11 research outputs found
Formation of Adhesions at Surgical Meshes in a Rat Experimental Model
Abdominal wall hernias are surgical problem that are easily solved with laparoscopic surgery. The determining factor
for the success of the operation is the right choice and use of surgical mesh as the support material. The most common
complication of surgical mesh placement is the formation of adhesions. Aim of this paper is to determine whether there is
a statistic difference in formation of adhesions between different surgical meshes in lab environment. Wistar rats were
used as the experimental model. After the anaesthesia a 1x1 cm defect of the abdominal wall was made, but the skin was
left intact. The mesh was placed directly on the internal organs. The experiment considered four different mesh types. After
set time periods of one, two or four weeks the animals were sacrificed and the amount of formed adhesions were evaluated
based on the modified Diamond scale. Immediately after the first week we found a statistically significant difference
in the adhesion occurrence rate between compared materials. The smallest amount of adhesions was caused by polypropylen
+ polydoksanon mesh, and the most by polypropilen mesh. Polypropylen + polyglactin mesh showed significant
reduction of adhesion formation between the tested weeks. We can conclude that polypropylen + polydoxanon meshes
are superior for ventral hernia operation, because those defects are in close contact with the internal organs and it is
very important to have the smallest amount of adhesions
COMPUTER REPRESENTATION OF OSTEOSYNTHESIS STABILITY IN LOCKING PLATES USED FOR THE TREATMENT OF OSTEOPOROTIC PROXIMAL HUMERUS FRACTURES
Background: Proximal humerus fractures are represented as 4-5% of all fractures, with incidence notably growing with age.
Since surgical internal fixation in treatment of proximal humeral fractures is used, fractures of osteoporotic bone and choice of plate
for their osteosynthesis represent particular problem. The aim of the study was to test two locking plates: Philos plate with locking
screws with determinated direction, and Arthrex plate with poliaxial locking screws, using the finite element method.
Subjects and methods: This study used version 6.10 of Abaqus FEA software package for simulation and fine element analysis of
Philos and Artrex plates attached to the osteotomy models of proximal humerus with fracture gap at 0Ā°, 10Ā° and 20Ā° in four types of
static load: abduction, adduction, axial compression and flexion. Simulation results of loads in abduction, adduction, axial loads and
flexion, were described with the total bone displacement (U) and maximum bone displacement in the fracture gap (Uf ).
Results: When examining the Philos plate in axial load on the bone with fracture gap angle from 0Ā°, 10Ā° and 20Ā° no significant
differences between the results for the displacements were observed. Therefore, results for other loads are related to total
displacements of the bone only at the angle of 0Ā°. Given that the results of the total bone displacement and maximum bone
displacement in the fracture gap with Artrex plate were mostly higher, for comparison with the results of bone displacement in Philos
plate it was taken that total bone displacement and maximum displacement in the fracture gap in Artrex plate represent 100% of the
total displacement. Philos plate showed 60.71% for abduction, 76.07% for adduction, 102.24% for axial loads and 79.59% for
flexion of total bone displacement in Artrex plate, and 60.48% for abduction, 76.07% for adduction, 96.05% for axial load and
79.96% for flexion of maximum displacement in the fracture gap in Artrex plate.
