performed in four patients whereas four underwent perineal repair (2 of each with mesh). None have recurred with a median follow-up of 36 (range, 6-60) months. CONCLUSIONS Perineal hernias are rare complications of abdominoperineal surgery with a more common prevalence after cancer operations. Smoking and chemoradiotherapy, but not corticosteroid immunosuppression, may be factors. The abdominal approach has advantages over the perineal approach, but both are suitable with good medium-term results.
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Affiliation(s)
- E Aboian
- Department of Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
PURPOSE Parastomal hernia continues to be an important clinical problem with a reported incidence of up to 50 percent. In studies using computerized tomography in selected cases for detection of parastomal hernia, physical examination alone was underestimating the true incidence. Also after closure of the enterostomy, the ostomy site could still be a potential area of herniation. In this study in addition to physical examination, we used computerized tomography to determine the true incidence of parastomal hernia and ostomy closure site hernias. METHODS We examined patients with enterostomies and with closed enterostomy sites both with physical examination and computerized tomography for the detection of hernias, hernia content, and relation to rectus muscles. Risk factors for hernia formation, such as age, gender, body mass index, associated medical problems, and surgical site infections, were determined. RESULTS Evaluation of 23 patients with ostomies resulted in 52 percent incidence of parastomal hernia, whereas the addition of tomography examination gave a corrected incidence of 78 percent. In a second subset of 23 patients with closed ostomies, although 26 percent of the patients were found to have ostomy site hernias with physical examination alone, this incidence increased to 48 percent when combined with computerized tomography. The potential risk factors for hernia formation, such as body mass index, surgical site infection, and ostomy site whether pararectus or transrectus, were not proven to have a significant role in this study. CONCLUSIONS Parastomal hernia and closed ostomy site incisional hernias have a high incidence, and computerized tomography has been shown to be a valuable diagnostic tool.
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Affiliation(s)
- Asim Cingi
- Department of General Surgery, Marmara University Hospital, Istanbul 34662, Turkey
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Rosenthal RJ, Szomstein S, Kennedy CI, Zundel N. Direct visual insertion of primary trocar and avoidance of fascial closure with laparoscopic Roux-en-Y gastric bypass. Surg Endosc 2006; 21:124-8. [PMID: 16960672 DOI: 10.1007/s00464-005-0823-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 04/03/2006] [Indexed: 12/29/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (RYGBP) has been used increasingly more often in the past 10 years. The authors summarize their experience and safety/complications data based on 849 laparoscopic RYGBP procedures. They also evaluate the use of the Endopath trocar in terms of trocar-site hernias, bowel obstruction, and elimination of time-consuming fascial closure. METHODS From July 2000 to December 2003, 849 laparoscopic RYGBP procedures were performed using a bladeless, 12-mm, visual entry trocar. The patients' average body mass index (BMI) was 53.2 kg/m2. The trocar ports (n = 3,744) were not closed. Perioperative and postoperative assessments were performed. RESULTS In this study, 74% of the patients were retained for follow-up evaluation (mean, 10 months). Among these patients, no intraoperative bowel or vascular injuries, no mortality, and two trocar-site hernias (0.2%) were found. At 1 year, the mean excess weight loss was 73.4%. CONCLUSIONS The Endopath trocar system shows a trend toward reducing trocar-site hernias, decreasing bowel obstruction, and eliminating the need for time-consuming fascial closure, although further studies are needed to confirm these findings.
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Affiliation(s)
- R J Rosenthal
- Section of Minimally Invasive Surgery and The Bariatric Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
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Mølsted-Pedersen L, Rudnicki M, Lose G. Transvaginal repair of enterocele and vaginal vault prolapse using autologous fascia lata graft. Acta Obstet Gynecol Scand 2006; 85:874-8. [PMID: 16817089 DOI: 10.1080/00016340500342052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim was to describe the operative technique of transvaginal repair of enterocele and apical prolapse using autologous fascia lata and report intra- and postoperative complications and long-term outcome. METHODS A retrospective chart review of 74 consecutive patients who had repair of a symptomatic enterocele and vaginal vault prolapse or uterine prolapse from January 1987 to August 1999. All patients were followed for a minimum of 3 months and 61 were available for long-term evaluation at 18-106 months (median 52 months). RESULTS Intra- and postoperative complications were few. Pelvic examination at long-term follow-up disclosed a recurrence rate for enterocele of 1.7%, vaginal vault prolapse of 8.3%, and cystocele of 15%. Ninety-one per cent were subjectively satisfied with the relief of mechanical vaginal symptoms. Only 35% (6/17) were cured of constipation. Out of the 22 women who were sexually active after the procedure, 12 (54%) experienced improved quality. CONCLUSION Repair of the posterior compartment defect and suspension of the vaginal vault using autologous fascia lata graft provides acceptable intra- and postoperative complication and long-term results.
