Top PDF Mesh Plug Repair of Inguinal Hernia; Single Surgeon Experience

Mesh Plug Repair of Inguinal Hernia;  Single Surgeon Experience

Mesh Plug Repair of Inguinal Hernia; Single Surgeon Experience

Bütün hastalara plug-mesh onarımı Rutkow tekniği kullanıla- rak uygulandı. Bütün hastalara anestezi indüksiyonu sırasında prolaktik antibiyotik uygulamasını takiben cilt tıraşı, ameliyat- tan hemen önce ameliyathanede yapıldı. Cilt temizliği için % 10 povidon iyod solüsyonu kullanılarak; cerrahi alan steril örtüler- le örtüldü. Transverse yakın oblik inguinal cilt insizyonu ile ingu- inal kanala girilip eksternal oblik kas aponevrozu, altta inguinal ligamana kadar, üstte ve lateralde de gretin konulacağı boş- luk oluşturulacak şekilde hazırlandı. Bundan sonra kordon, eks- ternal spermatik damarlar ve genitofemoral sinirin genital dalı korunacak şekilde bunlarla birlikte kaldırılıp askıya alındı. Kanal arka duvarı, kordon eksplore edilip, kordon lipomu varsa eksize edildi. İndirekt keselere plug mesh absorbabl sütürlerle tespit edildi. Skrotal kese varlığında ise kesenin skrotuma uza- nan kısmı diseke edilmeyip, kese inguinal kanal ortasında açılıp transseksiyon uygulandı. Ancak yüksek ligasyon yapılmayıp peri- ton 0/0 vycrl ile kapatılarak fıtık kesesi karın içerisine gönderil- di. Direkt keseler de plug- mash ile absorbabl sütürlerle göm- dürüldü. Pubik köşesi yuvarlatılmış ve lateralde kordonun geçe- ceği bir yer hazırlanmış olan On-lay greti pubik kemik üstünde- ki aponeurotik yapılara 00 vycryl sütür ile dikilerek tespit edildi. Eksternal oblik aponevroz devamlı 00 polipropilen sütür ile diki- lerek inguinal kanal yeniden oluşturuldu. Cilt altı 000 polyglactin ile, cilt 000 nylon ile kapatıldı. Hastalarda ameliyat bölgesi, izo- tonik NaCl solüsyonu dışında, herhangi bir solüsyonla yıkanmadı.
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Novel retrograde puncture method to establish preperitoneal space for laparoscopic direct inguinal hernia repair with internal ring suturing

Novel retrograde puncture method to establish preperitoneal space for laparoscopic direct inguinal hernia repair with internal ring suturing

Whether a mesh plug is needed in the laparoscopic inguinal hernia repair (LIHR) remains controversial (20–22). Earlier, mesh fixations were performed using a fibrin sealant or sutures (23), which led to complications such as foreign body sensation, paresthesia, and acute and chronic pain, and thus increased the medical costs (24–27). In 1995, Dunn (28) questioned the necessity of mesh plug placement. In 2004, Moreno-Egea et al. (17) found a high recurrence rate in patients undergoing TEP without mesh fixation. In 2006, Koch et al. (29) claimed that mesh fixation was not needed for defects with a diameter o3 cm. In 2008, Taylor et al. (21) reported that patients with a defect o2 cm could safely undergo a repair surgery without mesh fixation. According to IEHS guidelines (18), mesh fixation is required in TEP for direct hernia. In our practice of internal ring suturing, we noticed that the internal ring is already occluded before mesh fixation, and recurrence does not seem to occur in the short term even if mesh fixation was not performed (30). However, better results might be achieved if the repair is reinforced with a mesh fixation.
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Rev. Col. Bras. Cir.  vol.40 número1

Rev. Col. Bras. Cir. vol.40 número1

Objective: To identify and assess the complications of laparoscopic inguinal hernia treatment with totally extraperitoneal mesh placement (TEP). Methods Methods Methods Methods Methods: We included patients who had undergone the TEP procedure in a consecutive series of 4565 laparoscopic hernia repairs between January 2001 and January 2011. Inclusion criteria were diagnosis with symptomatic inguinal hernia, including recurrence after inguinal hernia repair and previous surgery in the lower abdomen and pelvis. All patients were 18 years of age or above. Patients with incarcerated hernia in emergency were excluded from the study. Results Results Results Results Results: A total of 4565 hernias were included in the study. In the group, there were 27 severe complications (0.6%): 12 bleedings (0.25%), two bladder lesions (0.04%), five intestinal obstructions (0.11%), four intestinal perforations (0.09%) one injury to the iliac vein (0.02%), one femoral nerve injury (0.02%), two lesions of vas deferens (0.04%) and two deaths (0.02%) (pulmonary embolism, peritonitis). Conclusion Conclusion Conclusion Conclusion Conclusion: The rate of complications with the TEP procedure is low. Laparoscopic hernia repair technique is reproducible and reliable. In our experience, there are contraindications to the TEP procedure. TEP technique must be meticulous to avoid intraoperative complications (bipolar diathermy). Complications can occur even after the surgeon has gained substantial experience.
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Recidiva de hernioplastia inguinal à Lichtenstein: o emprego do plug de poliproplileno.

