The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
COMPOSITE GRAFT: ANTROPYLORUS TRANSPOSITION AND GLUTEUS MAXIMUS WRAPDr Amit Dangi
THIS PRESENTATION DESCRIBES THE NOVEL SURGICAL TECHNIQUE OF TOTAL ANORECTAL RECONSTRUCTION WITH ANTROPYLORUS TRANSPOSITION AND GLUTEOPLASTY AND ITS RESULTS.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
Cancer of Oral Cavity Abutting the Mandible; Predictors of Loco-regional Fail...Dr./ Ihab Samy
TAREK K. SABER, M.D.; HESHAM A. HUSSEIN, M.D.; ALI H. MEBEED, M.D.;
HESHAM I. EL SEBAI, M.D.; IHAB SAMI, M.D. and IMAN G. FARAHAT, M.D.*
The Departments of Surgical Oncology and Pathology*, National Cancer Institute, Cairo University.
Journal of the Egyptian Nat. Cancer Inst., Vol. 21, No. 3, September: 219-227, 2009
A simplified technique of esophageal self-expandable metallic stent placement...Peachy Essay
The advantages of the simplified technique are as follows: technical ease, cost-effectiveness, no exposure to radiation,
requirement of minimal manpower, and less time-consuming; these advantages make it the technique day-care procedure.
COMPOSITE GRAFT: ANTROPYLORUS TRANSPOSITION AND GLUTEUS MAXIMUS WRAPDr Amit Dangi
THIS PRESENTATION DESCRIBES THE NOVEL SURGICAL TECHNIQUE OF TOTAL ANORECTAL RECONSTRUCTION WITH ANTROPYLORUS TRANSPOSITION AND GLUTEOPLASTY AND ITS RESULTS.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
Cancer of Oral Cavity Abutting the Mandible; Predictors of Loco-regional Fail...Dr./ Ihab Samy
TAREK K. SABER, M.D.; HESHAM A. HUSSEIN, M.D.; ALI H. MEBEED, M.D.;
HESHAM I. EL SEBAI, M.D.; IHAB SAMI, M.D. and IMAN G. FARAHAT, M.D.*
The Departments of Surgical Oncology and Pathology*, National Cancer Institute, Cairo University.
Journal of the Egyptian Nat. Cancer Inst., Vol. 21, No. 3, September: 219-227, 2009
A simplified technique of esophageal self-expandable metallic stent placement...Peachy Essay
The advantages of the simplified technique are as follows: technical ease, cost-effectiveness, no exposure to radiation,
requirement of minimal manpower, and less time-consuming; these advantages make it the technique day-care procedure.
Flyer for one day seminar for surgeons and gastroenterologists showcasing innovative technologies in endosurgery and robotic surgery
Sept 19, 2011 New Delhi
A Prospective Study to Compare the Suture Technique (Continuous Versus Interr...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Frequency of Anastomotic Leak in Early Versus Dealyed Oral Feeding after Elec...semualkaira
Intestinal stoma is usually performed as component of other surgical intervention for small and large bowel
pathologies. Of these temporary colostomy are commonest stomas
created for de-functioning of the distal anastomotic site to minimise the chances of leak. Colostomy is usually reversed at 8 to 12
weeks and Ileostomy closure is often considered a minor procedure but it is associated with significant morbidity and mortality
Frequency of Anastomotic Leak in Early Versus Dealyed Oral Feeding after Elec...semualkaira
Intestinal stoma is usually performed as component of other surgical intervention for small and large bowel
pathologies. Of these temporary colostomy are commonest stomas
created for de-functioning of the distal anastomotic site to minimise the chances of leak. Colostomy is usually reversed at 8 to 12
weeks and Ileostomy closure is often considered a minor procedure but it is associated with significant morbidity and mortality
Incisional Hernia, risk factors, management and relation to Surgical Abdomina...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Dr Rutledge
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
Managing ComplicationsFIRST Prevent Complications
Managing LeaksFirst Prevent Leaks!!
