Adhesion formation and incorporation in the diaphragm of a double layered mesh after intraperitoneal placement in an experimental model of animals

Purpose The purpose of this study is to evaluate the tissue integration of a double-sided mesh after intra-abdominal fixation in diaphragm and to study the mobility of the diaphragm by means of ultrasound. MethodsTwenty male Wistar rats were used. The animals were assigned into two equal groups. The animals were anesthetized and a 1.5 x 1.5 cm of double-layer mesh was inserted between the diaphragm and the liver. For the evaluation of the diaphragm mobility a sonographic method was used. Measurements on specific parameters including Ti (diaphragm inspiratory time), Te (diaphragm expiratory time), Ttot (Total breathing time), IR (Ti/Ttot) were taking place. Pathological evaluation took place after the euthanasia.ResultsConcerning percentage differentiation, extra-hepatic granuloma was not differentiated, (χ2=0. 04, p>0.05). Neither fibrosis was significantly differentiated, (χ2=0.04, p>0.05). Intra-hepatic granuloma was significantly differentiated, (χ2 = 10.21, p 0,05). Ούτε η ίνωση ήταν σημαντικά διαφοροποιημένη, (χ2 = 0.04, p> 0,05). Το ενδοηπατικό κοκκίωμα ήταν σημαντικά διαφοροποιημένο, (χ2 = 10,21, ρ <0,05). Η παράμετρος Te ήταν σημαντικά διαφοροποιημένη με τη πάροδο του χρόνου, F (3, 30) = 5.12, (p <0,01). Η παράμετρος Ttot διαφοροποιήθηκε, F (3, 8) = 4.79, (p <0,05). Η παράμετρος IR επίσης διαφοροποιήθηκε, F (3, 30) = 3.73, (p <0,05).ΣυμπέρασμαΗ Φλεγμονώδης αντίδραση, η ίνωση και το εξωηπατικό κοκκίωμα δεν διαφοροποιήθηκαν σημαντικά με το πέρασμα του χρόνου. Η κινητικότητα του διαφράγματος επηρεάστηκαν παροδικά

Technical Intraoperative Maneuvers for the Management of Inferior Vena Cava Thrombus in Renal Cell Carcinoma

IntroductionRenal vein or inferior vena cava (IVC) invasion by neoplastic thrombus in patients with renal cell carcinoma (RCC) is not an obstacle for radical oncological treatment. The aim of this study is to present our technical maneuvers for complete removal of the intracaval thrombus without compromising hemodymanic stability of the patient.Materials and methodsBetween 2000 and 2014, 15 RCC patients with IVC involvement of levels I–III were treated with curative intent and were prospectively studied. The operative technique varied according to thrombus extent. For type I, extraction of the thrombus is facilitated by a 2–3 cm longitudinal incision on the IVC that begins at the level of the renal vein and extends cranially, encompassing a vessel wall rim of the orifice of the resected renal vein. For type II cases, the IVC is clamped above the neoplastic thrombus, and for type III, the IVC clamping is combined with hepatic blood flow control with “Pringle maneuver.” For type IV, the IVC is clamped above the diaphragm, or if the thrombus extends into the right atrium cardiothoracic input is appropriate.ResultsThe main operative steps include preparation and control of the renal vessels and the IVC. Occasionally, for type III tumor thrombi, the patient becomes hemodynamically unstable when IVC is clamped suprahepatically. In such a case, a novel operative maneuver of milking the thrombus below the orifice of the hepatic veins, and subsequently the IVC clamp also beneath the hepatic veins, allowing release of the “Pringle maneuver” is performed. This operative step restores hepatic blood flow and hemodynamic stability and is based on the floating nature of the thrombus into the IVC. Mean operative time was 120 min (range from 90 to 180 min), and average liver and renal warm ischemia time was 20 min (range from 15 to 35 min). Postoperative overall hospital stay ranged from 7 to 13 days.ConclusionThe technical solutions employed in the current study allow successful removal of neoplastic thrombi from the IVC in most cases, associated with minimal perioperative complication rate even for patients who due to multiple comorbidities would be considered otherwise inoperable

Technical intraoperative Maneuvers for the Management of inferior Vena cava Thrombus in renal cell carcinoma

Introduction: Renal vein or inferior vena cava (IVC) invasion by neoplastic thrombus in patients with renal cell carcinoma (RCC) is not an obstacle for radical oncological treatment. The aim of this study is to present our technical maneuvers for complete removal of the intracaval thrombus without compromising hemodymanic stability of the patient. Materials and methods: Between 2000 and 2014, 15 RCC patients with IVC involvement of levels IIII were treated with curative intent and were prospectively studied. The operative technique varied according to thrombus extent. For type I, extraction of the thrombus is facilitated by a 23 cm longitudinal incision on the IVC that begins at the level of the renal vein and extends cranially, encompassing a vessel wall rim of the orifice of the resected renal vein. For type II cases, the IVC is clamped above the neoplastic thrombus, and for type III, the IVC clamping is combined with hepatic blood flow control with Pringle maneuver. For type IV, the IVC is clamped above the diaphragm, or if the thrombus extends into the right atrium cardiothoracic input is appropriate. Results: The main operative steps include preparation and control of the renal vessels and the IVC. Occasionally, for type III tumor thrombi, the patient becomes hemodynamically unstable when IVC is clamped suprahepatically. In such a case, a novel operative maneuver of milking the thrombus below the orifice of the hepatic veins, and subsequently the IVC clamp also beneath the hepatic veins, allowing release of the Pringle maneuver is performed. This operative step restores hepatic blood flow and hemodynamic stability and is based on the floating nature of the thrombus into the IVC. Mean operative time was 120 min (range from 90 to 180 min), and average liver and renal warm ischemia time was 20 min (range from 15 to 35 min). Postoperative overall hospital stay ranged from 7 to 13 days. Conclusion: The technical solutions employed in the current study allow successful removal of neoplastic thrombi from the IVC in most cases, associated with minimal perioperative complication rate even for patients who due to multiple comorbidities would be considered otherwise inoperable

Evaluation of diaphragmatic mobility following intra-abdominal sub-diaphragmatic fixation of a double-layered mesh in rats

PURPOSE: To evaluate the tissue integration of a double-sided mesh after fixation in diaphragm and to study the diaphragmatic mobility by ultrasound. METHODS: Twenty male Wistar rats were used. The animals were assigned into two equal groups according to the day of euthanasia. The animals were anesthetized and a 1.5 x 1.5 cm of double-layer mesh was inserted between the diaphragm and the liver. For the evaluation of the diaphragm mobility a sonographic method was used. Measurements on specific breathing parameters were taking place. Pathological evaluation took place after the animal&apos;s euthanasia. RESULTS: Extra-hepatic granuloma was not differentiated overtime, (chi 2= 0.04, p&gt;0.05). Neither fibrosis was significantly differentiated, (chi 2=0.04, p&gt;0.05). Intra-hepatic granuloma was significantly differentiated overtime, (chi 2= 10.21, p&lt;0.05). Concerning Te parameter, means were significantly differentiated over time, F (3, 30) = 5.12, (p&lt;0.01). Ttot parameter, it was differentiated over time, F (3, 8)= 4.79, (p&lt;0.05). IR parameter was also longitudinally differentiated, F (3, 30)= 3.73, (p&lt;0.05). CONCLUSION: The measurements suggest a transient malfunction of diaphragmatic mobility despite the fact that inflammatory reaction, fibrosis and extra-hepatic granuloma were not significantly differentiated with the passage of time