Recidiva de hernioplastia inguinal à Lichtenstein: o emprego do plug de poliproplileno.

ABSTRACT - Background – The Lichtenstein hernia repair is considered the gold-standard treatment for inguinal hernias in the last two decades. It is tension-free technique and present the smallest published recurrence rates. The treatment after Lichtenstein recurrence is controversial. Aim - To show the results after the use polypropylene mesh plug in this condition. Methods - Among the total of 649 hernioplasties using Lichtenstein technique from August, 1994 to October, 2006, the authors present 5 cases of recurrence (0,77%), all males, from 42 to 68 years old, being 4 (80%) on the right side and 1 (20%) on left. The technical option was to perform an inguinotomy on the previous incision; defect wall dissection; identification and reduction of the peritoneal sac to the pre-peritoneal space; introduction and fixation of a polypropylene mesh plug into the defect. Results - In 4 cases the recurrence occurred between the previous mesh and the pubic tubercle, secondary to the inadequate mesh fixation or an insufficient mesh size (direct inguinal hernia) and in 1 case (20%) it was near to the internal inguinal ring, left very large (indirect inguinal hernia). No post-operative complication was related with this mesh plug, neither recurrences in long follow-up. Conclusion - A mesh plug repair in Lichtenstein recurrences permits adequate, safe and effective re-operation without the need to remove the mesh previously used with very low complication rate. hEADInGS - Inguinal hernia. Lichtenstein technique. Recurrence. Plug.
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Comparative study of inflammatory response and adhesions formation after fixation of different meshes for inguinal hernia repair in rabbits

Comparative study of inflammatory response and adhesions formation after fixation of different meshes for inguinal hernia repair in rabbits

anesthetized with ketamine hydrochloride (30mg/kg, i.m.) and xylazine hydrochloride (10mg/kg, i.m.). The abdomen of each animal was shaved and prepped with povidone/ iodine scrub and successive alcohol wipes. All operative technique was performed in aseptic standards. A 8 cm midline incision was made, caudal to the xyphoid appendix and the peritoneal cavity was exposed. The 2,0X1,0 cm polypropylene mesh was fixed in the left flank and secured to the margins with 3-0 prolene in a separate pattern. In the right flank, a 2,0X1,0 cm Vypro II mesh was sewn in the same way. The abdominal wall was sewn with 2-0 polyglactin simple continuous pattern and the skin closed with 4-0 mononylon thread. Povidone ointment was applied to the incision and a pressure bandage was applied. The animals were allowed to recover in individual cages and were observed for 28 days. They were controlled daily for local and systemic complications throughout the observation period. Every alteration were controlled and pointed out in the protocol resume. After the post surgical period, the animals were again anesthetized and underwent laparoscopic approach, in order to identify and evaluate adhesions degree. The 10 mm trocar was set 5 cm caudal to the previous incision for the pneumoperitoneum and introduction of the optic. Another two 5 mm trocars were placed in the right and left hypocondrium. Abdominal pressure was kept in 10 mmHg and the whole peritoneal cavity was evaluated, principally the sites where meshes were fixed. The findings were recorded to be analyzed by an independent investigator surgeon, who was unaware of the kind of mesh implanted. After the recording phase, laparotomy was performed and both fixed prosthesis were excised bilaterally with the abdominal wall segment, including peritoneum, aponeurosis and muscle. The entire tissue was fixed in 10% paraformaldehyde and sent to a pathologist. The animals were finally euthanized with endovenous injection of potassium chloride. The degree of adhesions was graded from 0 to 4 using an adhesion scoring scale as described by Shimanuki et al. 5 In this scoring
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LAPAROSCOPIC TEP VERSUS OPEN HERNIOPLASTY: A COMPARATIVE STUDY OF EXTRAPERITONEAL TENSION FREE MESH REPAIRS IN INGUINAL HERNIA

