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BACKGROUND: Incisional hernia (IH) is an important surgical complication that has several ways of prevention, including modifications in the surgical technique of the initial procedure. Its incidence can reach 69% in high-risk patients and long-term follow-up. Of the risky procedures, open abdominal aortic aneurysmectomy is the one with the highest risk. Ways to reduce this morbid complication were suggested, and prophylactic mesh rises as an important tool to prevent recurrence. METHODS: A retrospective cohort study review of medical records of patients undergoing vascular surgery for abdominal aortoiliac aneurysm (AAA) or vascular bypass surgery due to aortoiliac occlusive disease. We identified 193 patients treated between 2010 and 2020. We further performed a one-to-nine matching analysis between the use of prophylactic mesh and control groups, based on estimated propensity scores for each patient. RESULTS: Prophylactic mesh group had a 18% lower risk of IH, compared with the control group (relative risk: 0.82; 95% confidence interval [CI] = 0.74-0.93). The difference in IH rates between the groups compared was 2.6% (95% CI: -19.8 to 25.5). From the perspective of the number needed to treat, it would be necessary to use prophylactic mesh in 39 (95% CI: 35-44) patients to avoid one IH in this population. CONCLUSION: Use of prophylactic mesh in the repair of AAA significantly reduces the incidence of IH in nearly one in five cases. Our data suggest that there is benefit in the use of prophylactic mesh in open aneurysmectomy surgery regarding postoperative IH development.
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INTRODUCTION: recurrence rates for primary hernia repair range from 0.5 to 15 percent depending upon the hernia site, type of repair, and clinical circumstances. Many risk factors are known and they must be considered before the procedure. In developing countries, follow up and maintenance of databases are critical to understand the real numbers. METHODS: a retrospective cohort study analyzed adult patients who have undergone inguinal hernia repair at Hospital de Clínicas de Porto Alegre, a tertiary care government public hospital, between 2013 and 2015. Medical records, telephone, and letter contact have been reviewed in order to complete the minimum period of 5 years of follow-up. The analyzed data focused on the surgeon's experience and the recurrence rate in 5 years of follow-up. RESULTS: a total of 1094 medical records were selected and a complete five years follow-up were possible in 454 patients - 538 inguinal hernia repairs due to bilateral approach in 84 patients. These 454 patients answered, in a validated questionnaire about symptoms of recurrence. The total recurrence rate was 9.29%. For the patients who had Nyhus IV, recurrence rate was 24.1% against 9.9% after primary hernia repair, with a 2.4 higher risk. There was no difference in recurrence between surgeons and training surgeons. CONCLUSION: our data reveal an acceptable recurrence rate in a tertiary care hospital with residents, and to our knowledge is the first Brazilian report with long term follow up. An increased re-recurrent hernia was found when compared with primary hernia repair.
Assuntos
Hérnia Inguinal , Laparoscopia , Adulto , Brasil/epidemiologia , Seguimentos , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Humanos , Laparoscopia/métodos , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas , Resultado do TratamentoRESUMO
ABSTRACT Introduction: recurrence rates for primary hernia repair range from 0.5 to 15 percent depending upon the hernia site, type of repair, and clinical circumstances. Many risk factors are known and they must be considered before the procedure. In developing countries, follow up and maintenance of databases are critical to understand the real numbers. Methods: a retrospective cohort study analyzed adult patients who have undergone inguinal hernia repair at Hospital de Clínicas de Porto Alegre, a tertiary care government public hospital, between 2013 and 2015. Medical records, telephone, and letter contact have been reviewed in order to complete the minimum period of 5 years of follow-up. The analyzed data focused on the surgeon's experience and the recurrence rate in 5 years of follow-up. Results: a total of 1094 medical records were selected and a complete five years follow-up were possible in 454 patients - 538 inguinal hernia repairs due to bilateral approach in 84 patients. These 454 patients answered, in a validated questionnaire about symptoms of recurrence. The total recurrence rate was 9.29%. For the patients who had Nyhus IV, recurrence rate was 24.1% against 9.9% after primary hernia repair, with a 2.4 higher risk. There was no difference in recurrence between surgeons and training surgeons. Conclusion: our data reveal an acceptable recurrence rate in a tertiary care hospital with residents, and to our knowledge is the first Brazilian report with long term follow up. An increased re-recurrent hernia was found when compared with primary hernia repair.
