Incisional hernia after liver transplantation: A single center experience

Amaç: İnsizyonel herni, tüm ameliyatlardan sonra ortaya çıkabilecek ve hastanın yaşam kalitesini etkileyebilecek ciddi bir komplikasyondur. İnsidansı, karaciğer naklinden sonra %5 ile 35 arasındadır. Bu retrospektif çalışmanın amacı, karaciğer nakli sonrası gelişen insizyonel hernilerin değerlendirilmesidir. Gereç ve Yöntem: Nisan 2014 - Nisan 2018 tarihleri arasında İstanbul Medipol Üniversitesi Tıp Fakültesi Hastanesi Organ Nakli Bölümü'nde, canlı vericili karaciğer nakli yapılan 140 yetişkin hasta retrospektif olarak incelendi. İnsizyonel herni 10 (%7.1) hastada saptandı. Bu hastaların demografik ve klinik özellikleri, predispozan faktörleri ve cerrahi sonuçları değerlendirildi. Bulgular: Hastaların yaş ortalaması 58.3±5.8 yıldı. Bu hastaların 7'si (%70) erkekti. Hastaların ortalama Vücut Kitle İndeksi (VKİ) 33.9±1.6 kg/m2 ( kilogram/metrekare) idi. Hastaların ortalama son dönem karaciğer hastalığı (MELD) skoru 19±2.2 idi. Hastaların ameliyat öncesi ortalama serum albümin düzeyleri 2.99±0.12 g/L idi. 8 (%80) hastada nakil sonrası şiddetli assit (>2 L) vardı. Tüm hastalardaki herni defekti prolene mesh greft ile onarıldı (açık onlay tekniği ile). Otuz altı (22- 42) aylık takipte komplikasyon ve nüks görülmedi. Sonuç: Risk grubunda yaşlı - erkek - obez hastalar, düşük serum albümin düzeyleri ve şiddetli assit vardı. Karaciğer nakli sonrası gelişen insizyonel hernilerin erken tanı ve tedavisi için özellikle bu hasta gruplarına dikkat edilmesi gerektiğini düşünülmektedir.Objective: An incisional hernia is a serious complication that may develop after all operations and may affect the quality of a patient's life. The incidence is between 5 to 35% after liver transplantation. The aim of this retrospective study is to evaluate the development of incisional hernias after liver transplantation. Materials and Methods: Between April 2014 and April 2018 at Istanbul Medipol University Medical Faculty Hospital Organ Transplantation Department, 140 adult patients with living donor liver transplantation were studied retrospectively. The incisional hernia was diagnosed in 10 (7.1%) patients. The demographic features, clinical features, predisposing factors and surgical outcomes were evaluated in these patients. Results: The mean age of patients was 58.3±5.8 years. Of these patients, seven (70%) were male. Mean Body Mass Index (BMI) of the patients was 33.9±1.6 kg/m2 (kilogram/ square meter). The mean end-stage liver disease (MELD) scores of the patients was 19±2.2. Mean preoperative serum albumin levels of the patients was 2.99±0.12 g/L. There was posttransplant severe ascites (>2 liters) in 8 (80%) patients. The hernia defects in all these patients were repaired (with open onlay technique) with prolene mesh graft. No complication and recurrence were observed in the follow up of 36 (22-42) months. Conclusions: There were elderly - male - obese patients, low serum albumin levels and severe ascites in the risk group. We think, attention must be paid especially in these patient groups for the early diagnosis and treatment of incisional hernias which may develop after liver transplantation

Comparison of ultrasound-guided type-II pectoral nerve block and rhomboid intercostal block for pain management following breast cancer surgery: A randomized, controlled trial

Purpose Although breast-conserving surgery-axillary dissection (BCS-AD) is a minimally invasive surgery, patients may suffer from moderate-to-severe pain. Several regional techniques can be used for pain control. The type II pectoral nerve block (PECS II) and the rhomboid intercostal block (RIB) are interfascial plane blocks that have been reported to provide effective analgesia after breast surgery. This study aims to compare the analgesic efficacy of the PECS II block and the RIB after breast surgery. Patients and Methods Ninety female patients aged 18 to 65 years with American Society of Anesthesiologists (ASA) classes I and II physical status who underwent unilateral BCS-AD surgery were included. Patients were divided into three groups (n = 30 in each): the PECS II group, the RIB group, or the control group. PECS II block and RIB were performed with 30 mL 0.25% bupivacaine. Ibuprofen 400 mg IV 3 x 1 was given in the postoperative period. A patient control analgesia device included a dose of 10 mu g/mL fentanyl, which was prepared and connected to the patients. Results There were no statistical differences between groups in terms of demographical data. Postoperative fentanyl consumption was significantly lower in the PECS II and RIB groups than the control group. The need for rescue analgesia use was significantly higher in the control group than the other groups. At all times, visual analog scale scores were significantly lower in the PECS II and RIB groups than the control group. Conclusions The PECS II block and the RIB provide similar effective analgesia after BCS-AD

Comparison of Ultrasound‐Guided Type‐II Pectoral Nerve Block and Rhomboid Intercostal Block for Pain Management Following Breast Cancer Surgery: A Randomized, Controlled Trial

Purpose Although breast-conserving surgery-axillary dissection (BCS-AD) is a minimally invasive surgery, patients may suffer from moderate-to-severe pain. Several regional techniques can be used for pain control. The type II pectoral nerve block (PECS II) and the rhomboid intercostal block (RIB) are interfascial plane blocks that have been reported to provide effective analgesia after breast surgery. This study aims to compare the analgesic efficacy of the PECS II block and the RIB after breast surgery. Patients and Methods Ninety female patients aged 18 to 65 years with American Society of Anesthesiologists (ASA) classes I and II physical status who underwent unilateral BCS-AD surgery were included. Patients were divided into three groups (n = 30 in each): the PECS II group, the RIB group, or the control group. PECS II block and RIB were performed with 30 mL 0.25% bupivacaine. Ibuprofen 400 mg IV 3 x 1 was given in the postoperative period. A patient control analgesia device included a dose of 10 mu g/mL fentanyl, which was prepared and connected to the patients. Results There were no statistical differences between groups in terms of demographical data. Postoperative fentanyl consumption was significantly lower in the PECS II and RIB groups than the control group. The need for rescue analgesia use was significantly higher in the control group than the other groups. At all times, visual analog scale scores were significantly lower in the PECS II and RIB groups than the control group. Conclusions The PECS II block and the RIB provide similar effective analgesia after BCS-AD