scholarly journals Preventing Peterson’s space Hernia Using a Bio Synthetic Mesh

2019 ◽  
Author(s):  
Adam Peter Skidmore ◽  
Edo O Aarts
Keyword(s):  
Internal Hernia ◽  
Controlled Trial ◽  
Gastric Pouch ◽  
Synthetic Mesh ◽  
First Year ◽  
Absorbable Suture ◽  
Private Hospitals ◽  
Randomized Controlled ◽  
Mesenteric Defects ◽  
Ideal Technique

Abstract Introduction Up to 30% of all Bariatric procedures performed worldwide still are Roux-en-Y Gastric Bypasses (RYGB). Internal hernia’s occur when small bowel herniates into the intermesenteric spaces created when the roux limb is mobilised for anastomosis to the gastric pouch. To prevent internal hernia’s to occur many surgeons nowadays close the mesenteric defects during primary RYGB. Using a non-resorbable double layered suture, this risk can be significantly reduced from 8.9 to 2.5% in the first three postoperative years. However the technique of closure seems to be related to these reduced internal hernia risks outcomes while for example closure with staples does reduce the amount of internal hernia’s but in a much lesser extent. Setting Two large private hospitals specialized in bariatric surgeryMethods All patients receiving a RYGB for (morbid) obesity between 2014 and 2018 were included in this retrospective study. In the first year Peterson’s space was closed using glue, the years hereafter it was closed using a double layered non absorbable suture combined with a piece of glued BIO Mesh.Results The first group of glued RYGB patients showed 15% of patients with an internal hernia through Peterson’s space compared to 0% of patients (p<0.001) who had a combined sutured and BIO Mesh Closure of their Peterson’s space defect. Although an ideal technique for Peterson’s space, it led to 1% of entero-enterostomy kinking due to firm adhesions.Conclusion Closing this defect with clips or sutures partially reduces the chances on herniation, but not completely. Gluing this defect is not beneficial, but placing a BIO Mesh in Peterson’s space is a promising new technique to induce local adhesions. It is at least safe, effective and led to a complete reduction of Peterson’s internal herniations. In the future, a randomized controlled trial comparing this technique to a double layered, non-absorbable suture would give more insights in which is the optimal closure technique.

scholarly journals Preventing Peterson’s space Hernia Using a Bio Synthetic Mesh

2020 ◽  
Author(s):  
Adam Peter Skidmore ◽  
Edo O Aarts
Keyword(s):  
Internal Hernia ◽  
Gastric Bypass Surgery ◽  
Controlled Trial ◽  
Adhesion Formation ◽  
Synthetic Mesh ◽  
Absorbable Suture ◽  
Closure Technique ◽  
Private Hospitals ◽  
Internal Hernias ◽  
Ideal Technique

Abstract Introduction Internal hernias occur after Roux-en-Y Gastric Bypass surgery (RYGB) when small bowel herniates into the intermesenteric spaces that have been created. The closure technique used is related to the internal hernia risks outcomes. Using a non-resorbable double layered suture, this risk can be significantly reduced from 8.9 to 2.5% in the first three postoperative years. By closing over a BIO mesh, the risk might be reduced even more.Setting Two large private hospitals specialized in bariatric surgery.Methods All patients receiving a RYGB for (morbid) obesity between 2014 and 2018 were included in this retrospective study. In all patients, the entero-enterostomy (EE) was closed using a double layered non-absorbable suture. In 2014, Peterson’s space was closed exclusively using glue, the years hereafter in a similar fashion as the EE, combined with a piece of glued BIO Mesh.Results The glued RYGB patients showed 25% of patients with an internal hernia (14%) or open Peterson’s space compared to 0.5% of patients (p<0.001) who had a combined sutured and BIO Mesh Closure of their Peterson’s space defect. Although this was an ideal technique for Peterson’s space, it led to 1% of entero-enterostomy kinking due to the firm adhesion formation. Conclusion Gluing the intermesenteric spaces is not beneficial but placing a BIO Mesh in Peterson’s space is a promising new technique to induce local adhesions. It is above all safe, effective and led to an almost complete reduction of Peterson’s internal herniations. In the future, a randomized controlled trial comparing this technique to a double layered, non-absorbable suture should give more insights into which is the optimal closure technique.

