Intraoperative Fascia Tension as an Alternative to Component Separation. A Prospective Observational Study

Incisional hernias are common late complications of abdominal surgery, with a 1-year post-laparotomy incidence of about 20%. A giant hernia is often preceded by severe peritonitis of various causes. The Fasciotens® Abdomen device is used to stretch the fascia in a measurably controlled manner during surgery to achieve primary tension-free abdominal closure. This prospective observational study aims to clarify the extent to which this traction method can function as an alternative to component separation (CS) methods.Methods: We included data of 21 patients treated with intraoperative fascia stretching in seven specialized hernia centers between November 2019 and August 2020.Results: Intraoperatively-measured fascial distance averaged 17.3 cm (range 8.5–44 cm). After application of diagonal-anterior traction >10 kg for an average duration of 32.3 min (range 30–40 min), the fascial distance decreased by 9.8 cm (1–26 cm) to an average 7.5 cm (range 2–19 cm), which is a large effect (r = 0.62). The fascial length increase (average 9.8 cm) after applied traction was highly significant. All hernias were closed under moderate tension after the traction phase. In 19 patients, this closure was reinforced with mesh using a sublay technique.Conclusion: This method allows primary closure of complex (LOD) hernias and is potentially less prone to complications than component separation (CS) methods.

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O36 LOD (LOSS-OF-DOMAIN) HERNIA TREATMENT WITH INTRAOPERATIVE FASCIA TRACTION. DOES THIS TECHNIQUE MAKE RELEASE OPERATIONS SUPERFLUOUS?

British Journal of Surgery ◽

10.1093/bjs/znab396.035 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Henning Niebuhr ◽

Thomas Aufenberg ◽

Halil Dag ◽

Wolfgang Reinpold ◽

Christian Peiper ◽

...

Keyword(s):

Prospective Observational Study ◽

Average Duration ◽

The Body ◽

Component Separation ◽

Gender Ratio ◽

Abdominal Wall Closure ◽

Traction Method ◽

Length Increase ◽

Sublay Technique ◽

Average Patient

Abstract Aim Measurable and controlled stretching of the fascia for 30 minutes during surgery to achieve primary tension-free abdominal wall closure in LOD hernias. This prospective observational study aimed to clarify the extent to which this traction method can function as an alternative to component separation methods. Material and Methods We have already applied this technique in > 50 procedures of LOD hernias. We published the data of first 21 patients treated with intraoperative fascia stretching in seven specialized hernia centers between November 2019 and August 2020. The average patient age was 58 years with a gender ratio of 2.5 males: 1 female. ASA scores were III in 66.7% and II in 33.3%. The body mass index (BMI) averaged 32.5 kg/m2. Thirteen patients were treated with BTA 4 weeks before surgery. Results Intraoperatively-measured fascial distance averaged 17.3 cm (range 8.5–44 cm). After application of diagonal-anterior traction >10 kg for an average duration of 32.3 min (range 30–40 min), the fascial distance decreased by 9.8 cm (1–26 cm) to an average 7.5 cm (range 2–19 cm), which is a large effect (r = 0.62). The fascial length increase (average 9.8 cm) after applied traction was highly significant. All hernias were closed under moderate tension after the traction phase. In 19 patients, this closure was reinforced with mesh using a sublay technique. Conclusions This method allows primary closure of complex LOD hernias and is potentially less prone to complications than component separation methods.

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Ultrasound-Guided Cannulation of the Brachiocephalic Vein in Neonates and Preterm Infants: A Prospective Observational Study

American Journal of Perinatology ◽

10.1055/s-0037-1608803 ◽

2017 ◽

Vol 35 (05) ◽

pp. 503-508 ◽

Cited By ~ 3

Author(s):

Paula Alonso-Quintela ◽

Sandra Terroba-Seara ◽

Aquilina Jiménez-González ◽

Silvia Rodríguez-Blanco ◽

José Vázquez-Martínez ◽

...

Keyword(s):

Observational Study ◽

Success Rate ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Prospective Observational Study ◽

Venous Catheter ◽

Late Complications ◽

Brachiocephalic Vein ◽

Success Rates ◽

Low Weight

Introduction Percutaneous central venous catheter (CVC) insertion is a challenging procedure in neonates, especially in preterm infants. Objective This study aims to describe the technical success and safety profile of ultrasound (US)-guided brachiocephalic vein (BCV) cannulation in neonates. Methods Prospective observational study. Neonates admitted to the neonatal intensive care unit (NICU) in whom US-guided cannulation of the BCV was attempted were eligible. Outcomes included first attempt success rate, the overall success rate, the number of attempts, the cannulation time, immediate mechanical complications, catheter indwelling days, and late complications. Results A total of 40 procedures in 37 patients were included. Median weight and age at the time of cannulation were 1.85 kg (0.76–4.8) and 13 days (3–31), respectively. First attempt and overall success rates were 29 (72.5%) and 38 (95%), respectively. No major complications were observed. Catheter-associated infection rate was 2.4/1,000 catheter days. There were no difference in outcomes between low weight preterm infants (<1.5 kg) and the rest of the cohort. There was no linear relationship between weight at time of insertion and the number of puncture attempts (r = 0.250; p = 0.154) or cannulation time (r = 0.257; p = 0.142). Conclusion US-guided cannulation of the BCV may be considered in acutely ill neonates, including small preterm infants, who need a large bore CVC.

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1498 A Ten-Year Observational Study of The Use of Two-Way Catheters Post-Transurethral Resection of The Prostate Without the Use of Post-Op Irrigation

British Journal of Surgery ◽

10.1093/bjs/znab259.1112 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

L Kretzmer ◽

A Damola ◽

M Sandher ◽

W Martin ◽

S. Ali Ehsanullah ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Primary Outcome ◽

Average Duration ◽

Bladder Irrigation ◽

Post Operative Period ◽

Operative Care ◽

Nice Guidance ◽

Secondary Outcomes ◽

The Uk

Abstract Over 15,000 transurethral resections of the prostate (TURP) are performed yearly in the UK. It is therefore vital that peri-operative care is optimised. Our centre favours the use of two-way catheters post-operatively without continuous bladder irrigation (CBI). Aim To evaluate our practice of using two-way catheters without irrigation post-TURP and to determine impact on patient care compared to standard three-way catheterization. Our primary outcome was duration of admission, but multiple secondary outcomes were also analysed. Method This was a prospective observational study. Every patient undergoing TURP at our centre from 2009 to 2019 was included. Prospective patient data were collected pertaining to peri-operative factors. This data was then compared with data published in the NICE guidance pertaining to TURP. Results 687 patients underwent TURP at our centre between 2009-2019. The average age of patients was 71.42 (±7.89). 87.17% (n = 598) had two-way catheters placed post-operatively. Average duration of admission was 1.61 (±1.35) days. TWOC was successful in 93.74% (n = 644). Complication rate was 8.73% (n = 60), reduced in comparison to other units. Furthermore, when compared to other centres, our method reduced lengths of admission and transfusion rates (1.6 days vs. 3.1 days and 0.87% vs. 2.83% respectively). Conclusions Our method preserves patient safety and is associated with reduced length of admission. It also has cost-saving benefits and a reduced post-operative period of catheterisation. We recommend this practice to the wider urological community.

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