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PURPOSE: Despite the advancements in the reinforcement and closure techniques available, complex abdominal wall reconstruction (CAWR) remains a challenging surgical undertaking with considerable risk of postoperative complications. Biological meshes were developed that may help to complement standard closure techniques and offer an alternative to synthetic meshes, which carry significant risks with their use in complex cases. PATIENTS AND METHODS: A total of 114 patients underwent surgical treatment for CAWR with a Permacol™ (a biologic surgical implant). The study objective was to evaluate the short-term (6 months), mid-term (12-24 months), and long-term (36 months) clinical outcomes (through 36 months) associated with the use of a biologic surgical implant in these cases. RESULTS: The cumulative hernia recurrence rate was 18.7% (17/91) at 24 months and 22.4% (19/85) at 36 months. Twelve (14.1%) subjects required reoperation for hernia repair within 36 months for repair of recurrent hernias. Between 6- and 36-months post-surgery, patients reported improvement in their Carolina comfort scale (CSS) measures of severity of pain, sensation of mesh, and movement limitations. CONCLUSION: A biologic surgical implant can provide long-term benefit to complex abdominal wall repairs in patients staged grade III according to the Ventral Hernia Working Group (VHWG).
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Millions of abdominal wall repair procedures are performed each year for primary and incisional hernias both in the European Union and in the United States with extremely high costs. Synthetic meshes approved for augmenting abdominal wall repair provide adequate mechanical support but have significant drawbacks (seroma formation, adhesion to viscera, stiffness of abdominal wall, and infection). Biologic scaffolds (i.e., derived from naturally occurring materials) represent an alternative to synthetic surgical meshes and are less sensitive to infection. Among biologic scaffolds, extracellular matrix scaffolds promote stem/progenitor cell recruitment in models of tissue remodeling and, in the specific application of abdominal wall repair, have enough mechanical strength to support the repair. However, many concerns remain about the use of these scaffolds in the clinic due to their higher cost of production compared with synthetic meshes, despite having the same recurrence rate. The present review aims to highlight the pros and cons of using biologic scaffolds as surgical devices for abdominal wall repair and present possible improvements to widen their use in clinical practice.
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Central Mesh Failure (CMF) after abdominal wall repair (AWR) is uncommon but should be considered in case of recurrence. The mechanism is unclear and different theories are actually proposed, as the action of opposite forces acting in the abdominal wall on the prosthesis, and the characteristics of the device to be implanted. The use of lightweight meshes in some cases could be inadequate to withstand the bursting strenght of the abdominal wall. Three cases of incisional hernia recurrence due to central mesh failure are here reported. KEY WORDS: Abdominal wall repair (AWR), Central mesh failure (CMF), Hernia recurrence, Lightweight mesh.
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Pared Abdominal/cirugía , Hernia Abdominal/cirugía , Hernia Incisional/cirugía , Mallas Quirúrgicas/efectos adversos , Adulto , Anciano , Remoción de Dispositivos , Falla de Equipo , Femenino , Hernia Abdominal/etiología , Humanos , Laparotomía , Masculino , Recurrencia , ReoperaciónRESUMEN
INTRODUCTION: Meshes are commonly employed in abdominal hernia repair to reduce recurrence rates. Prosthetic repair, however, increases the risk of mesh related complications, including migration into adjacent viscera and erosion which can occur as uncommon and can be difficult to be diagnose. PRESENTATION OF CASE: This is a case of transmural migration of composite mesh into the bowel, presenting as chronic abdominal pain and anemia 14 years after incisional hernia repair. DISCUSSION: Mesh implantation in hernia repair has increased the incidence of complications, such as seroma, hematoma and infection. Migration into adjacent viscera and erosion may present as complications related to the use of meshes. Their precise frequency after abdominal wall hernia repair is not well known and their late occurrence can make the diagnosis difficult. CONCLUSION: Transmural migration of composite mesh is an uncommon complication of incisional hernia repair. Its pathogenesis is still not completely clear but it has been reported many years after implant surgery. It should be considered in a typical presentation of patients with history of previous prosthetic ventral hernia repair.
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: The authors read the article "The importance of registries in the postmarketing surveillance of surgical meshes" by Kockerling et al, and they completely agree on the role of a clinical follow-up of surgical meshes even if they suggest that a surveillance longer than one year is advisable, particularly in IPOM repair, to collect not only late complications but also more serious adverse events. This seems be the only way to properly assess the safety of the mesh.