Conclusions: Osteosynthesis for osteoporotic fractures of proximal humerus with Philos plate in computer simulation proved to
be more stable than with Arthrex plate
Formation of Adhesions at Surgical Meshes in a Rat Experimental Model
Abdominal wall hernias are surgical problem that are easily solved with laparoscopic surgery. The determining factor
for the success of the operation is the right choice and use of surgical mesh as the support material. The most common
complication of surgical mesh placement is the formation of adhesions. Aim of this paper is to determine whether there is
a statistic difference in formation of adhesions between different surgical meshes in lab environment. Wistar rats were
used as the experimental model. After the anaesthesia a 1x1 cm defect of the abdominal wall was made, but the skin was
left intact. The mesh was placed directly on the internal organs. The experiment considered four different mesh types. After
set time periods of one, two or four weeks the animals were sacrificed and the amount of formed adhesions were evaluated
based on the modified Diamond scale. Immediately after the first week we found a statistically significant difference
in the adhesion occurrence rate between compared materials. The smallest amount of adhesions was caused by polypropylen
+ polydoksanon mesh, and the most by polypropilen mesh. Polypropylen + polyglactin mesh showed significant
reduction of adhesion formation between the tested weeks. We can conclude that polypropylen + polydoxanon meshes
are superior for ventral hernia operation, because those defects are in close contact with the internal organs and it is
very important to have the smallest amount of adhesions
Acute Appendicitis and Ileal Perforation with a Toothpick Treated by Laparoscopy
A 69-year-old man underwent an emergency laparoscopic procedure after the acute appendicitis diagnosis has been
established. Laparoscopic exploration showed inflamed appendix and perforation of terminal ileum with a swallowed
part of the wooden toothpick. The treatment consisted of typical laparoscopic appendectomy and laparoscopic removal of
the foreign body, followed by laparoscopic closure of the perforation site and lavage of the abdominal cavity. The postoperative
course was uneventful and the patient was discharged from the hospital on day 3 after the operation
Peutz-Jeghers Syndrome Complicated with Intussusception: Enteroscopic Polyps Resections through Laparotomy
Peutz-Jeghers syndrome is an autosomal dominant inherited disorder characterized by intestinal hamartomatous polyps in association with mucocutaneous pigmentations. Here we present a case of a 30-year-old woman who was hospitalized and underwent diagnostic procedures because of crampy adbdominal pain. Physical examination on admission revealed pigmented spots around lips and on the oral mucosa. Multiple polyps were found in stomach, small and large intestine, with signs of initial ileo-ileal intussusception. After endoscopic removal of achievable polyps, we applied gastroscope through laparotomy and enterotomy and removed total number of 34 polyps from small bowell. The polyps were found to be mostly hamartomatous at histological examination. This procedure can provide removal of the most polyps, which are potentially premalignant, also with less complicationes than after multiple intestinal resectiones
Laparoscopic Abdominal Cysts Fenestration Using Harmonic Scalpel
The use of ultrasonically activated scalpel for tissue cutting and coagulation is a potential replacement for electrosurgery,
which can be related to different complications. Its working principle is to transform the electric power into
the mechanical longitudinal movement of the working part of the instrument, by a piezoelectric transducer situated in
the hand piece. Between October 2000 and June 2004, six patients with abdominal cysts were treated by laparoscopy, using
the harmonic scalpel. The average age was 40.8 (ranging from 15ā60) years. Laparoscopic abdominal cyst fenestration
was performed in five patients, and laparoscopic cholecystectomy and abdominal cyst fenestration were done in one
patient during the same operation. The average duration of the operation was 40 (ranging from 25ā70) minutes and hospital
stay was 2.8 (ranging from 1ā5) days. Laparoscopic abdominal cyst fenestration using the harmonic scalpel is a
safe and successful operation, with good results including all the advantages of the minimally invasive surgery
Partial Cecal Necrosis Treated by Laparoscopic Partial Cecal Resection
Acute colonic ischemia is the common cause of colitis in elderly population. However, isolated ischemic necrosis of cecum
is rare entity, often associated with variety of conditions. Here we present a case of a 73-year old woman with a past history
of hypertension presented with clinical symptoms of right lower quadrant abdominal pain and tenderness localized
to the right lower quadrant, guarding and rebound tenderness. With diagnosis of acute appendicitis, the patient underwent
laparoscopy where the cecal partial necrosis was discovered. Necrotic area of cecum was excised using two endoscopic
cutters and laparoscopic appendectomy was performed. Pathologist report showed thrombosis of vessels and necrosis
of entire cecal wall. The patient completely recovered without any surgical complications. This is the first case of
partial cecum necrosis laparoscopicaly managed and with a partial cecal resection only
Computer representation of osteosynthesis stability in locking plates used for the treatment of osteoporotic proximal humerus fractures
Background: Proximal humerus fractures are represented as 4-5% of all fractures, with incidence notably growing with age.