LAPAROSCOPIC TEP VERSUS OPEN HERNIOPLASTY: A COMPARATIVE STUDY OF EXTRAPERITONEAL TENSION FREE MESH REPAIRS IN INGUINAL HERNIA

system. In this article, we examine the advantages and disadvantages of two extra peritoneal inguinal hernia repair methods, which are open lichenstein’s hernioplasty and Laparoscopic Total Extra Peritoneal approaches of inguinal hernia repair. AIMS AND OBJECTIVES: The aim of this study was to compare the effectiveness and safety of laparoscopic and conventional open hernioplasty repair in the treatment of inguinal hernia and their results were studied in terms of operation time, patient comfort, hospital stay, return to normal activity and postoperative complications. METHODS: This study was done in a post-graduate teaching hospital where 50 cases were included. Of which 25 cases were operated by laparoscopic method and other 25 cases by conventional open hernioplasty. Outcome were compared in demographics and perioperative details with postoperative data. CONCLUSION: Since evidence in the literature does not point to either the laparoscopic or open approaches the clear superior procedure, surgeon preference and circumstantial influences will probably continue to dictate the approach employed in inguinal hernia repair. For primary inguinal hernias in general, the open hernioplasty is superior to the laparoscopic technique, both in terms of recurrence rates and in terms of safety whereas in bilateral inguinal hernia, recurrent inguinal hernia and sliding hernia, laparoscopic approach can be recommended.
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PERFORATED APPENDIX IN THE INDIRECT INGUINAL HERNIAL SAC PRESENTING WITH A SCROTAL  EMERGENCY: A PROSPECTIVE STUDY

PERFORATED APPENDIX IN THE INDIRECT INGUINAL HERNIAL SAC PRESENTING WITH A SCROTAL EMERGENCY: A PROSPECTIVE STUDY

Preoperative diagnosis requires a high degree of clinical suspicion and awareness and is extremely difficult, because the symptoms are non-typical and depend on the extent of peri-appendicular inflammation and the presence or absence of peritoneal contamination and usually point to incarcerated or strangulated hernia. In 2009, Coleman et al reported a case of incarcerated appendicitis masquerading as epididymitis. The final diagnosis was revised as an Amyand ’s hernia after performance of an abdominal CT scan. Fernando and Leelaratna and Losanoff and Basson defined Amyand’s hernia as an inguinal hernia containing (1) A non-inflamed appendix, (2) An inflamed appendix, (3) A perforated appendix, or (4) Acute appendicitis complicated with related or unrelated intra-abdominal pathology. The classification systems have been based on the surgical treatment recommended, which differs for each type of Amyand ’s hernia.
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Chondrosarcoma of the superior pubic ramus simulating an inguinal hernia.

Chondrosarcoma of the superior pubic ramus simulating an inguinal hernia.

Paciente do sexo feminino, 27 anos, notou um abau- lamento na região inguinal direita, indolor, de crescimento pro- gressivo há alguns meses. Procurou serviço médico onde foi realizado diagnóstico de hérnia inguinal direita. Foram solici- tados exames pré-operatórios de rotina e a paciente foi sub- metida à inguinotomia para realização de herniorrafia inguinal. Porém, foi encontrada uma tumoração fixa, endurecida, que foi curetada. O exame anatomopatológico demonstrou tratar- se de um condrossarcoma de baixo grau.

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Prospective ultrasonographic study of blood flow and testicular volume in patients submitted to surgical repair of inguinal hernia without using prosthesis

Prospective ultrasonographic study of blood flow and testicular volume in patients submitted to surgical repair of inguinal hernia without using prosthesis

on the spermatic cord - testicular atrophy and occlusion of the vas deferens - are feared because the irritated patient, fearing his masculinity has been threatened, often resorts to legal suits. Testicular ischemia was attributed as a result of a very tight reconstruction of the internal inguinal ring. Lesions in the vas deferens may arise after inadvertent dissection of the hernia sac and may be ligated, sectioned, or devascularized. These lesions may be underestimated, since the majority of men submitted to hernia repair in the groin tend to be older, without concern for their reproductive capacity. It is added that most inguinal hernias are unilateral, which rarely causes sterility in younger patients. However, a significant minority has bilateral repairs. In addition, cryptorchidism or even epididymitis may eliminate the contralateral reproductive contribution 14 .
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Rev. dor  vol.12 número4 en a07v12n4

Rev. dor vol.12 número4 en a07v12n4

because with preemptive iniltration probably nocicep- tors sensitization was not present, as observed in animal studies 19 . Without previous nervous receptors sensitiza- tion, pain intensity was lower throughout the postopera- tive period and this difference was clearly observed at anesthetic blockade regression when group D, which had been sensitized and then blocked, started to present more pain, being equal to the control group at the end of the anesthetic blockade.