Examples of ComplacencySleeve Gastrectomy Leak
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Hot Selling Organic intermediates
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Surgical Site Infections, pathophysiology, and prevention.pptx
Alloderm hernia paper
1. World J Surg
DOI 10.1007/s00268-011-1131-6
Does Prophylactic Biologic Mesh Placement Protect Against
the Development of Incisional Hernia in High-risk Patients?
O. H. Llaguna • D. V. Avgerinos • P. Nagda •
D. Elfant • I. M. Leitman • E. Goodman
Ó Societe Internationale de Chirurgie 2011
´´
Abstract incisional hernia (mesh = 2, nonmesh = 2). The mean
Background The purpose of this study was to determine follow-up period was 17.3 ± 8.5 months. The overall
whether the prophylactic use of a biologic prosthesis pro- incidence of incisional hernia was 11.3% (95% CI: 5.2–
tects against the development of incisional hernia in a high- 17.45). The incidence of incisional hernia was significantly
risk patient population. lower in the mesh group versus the nonmesh group (2.3 vs.
Methods A prospective, nonrandomized trial was con- 17.7%, P = 0.014). In a multivariate logistic regression
ducted on 134 patients undergoing open Roux-en-Y gastric model that adjusted for age, sex, body mass index, albu-
bypass by a single surgeon, at two institutions, from Jan- min, smoking, diabetes, prior surgery, seroma formation,
uary 2005 to November 2007. At Hospital A, all patients weight loss, and mesh placement, the development of
(n = 59) underwent fascial closure of the abdominal incisional hernia was found to be associated with smoking
midline wound with the prophylactic placement of a bio- (adjusted odds ratio [OR] 8.46, 95% CI: 1.79–40.00,
logic mesh (AlloDermÒ) in an in-lay fashion. Patients at P = 0.007) while prophylactic mesh was noted to be pro-
Hospital B (n = 75) underwent primary abdominal wall tective against hernia development (adjusted OR 0.06, 95%
closure using #1 PDS in a running fashion. Data collected CI: 0.006–0.69, P = 0.02).
included patient demographics, abdominal wall closure Conclusion The prophylactic use of biologic mesh for
technique, postoperative wound complications, follow-up abdominal wall closure appears to reduce the incidence of
period, and incidence of incisional hernia. incisional hernia in patients with multiple risk factors for
Results During the study period 134 patients (mean incisional hernia development.
age = 40.4 years, 80.7% female) underwent open Roux-en-Y
gastric bypass (59.7% mesh, 41.5% nonmesh). Twenty-
eight patients were excluded from the analysis secondary to Introduction
a short follow-up period (mesh = 13, nonmesh = 11) and/
or reoperative surgery unrelated to the development of an The traditionally recommended method of abdominal wall
closure following laparotomy includes the use of a non-
absorbable or slowly absorbing running suture with a 1 cm
Presented at the 4th Annual Academic Surgical Congress, Fort Myers,
FL, February 3-6 2009. distance between stitches and the fascial margin. Despite
technical improvement and adherence to principles, the
O. H. Llaguna (&) overall incidence of incisional hernia following laparotomy
Division of Surgical Oncology and Endocrine Surgery,
remains reported to be between 11 and 23% [1–3].
University of North Carolina, 170 Manning Drive, 1150
Physicians Office Building, Chapel Hill, NC 27599, USA Although patient-related risk factors such as a history of
e-mail: omarllaguna.md@gmail.com smoking, morbid obesity, pulmonary disease, abdominal
aortic aneurysmal disease, prior abdominal surgery, or
D. V. Avgerinos Á P. Nagda Á D. Elfant Á
surgical site infections [4] cannot be controlled, modifica-
I. M. Leitman Á E. Goodman
Department of Surgery, Beth Israel Medical Center, tions in the standard abdominal wall closure in pre-iden-
Albert Einstein College of Medicine, New York, NY, USA tified high-risk patient populations may reduce the
123
2. World J Surg
incidence of postoperative incisional hernias. One simple visible protrusions at or near the surgical incision at rest or
and feasible modification may be the prophylactic place- with valsalva. Imaging studies were performed only when
ment of subfascial prosthetic materials at the time of initial clinically warranted. Data collected included patient demo-
laparotomy. graphics, abdominal wall closure technique (mesh versus
While many studies validate the use of mesh for inci- nonmesh), postoperative wound complications, follow-up
sional hernia repair [5–11], few attempt to prove its use- period, and incidence of incisional hernia. Data were analyzed
fulness in the prophylaxis of incisional hernia using SPSS for Windows v16 (SPSS Inc., Chicago, IL). A
development. Although limited, the available data suggest P value less than 0.05 was considered statistically significant.
