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

Laparoscopic surgery may reduce the inflammatory response to surgery by the avoidance of a skin incision which is frequently the site of maximum tissue trauma. We hypothesized that the inflammatory response is less with minimally invasive procedures. The aim of this study was to evaluate the response of inflammatory mediators following laparoscopic and open hernia repair. Thirty-four patients undergoing unilateral primary inguinal hernia repair were prospectively assigned to either laparoscopic mesh hernia repair (n = 14), open mesh hernia repair (n = 11), or a Bassini repair (n = 9). Serum samples withdrawn prior to surgery, 6 h after surgery, and then again at 24 h after surgery were assayed for interleukin-6 and C-reactive protein content. Interleukin-6 levels at 24 h in the laparoscopic (13.1 +/- 3.1 pg/ml), open mesh (15.5 +/- 2.5 pg/ml), or Bassini group) (15.4 +/- 2.0 pg/ml) did not differ significantly. Neither did C-reactive protein levels at 24 h in the laparoscopic (12.4 +/- 2.7 pg/ml), open mesh (23.0 +/- 7.8 pg/ml), or Bassini group 18.6 +/- 6.6 pg/ml) differ significantly. The response of inflammatory mediators to hernia repair is not modified by undertaking the procedure laparoscopically.
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PMID:Inflammatory markers following laparoscopic and open hernia repair. 748 66

Although liposuction is considered to be a relatively safe procedure, several deaths and nonfatal serious complications such as sepsis, toxic shock syndrome, thromboembolic disease, fat emboli, and adult respiratory distress syndrome have been reported. In the present study, we have investigated a wide variety of components belonging to the coagulation, fibrinolytic, plasma kallikrein-kinin, and complement systems in 22 patients undergoing syringe-assisted liposuction using the superwet or tumescent technique. In spite of a relatively high mean aspirate volume (2,648 ml), only small changes over time well within the normal range were found for the different parameters. In nine randomly selected patients, we also measured interleukin 6 and tumor necrosis factor-alpha. The size of the interleukin-6 peaks was found to be of the same order of magnitude as those measured in patients undergoing hernia repair or percutaneous cholecystectomy but lower than those in patients undergoing open cholecystectomy, breast reduction, or breast reconstruction. Tumor necrosis factor-alpha was not detected in any sample in any of the patients. We conclude that syringe-assisted liposuction with the present aspirate volumes using the superwet or tumescent technique represents a small to moderate surgical trauma without clinical significant activation of the cascade systems.
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PMID:Effect of syringe-assisted liposuction on activation of cascade systems and circulating cells when using the superwet or tumescent technique. 750 16

Cytokines are early responders in the cascade of host mediators after injury. The cytokine response in neonates following surgery and its prognostic significance were studied prospectively. Twenty-one patients (oesophageal atresia [5], congenital diaphragmatic hernia [4], exomphalos [4], patent vitellointestinal duct [1], anorectal anomaly [2], choledochal cyst [1], renal cyst [1], ovarian cyst [1], myelomeningocoele [1], and pyloric stenosis [1]) operated on at a median age of 3 days (range, 1 to 24 days) and 12 age-matched controls were included in the study. Plasma samples were obtained once in the controls, and serially preoperatively and at 1, 3, 6, 12, 24, 36, and 48 hours postoperatively in the patients. The levels of the cytokines, interleukin-6 (IL-6), and interleukin-8 (IL-8) were measured using the enzyme-linked immunosorbent assay (ELISA) technique. The median plasma levels of IL-6 and IL-8 in normal controls were 2.4 pg/mL and 92.0 pg/mL, respectively. Of the 21 patients, four had postoperative complications (pulmonary consolidation [2], septicaemia [1], and oesophageal leak [1]) between days 4 and 6. All 17 uncomplicated cases had an increase in IL-6 and IL-8 in the early postoperative period, with the peak occurring within 12 hours after surgery. The mean (+/- SEM) peak levels of IL-6 and IL-8 in uncomplicated cases were of 92.6 +/- 15.8 pg/mL and 230.3 +/- 45.3 pg/mL, respectively. In the four complicated cases, there was a disproportionately higher increase in both IL-6 (peaks, 305.0, 125.0, 240.0, and 220.0 pg/mL) and IL-8 (peaks, 1500.0, 340.0, 245.0, 355.0 and pg/mL), which preceded the clinical onset of complications. The early postoperative increases in plasma IL-6 and IL-8 probably represent the stress response of neonates to surgery. Furthermore, the association of an exaggerated increase in postoperative levels of plasma IL-6 and IL-8 and postoperative complications may have prognostic significance.
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PMID:Cytokine response of neonates to surgery. 807 24

