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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We retrospectively reviewed our experience in performing endoscopic extraperitoneal radical prostatectomy (EERPE) and totally extraperitoneal (TEP) hernia repair in one procedure to evaluate its feasibility and safety. Based on our experience of 70 laparoscopic radical prostatectomies, a total of 60 patients underwent EERPE. Eight of these had 10 hernias repaired with Prolene mesh. The median total operating time for EERPE was 165 minutes. Mesh placement required an additional 15 minutes for a unilateral hernia and 25 minutes for bilateral hernias. The conversion rate and the reoperation rate were 0%. The median duration of vesical catheterization was 8.3 days. One patient required a blood transfusion. The most common minor complications, occurring in eight patients, were edema and hematoma of the penis. No wound infection occurred. The only major complication was a deep venous thrombosis in one patient. No additional complications developed in the hernioplasty group. We conclude that the extraperitoneal approach for radical prostatectomy allows concomitant inguinal hernia repair with a low morbidity rate and within an acceptable operating time.
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PMID:Hernia repair during endoscopic (laparoscopic) radical prostatectomy. 1267 18

A prospective study of patients with ventral hernias was undertaken to study the experience with an open intraperitoneal underlay technique utilizing a bilayer prosthetic mesh. From September 1998 to March 2001, 102 patients underwent repair with a bilayer expanded polytetrafluoroethylene (ePTFE) and polypropylene mesh placed intraperitoneally and fixed in place with full-thickness abdominal muscle wall sutures to achieve a 5-cm underlay of the fascial defect circumferentially. There were 67 females and 35 males ranging in age from 29 to 76 years (mean 53 years). Average patient weight was 207 lb with 64 patients in the obese category. Forty patients presented with recurrent hernias. Mean operative time was 103 minutes with an average diameter hernia defect size of 15 cm. Median hospital stay was 3 days. There was no surgical mortality, and major morbidity occurred in six patients (2 wound infections, one deep vein thrombosis, one myocardial infarction, one pneumonia, and one pulmonary embolus). Mean follow-up is 28 months (range 12-42 months). No recurrence has been found with 100 per cent follow-up to date. No bowel obstruction or enteric fistulas have occurred during the follow-up period. The open intraperitoneal underlay mesh technique can be performed with a zero per cent early recurrence rate. Bilayer prosthetic mesh composed of ePTFE and polypropylene can be safely placed intraperitoneally without causing intestinal obstruction or enteric fistula.
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PMID:Intraperitoneal underlay ventral hernia repair utilizing bilayer expanded polytetrafluoroethylene and polypropylene mesh. 1271 85

Bilateral prophylactic mastectomy can reduce the incidence of breast cancer by 87 to 93% in high-risk individuals and is an appealing option for many patients if reconstruction can be provided with acceptable morbidity and outstanding esthetic results. Autogenous breast reconstruction techniques have evolved over the last 20 years to meet this goal. Familiarity with the deep inferior epigastric perforator (DIEP) flap led us to carry out simultaneous bilateral breast reconstruction with acceptable morbidity and superior esthetic outcome in 3 patient groups: (1) after bilateral prophylactic mastectomy, (2) after therapeutic and contralateral prophylactic mastectomy, and (3) after explantation of bilateral implant failures. A retrospective review of our experience with 280 flaps in 140 patients was performed. Average operating times, including time for implant removal or mastectomy and reconstruction, was 7.3 hours. Average hospitalization was 3.9 days. Significant perioperative complications occurred in 9 patients (6.4%); all returned to the operating room. This included 7 microvascular complications, 1 hematoma, 1 seroma, and 1 DVT. Less significant complications were divided into early and late. The early complications included 1.8% partial flap necrosis, 4.2% abdominal apron necrosis greater than 5 cm2, 2.9% seromas that required intervention, and 5.7% partial breast flap dehiscence. Late complications included 12.5% fat necrosis of any size and 2.1% hernia formation. Smoking, obesity, age, history of chest wall radiation, and flap size were evaluated as risk factors for increased morbidity.
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PMID:Bilateral breast reconstruction with the deep inferior epigastric perforator (DIEP) flap: an experience with 280 flaps. 1515 76