that the prophylactic use of a nonabsorbable mesh at the
time of initial laparotomy confers protection against hernia
development [12–16]. Surgeons, however, are appropri- Results
ately hesitant to adopt this practice, citing the paucity of
data demonstrating the proposed technique’s effectiveness During the study period, 134 patients (mean age = 40.4 years,
and concerns about the placement of permanent mesh at the 80.7% female) underwent open Roux-en-Y gastric bypass
time of a potentially contaminated case. To help nullify (44% mesh, 56% nonmesh). Twenty-eight patients were
these concerns, we suggest that AlloDermÒ (LifeCell excluded from the analysis secondary to a short follow-up
Corp., Branchburg, NJ), a biologic acellular matrix pros- period (mesh = 13, nonmesh = 11) and/or reoperative
thetic mesh that has been found to be safe to use in con- surgery unrelated to the development of an incisional
taminated cases [17, 18], may be ideal for prophylactic hernia (mesh = 2, nonmesh = 2). The mean follow-up
mesh placement, obviating the concern for infectious period was 17.3 ± 8.5 months (mesh, 16.6 ± 7.1; non-
complications. The purpose of this study was to determine mesh, 17.7 ± 9.4, P = 0.50). No significant difference
whether the prophylactic use of a biologic mesh is pro- was noted between the mesh and nonmesh groups with
tective against the development of incisional hernia in a regard to age (P = 0.06), gender (P = 0.10), preoperative
high-risk patient population, and if so, is it at the cost of body mass index (BMI) (P = 0.26), total weight loss
added morbidity. (P = 0.53), diabetes (P = 0.89), sleep apnea (P = 0.22),
asthma (P = 0.06), exertional dyspnea (P = 0.12),
depression (P = 0.65), hypertension (P = 0.36), degener-
Methods ative joint disease (P = 0.94), smoking (P = 0.31), and
wound infection (P = 0.07) (Table 1). Patients in the
A prospective, nonrandomized trial was conducted on 134 nonmesh group were more likely to have undergone prior
patients undergoing open Roux-en-Y gastric bypass by a abdominal surgery (P = 0.001), while those in the mesh
single surgeon, at two institutions, from January 2005 to group had an overall lower postoperative BMI (P = 0.05)
November 2007. At Hospital A, all patients (n = 59, 44%) at the time of last follow-up. The overall incidence of in-
received prophylactic placement of a biologic mesh (Allo- cisional hernia was 11.3% (95% CI: 5.19–17.45). The
Derm) in an in-lay fashion during abdominal wall closure as incidence of incisional hernia was significantly lower in the
an institutionally approved internal review board protocol. A mesh group (mesh: 2.3%, 95% CI: -2.31-6.86; nonmesh:
16 cm 9 6 cm piece of mesh was routinely used. Given the 17.7%, 95% CI: 7.96–27.52, P = 0.01), while the inci-
biologic mesh’s flexibility and smooth texture, which makes dence of seroma was lower in the nonmesh group (mesh,
handling difficult, a moistened medium-sized malleable rib- 13.64%; nonmesh, 1.64%, P = 0.01) (Table 1). In a mul-
bon was placed underneath and used for positioning and sta- tivariate logistic regression model that adjusted for age,
bilization. The mesh was placed below the fascia with several sex, BMI, albumin, smoking, diabetes, prior surgery, ser-
interrupted #1 polydioxanone sulfate (PDSÒ, Ethicon, Som- oma formation, weight loss, and mesh placement, hernia
erville, NJ) monofilament sutures, and the fascia was closed in was found to be associated with smoking (adjusted odds
a primary running fashion also with #1 PDS with a 1 cm ratio [OR] 8.46, 95% CI: 1.79–40.00, P = 0.008) while
distance between stitches and the fascial margin. Patients at prophylactic mesh was noted to be protective against
Hospital B (n = 75, 56%) underwent primary abdominal wall incisional hernia development (adjusted OR: 0.06, 95%
closure using #1 PDS in a similar running fashion. At both CI: 0.006–0.69, P = 0.02) (Table 2).
