Intraoperative Fascia Tension as an Alternative to Component Separation. A Prospective Observational Study.

Incisional hernias are common late complications of abdominal surgery, with a 1-year post-laparotomy incidence of about 20%. A giant hernia is often preceded by severe peritonitis of various causes. The Fasciotens® Abdomen device is used to stretch the fascia in a measurably controlled manner during surgery to achieve primary tension-free abdominal closure.

Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis.

The aim of this study was to analyze and evaluate the long-term recurrence rate and risk factors for inguinal hernia recurrence in patients treated by the Shouldice suture repair. A total of 293 hernias treated by Shouldice suture technique in 1992 were studied retrospectively. After a 10-year follow-up, 15 potential risk factors for recurrence were assessed in 142 patients undergoing 171 Shouldice repairs.

Is there a risk of infertility after inguinal mesh repair? Experimental studies in the pig and the rabbit.

The implantation of a non-absorbable polypropylene mesh during hernia repair causes chronic foreign body reaction involving the surrounding tissue. In case of inguinal hernia repair using mesh techniques, the spermatic cord is potentially affected by this chronic inflammatory tissue remodeling. This effect has been investigated using standardized animal models (pig and rabbit).

The influence of inguinal mesh repair on the spermatic cord: a pilot study in the rabbit.

The permanent implantation of a polypropylene mesh during inguinal hernia repair causes chronic inflammatory changes in the surrounding tissue. We investigated the effect of this foreign body reaction on the structures of the spermatic cord in the rabbit. Eight Chinchilla rabbits underwent unilateral inguinal hernia repair by the Lichtenstein technique using Marlex (n = 4) or Ultrapro (n = 4) mesh.

[Ropivacain after inguinal hernia surgery. A prospective, randomised, double-blinded, controlled study].

Background: To optimise the satisfaction of patients after repair of primary inguinal hernias under local anaesthesia, we analysed the analgetic power of Ropivacain in the postoperative period.

Material And Methods: One hundred consecutive patients underwent repair under local anaesthesia with the same volume of 0.75% Ropivacain or 1% Mepivacain in a randomised and blinded manner.

Effect of zinc pretreatment on pulmonary endothelial cells in vitro and pulmonary function in a porcine model of endotoxemia.

Background: During endotoxemia, the systemic inflammatory response often leads to severe pulmonary damages. Destruction of endothelial cells, interstitial edema, and interstitial alveolitis depress pulmonary circulation and raise extravascular lung water and intrapulmonary shunt. As protective effects of zinc are described in vitro as well as in vivo, this study investigates its impact on septic porcine pulmonary endothelial monolayers as well as on the pulmonary function of endotoxemic pigs.

Titanium coating of a polypropylene mesh for hernia repair: effect on biocompatibilty.

Titanium and its alloys are used worldwide in surgery. The favorable characteristics that make this material desirable for implantation are corrosion resistance and biocompatibility. Concerning hernia repair, a mesh modification has been developed using titanium layering of a polypropylene mesh implant, which is said to lead to an improved biocompatibility compared to commercially available mesh materials.

Abdominal musculature and the transversalis fascia: an anatomical viewpoint.

This anatomical study investigated the connection of the muscles of the abdominal wall to the transversalis fascia in the groin. In six unfixed male corpses we prepared the single levels of the inguinal abdominal wall and examined their interrelationships. Of special interest were the direction of the force vectors determined by the direction of the muscular fibers in relation to the transversalis fascia.

[Ileocecal invagination due to a benign small intestine tumor. A case report].

We report a case of postoperative ileocecal invagination in a 63-year-old male. Forty-six days after esophageal resection and gastric tube reconstruction with cervical anastomosis for an esophageal carcinoma, the patient suffered from colicky pain in the right abdomen. The diagnostics showed an ileocecal invagination up to the right flexure of the colon.

Caecal-diverticulitis: a rare differential diagnosis for right-sided lower abdominal pain.

Objective: There are several differential diagnoses for acute abdominal discomfort with pain referred to the right lower quadrant region. The objective of this report is to outline our experience with diverticulitis of the caecum, which is a rare condition that is particularly difficult to diagnose correctly pre-operatively.

Methods: A retrospective analysis of acute diverticulitis of the caecum was performed over the period from January 1992 to December 2000 within the Surgical Department of the RWTH Aachen, Germany.

Breaking strength and tissue elasticity after Shouldice repair.

There are few objective studies in the surgical literature on the strength of an inguinal hernia repair during the immediate postoperative period. To provide the relevant advice and recommendations on physical activities during the period of convalescence, a study on the strength of the Shouldice repair was carried out. Twenty-eight Shouldice repairs were performed on 17 fresh human cadavers (11 male, 17 female, mean age 79.

[Long-term results after Spitzy's umbilical hernia repair].

A total of 140 patients presenting with umbilical hernia underwent Spitzy's operation and were included in a retrospective study to analyse the recurrence rate. The patients received a questionnaire and were invited for a physical examination including ultrasound. Participation included 108 patients (follow-up 77%).

