Assessment of short-term outcome with TiO2 mesh in laparoscopic repair of large paraesophageal hiatal hernias

Abstract Background Laparoscopic large para-oesophageal hiatal hernia (LPHH) repair using mesh reinforcement significantly reduces postoperative recurrence rates compared to conventional suture repair, especially within short follow-up times. However, the ideal strategy for repairing LPHH remains disputable because no clear guidelines are given regarding indications, mesh type, shape or position. The aim of this study was to survey our short-term results of LPHH management with a biosynthetic monofilament polypropylene mesh coated with titanium dioxide to enhance biocompatibility (TiO2Mesh™). Methods A retrospective study was performed at Ramon y Cajal University Hospital, Spain from December 2014 to October 2018. Data were collected on 27 consecutive patients with extensive hiatal hernia defects greater than 5 cm for which a laparoscopic repair was performed by primary suture and additional reinforcement with a TiO2Mesh™. Study outcomes were investigated, including clinical and radiological recurrences, dysphagia and mesh-related drawbacks. Results Twenty-seven patients were included in our analysis; 10 patients were male, and 17 were female. The mean age was 73 years (range, 63–79 years). All operations were performed laparoscopically. The median postoperative hospital stay was 3 days. After a mean follow-up of 18 months (range, 8-29 months), only 3 patients developed clinical recurrence of reflux symptoms (11%), and 2 had radiological recurrences (7%). No mesh-related complications occurred. Conclusions TiO2Mesh™ was found to be safe for laparoscopic repair of LPHH with a fairly low recurrence rate in this short-term study. Long-term studies conducted over a period of years with large sample sizes will be essential for confirming whether this mesh is suitable as a standard method of care with few drawbacks.

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Robotic Versus Laparoscopic Approach to Hiatal Hernia Repair: Results After 7 Years of Robotic Experience

The American Surgeon ◽

10.1177/0003134820943547 ◽

2020 ◽

Vol 86 (9) ◽

pp. 1083-1087

Author(s):

Sean C. O’Connor ◽

Matthew Mallard ◽

Shivani S. Desai ◽

Francisco Couto ◽

Matthew Gottlieb ◽

...

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Clinical Outcomes ◽

Laparoscopic Repair ◽

Laparoscopic Approach ◽

Hiatal Hernia Repair ◽

Continuous Variables ◽

Recurrence Rates ◽

Robotic Hiatal Hernia Repair

Introduction Robotic hiatal hernia repair offers potential advantages over traditional laparoscopy, most notably enhanced visualization, improved ergonomics, and articulating instruments. The clinical outcomes, however, have not been adequately evaluated. We report outcomes of laparoscopic and robotic hiatal hernia repairs. Methods A retrospective observational cohort study was performed of all hiatal hernia repairs performed from 2006 through 2019. Operative, demographic, and outcomes data were compared between laparoscopic and robotic groups. Discrete variables were analyzed with Chi-square of Fisher’s exact test. Continuous variables were analyzed with Student’s t test (mean) or Wilcoxon rank sum (medians). All analyses were performed using R statistical software. Results Laparoscopic repair was performed in 278 patients and robotic repair in 114. More recurrent hernias were repaired robotically (24.5% vs 12.9%, P = .08). Operative times were no different between groups (175 vs 179 minutes; P = .681). Robotic repair resulted in significantly shorter length of stay (LOS; 2.3 vs 3.3 days; P = .003). Rate of readmission was no different, and there were no differences in acute complications. For patients with at least 1 year of follow-up, recurrence rates were lower after robotic repair (13.3% vs 32.8%; P = .008); however, mean follow-up is significantly longer after laparoscopic repair (23.7 ± 28.4 vs 15.1 ± 14.9 months; P < .001). Discussion Robotic hiatal hernia repair offers technical advantages over laparoscopic repair with similar clinical outcomes.

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Comparative short-term and long-term outcomes between internal and external intestinal plication in the management of small bowel obstruction

BMC Surgery ◽

10.1186/s12893-021-01304-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Song Liu ◽

Qiongyuan Hu ◽

Lihua Shao ◽

Xiaofeng Lu ◽

Xiaofei Shen ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Gut Dysfunction ◽