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Affiliation(s)
- Lars Mølsted-Pedersen
- Department of Obstetrics and Gynecology, Copenhagen County Hospital Glostrup, Denmark
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Abstract
BACKGROUND Morbid obesity is a risk for fascial wound dehiscence and incisional hernia after abdominal surgery. The development of minimally invasive surgical techniques has led to a dramatic decrease in these complications. However, laparoscopic surgery may still be followed by trocar-wound herniation. Various methods have been advocated for its prevention. METHODS The records of 752 patients who underwent laparoscopic bariatric operations (610 mini-gastric bypass and 142 gastric banding) as treatment for morbid obesity between October 2001 and June 2005, with regular follow-up, were retrospectively reviewed. In all patients, the fascial layer of trocar wounds was not closed. Instead, a Surgicel plug was inserted into the muscle layer of trocar wounds of 10- and 12-mm diameter. RESULTS 2 male patients in the mini-gastric bypass group developed a trocar wound hernia, for an overall prevalence of 0.33% (2/610). The intervals between surgery and diagnosis were 3 and 5 months respectively. In these 2 patients, the hernia occurred at the 12-mm trocar wound of the left midclavicular line, 2-3 cm below the costal margin, outside the left rectus muscle. These 2 patients have not developed intestinal obstruction as a consequence of the hernia, and have not undergone hernia repair. No patient in the gastric banding group has been found to develop a hernia. CONCLUSION With our technique, the prevalence of trocar-wound hernia after laparoscopic bariatric surgery has been very rare.
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Affiliation(s)
- Chong-Chi Chiu
- Department of Surgery, Chi-Mei Hospital - Liou Ying Campus, Taiwan
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Abstract
Little is known about incidence and risk factors for incisional hernia after liver transplantation (OLT). More frequently this problem occurs at the junction of midline and transverse incisions. We prospectively and consecutively used three different types of abdominal incisions in 47 OLTs. The results were compared in order to identify the type of incision and risk factors that determine herniae after OLT. The overall incidence was 17%. It occurred in 6 out of 19 patients (31.3%) with a transverse and right subcostal both with upper midline incision versus 2 out of 26 patients (7.7%) with only a right subcostal incision. In conclusion, a subcostal incision is sufficient to perform OLT and reduce hernia incidence after OLT.
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Affiliation(s)
- M Donataccio
- Liver Transplant Program, Prima Chirurgia Clinicizzata, Ospedale Civile Maggiore, University of Verona, Italy.
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Nanni G, Tondolo V, Citterio F, Romagnoli J, Borgetti M, Boldrini G, Castagneto M. Comparison of oblique versus hockey-stick surgical incision for kidney transplantation. Transplant Proc 2006; 37:2479-81. [PMID: 16182716 DOI: 10.1016/j.transproceed.2005.06.055] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The hockey-stick surgical incision is becoming more popular than the oblique incision for kidney transplantations. Both incisions are convenient and comfortable. Both have some drawbacks, such as muscle denervation for the former, or section of lateral muscles for the latter. In this retrospective study, we compared these incisions with regard to the incidence of long-term complications, such as postincisional hernia, relaxation of the abdominal wall, and a poor cosmetic result. One hundred patients (50 of each type) were evaluated at an average of 4.5 years after transplantation (3 months-15 years). Occurrence of incisional hernia was 16% in the former (8 cases) versus 4% in the latter (2 cases: X(2) = 4; P < .05). A major relaxation of the abdominal wall was found in 24% of the former (12 cases) versus 8% of the latter (4 cases) (X(2) = 4.76; P < .05). These complications were not correlated with age, sex, weight, side of transplant, or immunosuppressive drugs. In the former patients with hockey-stick incisions, the overall cosmetic results were poor, because in most cases the incision had been prolonged upward, above the transverse umbilical line, even as high as the costal arch. In 20% of the former patients with hockey-stick incisions, the scar had widened, particularly in the upper vertical branch of the J incision. We conclude that the final outcome of the oblique surgical incision was better than the hockey-stick incision because of the lower incidence of hernia and abdominal wall relaxation and the more favorable cosmetic results.
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Affiliation(s)
- G Nanni
- Transplant Unit, Department of Surgery, Catholic University, Roma, Italy.
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Portnov AN, Portnov KA. [Experience with using a carbonic implant for plasty of hernia defects]. Vestn Khir Im I I Grek 2006; 165:52-3. [PMID: 16881176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Based on 3-year experiences with using "Karbonikus-P" as a transplant in 62 patients the authors have found that a carbonic implant causes a marked reaction of tissues and sequestration of certain fibers. It is necessary to use the implant as a method of choice and to continue observations.
