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EN
The aim of the study was to demonstrate the relation between the operation technique and the early and late complications after the primary and secondary inguinal hernia repairs with the use of artificial material.Material and methods. There were 103 patients qualified for the research from among 140 patients operated within the period of 2003 - 2005. In all patients the same kind of mesh was used (100% Prolene). The operators were asked to fill in a special, original questionnaire. In all patients hernia type was classified during the repair with the use of Nyhus classification, seven key technical details of the treatment were described, subsequently the most frequent post-operative complications and inexpedient symptoms were evaluated - just after the operation and in 18 months time. Statistic one-dimension analysis of X2 method was applied or Fisher's exact test. After indication of the links, multidimensional analysis of logistic regression was used.Results. Based on the multidimensional analysis of logistic regression the links between technical details of the treatment and complications were evaluated. The analysis shows that only high tension has a significant influence on complications' emergence (p<0.0001). Precision of the model amounts to 71%. Additionally each particular complication was analyzed separately.Conclusions. Based on above mentioned results the operation technique algorithm was created with the smallest number of complications. From among analyzed technical details of the operation the special attention should be put at those which are directly and indirectly connected to the mesh binding. The lack of its tension is assumed to be the key factor of the whole procedure that minimizes one of the most serious post-operative complication which is the chronic pain.
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Content available remote Migration of biomaterials used in gastroenterological surgery
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EN
Mesh biomaterials have become the standard in the treatment of hernias, regardless the location. In addition to the obvious advantages of the methods based on implantable biomaterials, one should be aware of the possible complications, such as their migration to the abdominal organs. Material and methods. The study group comprised patients operated at the Department of General, Gastroenterological Oncology, and Plastic Surgery during the period between 2008 and 2011, due to hernia surgery with mesh implantation. We also analysed the number of patients operated, due to complications of mesh migration during the same period. Results. 368 patients were subject to mesh implantation, due to hernias during the period between 2008 and 2011. Three patients underwent surgery because of symptomatic migration of the mesh (ileus, fistula). Conclusions. The frequency of mesh migration is difficult to determine because of the different criteria of migration, observation period, and other factors. In patients after mesh implantation the potential migration of the biomaterial should be considered in case of unclear or acute abdominal symptoms.
EN
Introduction. Appendix, located within the Spiegel hernia is a rare condition. Few cases have been reported to date. Although it is generally asymptomatic, patients can apply with strangulation findings. Along with the physical examination findings, imaging methods play an important role in diagnosis and definitive diagnosis is made intraoperatively. Per-operative surgical method is determined according to the condition of the structures in the hernia sac. If an appendix is detected in the hernia sac, appendectomy is often preferred regardless of symptoms. Postoperative pathology is mostly benign but malign appendix pathologies should be kept in mind. Aim. Here, we aimed to present our case undergoing emergency surgery due to incarcerated hernia as it is the first case of appendix neuroendocrine tumor in the Spiegel hernia sac according to our literature review. Description of the case. A 77-year-old female patient who was admitted to the hospital with complaints of nausea and vomiting was evaluated as an emergency. In the clinical evaluation of the patient, we detected ileus due to hernia. We operated on the patient and found the appendix and cecum in the spiegel hernia. We did appendectomy and hernia repair. Histopathological examination of the appendix revealed a well-differentiated neuroendocrine tumor. Conclusion. Detection of the appendix in a Spiegel hernia is a rare condition. This is the first case of appendiceal malignancy in a Spiegelian hernia.
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EN
The aim of the study was to analyze inguinal hernia procedures performed by means of Lichtenstein's method.Material and methods. During the period between December, 2004 and December, 2006, 216 patients were subject to surgery due to inguinal hernias. One hundred and three patients were qualified for analysis. Surgical operations were performed in most cases in local anesthesia, in addition to conduction, short intravenous or general anesthesia. Statistical analysis was used for assessing the average incidence split according to their gender and body weights. The length of treatment of patients depending on their gender was estimated and statistical analysis of hernia location was performed.Results. No patient was found to develop early complications, the average operation time was 65 minutes, the average length of treatment for men was 5 days, for women 3 days.Conclusions. Removal of inguinal hernia by the Lichtenstein method was found a good method in treating this disease. This method is convenient for the patient, safe, there are almost no complications and the length of patient's stay in the surgical ward is shortened down.
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Content available Quality of life after inguinal hernia repair
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EN
Introduction: Inguinal hernias are the most commonly presented abdominal hernias with approximately 20 million people operated annually throughout the world. Severe chronic pain after hernia repair effects social life, daily activity and overall quality of life. The Short Form-36 is (SF-36) a validated indicator of overall health status. Studies have shown that the reliability of the SF-36 is exceeding 0.80. Aim: Our aim of study is to determine the effect of unilateral open mesh repair by using SF-36 on pain control and quality of life of patient. Methods: This cross-sectional study was carried out at Indus Hospital Karachi from 1st April 2018 to 10th September 2018. 88 patients were enrolled in this study according to the inclusion and exclusion criteria. A written and informed consent was taken from all of them. After surgery they were sent home on painkillers. They were called at 4 weeks and were required to fill a pre designed questionnaire Short form-36. Results: Results showed that out of the 88 patients enrolled in this study 35 (39.8%) experienced mild pain, 37 (42%) experience moderate pain and only 16 (18.2%) experienced severe pain. Quality of life was satisfactory in 72 (81%) and unsatisfactory in 13 (14.7%). Conclusion: Hence it is concluded that post operatively patients experienced better physical functioning and emotional role functioning whereas their perceptions about their general health and energy were satisfactory. Hernia surgery should be offered to all the patients with a clinically detectable hernia.
