The aim of the study was to evaluate biosynthetic absorbable mesh in single-staged contaminated (Centers for Disease Control class II and III) ventral hernia (CVH) repair over 24 months.CVH has an increased risk of postoperative infection. CVH repair with synthetic or biologic meshes has reported chronic biomaterial infections and high hernia recurrence rates.Patients with a contaminated or clean-contaminated operative field and a hernia defect at least 9 cm had a biosynthetic mesh (open, sublay, retrorectus, or intraperitoneal) repair with fascial closure (n = 104). Endpoints included overall Kaplan-Meier estimates for hernia recurrence and postoperative wound infection rates at 24 months, and the EQ-5D and Short Form 12 Health Survey (SF-12). Analyses were conducted on the intent-to-treat population, and health outcome measures evaluated using paired t tests.Patients had a mean age of 58 years, body mass index of 28 kg/m, 77% had contaminated wounds, and 84% completed 24-months follow-up. Concomitant procedures included fistula takedown (n = 24) or removal of infected previously placed mesh (n = 29). Hernia recurrence rate was 17% (n = 16). At the time of CVH repair, intraperitoneal placement of the biosynthetic mesh significantly increased the risk of recurrences (P ≤ 0.04). Surgical site infections (19/104) led to higher risk of recurrence (P < 0.01). Mean 24-month EQ-5D (index and visual analogue) and SF-12 physical component and mental scores improved from baseline (P < 0.05).In this prospective longitudinal study, biosynthetic absorbable mesh showed efficacy in terms of long-term recurrence and quality of life for CVH repair patients and offers an alternative to biologic and permanent synthetic meshes in these complex situations.
Abstract Background Non-midline abdominal wall hernias present unique anatomic challenges, making repair more complex. The constraints of the peritoneal cavity, pelvis, and costal margin limit the utility of intraperitoneal mesh repair, and extraperitoneal repairs have traditionally been performed using open techniques, often resulting in higher wound morbidity. Advances in minimally invasive surgery make visualization and dissection of such complex cases feasible, with all the attendant benefits of a minimally invasive over an open approach. In this study we examined the use of the robotic platform to repair non-midline hernias. Methods Retrospective review of all non-midline abdominal wall hernias performed robotically at Prisma Health, excluding parastomal hernias. Study conducted and outcomes reported according to STROBE statement. Results Repair was performed in the retromuscular space (n=42), preperitoneal (n=22), and intraperitoneal (n=1). Mean hernia width was 9.4cm, permanent synthetic mesh used for all repairs. Mean LOS was 1.5 days. Surgical site occurrence (SSO) occurred in 49.2%, 78% of which were simple seroma. Three patients (4.6%) developed surgical site infection (SSI). Two recurrences were identified with a mean follow-up of 11 mos. Conclusion The robotic platform facilitates complex dissection to allow minimally invasive, extraperitoneal repair of complex non-midline hernias. This approach overcomes the anatomic constraints of intraperitoneal mesh repair and the wound morbidity of open repair.
It is widely assumed that the arguments tendered by Sokrates in the Protagoras involve serious logical fallacies. My contention is that this view is mistaken, and I shall argue that Sokrates makes no significant logical errors in this dialogue. I shall begin with a few general assertions about the dialogue as a dramatic whole, since I believe that a grasp of the general theme and character of the dialogue is essential for understanding the argumentation.
The literature on non-small cell lung cancer (NSCLC) brain metastases (BMs) managed using stereotactic radiosurgery (SRS) relies mainly on single-institution studies or randomized controlled trials (RCTs). There is a literature gap on clinical and radiological outcomes of SRS for NSCLC metastases in real-world practice. The objective of this study was to benchmark mortality and progression outcomes in patients undergoing SRS for NSCLC BMs and identify risk factors for these outcomes using a national quality registry.
The use of mesh materials for reinforcement of the abdominal wall has revolutionized the approaches to hernia repair. Whether it's a permanent, synthetic mesh, a biologically derived collagen graft, or a synthetic, bioresorbable construct, data demonstrate improved outcomes with respect to recurrence with their use. Numerous advances and development of component separation techniques of the abdominal wall musculature have provided surgeons the ability to close large fascial defects and reestablish the linea alba for midline hernias. Augmentation of the these repairs with a mesh helps to offset the tension on the fascial closure and provide biomechanical strength to the native tissue. However, the use of mesh materials as either permanent or temporary scaffolds is not without potential complications. Abdominal wall surgeons must have knowledge of the mesh composition and structure in an effort to mitigate these concerns. This chapter will review the polymers and characteristics of the currently available synthetic meshes for abdominal wall reconstruction in an effort to provide guidance to surgeons.
Background Computed tomographic angiography (CTA) has recently emerged as a non-invasive alternative to digital subtraction angiography (DSA) for the detection of residual cerebral aneurysms (RA). Objective To compare the diagnostic accuracy of CTA with the current ‘gold standard’, DSA, in the postoperative detection of RA. Methods Patient data from this single institution were prospectively gathered, and imaging results retrospectively blinded and analyzed. Between 2001 and 2005 eligible patients received microsurgical repair of cerebral aneurysms and were evaluated postoperatively by DSA and CTA. These single-institutional data were compiled with qualified studies published from 1997 to 2009, and a meta-analysis was performed. Results This institutional series reports sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of 100%. Eleven studies met the inclusion criteria for the meta-analysis. A total of 427 patients with 513 aneurysms were included, with 61 RA detected by DSA and 40 detected by CTA. Unweighted analysis resulted in pooled sensitivity of 73.8%, specificity of 96.3%, PPV of 91.0% and NPV of 86.1%. Stratified analysis of studies using 16-slice CTA versus 2D DSA reported pooled sensitivity of 92.6%, specificity of 99.3%, PPV of 95.8%, and NPV of 97.8%. Conclusions This meta-analysis supports CTA as an acceptable modality for postoperative detection of RA, although DSA remains the gold standard. By implementing multidetector CTA technology in experienced centers, the sensitivity and specificity of CTA may approach that of traditional DSA for detecting RA. As a cost-effective, non-invasive modality, CTA is a promising alternative to DSA for initial and long-term evaluation of RA.
