SciCombinator

Discover the most talked about and latest scientific content & concepts.

Concept: Pediatric surgery

29

Hernia repairs in contaminated fields are often reinforced with a bioprosthetic mesh. When choosing which of the multiple musculofascial abdominal wall planes provides the most durable repair, there is little guidance. We hypothesized that the retro-rectus plane would reduce recurrence rates versus intraperitoneal placement due to greater surface area contact of mesh with well-vascularized tissue.

Concepts: Surgery, Hernia, Hernias, Area, Surface area, Reinforcement, Pediatric surgery

28

Ventral hernias are common surgical targets. The Bard(®) Ventralex™ Hernia Patch was introduced for the repair of such hernias in the early 2000s. Ethicon (Johnson & Johnson) introduced the Proceed™ Ventral Patch (PVP™) in the late 2000s for the same indication. The effectiveness and safety of the Bard(®) Ventralex™ Hernia Patch has been proven in a series of studies. There are no medical studies on the PVP™ in humans. This study examines the effectiveness and safety of PVP™ in the closure of ventral hernias.

Concepts: Surgery, Hernia, Pediatric surgery

28

Elective repair for umbilical or epigastric hernia is a frequent minor surgical procedure. Several studies have demonstrated chronic pain after groin hernia repair but long-term complaints have been only scarcely studied. This study was undertaken to investigate long-term pain and discomfort after open repair for small umbilical or epigastric hernias.

Concepts: Medicine, Surgery, Hernia, Cultural studies, Hernias, Herniorrhaphy, Pediatric surgery, Epigastric hernia

25

There is a lack of consensus about the surgical management of umbilical hernias. The aim of this study is to analyze the medium-term results of 934 umbilical hernia repairs. In this study, 934 patients with an umbilical hernia underwent surgery between 2004 and 2010, 599 (64.1%) of which were evaluated at least one year after the surgery. Complications, recurrence, and the reoperation rate were analyzed. Complications were observed in 5.7 per cent of the patients. With a mean follow-up time of 35.5 months, recurrence and reoperation rates were 3.8 per cent and 4.7 per cent, respectively. A higher percentage of female patients (60.9 % vs 29 %, P = 0.001) and a longer follow-up time (47.4 vs 35 months, P = 0.037) were observed in patients who developed a recurrence. No significant differences were observed between complications and the reoperation rate in patients who underwent Ventralex(®) preperitoneal mesh reinforcement and suture repair; however, a trend toward a higher recurrence rate was observed in patients with suture repair (6.5 % vs 3.2 %, P = 0.082). Suture repair had lower recurrence and reoperation rates in patients with umbilical hernias less than 1 cm. Suture repair is an appropriate procedure for small umbilical hernias; however, for larger umbilical hernias, mesh reinforcement should be considered.

Concepts: Time, Surgery, Hernia, Hernias, Herniorrhaphy, Navel, Pediatric surgery, Umbilical hernia

25

Abstract Introduction: Though minimally invasive pediatric surgery has become more widespread, pediatric-specific surgical skills have not been quantitatively assessed. Material and methods: As a first step toward the quantification of pediatric-specific surgical skills, a pediatric chest model comprising a three-dimensional rapid-prototyped pediatric ribcage with accurate anatomical dimensions, a suturing skin model with force-sensing capability, and forceps with motion-tracking sensors were developed. A skill assessment experiment was conducted by recruiting 16 inexperienced pediatric surgeons and 14 experienced pediatric surgeons to perform an endoscopic intracorporeal suturing and knot-tying task in both the pediatric chest model setup and the conventional box trainer setup. Results: The instrument motion measurement was successful in only 20 surgeons due to sensor failure. The task completion time, total path length of instruments, and applied force were compared between the inexperienced and experienced surgeons as well as between the box trainer and chest model setups. The experienced surgeons demonstrated better performance in all parameters for both setups, and the pediatric chest model was more challenging due to the pediatric features replicated by the model. Conclusion: The pediatric chest model was valid for pediatric skill assessment, and further analysis of the collected data will be conducted to further investigate pediatric-specific skills.