EN
Mesh hernioplasty is among the most frequently performed surgical procedures. The introduction of mesh implants has decreased recurrence rates, but the use of synthetic materials carries the risk of infection and biofilm formation. This paper presents the course of the disease in the case of biofilm formation on the surface of an implanted surgical mesh. Antimicrobial therapy and partial removal of the implant were unsuccessful. Recurring surgical site infection could be managed only through total excision of the infected implant.
EN
Diaphragmatic hernia is one of the most frequently observed injuries caused by trauma in cats. Study materials were a total of 44 cats (20 male, 24 female), at different ages (2-months-old to 2-3-years-old) from various breeds. Following direct radiography, positive-contrast radiography was also taken to confirm the diagnosis. General anesthesia was induced using 5% isoflurane inhalation. Following entubation, the anesthesia was continued using 1.5-2% isoflurane inhalation by a nonrebreathing system with a pediatric circle. When the repair was about to be completed, positive pressure was increased for treating atelectasis. The mortality rate in traumatic diaphragmatic hernia cases was found to be 6.8% at the end of the study. It was concluded in this study that the success of the surgery may be increased by effective anesthetic procedures.
EN
Inguinal hernia repairs are very common yet fairly complex surgical procedures. Variations in the anatomical course of the inguinal nerves require that diligence is taken in their proper recognition. Inadvertent surgical injury to these nerves is associated with long term postoperative pain and complications. The aim of the present study was to highlight the complexity and variation in the innervation of the inguinal region in order to increase proper nerve identification during surgical interventions. Bilateral dissection of the inguinal and posterior abdominal regions in one human male cadaver revealed an atypical anatomic topography of the groin innervation. This unusual case was observed at the Jagiellonian University Anatomy Department during routine cadaveric preparations. The left ilioinguinal nerve was absent. The left genital branch of the genitofemoral nerve arose higher than expected from the lumbar plexus and supplied the groin region, which is typically innervated by the ilioinguinal nerve. Furthermore, the left lateral cutaneous femoral nerve and the right genital branch of the genitofemoral nerve also followed uncharacteristic courses. Awareness of topographical nerve variations during inguinal hernia repair will help surgeons identify and preserve important nerves, thus decreasing the incidence of chronic postoperative pain. (Folia Morphol 2013; 72, 3: 267–270)
EN
The paper describes a case of a dorsal type of perineal hernia in an 11-year-old bitch of the Yorkshire terrier breed. The hernia was situated between the levator ani muscle and the coccygeal muscle. The hernial sac contained small intestines and a small amount of the retroperitoneal fatty tissue. Additionally, both sided inguinal hernias and collapse of trachea were diagnosed in the dog. In the discussed case the perineal hernia was operated on by the means of placing sutures on the levator ani muscle and the coccygeal muscle. No recurrence of the problem was observed during 19 months following the surgery.
EN
The article presents a method of producing a composite surgical mesh. A synthetic, macroporous mesh with mechanical properties similar to that of the abdominal wall and with reduced surface density compared to conventional surgical meshes was made of polypropylene (PP) monofilament. The mesh was used as a substrate for a layer of modified bacterial cellulose (MBC) produced by a microbial synthesis with the use of the Acetobacter xylinum strain. The PP mesh was coated with the MBC layer directly in the process of biosynthesis in liquid culture medium with the addition of chitosan modifier. During the resorption process, under the action of body enzymes, amino sugars are released from the MBC layer, which have the ability to stimulate tissue granulation and accelerate the wound healing process, while preventing formation of scars.
PL
W artykule przedstawiono sposób wytwarzania kompozytowych makroporowatych siatek chirurgicznych Makroporowate siatki, o właściwościach mechanicznych zbliżonych do anatomii brzucha i masie powierzchniowej obniżonej w stosunku do konwencjonalnej (masa powierzchniowa poniżej 80 g/m2, rozmiar mikro-porów powyżej 1 mm2, ciągliwość powyżej 16 N/cm), wykonanych z monofilamentu polipropylenowego, stanowiących matrycę dla biopolimeru wytwarzanego w drodze mikrobiologicznej syntezy. Modyfikację powierzchniową siatek polipropylenowych prowadzono bezpośrednio w procesie biosyntezy z udziałem bakterii Acetobacter xylinum w płynnym podłożu hodowlanym z dodatkiem modyfikatora chitozanowego. W trakcie resorpcji warstwy celulozowej uwalniane są oligomery chitozanu, które wykazują zdolność do stymulowania ziarninowania tkanki i przyspieszenia procesu gojenia ran, zapobiegając jednocześnie powstawaniu blizn.
