scholarly journals Laparoscopic Sacrocolpopexy Mesh Removal for Persistent Lumbosacral and Right-sided Gluteal Pain Possibly Caused by Nerve “entrapment”

2021 ◽  
Author(s):  
Li Yan ◽  
Lu Bin Liu ◽  
Cheng Zhi Zhao
Keyword(s):  
Scar Tissue ◽  
Synthetic Mesh ◽  
Nerve Entrapment ◽  
Sexual Life ◽  
Laparoscopic Sacrocolpopexy ◽  
Tissue Formation ◽  
Cure Rate ◽  
Mesh Removal ◽  
Mesh Placement ◽  
Gluteal Pain

Abstract Background: Laparoscopic sacrocolpopexy (LSC), which is an important procedure for vault prolapse, has the advantages of high cure rate, low recurrence rate and little impact on sexual life. Few nerve entrapment complications have been reported in the literature.Case presentation: A 48-year-old woman developed persistent lumbosacral and right-sided gluteal pain after the LSC. During diagnostic laparoscopy, we found that the fixation site deviated by approximately 1.5 cm from the middle of the sacral promontory, the anterior surface of the first sacral vertebra. Hence we removed most of the mesh carefully. S1 nerve “entrapment” caused by this deviation, accompanied by the tissue fibrosis and scar tissue formation, may have been the main cause of pain. The patient’s symptoms resolved after surgical intervention. Conclusions: Our case emphasizes that sacral nerve entrapment is a potential complication of retroperitonealized synthetic mesh placement during sacrocolpopexy. We hope that this report can serve as a reference for dealing with similar situations. For skilled laparoscopists, laparoscopic mesh removal is safe and feasible, but attention should be paid to avoid damage to vessels, ureters and other important organs.

scholarly journals Experimental Methods to Simulate and Evaluate Postsurgical Peripheral Nerve Scarring

2021 ◽  
Vol 10 (8) ◽  
pp. 1613
Author(s):  
Alessandro Crosio ◽  
Giulia Ronchi ◽  
Benedetta Elena Fornasari ◽  
Simonetta Odella ◽  
Stefania Raimondo ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Experimental Methods ◽  
Scar Tissue ◽  
Experimental Models ◽  
Tissue Formation ◽  
Surgical Interventions ◽  
Pubmed Database ◽  
Different Types ◽  
Scar Tissue Formation

As a consequence of trauma or surgical interventions on peripheral nerves, scar tissue can form, interfering with the capacity of the nerve to regenerate properly. Scar tissue may also lead to traction neuropathies, with functional dysfunction and pain for the patient. The search for effective antiadhesion products to prevent scar tissue formation has, therefore, become an important clinical challenge. In this review, we perform extensive research on the PubMed database, retrieving experimental papers on the prevention of peripheral nerve scarring. Different parameters have been considered and discussed, including the animal and nerve models used and the experimental methods employed to simulate and evaluate scar formation. An overview of the different types of antiadhesion devices and strategies investigated in experimental models is also provided. To successfully evaluate the efficacy of new antiscarring agents, it is necessary to have reliable animal models mimicking the complications of peripheral nerve scarring and also standard and quantitative parameters to evaluate perineural scars. So far, there are no standardized methods used in experimental research, and it is, therefore, difficult to compare the results of the different antiadhesion devices.

Short-Term Outcomes Following Removal of Infected Hernia Mesh

2021 ◽  
pp. 000313482110241
Author(s):  
Christine Tung ◽  
Junko Ozao-Choy ◽  
Dennis Y. Kim ◽  
Christian de Virgilio ◽  
Ashkan Moazzez
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Logistic Regression ◽  
Body Mass ◽  
Smoking History ◽  
Multivariate Logistic Regression ◽  
Short Term ◽  
Mesh Removal ◽  
Mesh Placement ◽  
Infected Mesh

There are limited studies regarding outcomes of replacing an infected mesh with another mesh. We reviewed short-term outcomes following infected mesh removal and whether placement of new mesh is associated with worse outcomes. Patients who underwent hernia repair with infected mesh removal were identified from 2005 to 2018 American College of Surgeons-National Surgical Quality Improvement Program database. They were divided into new mesh (Mesh+) or no mesh (Mesh-) groups. Bivariate and multivariate logistic regression analyses were used to compare morbidity between the two groups and to identify associated risk factors. Of 1660 patients, 49.3% received new mesh, with higher morbidity in the Mesh+ (35.9% vs. 30.3%; P = .016), but without higher rates of surgical site infection (SSI) (21.3% vs. 19.7%; P = .465). Mesh+ had higher rates of acute kidney injury (1.3% vs. .4%; P = .028), UTI (3.1% vs. 1.3%, P = .014), ventilator dependence (4.9% vs. 2.4%; P = .006), and longer LOS (8.6 vs. 7 days, P < .001). Multivariate logistic regression showed new mesh placement (OR: 1.41; 95% CI: 1.07-1.85; P = .014), body mass index (OR: 1.02; 95% CI: 1.00-1.03; P = .022), and smoking (OR: 1.43; 95% CI: 1.05-1.95; P = .025) as risk factors independently associated with increased morbidity. New mesh placement at time of infected mesh removal is associated with increased morbidity but not with SSI. Body mass index and smoking history continue to contribute to postoperative morbidity during subsequent operations for complications.

