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Complex hernia

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https://www.readbyqxmd.com/read/27916364/the-cost-of-preventable-comorbidities-on-wound-complications-in-open-ventral-hernia-repair
#1
Tiffany C Cox, Laurel J Blair, Ciara R Huntington, Paul D Colavita, Tanushree Prasad, Amy E Lincourt, B Todd Heniford, Vedra A Augenstein
BACKGROUND: Patients with complex ventral hernias may benefit from preoperative optimization. This study evaluates the financial impact of preventable comorbidities (PCM) in elective open ventral hernia repair. METHODS: In this single institution prospectively collected data from 2007-2011, hospital charges (included all hernia-related visits, interventions, or readmissions) and wound-related complications in patients with PCM-diabetes, tobacco use, and obesity-were compared to patients without such risks using standard statistical methods...
November 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27884801/effect-of-flexible-duty-hour-policies-on-length-of-stay-for-complex-intra-abdominal-operations-a-flexibility-in-duty-hour-requirement-for-surgical-trainees-first-trial-analysis
#2
Jonah J Stulberg, Emily Pavey, Mark E Cohen, Clifford Y Ko, David B Hoyt, Karl Y Bilimoria
BACKGROUND: Changes to resident duty hour policies in the Flexibility in Duty Hour Requirements for Surgical Trainees ("FIRST") Trial could impact hospitalized patients' length of stay (LOS) by altering care coordination. LOS may also serve as a reflection of all complications, particularly those not captured in the FIRST Trial (eg, pneumothorax from central line). Programs were randomized to either maintaining current ACGME duty hour policies ("Standard Arm") or more flexible policies waiving rules on maximum shift lengths and time off between shifts ("Flexible Arm")...
November 8, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27865126/crossing-the-canal-looking-beyond-hernias-spectrum-of-common-uncommon-and-atypical-pathologies-in-the-inguinal-canal
#3
REVIEW
Subramaniyan Ramanathan, Yegu Palaniappan, Adnan Sheikh, John Ryan, Ania Kielar
Inguinal canal can have diverse range of pathologies due to its complex anatomy and multiple different contents in the males and females. Imaging plays a dominant role in the appropriate diagnosis and management as inguinal pathologies have fairly similar clinical presentation with pain and swelling. Various pathologies in the inguinal region include congenital, infectious/inflammatory, vascular, neoplastic and iatrogenic. This paper gives an overview of the role of various modalities like Ultrasound, CT and MRI in the evaluation of inguinal pathologies...
November 5, 2016: Clinical Imaging
https://www.readbyqxmd.com/read/27865095/assessment-and-determinants-of-spinal-pain-in-the-course-of-disc-disorders-treated-surgically
#4
Renata Jabłońska, Robert Ślusarz, Agnieszka Królikowska, Beata Haor, Magdalena Zając
BACKGROUND Intervertebral disc disease is defined as a complex of structural changes in the aftermath of disorders of mutual elements, the structure of which form the discus intervertebralis and the spinal canal. The present work assessed pain in patients who were surgically treated due to spinal discopathy and analyzed factors that determine the condition. MATERIAL AND METHODS The research was carried on a group of 187 patients diagnosed with discopathy of the lumbosacral and cervical segment. The data are discussed in the context of medical records and the Visual Analogue Scale used for pain assessment...
November 19, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/27832304/the-challenging-sonographic-inguinal-canal-evaluation-in-neonates-and-children-an-update-of-differential-diagnoses
#5
Yoshino T Sameshima, Maurício G I Yamanari, Mariana A Silva, Miguel J Francisco Neto, Marcelo B G Funari
Bulging of the inguinal region is a frequent complaint in the pediatric population and sonographic findings can be challenging for radiologists. In this review we update the sonographic findings of the most common disorders that affect the inguinal canal in neonates and children, with a focus on the processus vaginalis abnormalities such as congenital hydroceles, indirect inguinal hernias and cryptorchidism, illustrated with cases collected at a quaternary hospital during a 7-year period. We emphasize the importance of correctly classifying different types of congenital hydrocele and inguinal hernia to allow for early surgical intervention when necessary...