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Content available remote Process of Warp Knitting Mesh for Hernia Repair and its Mechanical Properties
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EN
Polypropylene monofilament is selected to fabricate the mesh used for hernia repair, and the mesh is warp knitted on a Tricot machine with a compound needle (gauge E 18); an atlas structure is used. The mesh with 18 to 20 courses per centimetre has the best mechanical properties. The heat-setting conditions are confirmed on the basis of trials. It can be concluded that the heat-setting temperature between 125 °C to 128 °C and the time between 5 to 8 minutes benefit the mechanical properties of the mesh.
PL
Wyselekcjonowano monofilamenty polipropylenowe, przeznaczone dla wytworzenia siatek stosowanych do wzmocnienia powłok mięśniowych przy operacjach przepuklin. Siatki w postaci dzianin osnowowych byfy produkowane na osnowarkach z igłami suwakowymi o rozmiarze E 18. Zastosowano splot atłasowy. Warunki stabilizacji termicznej ustalono na podstawie prób. Stwierdzono, że siatki poddane stabilizacji w temperaturze 125 -128°C, w czasie 5-8 minut wykazują dobre właściwości mechaniczne.
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Content available remote Ileus and Intestinal Obstruction - Comparison Between Children and Adults
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EN
Bowel obstruction is the interference with movement of bowel content. Large and small in testing from duodenum to anal region can be obstructed mechanical or non-mechanical and complete or partial. Mechanical obstruction can presented because of obstructive causes in intestinal lumen, intestinal wall or pressure from other tissue on intestine.The aim of the study was to evaluate etiology, laboratory findings of intestinal obstruction and ileus among children and adults who discharged with good condition.Material and methods. This retrospective study was carried out from 2001 to 2006 in Imam Khomeini Hospital (Ahvaz-Iran). Cases of bowel obstruction were included in this study. For each case, a questionnaire was filled. There are 752 cases with suspected bowel obstruction. From 752 cases, 403 patients that agreed and treated and discharged with good condition were studied. Cases were divided into two groups: children (age < 15 yrs) and adults (age> 15 yrs). Data were analyzed by SPSS Ver 16.0 (Chicago, IL, USA) and Epi-info Ver 6.00.Results. In our study, 221 adults and 192 children were included. Mortality rate was 12.2%. Forty-eight percent of 403 cases were children (m - 61%, f - 38%, ambigus genitalia - 1%) and 52% were adults (m - 67%, f - 33%). Etiology of bowel obstruction in children were as follows: ileus (26%); adhesion band (17.7%), partial obstruction (16.1%), and Hirschsprung's disease (12%). Causes of bowel obstruction in adults are: partial obstruction (29.9%); ileus (19%); adhesion band (18.5%); colonic pseudo obstruction(8.5%); GI cancer (5.2%); hernia (4.7%); Crohn (2.8%); fecal impaction (3.3%); bezoar (2.4%), and 4.7% for other causes. Fifty-one percent of children and 36% of adults were operated. Of all children, 91.7% had upright abdominal X-ray, 51.6% had supine X-ray, and 80.7% had sonography. Hundred percents of adults had upright & supine plain abdominal X-ray and 75.4% had sonography. Most change in children's CBC was 10000
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Content available remote Elaboration of the Optimal Structure of Flat Implants for Hernia Treatmentsn
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EN
One of the most commonly conducted procedures in general surgery is hernia treatment. This problem concerns approx. 4% of the human population. The factor that significantly lowers the efficacy of the hernia treatment procedure, also called hernioplasty, is the high risk of recurrence, which leads to repeated surgery. The aim of this thesis is to design an optimal surgical mesh structure for hernia treatment with the use of the non-tension method. In order to select an optimal prototype, qualitative analysis of chemical purity, physical properties as well as morphology and pathophysiology were performed. A designated group of quality markers and a general quality marker based on risk analysis acc. PN-EN ISO 14971:2004 Standard allowed to select an optimal hernia mesh prototype.
PL
Jednymi z najczęściej wykonywanych zabiegów w chirurgii ogólnej są operacje zaopatrywania przepuklin (łac. hernia). Problem ten dotyczy około 4% populacji ludzkiej. Czynnikiem znacznie obniżającym efektywność wspomnianych zabiegów, zwanych także hernioplastyką, jest wysokie ryzyko nawrotu, co prowadzi do konieczności przeprowadzenia ponownego zabiegu. Celem niniejszej pracy jest zaprojektowanie optymalnej struktury siatki chirurgicznej, służącej do zaopatrywania przepuklin techniką beznapięciową. Optymalny prototyp implantu został wyselekcjonowany dzięki analizie jakościowej w zakresie czystości chemicznej oraz właściwości fizycznych pod kątem morfologicznym oraz patofizjologicznym. Wyznaczone grupowe wskaźniki jakości oraz generalny wskaźnik jakości, wyselekcjonowane na podstawie analizy ryzyka przeprowadzonej w zgodności z normą PN-EN ISO 14971:2004, pozwoliły na wyselekcjonowanie optymalnego prototypu siatki chirurgicznej.
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