RESUMO Introdução: a recorrência da hérnia inguinal após hernioplastia varia de 0,5 a 15 por cento, dependendo do local da hérnia, tipo de reparo e circunstâncias clínicas. Muitos fatores de risco são conhecidos e devem ser considerados antes do procedimento. Acompanhamento e adequado bancos de dados são fundamentais para entender a incidência de recidiva. Métodos: estudo de coorte retrospectivo analisou hernioplastias inguinais realizados no Hospital de Clínicas de Porto Alegre entre 2013 e 2015. Para concluir 5 anos de seguimento, analisamos o prontuário e fizemos contato telefônico e por correio. Resultados: o total de 1094 registros médicos foram selecionados e um seguimento de pelo menos 5 anos foi possível em 454 pacientes - 538 reparos de hérnia inguinal devido à abordagem bilateral em 84 pacientes. Os pacientes responderam um questionário validado sobre sintomas de recorrência. A taxa total de recorrência foi de 9,29%. No grupo masculino, a recorrência foi de 10% contra 4% no grupo feminino. Para os pacientes com hérnia Nyhus IV, a recidiva foi de 24% contra 8% após o reparo da hérnia primária, com um risco de 2,8 maior. Não houve diferença na recorrência entre cirurgiões experientes e em treinamento. Conclusão: nossos dados revelam uma taxa de recorrência aceitável em um hospital de ensino, e para o nosso conhecimento é o primeiro artigo com acompanhamento de longo prazo no sul do Brasil. A re-recidiva da hérnia foi maior quando comparada com o reparo da hérnia primária.
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Malignant melanoma is the 19th leading cause of cancer worldwide. It is an aggressive neoplastic disease in which pathophysiological understanding and management has been in constant evolution in recent decades. The primary site is the skin, uvea and mucous membranes and has the capacity to metastasize to any organ. There are few reports of primary or secondary involvement of the biliary tract. We present the case of a 73-year-old woman with a bile duct lesion suggestive of cholangiocarcinoma and a final diagnosis of a single melanoma metastasis. Surgical treatment was performed due to oligometastatic stage IV melanoma with possibility of R0 resection followed by immune checkpoint therapy.
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Complex reconstructions of the abdominal wall, necessary after resection of neoplasms, infection or trauma, are a challenge for the surgical team. Although ovarian carcinoma is commonly presented with peritoneal carcinomatosis and invasion of adjacent organs, it rarely can invade the abdominal wall. Invasion of the abdominal wall was documented on ultrasound and abdominal computed tomography. Surgery was discussed and performed in a multidisciplinary team and consisted of wide en bloc excision and reconstruction with open intraperitoneal onlay mesh with inorganic polypropylene-coated mesh (Bard/BD Sepramesh), a midweight macroporous mesh and abdominoplasty. Postoperative course was uneventful and the patient showed good evolution 1 year after the procedure. Our report highlights the main objectives in complex reconstructions, the importance of a multidisciplinary team and discusses the characteristics that the mesh must have in order to achieve the desired goal.
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INTRODUCTION: Inspiratory muscle weakness (IMW) is a potential cause of exertional dyspnea frequently under-appreciated in clinical practice. Cardiopulmonary exercise testing (CPET) is usually requested as part of the work-up for unexplained breathlessness, but the specific pattern of exercise responses ascribed to IMW is insufficiently characterized. OBJECTIVES: To identify the physiological and sensorial responses to progressive exercise in dyspneic patients with IMW without concomitant cardiorespiratory or neuromuscular diseases. METHODS: Twenty-three subjects (18 females, 55.2 ± 16.9 years) complaining of chronic daily life dyspnea (mMRC = 3 [2-3]) plus maximal inspiratory pressure < the lower limit of normal and 12 matched controls performed incremental cycling CPET. FEV1/FVC<0.7, significant abnormalities in chest CT or echocardiography, and/or an established diagnosis of neuromuscular disease were among the exclusion criteria. RESULTS AND CONCLUSION: Patients presented with reduced aerobic capacity (peak VÌO2: 79 ± 26 vs 116 ± 21 %predicted), a tachypneic breathing pattern (peak breathing frequency/tidal volume = 38.4 ± 22.7 vs 21.7 ± 14.2 breaths/min/L) and exercise-induced inspiratory capacity reduction (-0.17 ± 0.33 vs 0.10 ± 0.30 L) (all P < .05) compared to controls. In addition, higher ventilatory response (ΔVÌE/ΔVÌCO2 = 34.1 ± 6.7 vs 27.0 ± 2.3 L/L) and symptomatic burden (dyspnea and leg discomfort) to the imposed workload were observed in patients. Of note, pulse oximetry was similar between groups. Reduced aerobic capacity in the context of a tachypneic breathing pattern, inspiratory capacity reduction and preserved oxygen exchange during progressive exercise should raise the suspicion of inspiratory muscle weakness in subjects with otherwise unexplained breathlessness.