Hernia

Ilioinguinal neuropathy is a rare but disabling condition. The condition may arise spontaneously or in the setting of pelvic surgery. To date, most therapeutic options have been limited to neuropathic pain medications, anti-inflammatory medications, nerve blocks with local anesthetics, or neurectomy. Long-term results of non-surgical interventions are fair at best. We present a case of chronic ilioinguinal neuropathy treated with pulsed radiofrequency. To examine the efficacy of pulsed radiofrequency (PRF) lesioning on pain in ilioinguinal neuropathy. A 58-year old man with chronic ilioinguinal neuropathy was treated with PRF and was followed for 3 months. The patient had significant pain relief at 3 months follow up. Pulsed radiofrequency lesioning may be a good treatment for chronic ilioinguinal neuropathy in cases refractory to conservative management.

Patients with a history of cancer-related abdominal surgery undergoing incisional hernia repair (IHR) are highly heterogenous and increasingly prevalent. We explored whether cancer surgery should be considered an independent risk factor for worse IHR perioperative outcomes. Patients undergoing IHR between 2018 and 2020 were identified within the Abdominal Core Health Quality Collaborative (ACHQC). Regression models were used to assess associations between cancer operation history and 30 d surgical site occurrences—exclusive of infection (SSO-EIs), surgical site infections (SSIs), reoperations, time to recurrence, and quality of life (QoL) scores. Cancer cohort subgroup analysis was performed for operative approach and mesh location. 8019 patients who underwent IHR were identified in the ACHQC, 1321 of which had a history of cancer operation. Cancer cohort patients were more likely to be older, males with a higher ASA status and lower BMI, and have longer and wider hernias (p < 0.001). After adjusting for confounding, the cancer cohort was less likely to experience SSO-EIs (OR 0.74, 95% CI 0.59–0.94 p = 0.0092) and showed lower odds of SSIs, reoperations, and recurrence (SSI OR 0.7, 95% CI 0.47–1.05, p = 0.0542; reoperation OR 0.66, 95% CI 0.37–1.17, p = 0.1002; recurrence OR 0.8, 95% CI 0.63–1.02, p = 0.08). There was no difference in postoperative QoL scores between cohorts. There were also no differences in perioperative or QoL outcomes within the cancer cohort based on operative approach or mesh location. These data show no evidence that history of cancer operation predisposes patients to worse incisional hernia repair perioperative or quality of life outcomes.

The primary objective of this observational study was to determine the best possible dilution of fibrin glue (Tissucol) to employ for prosthesis fixing in laparoscopic treatment of abdominal wall defects and, secondly, to assess its feasibility and safety. This study was carried out in a university experimental animal laboratory in accordance with all international laws, ethics regulations and quality criteria associated with animal experiments. The tests were carried out on two pigs, using four samples of mesh (Parietex). All meshes were fixed using two different Tissucol dilutions (standard with distilled water and that with calcium chloride). Follow-up evaluations were at 15 days after 30 days, with the latter consisting of traction tests and a biopsy for histological analysis. No post-operative complications were observed. The collagen-coated polyester meshes showed 0% adhesions, and reperitonealization had ensued after 15 days. We saw no shrinkage or migration of any of the meshes. Histopathological analyses confirmed a greater stability, greater tissue integration and the largest number of fibroblasts in meshes fixed with a 1/10 Tissucol dilution without calcium chloride. This observational study using animals showed that the 1/10 standard dilution – not that with calcium chloride – provided the best fixation and integration and prevented the formation of intraperitoneal adhesions, provided a hydrophilic collagen film-covered mesh was used.

1999 is a fit time to belatedly recognize Francis Usher, who epitomizes the best of 20th Century herniology. This pioneer, in the '50s, had fabricated and developed Marlex mesh, an infection-proof prosthesis which today is the most widely used worldwide. Despite academic disdain, he made a number of technical advances, many of which were later credited to others. Thus, he replaced overlay reinforcement of sutured repairs with inlay tension-free bridging of hernial defects. In the groin, he introduced anterior preperitoneal prosthetic replacement of the transversalis fascial floor of the inguinal canal. His unsplit groin prostheses provided lateral, sutured, preperitoneal parietalization of the spermatic cord, thereby maintaining obliquity of the internal ring. Selvage techniques may, in the future, be used to prevent “buttonholing” after closure of laparotomies in those known to be at risk for incisional herniation. More than any other he, at long last, should receive the credit he deserved for his primary role in the greatest advance in herniology this century — control of recurrence after herniorrhaphy.