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Jander A, Nowicki M, Tkaczyk M, Makulska I, Zwolińska D, Latoszyńska J, Boguszewska-Baczkowska A, Grenda R, Bałasz-Chmielewska I, Zagozdzon I, Załuska-Leśniewska I, Zurowska A, Stefaniak E, Zachwieja J, Leszczyńska B, Roszkowska-Blaim M, Zachwieja K, Pietrzyk JA, Wierciński R, Zoch-Zwierz W, Stankiewicz R. [Chronic peritoneal dialysis in infants--preliminary results of the multicenter survey]. Przegl Lek 2006; 63 Suppl 3:72-4. [PMID: 16898493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We retrospectively analysed peritoneal dialysis treatment in 29 infants dialysed in 9 paediatric centres in Poland in the years 1993-2004. The mean age at the start of dialysis was 4.9 +/- 3.5 months (range 2 days to 11 months), mean body mass 5.6 +/- 2.5 kg (range 2.5 to 11 kg). The mean duration of PD was 6.8 +/- 3.9 in the first year of life and total duration of the therapy 34 +/- 27 months. Of the 29 infants 4 died (2 in infancy), 11 underwent renal transplantation, in 2 children PD was stopped (they received a conventional treatment) and 12 were still dialysed at the date of data collection. The peritonitis rate was 1/9.5 patient-month and exit site infection rate 1/16 patient-month up to 1 year of life. 9 children (31%) required hernia repairs and in 9 catheters were replaced. Chronic peritoneal dialysis in infants is associated with high risk of infections and surgical complications and remains a challenge for paediatric nephrologists.
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Affiliation(s)
- Anna Jander
- Klinika Nefrologii i Dializoterapii, Instytutu Centrum Zdrowia Matki Polki, Lódź.
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de Campos FGCM, Habr-Gama A, Araújo SE, Sousa AHDSE, Nahas CR, Lupinacci RM, Nahas SC, Kiss DR, Gama-Rodrigues J. Incidence and Management of Perineal Hernia After Laparoscopic Proctectomy. Surg Laparosc Endosc Percutan Tech 2005; 15:366-70. [PMID: 16340572 DOI: 10.1097/01.sle.0000191592.93326.63] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Perineal hernia (PH) is formed by the protrusion of intra-abdominal viscera through a defect in the pelvic floor. This is a rare complication after conventional abdominoperineal resection, pelvic exanteration, proctectomy, and other pelvic procedures. The purpose of the present paper is to report 4 cases of PH after laparoscopic abdominoperineal resection for rectal cancer and to review literature data about the incidence, predisposing factors, and treatment of this challenging problem. When added to other 3 cases previously reported in the Brazilian series of laparoscopic surgery, this group of 7 cases comprises a PH incidence of 3.5% after rectal resection procedures. Surgical treatment is indicated only in symptomatic patients with no signs of cancer recurrence. Proposed methods of surgical repair include abdominal, perineal, or combined approaches to the hernia in association with the use of autologous tissues or prosthetic meshes. Preventive measures are represented by closure of the pelvic peritoneum whenever possible, primary perineal suture and wound care to avoid infection.
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Affiliation(s)
- Fábio Guilherme C M de Campos
- Colorectal Surgery Unit, Department of Gastroenterology of Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
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Abstract
PURPOSE Hand assisted laparoscopic surgery (HALS) provides benefits similar to standard laparoscopy but generally requires a larger incision. We assessed the nature of and risk factors for incisional complications after HALS. MATERIALS AND METHODS All patients who underwent HALS at our institution from February 1997 through December 2003 were included in a prospective and retrospective review to assess postoperative wound complications. Literature regarding wound complications associated with open surgery and standard laparoscopy was reviewed. RESULTS A total of 424 consecutive procedures performed on 422 patients were evaluated. Postoperative HALS incision site complications included 29 infections (6.8%), 15 hernias (3.5%) and 2 dehiscences (0.5%). Multivariate logistic regression models revealed that HALS incision site hernias were associated with current or past tobacco smoking (6.0%, p = 0.04), with a trend toward significance for diabetes mellitus (14%, p = 0.07), male gender (5.3%, p = 0.08) and renal failure (16%, p = 0.08). HALS incision site infections were associated with omission of perioperative antibiotics (13%, p = 0.007), obesity (12%, p = 0.03) and increased operative time (252 vs 222 minutes in patients with and without infection, respectively, p = 0.001). CONCLUSIONS Our findings suggest that wound infections and hernias occur less frequently with HALS than with open surgery, but more often than with standard laparoscopy. Certain patient comorbidities (eg obesity), modifiable risk factors (eg smoking status) and procedural variables (eg omission of perioperative antibiotics or length of procedure) may adversely influence HALS wound complications. This information can be used to decide between HALS and standard laparoscopic approaches in particular patients.