November 10, 2016: Pediatric Radiology
https://www.readbyqxmd.com/read/27822724/3d-printed-surgical-instruments-the-design-and-fabrication-process
#6
Mitchell George, Kevin R Aroom, Harvey G Hawes, Brijesh S Gill, Joseph Love
BACKGROUND: 3D printing is an additive manufacturing process allowing the creation of solid objects directly from a digital file. We believe recent advances in additive manufacturing may be applicable to surgical instrument design. This study investigates the feasibility, design and fabrication process of usable 3D printed surgical instruments. METHODS: The computer-aided design package SolidWorks (Dassault Systemes SolidWorks Corp., Waltham MA) was used to design a surgical set including hemostats, needle driver, scalpel handle, retractors and forceps...
November 7, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27800587/evaluation-of-antibiotic-pressurized-pulse-lavage-for-contaminated-retromuscular-abdominal-wall-reconstruction
#7
Arnab Majumder, Heidi J Miller, Parita Patel, Yuhsin V Wu, Heidi L Elliott, Yuri W Novitsky
BACKGROUND: Despite patient risk factors such as diabetes and obesity, contamination during surgery remains a significant cause of infections and subsequent wound morbidity. Pressurized pulse lavage (PPL) has been utilized as a method to reduce bacterial bioburden with promising results in many fields. Although existing methods of lavage have been utilized during abdominal operations, no studies have examined the use of PPL during complex hernia repair. METHODS: Patients undergoing abdominal wall reconstruction (AWR) in clean-contaminated or contaminated fields with antibiotic PPL, from January 2012 to May 2013, were prospectively evaluated...
October 31, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27790873/preperitoneal-onlay-mesh-repair-for-ventral-abdominal-wall-and-incisional-hernia-a-novel-technique
#8
Pc George Yang, Lm Karen Tung
INTRODUCTION: Intraperitoneal onlay mesh repair is a current technique for laparoscopic repair of ventral and incisional hernias. However, the placement of synthetic mesh intraperitoneally may potentially lead to mesh-induced complications such as adhesive intestinal obstruction, enterocutaneous fistula, or even mesh erosion into organs. Inspired by the concept of laparoscopic inguinal hernia repair, we developed a novel technique: preperitoneal onlay mesh repair (PPOM). This involves placing the mesh in the preperitoneal plane to help eliminate mesh-induced complications...
November 2016: Asian Journal of Endoscopic Surgery
https://www.readbyqxmd.com/read/27785329/no-need-of-fascia-closure-to-reduce-trocar-site-hernia-rate-in-laparoscopic-surgery-a-prospective-study-of-200-non-obese-patients
#9
Rikki Singal, Muzzafar Zaman, Amit Mittal, Samita Singal, Karamjot Sandhu, Anshu Mittal
BACKGROUND: Laparoscopy is widely practiced and offers realistic benefits over conventional surgery. Port closure is important after a laparoscopic procedure to prevent port site incisional hernia. Larger port size and increasing numbers of ports needed to perform more complex laparoscopic procedures are likely to increase the incidence of port site hernias (PSHs). PSHs tend to develop more frequently at umbilical and midline port sites due to the thinness of the umbilical skin and weaknesses in the linea alba...
October 2016: Gastroenterology Research
https://www.readbyqxmd.com/read/27783142/revisiting-the-anterior-rectus-sheath-repair-for-incisional-hernia-a-10-year-experience
#10
Erica I Hodgman, Mark J Watson
BACKGROUND: Surgeons continue to seek an incisional hernia repair technique which minimizes cost and morbidity while maximizing durability. We present a single surgeon's experience with a technique described by N.L. Browse and J.P. Chevrel in 1979. METHODS: The Chevrel/Browse repair consists of a bilateral anterior rectus sheath release, hernia sac imbrication, bilateral rectus complex medialization, and repair reinforcement with an anterior prosthetic mesh. Data were collected on all patients who underwent herniorrhaphy between April 2003 and April 2013...