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Rev. Hosp. Clin.  vol.58 número2

Rev. Hosp. Clin. vol.58 número2

The Stoppa (GPRVS) procedure utilizes the many advantages of the preperitoneal approach in inguinal hernia repair. It has many advantages, particularly in cases of recurrent or multirecurrent inguinal hernias. We have used GPRVS for inguinal hernia repair since 1983. At present, this op- eration is performed in 22% to 28% of groin hernias referred to our General Surgery Division . A key feature of GPRVS is the application of Pascal’s principle in mesh placement that rein- forces the lower abdominal wall with an elegant anatomical approach that does not disturb groin structures, even in cases that were dissected before. However, the GPRVS procedure re- quires a very extensive dissection of the preperitoneal space for the inser- tion and wrapping of the visceral sac in a large bilateral mesh prosthesis.
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Rev. Col. Bras. Cir.  vol.37 número6

Rev. Col. Bras. Cir. vol.37 número6

The need for an effective pathway for the treatment of less complex surgical disorders, of great socioeconomic impact, with the recognition of inguinal hernia as an important public health problem in Brazil, which keeps a very large number of individuals out of their work posts, and the concern about the need to ensure adequate training to our residents, made in 2004, the First Surgical Clinic of Bonsucesso General Hospital develop actions to ensure achievement of these procedures, without, however, compromising the need of beds for more severe patients. In this context, the “Program for surgery under local anesthesia without hospitalization” arose, in which was introduced the surgical treatment of inguinal hernias along with procedures such as: other abdominal hernias, anorectal surgery and surgical treatment of pilonidal cysts. This program was inspired and adapted to the reality of the institution from the successful experience of the outpatient Piquet Carneiro Polyclinic developed at the University of Rio de Janeiro (UERJ).
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Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience.

Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience.

Before the present study, few studies had reported the management of right ventricular dys- function from long-standing PAH and increased risk of postoperative pulmonary hypertensive crisis after surgical repair of patients with PTA who were late referrals [9–10, 14]. Some authors [15–16] reported flap valve double patch or a unidirectional flap valve VSD patch to allow right-to-left shunting and decompression of the right ventricle during periods of increased PVRi. Similarly, we maintained patency of the foramen ovale or performed atrial septum defect patch fenestration to prevent pulmonary hypertensive crises. Moreover, special treatment must be given after surgery because of the possible postoperative pulmonary hypertensive crisis. In our study, patients were routinely kept under deep sedation with continuous sedative and neu- romuscular blockade. The postoperative pulmonary artery pressure was monitored occasion- ally though echocardiography. Inhaled nitric oxide, oral sildenafil or Bosentan were used to manage pulmonary hypertensive crisis. In the latest follow-up, there were three patients (6.8%, 3/44) with residual PAH, only one needed medication.
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Paravesical haematoma following placement of an isolated anterior mesh for cystocele repair

Paravesical haematoma following placement of an isolated anterior mesh for cystocele repair

If abnormal abdominal pain appears after those proce- dures, it is necessary to perform both vaginal and ultrasound examination. Patients should also be carefully examined if other complications occur, like buttock or groin pain, signs of shock, brisk vaginal bleeding and urinary retention. Most of the haematomas are asymptomatic or produce only minor symptoms. These are haematomas with small volume and usually no intervention is necessary. In contrast to that, hae- matomas with a greater volume provoke moderate to severe problems, like abdominal pain, urge symptoms, dysuria or circulatory disturbances. In such cases operative manage- ment of the haematoma is indicated 5 . Therefore, the decision if a patient should be treated conservatively or surgically must be made for each patient individually and with their consent.
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Animal model of chronic abdominal hernia in rabbit

Animal model of chronic abdominal hernia in rabbit

Up to now, the number of studies reporting a standard animal model to improve the knowledge about hernia repair is rather limited. A brief review of five years on electronic data base of biomedical literature (Medline and Pubmed) showed thirty seven reports with rats, nineteen with rabbits, five with pigs or mini pigs, three with guinea-pigs, three with dogs, two with mice and no one with sheep or goats. Except for reports of one research group 16,17,20-22 in rats and another one in rabbits 18 , almost all studies

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Comparison of combined and sequential surgery for proliferative diabetic retinopathy: a single surgeon study.

Comparison of combined and sequential surgery for proliferative diabetic retinopathy: a single surgeon study.