Since surgical internal fixation in treatment of proximal humeral fractures is used, fractures of osteoporotic bone and choice of plate
for their osteosynthesis represent particular problem. The aim of the study was to test two locking plates: Philos plate with locking
screws with determinated direction, and Arthrex plate with poliaxial locking screws, using the finite element method.
Subjects and methods: This study used version 6.10 of Abaqus FEA software package for simulation and fine element analysis of
Philos and Artrex plates attached to the osteotomy models of proximal humerus with fracture gap at 0Ā°, 10Ā° and 20Ā° in four types of
static load: abduction, adduction, axial compression and flexion. Simulation results of loads in abduction, adduction, axial loads and
flexion, were described with the total bone displacement (U) and maximum bone displacement in the fracture gap (Uf ).
Results: When examining the Philos plate in axial load on the bone with fracture gap angle from 0Ā°, 10Ā° and 20Ā° no significant
differences between the results for the displacements were observed. Therefore, results for other loads are related to total
displacements of the bone only at the angle of 0Ā°. Given that the results of the total bone displacement and maximum bone
displacement in the fracture gap with Artrex plate were mostly higher, for comparison with the results of bone displacement in Philos
plate it was taken that total bone displacement and maximum displacement in the fracture gap in Artrex plate represent 100% of the
total displacement. Philos plate showed 60.71% for abduction, 76.07% for adduction, 102.24% for axial loads and 79.59% for
flexion of total bone displacement in Artrex plate, and 60.48% for abduction, 76.07% for adduction, 96.05% for axial load and
79.96% for flexion of maximum displacement in the fracture gap in Artrex plate.
Conclusions: Osteosynthesis for osteoporotic fractures of proximal humerus with Philos plate in computer simulation proved to
be more stable than with Arthrex plate
Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study
BACKGROUND: There are few surgical approaches for treating humeral shaft fractures. Here we present our results using a subbrachial approach. METHODS: We conducted a retrospective case series involving patients who had surgery for a humeral shaft fracture between January 1994 and January 2008. We divided patients into 4 groups based on the surgical approach (anterior, anterolateral, posterior, subbrachial). In all patients, an AO 4.5 mm dynamic compression plate was used. RESULTS: During our study period, 280 patients aged 30- 36 years underwent surgery for a humeral shaft fracture. The average duration of surgery was shortest using the subbrachial approach (40 min). The average loss of muscle strength was 40% for the anterolateral, 48% for the posterior, 42% for the anterior and 20% for the subbrachial approaches. The average loss of tension in the brachialis muscle after 4 months was 61% for the anterolateral, 48% for the anterior and 11% for the subbrachial approaches. Sixteen patients in the anterolateral and anterior groups and 6 patients in the posterior group experienced intraoperative lesions of the radial nerve. No postoperative complications were observed in the subbrachial group. CONCLUSION: The subbrachial approach is practical and effective. The average duration of the surgery is shortened by half, loss of the muscle strength is minimal, and patients can resume everyday activities within 4 months. No patients in the subbrachial group experienced injuries to the radial or musculocutaneous nerves
Laparoscopic Colon Surgery: Our Results
Formerly, the laparoscopic surgery was accepted as a method of choice for benign diseases, and for palliative operations
in progressive stages of malignant diseases of the colon. Today, the laparoscopic surgery of the colon has been also
adopted in treating malignant diseases. The first laparoscopic colon resection was performed in our Clinic on December
12, 2002, and 114 patients have been successfully operated until June 1, 2007. Among those 114 patients 56 were men
and 57 were women with the average age 65 (ranging from 28ā86) years. A series of various laparoscopic operations have
been performed for malignant disease mainly (almost 80%). The pre-surgical treatment, preparation of patients and the
types of the operations were identical to those applied in patients treated by open surgery. Patients with colon carcinoma
have been operated on with the principles of oncologic radicality. In post-operative period we encountered eight complications
(four minor and four major) with only one fatal outcome. According to our experience and the facts found in literature,
the results of laparoscopic colon surgery are comparable with open surgery