October 25, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27777499/minilaparoscopy-for-inguinal-hernia-repair
#11
Flavio Malcher, Leandro Totti Cavazzola, Gustavo L Carvalho, Guilherme D E Araujo, José Antônio Da Cunha E Silva, Prashanth Rao, Antonio Carlos Iglesias
BACKGROUND AND OBJECTIVES: Inguinal hernia repair is among the most common procedures performed worldwide and the laparoscopic totally extraperitoneal (TEP) approach is a recognized and effective surgical technique. Although technically advantageous because of the option of no mesh fixation and no need for creation of a peritoneal flap resulting, in less postoperative pain and faster recovery, TEP has not achieved the popularity it deserves, mainly because of its complexity and steep learning curve...
October 2016: JSLS: Journal of the Society of Laparoendoscopic Surgeons
https://www.readbyqxmd.com/read/27770141/-inguinal-and-femoral-hernia-surgery-open-mesh-procedure-video-article
#12
U A Dietz, C-T Germer, A Wiegering
There are several techniques for repair of symptomatic inguinal and femoral hernias. There is an increased acceptance and tendency favoring minimally invasive procedures, such as plug or transinguinal preperitoneal mesh prosthesis (TIPP) and endoscopic procedures, such as totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair. In the present review the classical techniques of Irving L. Lichtenstein (1986) and Jean Rives (1965), two indispensable procedures, are presented and the results from the literature are discussed...
October 21, 2016: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
https://www.readbyqxmd.com/read/27754767/synthetic-versus-biologic-mesh-in-single-stage-repair-of-complex-abdominal-wall-defects-in-a-contaminated-field
#13
Jad Chamieh, Wen Hui Tan, Ricardo Ramirez, Eden Nohra, Chukwuma Apakama, William Symons
BACKGROUND: Synthetic meshes have been used with varying rates of success in a contaminated setting, although their use is not widely accepted because of concerns for infection. A biologic mesh (BM) is assumed to be more resistant to infection than a synthetic mesh; however, sparse clinical data support this theory. The hypothesis for this study: Uncoated polypropylene synthetic mesh (USM) can be used to obtain a durable repair in the setting of a contaminated abdominal wall reconstruction (AWR) in a single-stage procedure with comparable infectious outcomes to a biologic mesh repair...
October 18, 2016: Surgical Infections
https://www.readbyqxmd.com/read/27733627/a-novel-function-for-the-map-kinase-sma-5-in-intestinal-tube-stability
#14
Florian Geisler, Harald Gerhardus, Katrin Carberry, Wayne Davis, Erik Jorgensen, Christine Richardson, Olaf Bossinger, Rudolf E Leube
Intermediate filaments are major cytoskeletal components whose assembly into complex networks and isotype-specific functions are still largely unknown. Caenorhabditis elegans provides an excellent model system to study intermediate filament organization and function in vivo. Its intestinal intermediate filaments localize exclusively to the endotube, a circumferential sheet just below the actin-based terminal web. A genetic screen for defects in the organization of intermediate filaments identified a mutation in the catalytic domain of the MAP kinase 7 orthologue sma-5(kc1) In sma-5(kc1) mutants, pockets of lumen penetrate the cytoplasm of the intestinal cells...
December 1, 2016: Molecular Biology of the Cell
https://www.readbyqxmd.com/read/27729548/systemic-delivery-of-bone-marrow-mesenchymal-stem-cells-for-in-situ-intervertebral-disc-regeneration
#15
Carla Cunha, Catarina R Almeida, Maria Inês Almeida, Andreia M Silva, Maria Molinos, Sofia Lamas, Catarina L Pereira, Graciosa Q Teixeira, António T Monteiro, Susana G Santos, Raquel M Gonçalves, Mário A Barbosa
: : Cell therapies for intervertebral disc (IVD) regeneration presently rely on transplantation of IVD cells or stem cells directly to the lesion site. Still, the harsh IVD environment, with low irrigation and high mechanical stress, challenges cell administration and survival. In this study, we addressed systemic transplantation of allogeneic bone marrow mesenchymal stem cells (MSCs) intravenously into a rat IVD lesion model, exploring tissue regeneration via cell signaling to the lesion site...