Gut Function

Abstract Background Small bowel obstruction (SBO) is common and usually requires surgical intervention. Intestinal plication is a traditional but critical strategy for SBO in certain scenarios. This study is to compare the short-term and long-term outcome between internal and external plications in the management of SBO. Methods All patients receiving intestinal plication in our hospital were retrospectively collected. Short-term outcome including postoperative complications, reoperation, postoperative ICU stay, starting day of liquid diet and postoperative hospitalization, as well as long-term outcome including recurrence of obstruction, readmission, reoperation and death were compared between groups. Gut function at annual follow-up visits was evaluated as well. Results Nine internal and 11 external candidates were recruited into each group. The major causes of plication were adhesive obstruction, abdominal cocoon, volvulus and intussusception. Lower incidence of postoperative complication (p = 0.043) and shorter postoperative hospitalization (p = 0.049) was observed in internal group. One patient receiving external plication died from anastomosis leakage. During the 5-year follow-up period, the readmission rate was low in both groups (22.2 % vs. 9.1 %), and none of patients required reoperation or deceased. None of patients exhibited gut dysfunction, and all patients restored normal gut function after 4 years. Patients in external group demonstrated accelerated recovery of gut function after surgery. Conclusions This study compares short-term and long-term outcome of patients receiving internal or external intestinal plication. We suggest a conservative attitude toward external plication strategy. Surgical indication for intestinal plication is critical and awaits future investigations.

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Presurgical fMRI Affecting the Extent of Resection and Outcome of the Supratentorial Gliomas; a Single-center Experience From a Developing Country

10.21203/rs.3.rs-528310/v1 ◽

2021 ◽

Author(s):

Abolghasem Mortazavi ◽

Mohammad Ali Suraki Azad ◽

Abbas Amirjamshidi ◽

Mohammad Shirani ◽

Seyed Ebrahim Ketabchi ◽

...

Keyword(s):

Tumor Grade ◽

Extent Of Resection ◽

Positive Outcome ◽

Short Term ◽

Glioma Surgery ◽

Term Outcome ◽

Eloquent Areas ◽

Single Center Experience ◽

Supratentorial Gliomas

Abstract BackgroundFunctional magnetic resonance imaging (fMRI) is one of the available non-invasive imaging to map the different brain areas, which has been used during the current years. In this study, we aimed to evaluate the effect of fMRI on decision-making, the extent of resection, and the outcome of the patients with supratentorial gliomas.MethodsThis prospective study conducted from 2014 through 2017 to investigate how presurgical fMRI can help the neurosurgeon during glioma surgery. Baseline demographic and clinical data were collected, and standard fMRI protocol was used for each patient.Results Forty-one patients with supratentorial gliomas met inclusion criteria, including 29 males and 12 females ranging in age from 21 to 72. Our results showed a significant association between eloquent areas tumor and the EOR. Eight out of 41 (19.5%) experienced higher EOR than what the neurosurgeon expected after adjusting the fMRI findings with the intraoperative situation. Among these patients, postoperative KPS and motor indices reflected dropped levels accompanied by an instant language index level in the short-term period, whereas all indices improved after long-term follow-up. There was a significant association between increasing EOR and all indices in the 1-year follow-up.ConclusionsIn conclusion, we postulate that preoperative fMRI should be considered preoperatively, especially in the eloquent areas gliomas disregarding tumor grade. Moreover, it can lead to a positive outcome in supratentorial gliomas via giving useful data about the relation of the tumor and vital centers of the brain, although it may result in an unfavorable short-term outcome.

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Short-term Gait Parameters Change in Mild Spastic Cerebral Palsy after Selective Dorsal Rhizotomy Guided by Our Newly-Modified Protocol

10.21203/rs.3.rs-278334/v1 ◽

2021 ◽

Author(s):

wenbin jiang ◽

Shuyun Jiang ◽

Yan Yu ◽

Qijia Zhan ◽

Min Wei ◽

...

Keyword(s):

Cerebral Palsy ◽

Lower Limbs ◽

Spastic Cerebral Palsy ◽

Selective Dorsal Rhizotomy ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Dorsal Rhizotomy ◽

Gait Parameters

Abstract Background Selective Dorsal Rhizotomy (SDR) guided by our modified protocol can decrease spasticity in certain muscles. This study aimed to investigate gait parameters changes in cerebral palsy (CP) with focal spasticity after SDR in short-term follow-up. Methods CP classified as Gross Motor Function Classification System (GMFCS) level Ⅰ and Ⅱ who underwent SDR were included. Changes of spasticity, gait parameters and gait deviation index (GDI) were retrospectively reviewed. Results This study contained 26 individuals with 44 affected and 8 intact lower limbs (4 monoplegia, 4 hemiplegia and 18 diplegia). Mean age was 5.7 ± 1.9 years-old and follow-up duration was 9.9 ± 6.6 months. After SDR, average spasticity of 108 target muscles decreased from 2.9 ± 0.8 to 1.8 ± 0.6 in Modified Ashworth Scale (MAS). Kinematic curves changed after the surgery in sagittal and transverse plane in affected sides, further investigation showed improvements in ankle and knee. No changes were found in temporal-spatial parameters except decrease in cadence in affected sides. GDI improved significantly in affected limbs. Conclusion In short-term follow up, the new-protocol-guiding SDR can lower focal spasticity, GA showed improvements in kinematic parameters and GDI. Longer follow-up duration is needed to clarify the long-term outcome.