Nhiều công cụ đo lường cơn đau, bao gồm Thang đo Tương tự Hình ảnh (VAS) và Thang đánh giá bằng lời (VRS), hiện đang được sử dụng cho bệnh nhân bị đau mãn tính. Mục tiêu của nghiên cứu hiện tại là xác định công cụ nào trong hai thử nghiệm cơn đau này hoạt động tối ưu ở bệnh nhân sau khi phẫu thuật sửa thoát vị bẹn. Một bảng câu hỏi đã xác định mức độ đau ở một nhóm bệnh nhân đã từng thực hiện phẫu thuật sửa thoát vị bẹn. Cường độ đau hiện tại được phân loại theo thang điểm VRS bốn mức (không đau, nhẹ, vừa phải hoặc đau nặng) và theo thang điểm VAS 100 mm (0 = không đau, 100 = không thể chịu đựng được). “Thất bại thang đo” (một hoặc cả hai bài kiểm tra không được hoàn thành chính xác) đã được xác định, và các điểm cắt cho bài thử nghiệm VAS được tính toán bằng cách tạo ra hệ số kappa tối ưu giữa cả hai công cụ. Tỉ lệ phản hồi là 78,2% (706/903). Thất bại thang đo xuất hiện ở thử nghiệm VAS nhiều hơn VRS (VAS: 12,5%, 88/706 so với VRS: 2,8%, 20/706; P < 0,001). Tuổi cao là một yếu tố rủi ro cho thất bại thang đo (P < 0,001). Bốn phân loại của VRS tương ứng với điểm VAS trung bình là 1, 20, 42 và 78 mm, tương ứng. Các phân loại VAS liên quan đến hệ số kappa cao nhất (k = 0,78) được xác định như sau: 0-8 = không đau, 9-32 = đau nhẹ, 33-71 = đau vừa, >71 = đau nặng. Điểm VAS được nhóm theo phân loại VRS cho thấy sự chồng chéo đáng kể. Tuổi và giới tính không ảnh hưởng đáng kể đến các điểm cắt. Do tỷ lệ thất bại thang đo thấp hơn và sự chồng chéo của các điểm VAS theo từng phân loại VRS, VRS nên được ưu tiên hơn so với VAS trong việc đánh giá cơn đau sau phẫu thuật thoát vị bẹn trong tương lai. Nếu VAS được ưa chuộng, các điểm cắt được trình bày nên được sử dụng.

The purpose of this study is to compare the tissue incorporation of a novel fenestrated and non-fenestrated crosslinked porcine dermal matrix (CPDM) (CollaMend™, Davol Inc., Warwick, RI) in a porcine model of ventral hernia repair. Bilateral abdominal wall defects were created in 12 Yucatan minipigs and repaired with a preperitoneal or intraperitoneal technique 21 days after hernia creation. Animals were randomized to fenestrated or non-fenestrated CPDM for n = 6 pieces of each graft in the preperitoneal or intraperitoneal location. All animals were sacrificed at 1 month. Adhesion characteristics and graft contraction/growth were measured by the Garrard adhesion grading scale and transparent grid overlay. Histological analysis of hematoxylin and eosin (H&E)-stained slides was performed to assess graft incorporation. Tissue incorporation strength was measured by a T-peel tensile test. The strength of explanted CPDM alone and de novo CPDM was measured by a uniaxial tensile test using a tensiometer (Instron, Norwood, MA) at a displacement rate of 0.42 mm/s. Statistical significance (P < 0.05) was determined for histological analysis using a Kruskal–Wallis non-parametric test with a Bonferroni correction, and for all other analyses using a two-way analysis of variance (ANOVA) with a Bonferroni post-test or a Kruskal–Wallis non-parametric test with a Dunn’s post-test. Intraperitoneal placement of fenestrated CPDM resulted in a significantly higher area of adhesions and adhesion score compared to the preperitoneal placement of fenestrated CPDM (P < 0.05). For both preperitoneal and intraperitoneal placement, histological findings demonstrated greater incorporation of the graft due to the fenestrations. No significant differences were detected in the uniaxial tensile strengths of the graft materials alone, either due to the graft type (non-fenestrated vs. fenestrated) or due to the placement location (preperitoneal vs. intraperitoneal). The incorporation strength (T-peel force) was significantly greater for fenestrated compared to non-fenestrated CPDM when placed in the preperitoneal location (P < 0.01). The incorporation strength was also significantly greater for fenestrated CPDM placed in the preperitoneal location compared to fenestrated CPDM placed in the intraperitoneal location (P < 0.05). Fenestrations in CPDM result in greater tissue incorporation strength and lower adhesion area and score when placed in the preperitoneal location. Fenestrations in CPDM allow for greater tissue incorporation without accelerating graft degradation. Fenestrations may be placed in CPDM while still allowing adequate graft strength for intraperitoneal and preperitoneal hernia repairs at 1 month in a porcine model.