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Affiliation(s)
- Jeffrey S Montgomery
- Michigan Urology Center, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
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Kleeman S, Vassallo B, Segal J, Hungler M, Karram M. The ability of history and a negative cough stress test to detect occult stress incontinence in patients undergoing surgical repair of advanced pelvic organ prolapse. Int Urogynecol J 2005; 17:27-9. [PMID: 16094506 DOI: 10.1007/s00192-005-1367-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Accepted: 07/11/2005] [Indexed: 11/29/2022]
Abstract
To determine if a negative preoperative reduction cough stress test is a viable method of detecting occult stress incontinence or urge incontinence in women undergoing surgical repair of advanced pelvic organ prolapse. A retrospective chart review was done on all patients who denied any urinary complaints and had repair of advanced pelvic organ prolapse, grade two or greater, without the addition of an anti-incontinence procedure. Additionally patients had a simple office filling study done at the time of initial examination that failed to show the sign of stress incontinence or detrusor instability. Any urinary dysfunction that developed postoperatively was noted. A total of 53 patients met the inclusion criteria. Of these patients, one patient (1.9%) developed genuine stress incontinence, and one patient complained of urgency (1.9%). Patients without urinary complaints and a negative office filling study, who were present for surgical correction of advanced pelvic organ prolapse, have a low incidence of developing occult stress incontinence. Further work-up would not be cost effective.
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Affiliation(s)
- Steven Kleeman
- Department of Obstetrics and Gynecology Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, OH, USA.
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Piazzese E, Montalti R, Beltempo P, Bertelli R, Puviani L, Pacilè V, Nardo B, Cavallari A. Incidence, predisposing factors, and results of surgical treatment of incisional hernia after orthotopic liver transplantation. Transplant Proc 2005; 36:3097-8. [PMID: 15686704 DOI: 10.1016/j.transproceed.2004.10.047] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The literature provides little data about incisional herniae (IH) developing after orthotopic liver transplantation (OLTx). We evaluated the incidence, predisposing factors, and results of surgical treatment of this pathological condition. We reviewed the records of 718 consecutive OLTx performed in 623 patients between April 1986 and May 2002. Patients whose IH developed after transplantation were included in the study. We identified 31 patients (incidence, 4.9%) whose IH developed from 2 to 140 months after the transplantation. This complication was significantly more frequent in men. Important predisposing factors included: virus-correlated cirrhosis, body mass index >25, severe ascites, incision type for OLTx (bilateral subcostal extended upper midline to xiphoid), and post-OLTx complications. In 17 patients, repair of hernia was performed using direct fascial approximation, in 20 patients, it required a prosthesis. After hernia treatment, we observed no deaths but a morbidity rate of 6.4%, a mean postoperative hospital stay of 8 days and a recurrence rate of 6.4%. IH post-OLTx need surgical treatment.
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Affiliation(s)
- E Piazzese
- Surgery, ICU, and Transplantation, University of Bologna, S. Orsola Hospital, Bologna, Italy
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35
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Srikanth MS, Oh KH, Keskey T, Rumbaut R, Fox SR, Fox ER, Fox KM. Critical extreme anterior slippage (paragastric Richter's hernia) of the stomach after laparoscopic adjustable gastric banding: early recognition and prevention of gastric strangulation. Obes Surg 2005; 15:207-15; discussion 215. [PMID: 15802063 DOI: 10.1381/0960892053268471] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND We report an unusual complication after Lap-Band placement characterized by herniation of the anterior stomach through the band. METHODS Group 1 - 105 patients: Operated elsewhere (prior to US FDA approval) and followed by us; perigastric technique was used in 74 and pars flaccida in 31. Group 2 - 218 patients: Operated by us since August 2001 using the pars flaccida approach only. 4 patients with this unusual problem were identified. RESULTS Patients were all female, with age 37.5 (3343) yr, weight 143.7 (123-167) kg, and BMI 54 (45-65). Onset occurred at 9 (5-16) months, with weight loss: 38.5 (27-53) kg and %EWL 47.3 (31-54)%. All had sudden nausea, vomiting and epigastric abdominal pain that persisted despite emptying the band. None of these symptoms were related to a recent band adjustment. CT scan showed a paragastric Richter's hernia of the stomach underneath the band. At exploration, the band was in the normal location. 3 patients from Group 2 had Richter's hernia of the anterior stomach through the band; reduction of the stomach with closure of the defect was performed. One patient from group 1 had gangrene of the entrapped stomach, resulting in band removal and gastrectomy. CONCLUSION Lap-Band patients with sudden nausea, vomiting and abdominal pain, when not relieved by emptying the band, should undergo a CT scan. If a traditional slippage is not confirmed, paragastric Richter's hernia of the stomach through the band should be suspected. Immediate exploration with reduction of the stomach and closure of the defect can salvage the stomach and the band. Gastro-gastric sutures must completely close the space underneath the band to prevent this complication.