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Hernia Ventral , Mallas Quirúrgicas , Humanos , Sistema de RegistrosRESUMEN
INTRODUCTION: Entero-atmospheric fistula (EAF) is an uncommon complication. Its timing and surgical management could be extremely challenging because extensive adhesions may heavily affect the approach to the abdominal cavity. PRESENTATION OF CASE: We hereby report a case of EAF in a 70 year-old man. In order to control the fistula output and the surrounding tissue damage from enteric content, the patient was managed conservatively using different technical solutions. Finally, the patient underwent surgery that started with a laparoscopic approach in order to avoid the hostile abdomen. DISCUSSION: Due to the lack of guidelines, treatment of EAF requires a multidisciplinary approach and different technical options based on the experience and inventiveness of the surgeon. Among others, the vacuum assisted wound management proved to be a useful support andlaparoscopy demonstrated to be valuable in approaching the abdominal cavity. CONCLUSION: According to our experience the success of the treatment of EAF may be improved adopting a multidisciplinary approach and well-planned surgery in referral centers.
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AIM: Aim of the present study is to propose a clinic-therapeutic course for the treatment of hemorrhoidal disease able to combine radical anatomic surgery with a painless postoperative path. MATERIAL OF STUDY: The present study is based on the evaluation of 20 selected patients who underwent radical hemorrhoidectomy for very high grade hemorrhoidal disease. The clinical course was characterized by careful bowel cleansing, hemorrhoidectomy according to Milligan-Morgan using LigaSure, intraoperative perianal infiltration of Ropivacaine and postoperative use of analgesic drugs. DISCUSSION: A low postoperative pain may descend from a scheduled timing of clinical procedures. Preoperative bowel cleansing delays the first postoperative evacuation, thus avoiding the perianal nerve stimulation. The use of LigaSure allows to perform surgical excision in a perfect way: lack of hemostatic stitches, less tissue trauma, very low early morbidity. A rational and scheduled intra and postoperative drug administration offers a highly significant contribution to the pain control. The intra and postoperative use of drugs makes it possible to perform the so-called "preventive anesthesia with activation of the pain memory" and postoperative evacuations with low pain perception. All patients, in fact, reported low and well tolerated pain, satisfaction and return to normal activities in a short period. CONCLUSIONS: Radical hemorrhoidectomy with LigaSure and attention to pre, intra and postoperative protocol makes the procedure painless, safe and with low morbidity. KEY WORDS: Hemorrhoidectomy, LigaSure, Painless procedure.
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Hemorreoidectomía/métodos , Hemorroides/cirugía , Dolor Postoperatorio/prevención & control , Anciano , Amidas , Analgésicos/uso terapéutico , Anestesia Local/métodos , Catárticos , Femenino , Hemostasis Quirúrgica , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Ropivacaína , Resultado del TratamientoAsunto(s)
Hernia Ventral/cirugía , Herniorrafia , Productos Biológicos , Humanos , Recurrencia , Mallas QuirúrgicasAsunto(s)
Hernia Ventral/cirugía , Herniorrafia , Productos Biológicos , Humanos , Mallas QuirúrgicasRESUMEN
UNLABELLED: The history of groin hernia surgery is as long as the history of surgery. For many centuries doctors, anatomists and surgeons have been devoted to this pathology, afflicting the mankind throughout its evolution. Since ancient times the Italian contribution has been very important with many representative personalities. Authors, investigators and pioneers are really well represented. Every period (the classic period, the Middle Age, the Renaissance and the post-Renaissance) opened new perspectives for a better understanding. During the 18th century, more information about groin anatomy, mainly due to Antonio Scarpa, prepared the Bassini revolution. Edoardo Bassini developed the first modern anatomically based hernia repair. This procedure spread worldwide becoming the most performed surgical technique. After World War II synthetic meshes were introduced and a new era has begun for hernia repair, once again with the support of Italian surgeons, first of all Ermanno Trabucco. But Italian contribution extends also to educational, with the first national school for abdominal wall surgery starting in Rome, and to Italian participation and support in international scientific societies. Authors hereby wish to resume this long history highlighting the "made in Italy" for groin hernia surgery. KEY WORDS: Bassini, Groin hernia, History, Prosthetic repair.