The transverse rectus abdominis myocutaneous (TRAM) flap is ideal for postmastectomy reconstruction but is tenuous in morbidly obese patients. Because of their relatively high incidence of postoperative complications, morbidly obese patients are often not considered candidates for autogenous reconstruction. The midabdominal TRAM flap has a more favorable anatomy and may represent an alternative technique in this patient population. The records of 18 morbidly obese patients who underwent postmastectomy reconstruction using a mid-abdominal TRAM flap from 1998 through 2002 were retrospectively reviewed. The mid-abdominal TRAM flap territory includes more of the supraumbilical region than the traditional TRAM flap, corresponding to an area with more abundant musculocutaneous perforators and greater dependence on the superior epigastric vascular system. All patients underwent unipedicled mid-abdominal TRAM flap surgery. Four patients with previous subumbilical midline incisions had a delay procedure with ligation of the inferior epigastric vessels. Complications investigated were flap necrosis greater than 10 percent or sufficient to require surgical revision, abdominal donor-site breakdown, seroma formation, umbilical necrosis, abdominal wall bulging or hernia, deep vein thrombosis, infected mesh, surgical revisions, fat necrosis, and extended hospital stay. At a mean follow-up time of 15.6 months (range, 12 to 24 months), three patients had postoperative complications requiring surgical revision. Two of these patients had previous midline abdominal incisions. One patient had both partial flap necrosis and a donor-site complication. The second patient had partial flap necrosis, and the third had an abdominal donor-site complication. No occurrences of abdominal wall hernia, total flap loss, deep vein thrombosis, infected mesh, extensive surgical revision, or extended hospitalization were noted in this series. The mid-abdominal TRAM flap represents an alternative method for postmastectomy breast reconstruction in morbidly obese patients. Autologous reconstruction using a midabdominal TRAM flap may be considered in this patient population; however, additional research is required to conclusively demonstrate an improved outcome when compared with traditional reconstructive methods.
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PMID:The midabdominal TRAM flap for breast reconstruction in morbidly obese patients. 1573 76

Living donor liver transplantation evolved in response to donor shortage. Current guidelines recommend potential living donors (LD) have a body mass index (BMI) <30. With the current obesity epidemic, locating nonobese LD is difficult. From September 1999 to August 2003, 68 LD with normal liver function test (LFTs) and without significant comorbidities underwent donor hepatectomy at our center. Post-operative complications were collected, including wound infection, pneumonia, hernia, fever, ileus, biliary leak, biliary stricture, thrombosis, bleeding, hepatic dysfunction, thrombocytopenia, deep venous thrombosis, pulmonary embolism, difficult to control pain, depression and anxiety. Complication rates for LD with BMI >30 (n = 16) and BMI <30 (n = 52) were compared. The incidence of wound infection increased with BMI, 4% for nonobese and 25% for obese LD (p = 0.024). There were no statistically significant differences for all other complications. No LD died. Recipient survival was 100% with obese LD and 80% with nonobese LD (p = 0.1). Select donors with a BMI >30 may undergo donor hepatectomy with acceptable morbidity and excellent recipient results. Updating current guidelines to include select LD with BMI >30 has the potential to safely increase the donor pool.
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PMID:Select utilization of obese donors in living donor liver transplantation: implications for the donor pool. 1630 13

