Hoestgeïnduceerde ribfracturen met diafragmaruptuur rechts en intercostale hernia

A cough-induced diaphragmatic rupture is rare, even more on the right side. In this manuscript, the medical history of a 49-year-old patient with chronic obstructive pulmonary disease (COPD) and the rare combination of a coughinduced rib fracture as well as a right diaphragm rupture with herniation of the great omentum in the thoracic cavity associated with an intercostal hernia is presented. The hernia was surgically repaired and closed with a mesh.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

A minimally invasive, endoscopic transgluteal procedure for pudendal nerve and inferior cluneal nerve neurolysis in case of entrapment: 3-and 6-month results. The ENTRAMI technique for neurolysis

Background: Pudendal and cluneal nerve entrapment can cause a neuropathic pain syndrome in the sensitive areas innervated by these nerves. Recently, a new endoscopic minimal invasive approach for pudendal and inferior cluneal nerve neurolysis has been published in a cadaver study. The aim of our study was to describe the feasibility of this new approach and to evaluate the clinical outcome. Methods: Fifteen patients underwent the ENTRAMI technique. The Numeric Pain Rating Scale (NPRS) and Patient Global Impression of Change (PGIC) were recorded at baseline and at 3 and 6 months after surgery. Result: The average duration of intervention (skin to skin) was 139 min (range 50–270 min) for bilateral pudendal neurolysis and/or cluneal neurolysis and 113 min (range 100–130 min) for unilateral pudendal and/or cluneal neurolysis. No perioperative blood loss occurred. At 3 months, 50% of patients declared a more than 30% improvement of their PGIC, increasing to 57% at 6 months; 31% reported more than 90% improvement of PGIC at 6 months. Overall reduction of the average maximal NPRS score was from 9 (range 7–10) to 6 at 3 months (range 0–10; p value < 0.05) and to 5 at 6 months (range 0–10; p value < 0.05). There were no postoperative complications. Conclusions: The ENTRAMI technique is feasibly in patients suffering from pudendal and/or cluneal neuralgia and preliminary results are promising. Clinical trial number: NCT03883178.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Endoscopic trans gluteal minimal-invasive approach for nerve liberation (ENTRAMI technique) in case of pudendal and/or cluneal neuralgia by entrapment: One-year follow-up

Background: Chronic neuropathic perineal pain syndrome is a collective term that encompasses several diagnoses. In patients where the neuropathic pain syndrome is caused by pudendal or cluneal nerve entrapment, surgical release can be proposed if other measures have failed. The aim of this study is to evaluate the clinical outcome of patients suffering from pudendal and/or cluneal nerve entrapment at 1 year after this minimal invasive surgery, which is based on the open trans gluteal approach who has proven its efficacy compared to medical treatment in a randomized control trial. Methods: Patients eligible for inclusion had chronic perineal neuropathic pain for at least 3 months in the area served by the pudendal and/or cluneal nerve, refractory to conservative measurements. Patients met all five of the Nantes criteria. Results: Fifteen patients underwent the ENTRAMI technique. At 1 year after surgery, overall reduction of the average maximal Numeric Pain rating Scale (NPRS-score) was from 9 (range, 7-10) at baseline to 5 (range, 0-10; P-value 30%) and optimal treatment response (PGIC ≥90%) was found in 40% (P-value <.05). No complications were recorded. Conclusion: This study clearly shows that the technique is feasible with promising long-term results in a difficult to manage patient group.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

The ENTRAMI technique: Endoscopic transgluteal minimal invasive technique for implantation of a pudendal electrode under full visual control: A cadaver study

Aim: The aim of this article is to describe a minimal invasive trans gluteal endoscopic approach to implant a pudendal electrode for neuromodulation under full visual control. Methods: Eight trans gluteal approaches were performed on four cadavers. The sacral transforaminal percutaneous technique was performed to implant the electrode. The electrode was then picked up and placed under visual control next to the pudendal nerve. Results: The first trocar was placed in the upper lateral quadrant of the gluteal region. The 0° optical system was used to help with the pneumodissection to identify the sciatic nerve. At that point a second 3 mm trocar was placed to insert a dissecting grasping forceps. In some cases, a second 3 mm trocar was placed. A step by step dissection, based on anatomical findings, was necessary to be able to locate the pudendal nerve. The electrode, which was placed percutaneously and transforaminal through S3 or S4, was picked up and placed under full visual control next to the pudendal nerve, slightly entering the Alcock's canal. The electrode was placed in an ideal manner, meaning that all 4-contact points of the electrode are in parallel and in contact with the targeted nerve. The electrode was fixed in that ideal position at the level of the sacrospinous ligament. After placement of that electrode, an X-ray of the pelvic area was done. Conclusions: The ENTRAMI technique allows optimal pudendal electrode placement under full visual control and should now be tested in a clinical setting.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Treatment of Fecal Incontinence With a Rechargeable Sacral Neuromodulation System: Efficacy, Clinical Outcome, and Ease of Use—Six-Month Follow-Up

Objective: Sacral neuromodulation is an effective treatment for fecal incontinence (FI) after conservative treatments have failed. A new rechargeable sacral neuromodulation system (r-SNM) includes a rechargeable implantable neurostimulator (INS). No data is available of the use of this technology in patients with fecal incontinence. Materials and Methods: Fifteen patients with FI were implanted with the Axonics rechargeable SNM system in a single-stage implant procedure and prospectively followed. Primary outcome was fecal incontinence episodes at four weeks and six months measured with stools diary. Success was defined as at least 50% improvement of fecal incontinence episodes. Additionally, quality of life and ease of use were evaluated. Results: At four weeks, 13 participants (87%) were test responders based on ≥50% reduction in FI episodes as documented on their bowel diary. Weekly FI episodes decreased from a median (25%–75% range) of 8 (5.8–20.3) at baseline to a median of 1.5 (0.4–4.5) at four weeks (p = 0.001), and 1.5 (0–2.6) at six months (p = 0.001), corresponding to 75% and 79% reduction in weekly FI episodes. Of the 13 subjects having ≥50% reduction in FI episodes at four weeks, 12 (PP = 92%) were therapy responders at six months. There were no unanticipated device or procedure-related adverse events. Mean time to recharge the system was 37 ± 3 min once or twice per week. All patients were moderately or very satisfied with the system and its effect. Conclusions: The r-SNM system provides safe and effective therapy in patients with FI at six months.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe