Transabdominal Preperitoneal Repair for Obturator Hernia

信州大学博士（医学）・学位論文・平成23年3月31日授与（甲第889号）・横山隆秀Background A laparoscopic surgical approach for obturator hernia (OH) repair is uncommon. The aim of the present study was to assess the effectiveness of laparoscopic transabdominal preperitoneal (TAPP) repair for OH. Methods From 2001 to May 2010, 659 patients with inguinal hernia underwent TAPP repair at in our institutes. Among these, the eight patients with OH were the subjects of this study. Results Three of the eight patients were diagnosed as having occult OH, and the other five were diagnosed preoperatively, by ultrasonography and/or computed tomography, as having strangulated OH. Bilateral OH was found in five patients (63%), and combined groin hernias, either unilaterally or bilaterally, were observed in seven patients (88%), all of whom had femoral hernia. Of the five patients with bowel obstruction at presentation, four were determined not to require resection after assessment of the intestinal viability by laparoscopy. There was one case of conversion to a two-stage hernia repair performed to avoid mesh contamination: addition of mini-laparotomy, followed by extraction of the gangrenous intestine for resection and anastomosis with simple peritoneal closure of the hernia defect in the first stage, and a Kugel hernia repair in the second stage. There was no incidence of postoperative morbidity, mortality, or recurrence. Conclusions Because TAPP allows assessment of not only the entire groin area bilaterally but also simultaneous assessment of the viability of the incarcerated intestine with a minimum abdominal wall defect, we believe that it is an adequate approach to the treatment of both occult and acutely incarcerated OH. Two-stage hernia repair is technically feasible in patients requiring resection of the incarcerated intestine.ArticleWORLD JOURNAL OF SURGERY. 35(10):2323-2327 (2011)journal articl

Reliability of growth prediction with hand-wrist radiographs

The aim of this study was to investigate the validity of hand-wrist radiographic analysis in estimating the amount of remaining craniofacial growth. The material compromised cephalograms of 22 males and 27 females with a Class I malocclusion. The median age of the females at the beginning (T1) was 11 years 10 months and of the males 12 years 6 months and at the end (T2) of treatment 14 years 7 months and 15 years 3 months, respectively. Statural height was measured and a lateral cephalogram was obtained for every patient at T1 and T2. A hand-wrist radiograph was taken only at T1. The cephalograms were scanned and analyzed. Relative dimensional growth changes in statural height as well as of the length of the cranial base (N-S), the maxilla (Ptm-A), and the dimensions of the mandible (Co-Gn, Go-Gn, and Co-Gn) from T1 to T2 were determined and statistically compared (Pearson's correlation coefficients) with the growth prediction assessed with the help of hand-wrist radiographs according to Greulich and Pyle. The results showed a highly significant correlation between statural growth increases and growth prediction assessed from the hand-wrist radiographs (females: r = 0.68; males: r = 0.7). Concerning craniofacial structures, the increase in mandibular corpus showed the highest correlation with growth prediction (females: r = 0.21; males: r = 0.52), but this association would not allow a reliable growth prediction. There was no significant correlation between growth increases of the cranial base, the maxilla, the ramus, and the effective length of the mandible and growth prediction assessed with the help of hand-wrist radiographs. As each patient has an individual growth pattern and different craniofacial structures show individual growth potential, it is questionable if quantitative craniofacial growth prediction with the help of hand-wrist radiographs is reliable. However, in an individual case for the assessment of the timing of the growth process, a hand-wrist radiograph can contribute to treatment planning