26 research outputs found
Recent Innovations & Daily Problems. A new prosthesis in inguinal hernia repair:preliminary results of a pilot study.
Introduction: Elective surgery for inguinal hernia is affected by very
low mortality « 1 per 10000 operation); in contrast, when surgery
is carried out for complicated inguinal hernia, risks of postoperative
complication are higher. TAPP is a world-wide accepted surgical practice
in the treatment of elective bilateral or recurrent inguinal hernia,
above all in young patients. Few exploratory studies were published on
laparoscopic approach in the treatment of urgent complicated inguinal
hernia. Aim of this study was to analyze feasibility (operative time,
conversion rate), safety (postoperative morbidity, length of hospital
stay) and quality of life (acute and chronic pain, return to work) of
trans-abdominal pre-peritoneal laparoscopic hernia repair in acute
incarcerated inguinal hernia. Rationale of laparoscopic trans-abdominal
approach is the easier hernia reduction under vision and a better
exploration of the abdominal cavity.
Methods: from September 2012 to September 2013, 15 consecutive
patients admitted in emergency at the Division of General Surgery of
University "Sapienza", Polo Pontino, for acute incarcerated inguinal
hernia were submitted to TAPP using 3 trocars (1 of 10 mm and 2 of
5mm) and polyester prosthesis fixed by fibrin glue. Exclusion criteria
for laparoscopic approach were age III, previous
abdominal surgery, signs of strangulated hernia. All of them were
evaluated for operative time, conversion rate, postoperative morbidity,
organ resection or other surgery required. All patients were scored for
pain by Visual Analogic Scale (VAS) during postoperative in hospital
stay at 7 days, 1,6 and 12 months after surgery.
Results: median follow-up was 16 months and 12 as minimum. In all
cases reduction of hernia was always possible and none conversion
to open surgery was recorded, median operative time was 89 minutes
(55-137 as range), omental resection was carried out in one patient
(6,6%), no other organ resections needed, whereas contralateral hernia
was diagnosed and repaired at the same time in 4 patients (26,6%). No
major complications were observed, median blood loss was 100 ml,
minor morbidity was contained to 18% represented by fever and
wound infection of surgical umbilical scar. Median in hospital stay
was 1,5 days with 1-5 days as range. Postoperative median acute pain,
measured by visual analogic scale (VAS), was 2 (range:0-4), none
patient referred any pain during follow-up. Median time of return to
work was 6,5 days, ranged between 3 to 15 days. Patients' compliance
to treatment and to follow-up was complete as well their satisfaction. Conclusions: In centres skilled for laparoscopy in emergency, TAPP
could be considered a feasible and safe technique. In well-selected
patients (especially if emolled in controlled clinical trial) TAPP could
represent an alternative surgical approach for complicated incarcerated inguinal hernia to conventional open surgery even in urgency. The
main advantages of laparoscopic approach are the ability to perform
surgical hernia reduction under vision, a better exploration and evaluation
of abdominal cavity and diagnosis and treatment of eventual
contralateral defect of wall, otherwise often missed. Finally, the good
control of acute and chronic pain, faster return to normal activity and
work, better aesthetic results contributed to total satisfaction and compliance
of the patients
Repeated successful surgical rescues of early and delayed multiple ruptures of ventricular septum, right ventricle and aneurysmal left ventricle following massive biventricular infarction
A 58 year old man underwent 6 surgical interventions for various complications of massive biventricular myocardial infarction over a period of 2 years following acute occlusion of a possibly "hyperdominant" left anterior descending coronary artery. These included concomitant repair of apicoanterior post-infarction VSD and right ventricular free wall rupture, repeat repair of recurrent VSD following inferoposterior extension of VSD in the infarcted septum 5 weeks later, repair of delayed right ventricular free wall rupture 4 weeks subsequently, repair of a bleeding left ventricular aneurysm eroding through left chest wall 16 months thereafter, repair of right upper lobe lung tear causing massive anterior mediastinal haemorrhage, mimicking yet another cardiac rupture, 2 months later, followed, at the same admission, 2 weeks later, by sternal reconstruction for dehisced and infected sternum using pedicled myocutaneous latissimus dorsi flap. 5 years after the latissimus myoplasty, the patient remains in NYHA class 1 and is leading a normal life