October 11, 2016: Stem Cells Translational Medicine
https://www.readbyqxmd.com/read/27726880/non-crosslinked-porcine-acellular-dermal-matrix-in-pediatric-abdominal-wall-reconstruction-a-case-series
#16
Richard W Siy, Rachel E Pferdehirt, Shayan A Izaddoost
INTRODUCTION: The use of biologic mesh where native tissue deficiencies limit reconstructive options has been well documented in the adult population, with increasing use to address the special requirements of complex abdominal wall reconstruction. There is, however, little documented evidence as to the safety and efficacy of these products in the pediatric population. METHODS: This retrospective case series details 5 pediatric cases of complicated abdominal hernia repair with Strattice®, a non-crosslinked porcine acellular dermal matrix...
September 23, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27715712/us-of-the-inguinal-canal-comprehensive-review-of-pathologic-processes-with-ct-and-mr-imaging-correlation
#17
Margarita V Revzin, Devrim Ersahin, Gary M Israel, Jonathan D Kirsch, Mahan Mathur, Jamal Bokhari, Leslie M Scoutt
Ultrasonography (US) has a fundamental role in the initial examination of patients who present with symptoms indicating abnormalities of the inguinal canal (IC), an area known for its complex anatomy. A thorough understanding of the embryologic and imaging characteristics of the contents of the IC is essential for any general radiologist. Moreover, an awareness of the various pathologic conditions that can affect IC structures is crucial to preventing misdiagnoses and ensuring optimal patient care. Early detection of IC abnormalities can reduce the risk of morbidity and mortality and facilitate proper treatment...
October 7, 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/27712875/insurance-status-is-associated-with-complex-presentation-among-emergency-general-surgery-patients
#18
John W Scott, Joaquim M Havens, Lindsey L Wolf, Cheryl K Zogg, John A Rose, Ali Salim, Adil H Haider
BACKGROUND: The Affordable Care Act has the potential to significantly affect access to care for previously uninsured patients in need of emergency general surgical care. Our objective was to determine the relationship between insurance status and disease complexity at presentation among a national sample of emergency general surgical patients. METHODS: Data from the National Emergency Department Sample from 2006-2009 were queried to identify all patients aged 18-64 years old admitted through the emergency department with a primary diagnosis of appendicitis, diverticulitis, inguinal hernia, or bowel obstruction...
October 3, 2016: Surgery
https://www.readbyqxmd.com/read/27705081/approach-to-recurrent-congenital-diaphragmatic-hernia-results-of-an-international-survey
#19
Nicholas E Bruns, Ian C Glenn, Neil L McNinch, Kelly Arps, Todd A Ponsky, Avraham Schlager
PURPOSE: Although recurrence remains one of the most feared complications following congenital diaphragmatic hernia (CDH) repair, there are minimal data on the optimal surgical approach to these complex situations. The purpose of this study was to survey the international pediatric surgery community to ascertain practice patterns for both minimally invasive (MIS) and open approaches for recurrent CDH. MATERIALS AND METHODS: A survey was e-mailed to members of an online community of pediatric surgeons...
October 5, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/27697922/nuclear-envelope-rupture-is-induced-by-actin-based-nucleus-confinement
#20
Emily M Hatch, Martin W Hetzer
Repeated rounds of nuclear envelope (NE) rupture and repair have been observed in laminopathy and cancer cells and result in intermittent loss of nucleus compartmentalization. Currently, the causes of NE rupture are unclear. Here, we show that NE rupture in cancer cells relies on the assembly of contractile actin bundles that interact with the nucleus via the linker of nucleoskeleton and cytoskeleton (LINC) complex. We found that the loss of actin bundles or the LINC complex did not rescue nuclear lamina defects, a previously identified determinant of nuclear membrane stability, but did decrease the number and size of chromatin hernias...
October 10, 2016: Journal of Cell Biology
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