A prospective comparison of metabolic and inflammatory responses after laparoscopic and open inguinal hernia operations was undertaken. There were 10 patients in each group. Plasma levels of cortisol, growth hormone, prolactin, C-reactive protein (CRP) and interleukin-6 (IL-6) were measured preoperatively and at fixed intervals up to 120 h postoperatively. In vitro, endotoxin stimulated whole blood tumour necrosis factor alpha (TNF alpha) was measured in preoperative and 24 h postoperative blood samples. Changes in the plasma levels of cortisol, growth hormone and prolactin showed no statistically significant difference between the groups. No significant change in IL-6 levels were recorded in any group. Changes in CRP levels were significantly higher (P < 0.006) in open hernia patients. Endotoxin stimulated TNF alpha production was suppressed in both groups. The degree of suppression in open hernia patients was significantly higher (P < 0.005). This study has shown that both these operations produce similar stress responses. However, open hernia operation results in a higher acute phase response and induces a greater endotoxin tolerance.
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PMID:Metabolic and inflammatory responses after laparoscopic and open inguinal hernia repair. 962 79

Endoscopic techniques are commonly used for many different types of surgery. It is claimed that videoendoscopic procedures have the advantage of being less traumatic and of offering higher postoperative patient comfort than conventional open techniques. The extent of tissue trauma can be evaluated on the basis of the inflammatory response observed in the wake of surgery. Available studies that have compared endoscopic and conventional techniques suggest that endoscopic cholecystectomy, laparoscopic colorectal resection, and thoracoscopic pulmonary resection have immunologic advantages over conventional approaches. The objective of this prospective study was to determine whether endoscopic hernia repair techniques are also preferable to conventional procedures and to what extent the anesthetic technique (local or general anesthesia) influences the postoperative inflammatory response. For this purpose, biochemical monitoring of cytokine activity [C-reactive protein (CRP), prostaglandin F1alpha (PGF1alpha), neopterin, interleukin-6 (IL-6)] was done prospectively in 101 patients [totally extraperitoneal approach (TEP) n=32, unilateral n=12, bilateral n=20; Shouldice n=69, local anesthesia (LA) n=23, general anesthesia (GA) n=46] before and until 3 days after surgery. The parameters IL-6 and PGF1alpha suggested that the immune trauma immediately after surgery was significantly higher in the group of patients with endoscopic hernia repair than in the group of patients who received a Shouldice repair. No significant differences were observed after the first postoperative day. A comparison between the TEP group and the patients who received conventional surgery under local anesthesia showed that the TEP approach was also associated with a higher postoperative neopterin level. Within the first 3 days after surgical intervention, bilateral endoscopic hernia repair induced no significantly higher inflammatory response than the surgical treatment of unilateral conditions. The anesthetic procedure that was used in the Shouldice operation had no significant effect on inflammatory response. Unlike other types of endoscopic surgery, the repair of groin hernias using an endoscopic technique cannot be regarded as a minimally invasive procedure that is less traumatic than conventional approaches. Instead, the conventional Shouldice procedure appears to cause the lowest inflammatory response and to be the least traumatic approach to hernia repair, especially when it is performed under local anesthesia.
Hernia 2004 Aug
PMID:Systemic inflammatory response after endoscopic (TEP) vs Shouldice groin hernia repair. 1504 32

Insulin sensitivity was determined before and after elective surgery in 31 otherwise healthy patients undergoing elective surgery for open cholecystectomy (n = 24) or inguinal hernia repair (n = 7) and compared with concomitant plasma concentrations of stress hormones and cytokines. Insulin sensitivity was determined employing the normoglycaemic, hyperinsulinaemic clamp at a plasma insulin concentration of 380 pmol/I and a blood glucose concentration of 4.5 mmol/I. Five of the patients undergoing cholecystectomy were studied again on days 5, 9 and 20 after surgery. Preoperative insulin sensitivity ranged from 2.2 to 14.3 mg/kg/min. All patients exhibited reduced insulin sensitivity on the first postoperative day and the mean value fell from 4.7 (0.4) to 2.7 (0.5) mg/kg/min. More pronounced reductions were found after cholecystectomy. A significant increase was found in plasma concentrations of interleukin-6 (IL-6) postoperatively as compared to preoperative values. However, no significant changes were seen in the postoperative plasma concentrations of any of the hormones studied in patients undergoing hernia repair, while minor increments were seen in patients undergoing open cholecystectomy. There was a significant (r = 0.50, P = 0.005) linear relationship between the reduction in relative insulin sensitivity and the concomitant plasma levels of IL-6. However, no such relation could be confirmed between the changes in plasma hormone concentrations (neither absolute nor relative changes) and the simultaneous alteration in relative insulin sensitivity. In addition, after including three patients who had undergone ileo-anal pouch construction surgery, the relationship between postoperative insulin sensitivity and IL-6 levels was even stronger (r = 0.62, P = 0.001). These results suggest that the immunomodulating effects of endogenous IL-6 is of importance in the acute response after surgery and are associated with the development of insulin resistance, while simultaneous plasma concentrations of stress hormones seem to be less sensitive markers of the degree of postoperative metabolic disturbance.
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PMID:Postoperative insulin resistance and circulating concentrations of stress hormones and cytokines. 1684 2

