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- Jacobsen, Hedin, et al.
(författare)
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Tensile Strength After Closure of Mesenteric Gaps in Laparoscopic Gastric Bypass: Three Techniques Tested in a Porcine Model.
- 2013
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Ingår i: Obesity surgery. - : Springer Science and Business Media LLC. - 1708-0428 .- 0960-8923. ; 23:3, s. 320-324
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Internal hernias occur frequently after laparoscopic gastric bypass. We have found no data on the relative strength of the various techniques available for closing these defects. The present study was performed to obtain such data to form a theoretical basis for clinical studies. METHODS: Six piglets were operated laparoscopically and four loops of small bowel created in each. These mesenteric gaps were closed over a distance of 40mm using (1) running 2-0 Ethibond® suture, (2) Endo Hernia stapler, (3) fibrin glue (Tisseel®) and (4) controls, where the mesenteric surfaces were rubbed with a sponge and approximated without further intervention. After 6weeks, the different segments of the mesentery were excised. The tensile strength was measured using continuously increased traction until the closure ruptured. The ordinary mesentery served as the control. The breaking tension and total amount of energy transferred to the tissue were registered. RESULTS: Control areas with rubbed areas developed no adhesions. Suture and staple lines contracted by 30% in length, whereas the fibrin glued lines were even shorter. Median tensile strength was greatest for the sutured lines (14,293mN) and stapled lines (10,798mN). Fibrin glued lines were significantly weaker (6,780mN, p=0.013 and p=0.026), but as strong as ordinary mesentery (4,165mN). CONCLUSIONS: If ongoing controlled randomized trials show closure to be beneficial, further studies should include staples as one of the options for the closure of mesenteric defects. The role of fibrin glue needs to be further investigated.
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- Dalenbäck, Jan, 1957, et al.
(författare)
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Long-term follow-up after elective adult umbilical hernia repair: low recurrence rates also after non-mesh repairs.
- 2013
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Ingår i: Hernia : the journal of hernias and abdominal wall surgery. - : Springer Science and Business Media LLC. - 1248-9204. ; 17:4, s. 493-497
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this study was to establish long-term outcome after elective adult umbilical hernia (AUH) repair. METHODS: Peri- and postoperative data considering all consecutive procedures at our institution during the time span from 1999 to 2009 were retrospectively gathered and followed by a questionnaire and, if needed, a clinical investigation in early 2011. RESULTS: A total of 162 patients (female/male 35%/65%) were operated, and 144/162 (89%) answers were gathered, mean follow-up time 70months; 77% were sutured, non-mesh repairs; 94% of all AUHs were smaller than 3cm; and 49% of the operations were performed under local anaesthesia. No perioperative complications were encountered. Five postoperative complications were encountered, two serious, both after mesh-based repairs. Wound infection rate (SSI) was low, 2/144 (1.4%). 7/144 (4.9%) recurrences were registered, none if mesh-based techniques were used, giving a recurrence rate of 6.3% in suture-based repairs, the difference, however, not statistically significant (p=0.141); 2% reported persistent pain at follow-up, 89% were overall satisfied with the outcome. CONCLUSIONS: AUH repair could be performed with low early and long-term complication rates, with low recurrence rates also after non-mesh repairs. A substantial cohort of patients will unnecessary be implanted with meshes if mesh-reinforced repairs should be used on a routine basis, that is, 16 surplus meshes to prevent one recurrence in the present study. We recommend a tailored approach to AUH repair: suture-based methods with defects smaller than 2cm and mesh-based repairs considered if larger than that.
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