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OV07 LAPAROSCOPIC HIATAL HERNIA MESH-SUTURE REPAIR

British Journal of Surgery ◽

10.1093/bjs/znab396.058 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Alexey Abolmasov

Keyword(s):

Hiatal Hernia ◽

Paraesophageal Hernia ◽

Suture Line ◽

Suture Technique ◽

Force Distribution ◽

Suture Repair ◽

Hernia Defect ◽

Hernia Mesh ◽

Pull Through

Abstract Aim “A new original laparoscopic operative technique was used to suture paraesophageal hernia (PEH) with the strips of mesh. Material and Methods The Mercilen (MercilenTM) mesh suture was used to close large hiatal hernia. The strips of mesh, instead of normal thread, were applied to close the gap between diaphragm’s crura in 12 patients with hernia defect more than 5 cm. Mesh suture were tighten as a simple laparoscopic intracorporeal knot. The surgical technique and surgical outcomes are presented. Results 12 patients underwent a laparoscopic PEH suturing with Mercilen strips of mesh. We recorded no recurrence or dysphagia at 6 and 12 months follow-up. Conclusions Mesh-sutured repairs of diaphragm’s hernia support the concepts of force distribution and resistance to suture pull through. The new original technique avoids using the sheet of mesh and enables to reduce the amount of dangerous complications connected with mesh and its fixation. Mesh-sutured closures of hiatal hernias seem to be safe and effective in tension closure of large hiatal defects. Further investigations are needed to evaluate the results. Using the mesh suture technique for the closure of large PEH, we protect the cruras from being cutting through. Besides, the mesh stripes and its knots produce tissue scarring around the esophagus making the suture line stronger.

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Ligation of the aorta for a mycotic abdominal aortic aneurysm in an infant

SAGE Open Medical Case Reports ◽

10.1177/2050313x18761309 ◽

2018 ◽

Vol 6 ◽

pp. 2050313X1876130

Author(s):

Zahira Zouizra ◽

Soukaina Benbakh ◽

Gaël Biaou ◽

Drissi Boumzebra

Keyword(s):

Mycotic Aneurysm ◽

Aortic Aneurysms ◽

Infrarenal Aorta ◽

Limited Data ◽

Short Term ◽

Term Outcome ◽

Short Term Outcome ◽

Abdominal Aortic ◽

Risk Of Rupture

Mycotic aortic aneurysms are exceedingly uncommon in infants and they have a high risk of rupture. Their surgical management is extremely challenging. We report a case of a 22-month-old girl who presented with abdominal pain and fever revealing a ruptured mycotic aneurysm of the infrarenal aorta. The surgical treatment consisted of a ligature of the proximal and distal ends of the aneurysm. Postoperative course was significant for hypertension. A year and a half follow-up showed no other complications. Limited data are available concerning our chosen technique, but the reported cases showed a good short-term outcome.

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Short-term outcome of routine use of EndoFLIP during hiatal hernia repair

Surgical Endoscopy ◽

10.1007/s00464-020-07788-x ◽

2020 ◽

Author(s):

Ugoeze Nwokedi ◽

Duc T. Nguyen ◽

Leonora M. Meisenbach ◽

Ray Chihara ◽

Edward Y. Chan ◽

...

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Hiatal Hernia Repair ◽

Short Term ◽

Term Outcome ◽

Short Term Outcome

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Very long-term follow-up of aplastic anemia treated with immunosuppressive therapy or allogeneic hematopoietic cell transplantation

Annals of Hematology ◽

10.1007/s00277-020-04271-4 ◽

2020 ◽

Vol 99 (11) ◽

pp. 2529-2538

Author(s):

Beatrice Drexler ◽

Felicitas Zurbriggen ◽

Tamara Diesch ◽

Romaine Viollier ◽

Joerg P. Halter ◽

...

Keyword(s):