[Tailgut cyst. Rare differential diagnosis of retrorectal tumors].

Tumors of the retrorectal space are rare entities. The case report of a retrorectal tailgut cyst serves to illustrate the clinical and diagnostic findings, differential diagnosis, and therapy of retrorectal tumors. Tumors in this area can be identified by palpation.

Effect of tension induced by Shouldice repair on postoperative course and long-term outcome.

Objective: To record intraoperative tension during Shouldice hernioplasty and correlate it with postoperative course and long-term outcome.

Design: Prospective clinical trial.

Setting: University clinic, Germany.

[Meshes in inguinal hernia repair].

Repair of a groin hernia is strongly influenced by prosthetic mesh implantation carried out in nearly 50 % of all operations. Recurrency rates, however, did not decrease by this policy. Many different materials are available.

[Leiomyosarcoma of the hernial sac in inguinal hernia].

Malignant tumors associated with hernial sacs are rare entities. A review of literature offers only small groups of patients. The high incidence of inguinal hernia repair operations demands recognition of this morbidity.

Prophylactic urgent revascularization of the internal carotid artery in the symptomatic patient.

Background: The symptomatic patient showing a string sign or ulcerative stenosis of the internal carotid artery (ICA) is subject to a high risk of arterial thrombosis or persisting intracranial embolization during the waiting period before operative revascularization.

Patients And Methods: During one year 186 operative revascularization procedures of the ICA were performed on the symptomatic patient. 26 of them fulfilled the prophylactic urgency criteria: symptoms of the cerebrovascular insufficiency and a string sign or ulcerative stenosis of the ICA with ulceration greater than 2 mm in depth.

Inguinal tensile strength and pain level after Shouldice repair.

Background: Tension of the abdominal wall in the inguinal region induced by Shouldice repair of an inguinal hernia is said to be responsible for elevated postoperative pain levels.

Patients And Methods: In 20 patients we recorded the inguinal tensile strength during closure of the hernial gap using a wound retractor equipped with strain gauges. Postoperative pain levels were scaled using a visual analogous score, and correlated with the tensile strength of the inguinal abdominal wall together with peak flow and forced expiratory volume in 1 s (FEV1) 8, 24, and 48 h after the time of operation.

[Primary angiosarcoma of the lung].

Introduction: Angiosarcomas are uncommon neoplasias, normally located in the skin, liver or heart. Primary angiosarcoma of the lung is rare.

Case Report: We report on a 41-year-old patient who presented increasing dyspnea.

[Acute retrocecal appendicitis caused by an Actinomyces israelii mixed infection].

We report the rare case of a retrocecal appendicitis in an adult caused by an Actinomyces israelii mixed infection. Suspecting an acute appendicitis the explorative laparotomy was performed. Appendectomy with extensive drainage of the abscess and subsequent high-dose penicillin therapy over several months were the definitive treatment, resulting in complete healing.

[Pancreatoblastoma: a rare malignant neoplasm in early adulthood].

Introduction: Here we report the ninth case of pancreatoblastoma in an adult.

Patient And Method: At the time of diagnosis the female patient was 22 years old. She had a tumor in the left upper abdomen, measuring 9 cm in diameter.

Load on the inguinal region under standard conditions in pigs.

Objective: To find out the effect of standardised stress on the load of the inguinal region.

Design: Experimental study.

Setting: Surgical university clinic, Germany.

Ultrasound-based volumetric evaluation of fluid retention after inguinal hernia repair.

Background: Daily routine has shown that there are differences between the aspirated volumes of subcutaneous liquid retention after inguinal hernia repair and the results of sonographic-based volumetry using the standard rotating ellipsoid formula.

Methods: In 83 patients, subcutaneous fluid retention after Shouldice repair was visualized by ultrasound and calculated as cuboid, cylinder, and rotating ellipsoid, respectively. The results were compared to the aspirated volume.

Electrophysiological and mechanical activity of the upper gastrointestinal tract after duodenoplasty or segmental resection of benign gastric outlet stenosis.

In an animal experimental study we examined the postoperative recovery of the motility of the upper gastrointestinal tract after operative treatment of a benign gastric outlet obstruction. At 45 Days after induction, a duodenal stenosis was resected in six dogs, and resolved by Finney's duodenoplasty in another six dogs. Fourteen days after segmental resection, the gastric emptying was faster [half evacuation time (T1/2) for semisolid food = 44.

Eversion endarterectomy versus open thromboendarterectomy and patch plasty for the treatment of internal carotid artery stenosis.

Objective: in 1996 we changed our treatment for stenosis of the internal carotid artery (ICA) from open thromboendarterectomy and PTFE-patch plasty (TEA) to eversion endarterectomy (EEA).

Design: retrospective study.

Methods: a total of 475 EEAs of the ICA were performed between 2/96 and 11/96.