The authors report their experience with 42 patients in whom anterior lumbar fusion was performed using titanium cages as a versatile adjunct to treat a wide variety of spinal deformity and pathological conditions. These conditions included congenital, degenerative, iatrogenic, infectious, traumatic, and malignant disorders of the thoracolumbar spine. Fusion rates and complications are compared with data previously reported in the literature. Between July 1996 and July 1999 the senior authors (C.I.S., R.P.N., and M.J.R.) treated 42 patients by means of a transabdominal extraperitoneal (13 cases) or an anterolateral extraperitoneal approach (29 cases), 51 vertebral levels were fused using titanium cages packed with autologous bone. All vertebrectomies (27 cases) were reconstructed using a Miami Moss titanium mesh cage and Kaneda instrumentation. Interbody fusion (15 cases) was performed with either the BAK titanium threaded interbody cage (in 13 patients) or a Miami Moss titanium mesh cage (in two patients). The average follow-up period was 14.3 months. Seventeen patients had sustained a thoracolumbar burst fracture, 12 patients presented with degenerative spinal disorders, six with metastatic tumor, four with spinal deformity (one congenital and three iatrogenic), and three patients presented with spinal infections. In five patients anterior lumbar interbody fusion (ALIF) was supplemented with posterior segmental fixation at the time of the initial procedure. Of the 51 vertebral levels treated, solid arthrodesis was achieved in 49, a 96% fusion rate. One case of pseudarthrosis occurred in the group treated with BAK cages; the diagnosis was made based on the patient's continued mechanical back pain after undergoing L4-5 ALIF. The patient was treated with supplemental posterior fixation, and successful fusion occurred uneventfully with resolution of her back pain. In the group in which vertebrectomy was performed there was one case of fusion failure in a patient with metastatic breast cancer who had undergone an L-3 corpectomy with placement of a mesh cage. Although her back pain was immediately resolved, she died of systemic disease 3 months after surgery and before fusion could occur. Complications related to the anterior approach included two vascular injuries (two left common iliac vein lacerations); one injury to the sympathetic plexus; one case of superficial phlebitis; two cases of prolonged ileus (greater than 48 hours postoperatively); one anterior femoral cutaneous nerve palsy; and one superficial wound infection. No deaths were directly related to the surgical procedure. There were no cases of dural laceration and no nerve root injury. There were no cases of deep venous thrombosis, pulmonary embolus, retrograde ejaculation, abdominal hernia, bowel or ureteral injury, or deep wound infection. Fusion-related complications included an iliac crest hematoma and prolonged donor-site pain in one patient. There were no complications related to placement or migration of the cages, but there was one case of screw fracture of the Kaneda device that did not require revision. The authors conclude that anterior lumbar fusion performed using titanium interbody or mesh cages, packed with autologous bone, is an effective, safe method to achieve fusion in a wide variety of pathological conditions of the thoracolumbar spine. The fusion rate of 96% compares favorably with results reported in the literature. The complication rate mirrors the low morbidity rate associated with the anterior approach. A detailed study of clinical outcomes is in progress. Patient selection and strategies for avoiding complication are discussed.
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PMID:Anterior lumbar fusion with titanium threaded and mesh interbody cages. 1691 6

The aim of this study was to assess the impact of living-donor liver transplantation on the donor's quality of life. Among the 48 performed at our hospital from October 2003 to June 2006, 46 (27 men, 19 women; mean age, 37.4 years) were followed for more than 4 months (mean, 16.5+/-8 months). In April 2006, these donors participated in a survey that included medical and psychosocial outcomes. Seven complications occurred in four of 46 donors (8.6%): two biliary leaks, two wound infections, one incisional hernia, one portal vein thrombosis, and one deep venous thrombosis. For the donor with portal vein thrombosis, the vein was recanalized, and she recovered without treatment; a bile leak from the cut liver surface and an incisional hernia also developed in the same donor. The biliary leak was treated with percutaneous drainage, and the incisional hernia was repaired surgically. Fifteen donors were housewives, 31 worked outside the home, and 94% returned to their work. A change in body image was reported in 4.3% of the donors. None reported impaired sexual function. Complete recovery occurred in 86% of donors, 94% of the donors said that they would donate again if necessary, and 97% believe that they had benefited from the donation experience. In conclusion, almost all donors were able to return to their prior jobs within a few months of surgery, and most donors were satisfied with the donation procedure.
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PMID:Right hepatic lobe donation: impact on donor quality of life. 1752 24