scholarly journals VEGF Receptor-2 Activation Mediated by VEGF-E Limits Scar Tissue Formation Following Cutaneous Injury

2018 ◽  
Vol 7 (8) ◽  
pp. 283-297 ◽  
Author(s):  
Lyn M. Wise ◽  
Gabriella S. Stuart ◽  
Nicola C. Real ◽  
Stephen B. Fleming ◽  
Andrew A. Mercer
Keyword(s):  
Scar Tissue ◽  
Vegf Receptor ◽  
Tissue Formation ◽  
Cutaneous Injury ◽  
Scar Tissue Formation

scholarly journals Laparoscopic pectopexy: the learning curve and comparison with laparoscopic sacrocolpopexy

2021 ◽  
Author(s):  
Fei Chi Chuang ◽  
Yu Min Chou ◽  
Ling Ying Wu ◽  
Tsai Hwa Yang ◽  
Wen Hsin Chen ◽  
...  
Keyword(s):  
Learning Curve ◽  
Operation Time ◽  
Synthetic Mesh ◽  
Laparoscopic Sacrocolpopexy ◽  
Apical Prolapse ◽  
Steep Learning Curve ◽  
Surgical Method ◽  
Surgical Field ◽  
Uncontrolled Bleeding

Abstract Introduction and hypothesis In addition to laparoscopic sacrocolpopexy (LS), laparoscopic pectopexy (LP) is a novel surgical method for correcting apical prolapse. The descended cervix or vaginal vault is suspended with a synthetic mesh by fixing the bilateral mesh ends to the pectineal ligaments. This study was aimed at developing a learning curve for LP and to compare it with results with LS. Methods We started laparoscopic/robotic pectopexy in our department in August 2019. This retrospective study included the initial 18 consecutive women with apical prolapse receiving LP and another group undergoing LS (21 cases) performed by the same surgeon. The medical and video records were reviewed. Results The age was older in the LP group than in the LS group (65.2 vs 53.1 years). The operation time of LP group was significantly shorter than that of the LS group (182.9 ± 27.2 vs 256.2 ± 45.5 min, p < 0.001). The turning point of the LP learning curve was observed at the 12th case. No major complications such as bladder, ureteral, bowel injury or uncontrolled bleeding occurred in either group. Postoperative low back pain and defecation symptoms occurred exclusively in the LS group. During the follow-up period (mean 7.2 months in LP, 16.2 months in LS), none of the cases had recurrent apical prolapse. Conclusions Laparoscopic pectopexy is a feasible surgical method for apical prolapse, with a shorter operation time and less postoperative discomfort than LS. LP may overcome the steep learning curve of LS because the surgical field of LP is limited to the anterior pelvis and avoids encountering the critical organs.

Layer-specific strain analysis: investigation of regional deformations in a rat model of acute versus chronic myocardial infarction

2012 ◽  
Vol 303 (5) ◽  
pp. H549-H558 ◽  
Author(s):  
Noa Bachner-Hinenzon ◽  
Offir Ertracht ◽  
Assaf Malka ◽  
Marina Leitman ◽  
Zvi Vered ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Wall Thickness ◽  
Strain Analysis ◽  
Scar Tissue ◽  
The Other ◽  
Tissue Formation ◽  
Operating Characteristics ◽  
Specific Strain ◽  
Characteristics Analysis ◽  
Extent Of Damage

Myocardial infarction (MI) injury extends from the endocardium toward the epicardium. This phenomenon should be taken into consideration in the detection of MI. To study the extent of damage at different stages of MI, we hypothesized that measurement of layer-specific strain will allow better delineation of the MI extent than total wall thickness strain at acute stages but not at chronic stages, when fibrosis and remodeling have already occurred. After baseline echocardiography scans had been obtained, 24 rats underwent occlusion of the left anterior descending coronary artery for 30 min followed by reperfusion. Thirteen rats were rescanned at 24 h post-MI and eleven rats at 2 wk post-MI. Next, rats were euthanized, and histological analysis for MI size was performed. Echocardiographic scans were postprocessed by a layer-specific speckle tracking program to measure the peak circumferential strain (SCpeak) at the endocardium, midlayer, and epicardium as well as total wall thickness SCpeak. Linear regression for MI size versus SCpeak showed that the slope was steeper for the endocardium compared with the other layers ( P < 0.001), meaning that the endocardium was more sensitive to MI size than the other layers. Moreover, receiver operating characteristics analysis yielded better sensitivity and specificity in the detection of MI using endocardial SCpeak instead of total wall thickness SCpeak at 24 h post-MI ( P < 0.05) but not 2 wk later. In conclusion, at acute stages of MI, before collagen deposition, scar tissue formation, and remodeling have occurred, damage may be nontransmural, and thus the use of endocardial SCpeak is advantageous over total wall thickness SCpeak.

Laparoscopic complete sacrocolpopexy mesh removal for right-sided gluteal pain and recurrent mesh erosion

2019 ◽  
Vol 31 (2) ◽  
pp. 411-413
Author(s):  
Aditi Siddharth ◽  
Rufus Cartwright ◽  
Simon Jackson ◽  
Natalia Price
Keyword(s):  
Mesh Erosion ◽  
Mesh Removal ◽  
Gluteal Pain
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