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Abstract
OBJECTIVE To review the relationship between the pathogenesis and clinical manifestations of trocar site hernias seeking to confirm the definition of trocar site hernias by classification. DATA SOURCES We searched this subject in English on MEDLINE by combining the words "trocar," "port," "hernia, and "laparoscopy."Data Extraction and STUDY SELECTION We limited the main operations to cholecystectomy, colon and rectal surgery, fundoplication, and gastric surgery; finding 44 reports on these procedures. Of these, 19 were case reports, 18 were original articles (setting criteria; the incidence of the trocar site hernia was clarified, and involved >100 patients), and 7 technical notes on "how to do it" were collected. We obtained 19 additional reports using the references of those previously obtained. We, thus, reviewed 63 reports (24 case reports, 27 original articles, 7 technical notes, and 5 review articles). DATA SYNTHESIS Trocar site hernia was classified into 3 types. The early-onset type that occurred immediately after the operation, with a small-bowel obstruction, especially the Richter hernia, frequently developing. The late-onset type that occurred several months after the operation, mostly with local abdominal bulging with no small-bowel obstruction developing. The special type that occurred indicated the protrusion of the intestine and/or omentum. Trocar site hernias with fascial defects of 10 mm or larger should be closed, including the peritoneum. Opinion varied if a 5-mm trocar site defect should be closed. CONCLUSION It is useful to clearly classify trocar site hernias to improve management of laparoscopic procedures.
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Affiliation(s)
- Hitoshi Tonouchi
- Departments of Innovative Surgery, Mie University School of Medicine, Mie, Japan
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Marema RT, Perez M, Buffington CK. Comparison of the benefits and complications between laparoscopic and open Roux-en-Y gastric bypass surgeries. Surg Endosc 2005; 19:525-30. [PMID: 15759184 DOI: 10.1007/s00464-004-8907-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2004] [Accepted: 10/26/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND In recent years, there has been an increase in numbers of individuals seeking laparoscopic surgical procedures for obesity. The current study compared the benefits and risks between laparoscopic and open Roux-en-Y gastric bypass (RYGBP) performed at the same center for more than 2,000 patients. METHODS The study population consisted of 1,077 laparoscopic and 1,198 open RYGBP procedures performed between the years 1999 and 2002. Measurements included population characteristics, anthropometries, complications, and hospital stay. RESULTS The laparoscopic RYGBP has both advantages and disadvantages. The disadvantages include a longer operative time and a higher incidence of fistulas, internal hernias, and small bowel obstruction. The advantages of the laparoscopic procedure are shorter hospital stay, lower incidence of wound infection, and fewer incisional hernias. Both procedures cause similar changes in body weight, but laparoscopic RYGBP is associated with less lean tissue loss during the early postoperative period. CONCLUSION Both laparoscopic and open RYGBP are effective in inducing massive weight loss. There are, however, differences in the benefits and risks between the two procedures.
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Affiliation(s)
- R T Marema
- U.S. Bariatric, 4800 NE 20th Terrace, Suit 303, Fort Lauderdale, FL 33308, USA
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38
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Shumakov VI, Shumakov DV, Mukha AV, Shurygin SN. [Treatment of patients with general surgical diseases after open-heart operations with cardiopulmonary bypass]. Khirurgiia (Mosk) 2005:4-6. [PMID: 16044117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Experience in surgical treatment of 69 patients suffering from coronary heart disease and valve pathology in combination with various general surgical diseases was summarized. Two methods of surgical correction were studied: combined one and staged one. Up-to-date technologies such as endoscopic surgery, tension free hernioplasty, and artificial materials were used during the procedures. Combined procedures reduce the risk of general surgery complications early after surgery. Correction of cardiovascular pathology has a priority in curative algorithm.
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Comeau E, Gagner M, Inabnet WB, Herron DM, Quinn TM, Pomp A. Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc 2004; 19:34-9. [PMID: 15529196 DOI: 10.1007/s00464-003-8515-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2003] [Accepted: 06/23/2004] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study was to describe the occurrence and clinical characteristics of symptomatic internal hernias (IH) after laparoscopic bariatric procedures. METHODS We conducted a retrospective review of cases of IH after 1,064 laparoscopic gastric bypasses (LGB) and biliopancreatic diversions with duodenal switch (LBPD-DS) performed from September 1998 to August 2002. RESULTS We documented 35 cases of IH (overall incidence of 3.3%). The IH occurred in 6.0% of patients with retrocolic procedures and 3.3% of patients with antecolic procedures. Most were in the Petersen defect (55.9%) and at the enteroenterostomy site (35.3%). A bimodal presentation was observed, with 22.9% of patients with IH diagnosed in the early postoperative period (2-58 days) and 77.1% in a delayed fashion (187-1,109 days). A laparoscopic approach to the repair of IH was possible in 60.0% of patients. Complications occurred in 18.8% of patients, including one death (2.9%). CONCLUSION Complete closure of all mesenteric defects is strongly recommended during laparoscopic bariatric procedures to avoid IH and their associated complications.