We initiated a new bariatric surgery program in February 2004. Before starting the program, we initiated a systemic planning process to design, develop, and implement a comprehensive, multidisciplinary program. Between May 2004 and June 2006, 178 patients underwent Roux-en-Y gastric bypass to treat morbid obesity at our institution. We have had no pulmonary emboli and no deaths. Twenty-one patients (11.8%) developed wound infection after surgery. Thirteen patients (7.3%) developed stenosis at the gastrojejunostomy. Five patients (2.8%) bled from the gastrojejunostomy. Four patients (2.2%) developed atelectasis. Three patients (1.6%) developed an internal hernia after surgery. One patient (0.5%) developed deep venous thrombosis. Two patients (1.1%) developed small bowel obstruction from adhesions. One patient developed a leak (0.6%). By 6 months after surgery, our patients have lost an average of 85 pounds (53% excess weight loss). By 12 months, they have lost an average of 104 pounds (65% excess weight loss). A focused effort to reduce infection has dropped our wound infection rate to 0 per cent in the past 6 months. Our results indicate that with proper planning, it is possible to initiate a new program and achieve excellent outcomes. Proper planning, systematic implementation, and a focus on patient education are critical to success.
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PMID:Developing a new bariatric surgery program. 1809 40

The increasing use of bariatric procedures in the treatment of morbidly obese patients means that aesthetic plastic surgeons can expect to care for more and more patients who have undergone bariatric surgery. It is important for aesthetic surgeons to understand the procedures, outcomes, and possible complications to recognize the signs and symptoms of any potential problems. Candidates for bariatric surgery must have a body mass index (BMI) of at least 40 kg/m(2) or a BMI of 35 kg/m(2) with at least one comorbidity, plus demonstrated failure of nonsurgical means of weight control to control weight and no significant psychiatric disorders. Surgical procedures can be categorized as restrictive or malabsorptive and include adjustable gastric band, Roux-en-Y gastric bypass, and biliopancreatic diversion with or without duodenal switch. There are no definitive criteria for choosing any single procedure, although in general restrictive procedures may be more appropriate for those patients with lower BMIs and malabsorptive procedures for those with higher BMIs. Results of bariatric surgery are impressive and include not only significant and sustained weight loss but also improvement or resolution of major comorbid conditions. Significant complications include anastomotic leak, marginal ulceration, and internal herniation, as well as wound infection, incisional hernia, hemorrhage, deep venous thrombosis, and pulmonary embolus. Innovative procedures now under study include gastrointestinal neuromodulation, sleeve gastrectomy, intragastric balloons, intraluminal sleeves, and other endoscopic procedures.
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PMID:Bariatric surgery: current concepts and future directions. 1908 10

Acting as a pneumatic tissue expander, progressive preoperative pneumoperitoneum (PPP) pressurizes the abdomen to prepare patients with giant hernias and loss of domain for hernia repair. We review our experience with PPP. Between 2006 and 2008, a prospective hernia database revealed nine patients who underwent PPP prior to hernia repair. Mean patient age was 54 years (41-68) and mean BMI was 31.3 kg/m2 (25.2-36.5). Patients had prophylactic vena cava filters and intraperitoneal catheters placed. Over a mean 22.4 days (7-64), patients received 7.6 (3-13) injections of air. PPP complications included death from pulmonary mycetoma (1), deep venous thrombosis and acute renal failure (1), port infection (1), kinked catheter requiring reoperation (1). Seven patients underwent successful hernia repair; open ventral (6) and laparoscopic inguinal (1). Defect size averaged 387 cm2 (110-980) with a mesh size of 420 cm (180-1200). Operative time averaged 256 minutes (175-330) with a mean blood loss of 157 ml (50-500). Post-hernia repair length of stay was 10.3 days (4-22). Hernia repair complications included ventricular tachycardia (1) and hernia recurrence (1). PPP has an acceptable risk, and for patients with large hernias and loss of domain, it may be a useful adjunct prior to definitive hernia repair.
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PMID:Progressive preoperative pneumoperitoneum for hernias with loss of domain. 1954 99


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