institutions the primary surgeon performed the entire
abdominal wall closure to minimize variability in technique.
Routine follow-up consisted of laboratory work, weight loss Discussion
assessment, and physical examination 1 week after discharge,
monthly for 3 months, then every 6 months for 2 years. Since its first description in 1975 by Dr. Rene Stoppa, an
Incisional hernias were defined as a palpable fascial defect or abundance of data has emerged supporting the superiority
123
3. World J Surg
Table 1 Patient demographics
Variable Nonmesh [62 (58.5%)] Mesh [44 (41.5%)] P valuea
and characteristics
n (%) n (%)
Age (mean ± SD) 39.39 ± 11.08 43.73 ± 11.81 0.06
Gender 0.10
Male 10 (16.13%) 13 (29.55%)
Female 52 (83.87%) 31 (70.45%)
Preoperative BMI (mean ± SD) 50.38 ± 9.31 52.58 ± 10.59 0.26
Postoperative BMI (mean ± SD) 33.48 ± 8.56 36.75 ± 7.73 0.05
Weight loss (mean ± SD) 103.25 ± 63.74 96.18 ± 46.16 0.53
Preoperative albumin (mean ± SD) 4.04 ± 0.32 3.92 ± 0.26 0.14
Diabetes 21 (33.87%) 14 (32.56%) 0.89
Sleep apnea 12 (19.35%) 13 (29.55%) 0.22
Asthma 18 (29.03%) 6 (13.64%) 0.06
Hypothyroidism 4 (6.75%) 5 (11.36%) 0.37
Exertional dyspnea 23 (37.10%) 10 (22.73%) 0.12
Prior abdominal surgery 33 (54.10%) 10 (22.73%) 0.001
Depression 15 (24.19%) 9 (20.45%) 0.65
Hypertension 31 (50.00%) 18 (40.91%) 0.36
Degenerative joint disease 58 (93.55%) 41 (93.18%) 0.94
Smoking 0.31
No 49 (79.03%) 31 (70.45%)
Yes 13 (20.97%) 13 (29.55%)
Incisional hernia 11 (17.74%) 1 (2.27%) 0.01
Wound infection 1 (1.61%) 4 (9.09%) 0.07
Seroma 1 (1.61%) 6 (13.64%) 0.01
a Follow-up period (mean ± SD) 17.72 ± 9.39 16.59 ± 7.05 0.50
Fisher’s exact test
of tension-free mesh repair over primary suture repair in the primary abdominal wall closure or supra-aponeurotic
management of incisional hernias [5–11]. At present, ten- polypropylene mesh placement. At 3-year follow-up, five
sion-free mesh repair is standard in the operative manage- patients in the nonmesh group had developed incisional
ment of incisional hernias, having proven to be efficacious hernias while all in the mesh group were without hernia
even in the face of multiple non-modifiable patient-related (P = 0.02) [15]. In contrast to these positive findings, Pan
risk factors, decreasing the incidence of recurrence by as et al. [19] were unable to show any reduction in incisional
much as 50% in some series [10]. From this success and hernia development with the prophylactic use of a
fostered by an era of newer biologic mesh that can safely be polyglactin mesh. Their study, however, differs dramati-
used in spite of intra-abdominal contamination, the question cally from the other cited studies in that an absorbable
arises: Can abdominal wall closure with permanent mesh be mesh was used, placed intraperitoneally without fixation,
similarly used to prevent, rather than repair, incisional and the overlying fascia was approximated with interrupted
hernias? Some of the data are promising. absorbable suture [19].