Vitrectomy has been widely used to treat proliferative diabetic retinopathy (PDR). The most common complication of pars plana vitrectomy (PPV) is the nuclear sclerosis cataract, which is reported in 75%–95% of cases within two years of surgery [1,2,3]. Age, pre- existing nuclear sclerosis and intra-operative use of silicone oil and gas are the risk factors for cataract formation [4]. Many diabetic patients also have different degrees of cataract before vitrectomy. Whether to remove the crystalline lens during vitreous surgery of diabetic patients is controversial. Cataract surgery after vitrectomy is technically demanding, due to the loss of vitreous support and posterior capsule weakness [5]. Moreover, removal of the lens ensures better visualization of anterior vitreous structures and the retina. Therefore, combined vitrectomy and phacoemul- sification surgery eliminates the inconvenience of a second surgery and shortens the mean recovery time [6]. Nevertheless, an increased incidence of postoperative anterior segment neovascu- larization after the combined surgery was reported in some studies [7,8]. While many surgeons believed that the crystalline lens provided a barrier that had protective effects on the anterior segment and retina, with the improvement of surgical instrumen-
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Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience

Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience

Presutti, in their 5-year retrospective study of 52 patients with endoscopic closure of CSF leak (2), used a septal mucoper- chondrial graft, with no lumbar drain and fluorescein tests. They reported a success rate of 88.5% on the first attempt. Banks, in their 21-year retrospective study of 193 patients with endoscopic closure using intrathecal fluorescein localization of site of leak and lumbar drain in 73% (3), had an initial success rate of 85 –90% and an overall success rate of 98%. Ye (9), in their 10-year retrospective study of 69 patients with no preoperative fluorescein injection, reported a success rate of 89% on the first attempt with an endoscopic multilayer reconstructive technique. Our results of endoscopic CSF rhinorrhea repair revealed a 100% success rate on the first attempt with a recurrence rate of 6%; and 97% success on the second attempt. It is possible that the recurrence was due to multiple sites of leak, which were not recognized during initial surgery. Another possibility is that there were areas of bony defect on the skull base with dural dehiscence which opened upon repair of the area of initial CSF leak. The main contributing factors for failure and recurrence of leak are non-identification of the site, large size of the defect, multiple sites of leak and associated conditions such as chronic cough.
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Analytical Determining Of The Steinmetz Equivalent Diagram Elements Of Single-Phase Transformer

Analytical Determining Of The Steinmetz Equivalent Diagram Elements Of Single-Phase Transformer

This model, preached by any teacher of electrical engineering to his students on the various levels, was given like postulate. This article proposes an analytical justification to the equivalent diagram elements of single-phase transformer current, particularly to those of the central branch. The article is organized in three main sections. Section II begins by the calculation of active power consumed in a parallelepiped electromagnetic domain subjected to a variable flow. The result is applied to a shell form single-phase transformer. With open load test, the power consumption linked to the leakage inductance and resistance of the transformer winding is neglected in front of the consumption of the central branch [11]. But it is not the case for a loaded transformer. The methods to determine resistances of the reels are indisputable. This article gives the expressions of the elements of the central branch in the model of Steinmetz starting from the powers and their site. It studies also the variation relation of the iron resistance and the iron reactance compared to the computed values with 220 V. Section 2 is dedicated to this calculation. Discussions and a comparison of results are described in Section 3. The final section is devoted to the article conclusion.
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Bilateral inguinal hernia containing a rudimentary uteri, ovaries and tubes in a woman with primary amenorrhe

Bilateral inguinal hernia containing a rudimentary uteri, ovaries and tubes in a woman with primary amenorrhe

We present a case of a 21-year-old woman was presented to the Gynecology Department presenting primary amenorrhea and a blind vagina (Mayer-Rokitansky-Küster-Hauser Syndrome). Physical examination revealed Tanner V, thelarche and adrenarche, a 1-2 cm vaginal dimple (Figure 1), and a suspected bilateral inguinal hérnia (During examination, when asked to stand up, it was observed a bulging of both labia majora (Figure 2). he patient’s karyotype was 46, XX. Pelvic ultrasound showed that no ovaries, uterus, or vagina could be seen. Inguinal ultrasound showed a complex mass bilaterally at the inguinal areas (Figure 3). his could suggest the presence of testicles or of a hernia. Considering the amenorrhea, the blind vagina and the bulging, it was thought that the patient presented the Complete
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en 0100 3984 rb 47 06 00XI

en 0100 3984 rb 47 06 00XI

The use of computed tomography facilitates the iden- tification of inguinal hernias, and sagittal and coronal re- constructions are particularly useful for the visualization of a blind-ending tubular structure arising from the cecum and entering the inguinal canal, representing the vermiform appendix within the hernial sac (16) .

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