Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Toy-Smoot laparoscopic hernioplasty has been performed on 75 patients with a total of 83 hernioplasties over the past 20 months. Sixty-nine patients were male and six were female. The age range was 20 to 75 years with an average age of 51.5 years. Twelve of the patients had bilateral hernias repaired: 55 direct hernias, 16 indirect hernias, and 5 pantaloon hernias. Eleven of the repairs were for recurrent hernias. The procedure was performed under general anesthesia. The abdomen was insufflated with carbon dioxide, establishing the pneumoperitoneum. Three 11 mm trocars were inserted, the first via the umbilicus, into which the 0 degrees endoscope was inserted. Two additional trocars were inserted at the level of the umbilicus at the anterior axillary lines. The hernia sacs were left in situ. The medial umbilical ligament was dissected medially, so as to identify directly the pubic tubercle and the Cooper's ligament. An expanded PTFE soft tissue patch, 1 mm thick and 7.5 x 10 cm in size, was attached to the Nanticoke Endo-patch spreader and introduced via the contralateral trocar and positioned over the hernia defect. The Endopath EMS stapler was then used to secure the PTFE patch over the hernia defect. This required secure anatomical fixation to the transversalis fascia anteriorly and laterally, the pubic tubercle, and the posterior rectus sheath, medially, Cooper's ligament, posteromedially, and the endoabdominal fascia, posterolaterally. There were a total of seven different complications, one major, which was a bladder injury that required an open repair of the bladder and then an open, conventional hernioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Laparoscopic hernioplasty update. 149 6

Recently, titanium staples have been designed to stabilize a small prosthetic mesh used for laparoscopic herniorrhaphy. Unlike the giant prosthesis employed by Stoppa, the small mesh must be fixed to the surrounding musculo-aponeurotic defect. The strength of these titanium staples has never been evaluated and was compared to 0-Prolene sutures. In an ex vivo study, we evaluated the maximal stress (bursting strength [BS]) a repair performed with 0-Prolene sutures or staples can bear. Bilateral abdominal-wall defects were created in 16 piglets. A Prolene mesh was fixed preperitoneally on one side of the abdomen with 0-Prolene sutures and on the other side with the Endopath EMS stapler or the Endo Hernia stapler. The mean BS of meshes attached with 0-Prolene was 1,461.7 mmHg. The mean BS of meshes fixed with Endopath EMS staples was 885.5 mmHg and that of meshes fixed with Endo Hernia staples was 665.2 mmHg. A repair with 0-Prolene sutures is stronger (P < 0.05) than one with staples (Endopath EMS or Endo Hernia). Also, repair with an Endopath EMS stapler has a significantly higher BS (P < 0.05) than one with the Endo Hernia stapler. In the second part of the study, evaluation of the longitudinal tensile strength also showed that 0-Prolene sutures are stronger (P < 0.05) than staples. Endopath EMS staples are stronger (P < 0.05) than Endo Hernia staples.
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PMID:Bursting strength evaluation. Comparison of 0-Prolene sutures and endoscopic staples in an experimental prosthetic patch repair of abdominal wall defect. 797 15

Laparoscopic colon and rectal surgery is still in its nascent stages of development. The ease, efficacy, and safety of intracorporeal mechanical colonic anastomosis are contingent upon expensive stapling devices. Although mobilization and mesenteric division are feasible, a method of inexpensive rapid anastomosis is not. A single inexpensive multifire stapler which could be used both to fashion the anastomosis and to close the mesenteric defect would be ideal. Therefore, this prospective randomized study was undertaken to compare the clinical and functional results of laparoscopic colotomy closure performed using the Endopath EMS hernia stapler (EMS; Ethicon Endosurgery Inc., Cincinnati, OH) to results of using standard two-layer hand suturing (HS). Both the colotomy itself and the mesenteric defect closure sites were included in the randomization and analysis. The abdominal cavity was assessed for evidence of anastomotic leakage, abscess, and adhesion formation. In addition, radiographic luminal diameter, bursting strength, and histology were evaluated. Eight healthy pigs were randomized to either the EMS (N = 4) or HS (N = 4). There was no evidence of leakage, abscesses, or adhesion formation in either group; however, the mesenteric defect revealed more scarring in the HS than in the EMS animals. There were no significant differences in either luminal diameter (HS: mean = 0.92 cm; EMS: mean = 0.91 cm) or bursting strength (HS: mean = 171 mm Hg; EMS: mean = 157 mm Hg) (P > 0.05). Histologic analysis also demonstrated no difference in inflammation, necrosis, or fibrosis. This study suggests that this technique can be safely applied to both colotomy closure and mesenteric defect repair.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:An initial comparative study of two techniques of laparoscopic colonic anastomosis and mesenteric defect closure. 816 85

Recent developments in laparoscopic hernia repair techniques have led to the design of titanium staples. In a laparoscopic hernia repair, a polypropylene mesh is stapled over the direct and indirect hernia sites in the inguinal region. The effectiveness of these staples in holding the prosthetic mesh, and therefore providing adequate strength to the abdominal wall, has not been yet investigated. We have characterized the bursting strength (BS) of an experimental hernia mesh repair fixed with Prolene suture, which is used extensively for this procedure, and the BS of repairs fixed with two currently available staplers, the Endopath EMS endoscopic multifeed stapler and the Endo Hernia stapler. We first simulated abdominal wall hernias in 16 piglets by creating incisions on both sides of the abdomen of each animal. Each defect was then covered with a polypropylene mesh, which was fixed on one side with Prolene sutures and on the other side using either the Endopath EMS (Group 1) or the Endo Hernia stapler (Group 2). The abdominal tissue with the mesh covering the defect was then excised and the BS evaluated using an Instron machine. Since many mechanical characteristics contribute to the BS of a repair, we investigated these characteristics in vitro, including tensile properties of the staples and the prosthetic mesh as well as the suture-tearing resistance of the mesh. Polypropylene mesh exhibits the same elongation in the three directions, i.e. 0 degrees , 45 degrees and 90 degrees . This elongation was estimated at 136% (SD = 130).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mechanical characterization of endoscopic surgical staples during an experimental hernia repair. 1014 27