Concepts: Medicine, Surgery, Physician, Research, Empiricism, Philosophy of science, Pediatric surgery, Abu al-Qasim al-Zahrawi

24

Prosthetic mesh rolled up and fixed with stitches like a slim cigarette (“slim-mesh”) for laparoscopic ventral hernia (VH) repair is an new technique which allows an easy intraperitoneally introduction, distension and circumferential fixation of a prosthetic mesh without transabdominal fixation sutures even for meshes larger than 16 cm up to 30 cm for the “slim-mesh” repair of wide ventral hernias. We report the technique of laparoscopic repair of VH with “slim-mesh”. This technique enables an easy intra-peritoneally introduction of the mesh through the trocar because it reduces consistently its size, it allows a rapid intra-abdominal handling of the mesh and a fast and easy fixation for VH repair. The average time of surgery with “slim-mesh” for treatment of all 28 VH was 97 min ranging from 57 to 160 min. The average time for the repair of the 24 VH smaller than 10 cm was 91 and 135 min for the four VH larger than 10-22 cm. This new surgical technique leads to a reduction of surgical risks avoiding the use of transfascial sutures with the associated complications. This new surgical procedure in our experience is fast, safe, simple and also easily reproducible by surgeons in laparoscopic training. This technique may be used in wide VH (larger than 10-22 cm) that generally require open surgery.

Concepts: Surgery, Anesthesia, Hernia, Al-Andalus, Surgeon, Laparoscopic surgery, Surgical staple, Pediatric surgery

23

The aim of this study was to compare the efficacy of different methods of sutureless fixation of lightweight meshes made of different polymers for repair of experimental hernias. Two lateral hernia defects were modeled in male rats and covered with polyester and polypropylene prostheses. The meshes were fixed with Histacryl glue (group 1), or self-gripping meshes were used (group 2), or the meshes were implanted without fixation (group 3). On day 5 after surgery, mesh position and efficiency of fixation were evaluated. It was found that fixation is necessary for all light surgical meshes. Polyester meshes demonstrated better adhesive properties than polypropylene meshes. The most pronounced differences in the adhesive properties were found for self-gripping prosthesis, while in the groups with glue fixation, the differences were less pronounced.

Concepts: Surgery, Hernia, Touring car racing, Amputation, Hernias, Herniorrhaphy, Adhesive, Pediatric surgery

7

Personal portable information technology is advancing at a breathtaking speed. Google has recently introduced Glass, a device that is worn like conventional glasses, but that combines a computerized central processing unit, touchpad, display screen, high-definition camera, microphone, bone-conduction transducer, and wireless connectivity. We have obtained a Glass device through Google’s Explorer program and have tested its applicability in our daily pediatric surgical practice and in relevant experimental settings.

Concepts: Medicine, Surgery, Book of Optics, Personal computer, Pediatric surgery, Information technology, Linux, Central processing unit

6

Surgical meshes, in particular those used to repair hernias, have been in use since 1891. Since then, research in the area has expanded, given the vast number of post-surgery complications such as infection, fibrosis, adhesions, mesh rejection, and hernia recurrence. Researchers have focused on the analysis and implementation of a wide range of materials: meshes with different fiber size and porosity, a variety of manufacturing methods, and certainly a variety of surgical and implantation procedures. Currently, surface modification methods and development of nanofiber based systems are actively being explored as areas of opportunity to retain material strength and increase biocompatibility of available meshes. This review summarizes the history of surgical meshes and presents an overview of commercial surgical meshes, their properties, manufacturing methods, and observed biological response, as well as the requirements for an ideal surgical mesh and potential manufacturing methods.

Concepts: Present, Surgery, Hernia, Bowel obstruction, Materials science, Materials, Pediatric surgery, Diseases involving the fasciae

6

For a number of pediatric and adult conditions, morbidity and mortality are increased when patients present to the hospital on a weekend compared to weekdays. The objective of this study was to compare pediatric surgical outcomes following weekend versus weekday procedures.

Concepts: Medicine, Hospital, Surgery, Physician, Hernia, Al-Andalus, Weeks, Pediatric surgery