Fetal lung hypoplasia is a common finding in several fetal conditions such as congenital diaphragmatic hernia (CDH). Interestingly, previous studies have demonstrated that hypoplastic lungs have the ability to recover to normal size, when relieved from mechanical factors. However, the underlying mechanisms remain largely unknown. Recently, interleukin-6 (IL-6) has been involved in catch-up growth phenomenon in children. Thus, we hypothesized that IL-6 could mediate fetal growth recover from hypoplastic lungs. Control and nitrofen-induced hypoplastic lung explants were cultured either in normal conditions or with IL-6 neutralizing antibodies. The total number of peripheral airway buds, epithelial perimeter, and total explant area were analyzed and daily branching rates were calculated. Additionally, IL-6 mRNA and protein expression was assessed both in qualitative (by in situ hybridization and immunohistochemistry) and in quantitative (by real-time PCR and Western blot) approaches, in control and hypoplastic lungs (nitrofen and CDH groups). Nitrofen-induced hypoplastic lungs showed in vitro, out of systemic environment, the ability to recover from hypoplasia and presented daily branching rates significantly higher than controls. Blocking IL-6 activity significantly diminished the intrinsic capacity of hypoplastic fetal lungs to recover from hypoplasia and attenuated their daily branching rates. Although more exacerbated in CDH, both nitrofen-exposed lungs presented significant IL-6 mRNA and protein over-expression throughout all studied gestational ages. The present study suggests, for the first time, that fetal lung is able to recover from growth retardation through a way that resembles the catch-up growth phenomenon, and it seems to be, at least partially, orchestrated by intrinsic mechanisms implicating IL-6.
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PMID:Intrinsic catch-up growth of hypoplastic fetal lungs is mediated by interleukin-6. 1850 Jul 30

Placement of mesh is involved in 75-80% of hernia operations. It is known that an exaggerated foreign body reaction leads to clinical complications. To further improve patients outcome using biotechnological agents targeted against tumor necrosis factor-alpha (TNF-alpha) or interleukin-6 (IL-6), a study was conducted investigating the impact of cytokine knockout on mesh integration. Sixty mice were used: C57BL/6 wild type control, C57BL/6-IL-6 interleukin-6 knockout, C57BL/6-Tnfrsf1a knockout of TNF-alpha receptor 1, and C57BL/6-Tnfrsf1b knockout of TNF-alpha receptor 2. Standard polypropylene mesh was implanted subcutaneously for 7, 21, and 90 days. The inflammatory and connective tissue formation was characterized by diameter of inner cellular infiltrate and outer fibrous capsule of the foreign body granuloma, and by quantity (collagen/protein ratio) and quality (collagen type I/III ratio) of collagen formation. Microscopic investigation of the mesh/host-tissue interface showed typical formation of foreign body granulomas. Ninety days after implantation none of the knockout strains showed significant differences compared to the control group investigating amount of inflammatory and connective tissue formation. Analyzing the quantity of filamentary collagen deposition the C57BL/6-IL-6 group showed significant lowered values compared to the control group 90 days after implantation. In all groups collagen type I/III ratio increased over time as an indicator for maturation of the surrounding collagen formation. However, no difference was found comparing strains at the end of the observation period. The results support the notion that wound healing is affected by cytokine deficiency. However, a desirable reduced amount of inflammatory tissue formation as well as an increased collagen type I/III ratio due to cytokine knockout could not be observed.
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PMID:Impact of proinflammatory cytokine knockout on mesh integration. 1984

The aim of this study was to compare the clinical results and the inflammatory responses against polypropylene and polyester meshes after groin hernia repair. Ninety patients with unilateral inguinal hernia randomly underwent Shouldice herniorrhaphy or Lichtenstein hernioplasty using polypropylene or polyester meshes. Venous blood samples were collected to evaluate serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels. Postoperative acute and chronic pain and time to attain to normal activities were evaluated. IL-6 levels decreased to preoperative levels in all groups at 48th hour. CRP levels of mesh-implanted groups are significantly higher than preoperative level at 48th hour, while it reduced to preoperative level in Shouldice herniorrhaphy group. Patients treated with mesh repair had less postoperative acute pain and recovered more rapidly than those who underwent Shouldice herniorrhaphy. It was concluded that polypropylene and polyester meshes used in hernia repair caused similar inflammatory responses and that clinical results after groin hernia repair with these prostheses were not significantly different.
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PMID:The Comparison of Inflammatory Responses and Clinical Results After Groin Hernia Repair Using Polypropylene or Polyester Meshes. 2673 10