scholarly journals Preventing Peterson’s space Hernia Using a Bio Synthetic Mesh

2020 ◽  
Author(s):  
Adam Peter Skidmore ◽  
Edo O Aarts
Keyword(s):  
Internal Hernia ◽  
Gastric Bypass Surgery ◽  
Controlled Trial ◽  
Adhesion Formation ◽  
Synthetic Mesh ◽  
Absorbable Suture ◽  
Closure Technique ◽  
Private Hospitals ◽  
Internal Hernias ◽  
Ideal Technique

Abstract BackgroundInternal hernias occur after Roux-en-Y Gastric Bypass surgery (RYGB) when small bowel herniates into the intermesenteric spaces that have been created. The closure technique used is related to the internal hernia risks outcomes. Using a non-resorbable double layered suture, this risk can be significantly reduced from 8.9 to 2.5% in the first three postoperative years. By closing over a BIO mesh, the risk might be reduced even more.SettingTwo large private hospitals specialized in bariatric surgery.MethodsAll patients receiving a RYGB for (morbid) obesity between 2014 and 2018 were included in this retrospective study. In all patients, the entero-enterostomy (EE) was closed using a double layered non-absorbable suture. In 2014, Peterson’s space was closed exclusively using glue, the years hereafter in a similar fashion as the EE, combined with a piece of glued BIO Mesh.ResultsThe glued RYGB patients showed 25% of patients with an internal hernia (14%) or open Peterson’s space compared to 0.5% of patients (p<0.001) who had a combined sutured and BIO Mesh Closure of their Peterson’s space defect. Although this was an ideal technique for Peterson’s space, it led to 1% of entero-enterostomy kinking due to the firm adhesion formation.ConclusionGluing the intermesenteric spaces is not beneficial but placing a BIO Mesh in Peterson’s space is a promising new technique to induce local adhesions. It is above all safe, effective and led to an almost complete reduction of Peterson’s internal herniations. In the future, a randomized controlled trial comparing this technique to a double layered, non-absorbable suture should give more insights into which is the optimal closure technique.

scholarly journals Group versus individual antenatal and first year postpartum care: Study protocol for a multi-country cluster randomized controlled trial in Kenya and Nigeria

2019 ◽  
Vol 2 ◽  
pp. 56 ◽  
Author(s):  
Mark M. Kabue ◽  
Lindsay Grenier ◽  
Stephanie Suhowatsky ◽  
Jaiyeola Oyetunji ◽  
Emmanuel Ugwa ◽  
...  
Keyword(s):  
Health Care ◽  
Randomized Controlled Trial ◽  
Data Collection ◽  
Pregnant Women ◽  
Controlled Trial ◽  
Phase 1 ◽  
First Year ◽  
Phase 2 ◽  
Randomized Controlled ◽  
Cluster Randomized

Background: Antenatal care (ANC) in many low- and middle-income countries is under-utilized and of sub-optimal quality. Group ANC (G-ANC) is an intervention designed to improve the experience and provision of ANC for groups of women (cohorts) at similar stages of pregnancy. Methods: A two-arm, two-phase, cluster randomized controlled trial (cRCT) (non-blinded) is being conducted in Kenya and Nigeria. Public health facilities were matched and randomized to either standard individual ANC (control) or G-ANC (intervention) prior to enrollment. Participants include pregnant women attending first ANC at gestational age <24 weeks, health care providers, and sub-national health managers. Enrollment ended in June 2017 for both countries. In the intervention arm, pregnant women are assigned to cohorts at first ANC visit and receive subsequent care together during five meetings facilitated by a health care provider (Phase 1). After birth, the same cohorts meet four times over 12 months with their babies (Phase 2). Data collection was performed through surveys, clinical data extraction, focus group discussions, and in-depth interviews. Phase 1 data collection ended in January 2018 and Phase 2 concludes in November 2018. Intention-to-treat analysis will be used to evaluate primary outcomes for Phases 1 and 2: health facility delivery and use of a modern method of family planning at 12 months postpartum, respectively. Data analysis and reporting of results will be consistent with norms for cRCTs. General estimating equation models that account for clustering will be employed for primary outcome analyzes. Results: Overall 1,075 and 1,013 pregnant women were enrolled in Nigeria and Kenya, respectively. Final study results will be available in February 2019. Conclusions: This is the first cRCT on G-ANC in Africa. It is among the first to examine the effects of continuing group care through the first year postpartum. Registration: Pan African Clinical Trials Registry PACTR201706002254227 May 02, 2017

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