Strzelczyk et al. [13], in a nonrandomized prospective The incisional hernia rate following nonmesh closure in
study of patients who underwent open Roux-en-Y gastric our series was 17.7%, a rate similar to that reported in the
bypass, found no hernias in the prophylactic mesh group literature [1–3, 20]. Patients who received prophylactic
(n = 12) and nine in the standard closure group (n = 48). mesh placement, however, experienced a significantly
A follow-up randomized controlled study by Strzelczyk lower incisional hernia rate (2.3%), with the only added
et al. [14] again found that none of the patients assigned to morbidity being increased seroma formation (mesh, 13.6%;
the prophylactic polypropylene mesh group (n = 36) nonmesh, 1.6%, P = 0.01). However, seroma formation
developed incisional hernias while one-fifth of those in the following hernia repair with mesh is a common occurrence,
primary closure group (n = 38) did. Similarly, Gutierrez´ with some laparoscopic series reporting a 35% incidence
˜
de la Pena et al. [15] found prophylactic polypropylene discovered clinically, and a 100% found on subsequent
mesh placement to be protective against incisional hernia ultrasonic evaluation [21]. These findings have led many to
development when they randomized a 100 patients to either consider it an expected mesh-related reaction rather than a
123
4. World J Surg
Table 2 Comparison of the
Variable Hernia group Nonhernia group P valuea
hernia and nonhernia groups
[12 (11.3%)] [94 (88.7%)]
n (%) n (%)
Biologic mesh use 1 (8.33%) 43 (45.74%) 0.01
Follow-up period (mean ± SD) 18.01 ± 9.51 17.16 ± 8.03 0.47
Age (mean ± SD) 39.75 ± 12.75 41.37 ± 11.47 0.64
Gender 0.46
Male 1 (8.33%) 22 (23.40%)
Female 11 (91.67%) 72 (76.60%)
Preoperative BMI (mean ± SD) 53.36 ± 7.54 51.03 ± 10.13 0.44
Postoperative BMI (mean ± SD) 33.13 ± 7.29 35.06 ± 8.49 0.45
Weight loss (mean ± SD) 125.75 ± 38.73 97.07 ± 58.24 0.10
Preoperative albumin (mean ± SD) 3.87 ± 0.31 4.01 ± 0.30 0.13
Diabetes 6 (50.00%) 29 (31.18%) 0.21
Sleep apnea 1 (8.33%) 24 (25.53%) 0.29
Asthma 2 (16.67%) 22 (23.40%) 0.73
Prior abdominal surgery 6 (50.00%) 37 (39.78%) 0.54
Smoking 0.008
No 5 (41.67%) 75 (79.79%)
Yes 7 (58.33%) 19 (20.21%)
Wound infection 0 (0.00%) 5 (5.32%) 1.00
BMI Body mass index
a
Seroma 1 (8.33%) 6 (6.38%) 0.58
Fisher’s exact test
complication, a small price to pay for a sturdier repair or in risk factors for incisional hernia development such as
our case a diminutive incisional hernia rate. diabetes, morbid obesity, and a history of smoking. Fur-
Given the current emphasis on health-care cost con- thermore, as the price of biologic mesh declines, the
tainment, novel interventions need not only be safe and observed improvement in incisional hernia rate may not
efficacious but also financially responsible prior to their only translate to better patient care, but also into overall
adoption. Simply stated, is a potential improvement in cost containment. The conclusions from this study will be
incisional hernia rate worth the additional expense associ- more compelling in the future with a larger sample size,
ated with routine biologic mesh placement? Although a prospective randomization, and thorough cost analysis.
formal cost analysis was not conducted, routine use of a
biologic mesh in high-risk patients may be a financially
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