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Affiliation(s)
- E Comeau
- Department of Surgery , Centre Hospitalier Universitaire de Sherbrooke, Sherbooke, Quebec, Canada
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40
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Affiliation(s)
- Y T Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
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41
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Lapalus MG, Henry L, Barth X, Mellier G, Gautier G, Mion F, Damon H. Entérocèle : facteurs de risque clinique et associations à d'autres troubles de la statique pelvienne (à partir de 544 défécographies). ACTA ACUST UNITED AC 2004; 32:595-600. [PMID: 15450257 DOI: 10.1016/j.gyobfe.2004.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2003] [Accepted: 05/10/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To study, by means of defecography, clinical risk factors of enterocele and association with others pelvic floor disorders. PATIENTS AND METHODS Five hundred and forty-four consecutive female patients were investigated by colpocystodefecography with contrast medium in the small bowel. One hundred and thirty-six women with enterocele were compared to 408 women without enterocele. RESULTS There were no significant differences in age, obstetrical history (parity, foetal macrosomia, instrumental extractions or perineal tear to delivery) between the two groups. More women with enteroceles had histories of hysterectomies (60% versus 24%) or cystopexies (29% versus 13%). Others pelvic floor disorders were associated in 91% of enterocele: rectocele (25%), cystocele (42%), uterine prolapse (28%), rectal intussusception (52%), rectal prolapse (4%) and abnormal perineal descent (30%). Stress urinary incontinence was significantly more frequent in women without enterocele. DISCUSSION AND CONCLUSIONS The study has demonstrated that previous hysterectomy and cystopexy increased the risk of enterocele formation and that enterocele and others pelvic floor disorders are often concomitant. Enterocele may have a pessary effect on urinary disorders. Results of colpocystodefecography reinforce the notion of pelvic floor local disease.
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Affiliation(s)
- M-G Lapalus
- Fédération des spécialités digestives, service d'hépato-gastro-entérologie, hôpital Edouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
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Ferrante F, Rusconi A, Galimberti A, Grassi M. Hernia repair in the Lombardy region in 2000: Preliminary results. Hernia 2004; 8:247-51. [PMID: 15146355 DOI: 10.1007/s10029-004-0229-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2002] [Accepted: 03/10/2004] [Indexed: 10/26/2022]
Abstract
Hernia repair is the most common surgical procedure in general surgery in Italy and in the Lombardy region. In the last decade, the use of mesh, the concept of a tension-free technique, and the postoperative rate of recurrences after Bassini or Shouldice operations have completely changed the surgical approach to hernia repair. For this reason, we sent a questionnaire to 148 surgical departments in the Lombardy region to investigate about total hernia operations performed in 2000 in Lombardy, the surgical approach, the surgical techniques used, the type of anesthesia and the hospital stay. One hundred five out of 148 surgical departments returned the questionnaire, and we collected information on a total of 16,935 surgical operations for hernia: 16,494 were performed using tension-free techniques. The inguinal anterior approach is the one of choice for primary and recurrent inguinal hernia, whereas the open preperitoneal and laparoscopic approaches are limited to bilateral and recurrent hernias. The majority of cases were treated under locoregional anesthesia and with a hospital stay of two nights.
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Affiliation(s)
- F Ferrante
- Department of General Surgery, Edoardo Bassini Hospital, Via Gorky 50, 20092, Cinisello Balsamo Milan, Italy.
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43
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Abstract
BACKGROUND This study evaluated the complications of colostomy and its closure in infants and children. METHODS One hundred forty-six colostomies were performed in 86 neonates, 23 infants, and 37 children older than 1 year. These children underwent colostomies for anorectal malformation (84), Hirschsprung's disease (47), and other miscellaneous (15) conditions like colonic atresia, volvulus, rectal tuberculosis, traumatic rectal perforation, and intestinal obstruction caused by ascariasis. RESULTS Of these, 17 (11.6%) had early complications, and 80 (69.8%) had stomal complications. Three patients died, but only 1 death was directly related to colostomy. Colostomy prolapse, peristomal excoriation, and malnutrition were the major complications. The complications were not dependant on the children's age or primary indication. Sigmoid colostomy had a lower malnutrition rate than transverse colostomy (34.9% v 16.9% P =.009). Among the 56 children who underwent colostomy closure, major complications include death (1.8%), anastomotic leak (7.1%), and wound infection (12.6%). CONCLUSIONS A divided sigmoid colostomy should be performed whenever possible. Proper stomal care, regular nutritional assessment, and early closure of the colostomy would minimize morbidity and mortality of colostomy and its closure.