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Hernia Inguinal/historia , Herniorrafia/historia , Tratamiento Conservador , Hernia Inguinal/cirugía , Hernia Inguinal/terapia , Herniorrafia/instrumentación , Herniorrafia/métodos , Historia del Siglo XV , Historia del Siglo XVI , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Historia Antigua , Historia Medieval , Italia , Mallas Quirúrgicas/historiaRESUMEN
UNLABELLED: Although Mesh Plug Repair (MPR) represents an effective method for the treatment of groin hernia, some criticisms still concern adverse effects related to the plug (shrinkage, chronic pain, migration and erosion). Different mesh and plug devices have been proposed in the past mostly to prevent migration but none of these achieved the same popularity as the cone or flower-shaped plug. Authors hereby present a pilot study with a new tridimensional device, denominated NeT Plug and Patch, that avoids any risk of migration. Results after 12 months follow-up have demonstrated low incidence of postoperative and chronic pain, with both patients and surgeons greatly satisfied. NeT Plug and Patch has proven to achieve a simple and effective repair for primary inguinal hernias. KEY WORDS: Mesh-plug, Plug migration, Trabucco repair.
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Hernia Inguinal/cirugía , Herniorrafia/instrumentación , Mallas Quirúrgicas , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Equipo , Femenino , Estudios de Seguimiento , Migración de Cuerpo Extraño/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/prevención & control , Satisfacción del Paciente , Proyectos PilotoRESUMEN
Familial polyposis coli is a heterogeneous disease with a broad spectrum of clinical manifestations including not only multiple polyposis of the small bowel, but also multiple primary tumours, such as carcinoma of the ampulla of Vater, subcutaneous tumours, bone tumours, central nervous system tumous and gynaecological malignancies. This report is of two brothers with familial polyposis, each showing peculiar distinctive features. In one case, polyposis was diagnosed during emergency surgery for ileo-colic intussusception. The patient later developed a tumour of the uterine cervix. Polyposis coli was identified late in the second patient who showed an evolution towards colonic adenocarcinoma with multiple hepatic metastases. The possible association of familial polyposis and extracolonic malignancies has already been emphasized in the literature. In this report we wish to stress the advisability of periodic gynaecological check-ups in affected patients.
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Poliposis Adenomatosa del Colon , Carcinoma in Situ , Neoplasias Primarias Múltiples , Neoplasias del Cuello Uterino , Poliposis Adenomatosa del Colon/diagnóstico , Poliposis Adenomatosa del Colon/cirugía , Adulto , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/cirugía , Femenino , Humanos , Masculino , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/cirugía , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/cirugíaRESUMEN
Vascular lesions may complicate the course of acute pancreatitis. The activated pancreatic enzymes, particularly elastase, might cause lysis of the elastic component of the arterial wall thus leading to aneurysmal changes. This report is on a case of aneurysm of the infrarenal aorta following complicated acute pancreatitis and treated by endovascular technique.
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Aneurisma de la Aorta Abdominal/etiología , Pancreatitis Aguda Necrotizante/complicaciones , Aneurisma de la Aorta Abdominal/enzimología , Aneurisma de la Aorta Abdominal/cirugía , Biomarcadores/metabolismo , Implantación de Prótesis Vascular/métodos , Humanos , Masculino , Persona de Mediana Edad , Elastasa Pancreática/metabolismo , Pancreatitis Aguda Necrotizante/enzimología , Pancreatitis Aguda Necrotizante/cirugía , Resultado del Tratamiento , Procedimientos Quirúrgicos VascularesRESUMEN
Plug and patch hernioplasty is a technique showing very good results. Actually some criticisms mainly concern the amount of prosthetic material and the shrinkage of the plug resulting in recurrence of hernia, groin pain, and/or migration. The new tridimensional mesh Parietene PP allows to achieve a plug and patch hernioplasty, without any risk of plug migration. The Parietene PP hernia repair in simple and easy to learn. Preliminary results are very satisfactory and comparable with the best outcome from mesh plug repair, without any risk of plug migration.
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Materiales Biocompatibles/uso terapéutico , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Hernia Inguinal/cirugía , Polipropilenos/uso terapéutico , Mallas Quirúrgicas , Adolescente , Adulto , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo/instrumentación , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Drugs are commonly considered a rare cause of acute pancreatitis but there are an increasing number of reports of numerous medications that seem to be involved in the pathogenesis of acute pancreatitis with different degrees of causative relationship to the disease (definite--probable--possible). The number of drugs that have been associated to date with acute pancreatitis exceeds 260. The authors report here on their personal series of four cases of drug-induced acute pancreatitis (warfarin, lysinopril/hydrochlorothiazide, lamivudine/stavudine/indinavir, valproic acid), focusing on a number of epidemiological and clinical aspects.