Aplastic Anemia ◽

Immunosuppressive Therapy ◽

Hematopoietic Cell Transplantation ◽

Clonal Evolution ◽

University Hospital ◽

Term Outcome ◽

Long Term Outcome ◽

Long Term Survivors

Abstract Introduction Since the 1970s outcome of aplastic anemia (AA) patients has improved significantly due to the introduction of immunosuppressive therapy (IST) and allogeneic hematopoietic transplantation (HCT). However, patients may suffer from persistent disease, relapse, clonal evolution, graft-versus-host disease and other late effects. Here, we analyse very long-term outcome of all AA patients at our institution comparing not only survival, but also response status and complications. Methods Patient charts of all 302 AA patients treated between 1973 and 2017 at the University Hospital Basel, Switzerland, were retrospectively analysed. Results First line treatment was IST in 226 (75%) and HCT in 76 (25%) patients. Overall survival at 30 years was similar in patients treated initially by HCT and IST (44% (±14%), and 40% (± 9%) respectively, with better results in more recent years. Partial and no response occurred more frequently after IST, relapse incidence after IST was 24 %, whereas non-engraftment and graft failure was documented in 15 patients (19 %) after HCT. Clonal evolution to myelodysplastic syndrome / acute myeloid leukemia was 16 % at 25 years in IST patients, 1.3 % in HCT patients, iron overload (18 versus 4 %, p = 0.002) and cardiovascular events (11 versus 1 %, p=0.011) occured significantly more often in IST than HCT treated patients. The majority of long-term survivors, 96% of those alive at 25 years, were in complete remission at last follow up, irrespective of the initial treatment modality. Conclusion Very long term survivors after AA are those with stable hematopoietic recovery.

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Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar

European Neurology ◽

10.1159/000507193 ◽

2020 ◽

Vol 83 (2) ◽

pp. 154-161 ◽

Cited By ~ 1

Author(s):

Naveed Akhtar ◽

Mahesh Kate ◽

Saadat Kamran ◽

Rajvir Singh ◽

Zain Bhutta ◽

...

Keyword(s):

Acute Stroke ◽

Major Adverse Cardiovascular Events ◽

Stroke Patients ◽

Long Term Outcomes ◽

Short Term ◽

Term Outcome ◽

Contributory Factors ◽

Short Term Outcome

Background: Sex differences may determine presentation, utility of treatment, rehabilitation, and occurrences of major adverse cardiovascular events (MACEs) in acute stroke (AS). Objective:The purpose of the study was to evaluate the short-term prognosis and long-term outcomes in MACEs in Qatari nationals admitted with AS. Methods: All AS patients admitted between January 2014 and February 2019 were included. We evaluated the preadmission modified Rankin scale (mRS) score, etiology and severity of symptoms, complications, and functional recovery at discharge and 90 days. MACEs were recorded for 5 years. Results: There were 891 admissions for AS (mean age 64.0 ± 14.2 years) (male, n = 519 [mean age ± SD 62.9 ± 14.1 years]; female, n = 372 [mean age ± SD 65.6 ± 14.2 years] p = 0.005). There were no differences in the preadmission mRS and severity of symptoms as measured on National Institute of Stroke Scale. At discharge, the outcome was better (mRS 0–2) in men (57.8 vs. 46.0%), p = 0.0001. This difference persisted at the 90-day follow-up (mRS 0–2, male 69.4% vs. female 53.2%, p = 0.0001). At the 90-day follow-up, more women died (total deaths 70; women 38 [10.2%] versus men 32 [6.2%], p = 0.03). MACEs occurred in 25.6% (133/519) males and 30.9% (115/372) females over the 5-year follow-up period (odds ratio 0.77, 95% confidence interval 0.57–1.0, p = 0.83). Conclusions: Female patients have a poor short-term outcome following an AS when corrected for age and comorbidities. While our study cannot explain the reasons for the discrepancies, higher poststroke depression and social isolation in women may be important contributory factors, and requires further studies are required to confirm these findings.

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Long-term outcome of modified radical mastoidectomy

The Journal of Laryngology & Otology ◽

10.1258/0022215041917970 ◽

2004 ◽

Vol 118 (8) ◽

pp. 612-616 ◽

Cited By ~ 13

Author(s):

Payal Mukherjee ◽

Nicholas Saunders ◽

Richard Liu ◽

Paul Fagan

Keyword(s):

Bone Conduction ◽

Radical Mastoidectomy ◽

Recurrence Rates ◽

Term Outcome ◽

Long Term Outcome ◽

Surgical Access ◽

Modified Radical Mastoidectomy ◽

Hearing Result

The primary aim of treatment of cholesteatoma is to attain a dry, safe, stable ear, free of disease. Maintaining or improving hearing is important but the pursuit of a hearing result should not compromise this primary aim. This study reviews the long-term outcome of 133 patients, suffering from advanced disease, who underwent modified radical mastoidectomy between 1995 and 2000. Of these, 49 per cent had had previous mastoid surgery elsewhere. A dry, waterproof ear was attained in 95 per cent of patients. In 77 per cent of patients, hearing was unchanged or improved. In this period, there were two cases of significant post-operative loss in bone conduction, including one dead ear secondary to suppurative labyrinthitis. There were epithelial pearls on follow up in two per cent. These results indicate that when properly performed, modified radical mastoidectomy provides safe surgical access and clears disease with low recurrence rates while mostly maintaining or improving hearing.

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