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Affiliation(s)
- B Chandramouli
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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44
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Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (RYGBP) has been shown to be a safe and effective alternative to traditional "open" RYGBP. Although lack of postoperative adhesions is one advantage of minimally invasive surgery, this is also responsible for a higher incidence of internal hernias. These patients often present with intermittent abdominal pain or small bowel obstruction with completely normal contrast radiographs. METHODS Data was obtained concurrently on 2,000 consecutive patients from February 1998 to October 2001 and analyzed retrospectively. Radiographs, when available, were interpreted by both the operative surgeon and radiologist before intervention. RESULTS 66 internal hernias occurred in 63 patients, an incidence of 3.1%. 1 patient presented with a traditional adhesive band and small bowel obstruction. 20% of patients had normal preoperative small bowel series and/or CT scans. The site of internal hernias varied: 44 - mesocolon; 14 - jejunal mesentery; 5 - Petersen's space. Although most patients were symptomatic, 5% were incidental findings at the time of another surgical procedure. 5 patients required open repair. 6 patients presented with perforation either at the time of diagnosis or as a result of manipulation of the bowel. There was 1 death associated with complications of the internal hernia. The negative exploration rate was 2%. CONCLUSION Internal hernias are more common following laparoscopic RYGBP than "open" RYGBP. Contrast radiographs alone are unreliable in ruling out this diagnosis. Early intervention is crucial; most repairs can be performed laparoscopically. This diagnosis should be entertained in all patients with unexplained abdominal pain following laparoscopic RYGBP. Meticulous closure of all potential internal hernia sites is essential to limit this potentially lethal complication.
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45
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Abstract
The reason for undertaking this study was that postoperative complications of colic surgery lead to patient discomfort, prolonged hospitalisation and increased cost. Potential risk factors for the 6 most common postoperative complications (jugular thrombosis, ileus, re-laparotomy, wound suppuration, incisional herniation and colic) were evaluated using multivariable models. Jugular thrombosis was associated significantly with heart rate greater than 60 beats/min and with increased packed cell volume (PCV) at admission. The risk of postoperative ileus also increased with increasing PCV at admission and was higher in horses recovering from pedunculated lipoma obstruction. Incisional herniation was strongly associated with wound suppuration and with increasing heart rate at admission. The emergence of cardiovascular parameters as risk factors for several postoperative complications is consistent with the hypothesis that endotoxaemia is important in the development of these complications. Early referral of colic cases, prior to the development of severe endotoxaemic shock, may minimise the risk of some postoperative complications. Horses that have suffered epiploic foramen entrapment, are more than 4 times as likely to undergo re-laparotomy than other horses. Horses that have suffered postoperative ileus have a similarly increased risk of undergoing re-laparotomy. The risk of postoperative colic is significantly associated with horses recovering from large colon torsion (>360 degrees) and with having undergone re-laparotomy. Hazard ratios (with 95% confidence intervals) for these last two effects are 3.1 (1.7, 5.7) and 3.4 (1.9, 6.2), respectively. Knowledge of the risk factors for postoperative complications allows more accurate prognostication postoperatively and suggests ways in which the risk of postoperative complications can be minimised.
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Affiliation(s)
- N P French
- Faculty of Veterinary Science, University of Liverpool, Neston, Wirral, UK
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46
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Abstract
Post-laparoscopics incisionals hernias are among the serious complications of laparoscopy, however they are probably under-reported. We undertook a literature review to discuss their main characteristics. We emphasized on the need of controlled studies regarding their prevention measures.
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Affiliation(s)
- J Loriau
- Service de chirurgie générale et digestive, CHU d'Amiens, hôpital Nord, Place-Victor-Pauchet, 80054 Amiens, France.
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47
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Abstract
Internal hernia is an uncommon cause of small bowel obstruction that may be increasing in frequency. Because the clinical diagnosis of internal hernia is difficult, imaging studies such as computed tomography (CT) and small bowel follow through play an important role. Transmesenteric hernia is the most common type and is usually related to prior abdominal surgery, especially with creation of a Roux-en-Y anastomosis (eg, liver transplantation, gastric bypass). CT may allow confident diagnosis in most cases. In this article, we review the clinical and imaging findings of internal hernia based on our experience with 54 cases of surgically proven internal hernias including 45 transmesenteric, 6 paraduodenal, and 3 omental hernias, 39 of which had imaging studies available for review.
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Affiliation(s)
- Arye Blachar
- Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA
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Uğuz MZ, Onal K, Karagöz S, Gökçe AH, Firat U. [Coexistence of laryngeal cancer and laryngocele: a radiologic and pathologic evaluation]. Kulak Burun Bogaz Ihtis Derg 2002; 9:46-52. [PMID: 12122625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES We investigated the incidence of laryngocele in patients with laryngeal cancer and in healthy controls and evaluated the role of laryngocele in neck metastasis and thyroid cartilage invasion. PATIENTS AND METHODS The incidence of laryngocele was investigated by computed tomography (CT) preoperatively in 52 patients (49 men, 3 women; mean age 56 years; range 36 to 79 years) with laryngeal cancer. The findings were compared with those of histopathologic studies; moreover, neck metastasis and thyroid cartilage invasion were sought. In addition, the incidence of laryngocele was examined in 50 normal controls. RESULTS Histopathologic examination showed laryngocele in 17 patients (32.7%). The incidence of laryngocele by CT was 30.7% (n = 16). Computed tomography showed laryngocele in three cases (6%). Of patients with laryngocele, lymph node metastasis and thyroid cartilage invasion were detected histopathologically in 47% and 23.5%, respectively, whereas lymph node metastasis and thyroid cartilage invasion were found in 22.8% of patients without laryngocele (p > 0.05). CONCLUSION The association between laryngeal cancer and laryngocele requires a detailed evaluation for laryngeal carcinoma in patients in whom an asymptomatic laryngocele had been detected by CT.
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Affiliation(s)
- Mustafa Zafer Uğuz
- Department of Otolaryngology, Atatürk Training and Research Hospital, Izmir, Turkey.
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Humar A, Ramcharan T, Denny R, Gillingham KJ, Payne WD, Matas AJ. Are wound complications after a kidney transplant more common with modern immunosuppression? Transplantation 2001; 72:1920-3. [PMID: 11773889 DOI: 10.1097/00007890-200112270-00009] [Citation(s) in RCA: 184] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The most common surgical complication after a kidney transplant is likely related to the wound. The purpose of this analysis was to determine the incidence of, and risk factors for, wound complications (e.g., infections, hernias) in kidney recipients and to assess whether newer immunosuppressive drugs increase the risk for such complications. METHODS Between January 1, 1984 and September 30, 1998, we performed 2013 adult kidney transplants. Of these 2013 recipients, 97 (4.8%) developed either a superficial or a deep wound infection. Additionally, 73 (3.6%) recipients developed either a fascial dehiscence or a hernia of the wound. We used univariate and multivariate techniques to determine significant risk factors and outcomes. RESULTS Mean time to development of a superficial infection (defined as located above the fascia) was 11.9 days posttransplant; to development of a deep infection (defined as located below the fascia), 39.2 days; and to development of a hernia or fascial dehiscence, 12.8 months. By multivariate analysis, the most significant risk factor for a superficial or deep wound infection was obesity (defined as body mass index>30 kg/m2) (RR=4.4, P=0.0001). Other significant risk factors were a urine leak posttransplant, any reoperation through the transplant incision, diabetes, and the use of mycophenolate mofetil (MMF) (vs. azathioprine) for maintenance immunosuppression (RR=2.43, P=0.0001). Significant risk factors for a hernia or fascial dehiscence were any reoperation through the transplant incision, increased recipient age, obesity, and the use of MMF (vs. azathioprine) for maintenance immunosuppression (RR=3.54, P=0.0004). Use of antibody induction and treatment for acute rejection were not significant risk factors for either infections or hernias. Death-censored graft survival was lower in recipients who developed a wound infection (vs. those who did not); it was not lower in recipients who developed an incisional hernia or facial dehiscence (vs. those who did not). CONCLUSIONS Despite immunosuppression including chronic steroids, the incidence of wound infections, incisional hernias, and fascial dehiscence is low in kidney recipients. As with other types of surgery, the main risk factors for postoperative complications are obesity, reoperation, and increased age. However, in kidney recipients, use of MMF (vs. azathioprine) is an additional risk factor -one that potentially could be altered, especially in high-risk recipients.
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Affiliation(s)
- A Humar
- Department of Surgery, University of Minnesota, MMC 195, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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Ng CS, Rackley RR, Appell RA. Incidence of concomitant procedures for pelvic organ prolapse and reconstruction in women who undergo surgery for stress urinary incontinence. Urology 2001; 57:911-3. [PMID: 11337293 DOI: 10.1016/s0090-4295(01)00938-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the incidence of concomitant procedures performed for pelvic organ prolapse or vaginal reconstruction at the time of surgery for stress urinary incontinence in contemporary practice. METHODS We recorded all concomitant procedures for pelvic organ prolapse or vaginal reconstruction in 264 women who underwent surgery for stress urinary incontinence at our institution from January 1995 to August 1997. RESULTS Of 264 women, 111 (42%) had at least one concomitant procedure performed for pelvic organ prolapse or vaginal reconstruction, including 87 cystocele repairs, 31 rectocele repairs, 8 sacrospinous fixations, 5 enterocele repairs, 5 abdominal sacrocolpopexies, 4 perineoplasties, 3 urethral diverticulectomies, and 1 vaginal hysterectomy. Furthermore, 9% of patients had two or more procedures. CONCLUSIONS We found that women who undergo surgery for stress urinary incontinence have a high incidence (42%) of associated pelvic organ prolapse requiring surgical repair. These additional repairs contribute to the overall success of surgery and should not be overlooked.
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Affiliation(s)
- C S Ng
- Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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