scholarly journals Modified Laparoscopic Sugarbaker Repair of Parastomal Hernia With a Totally Extraperitoneal Technique

2021 ◽  
Vol 8 ◽  
Author(s):  
Huiyong Jiang ◽  
Dil Momin Thapa ◽  
Xiangjun Cai ◽  
Chun Ma ◽  
Mofei Wang
Keyword(s):  
Parastomal Hernia ◽  
Special Treatment ◽  
Wound Complications ◽  
Stoma Creation ◽  
Totally Extraperitoneal ◽  
Stoma Formation ◽  
Parastomal Hernia Repair ◽  
The Mean ◽  
Laparoscopic Tep

Purpose: Many patients develop a parastomal hernia within the first 2 years of stoma formation, and even surgical repair is associated with high recurrence rates. An intraperitoneal approach is typically used for the laparoscopic repair of parastomal hernia; it is unknown whether a totally extraperitoneal technique (TEP) is feasible. Here we describe a laparoscopic TEP approach using a modified Sugarbaker method for the repair of parastomal hernia.Methods: Seven patients underwent parastomal hernia repair. The retrograde puncture technique was used to create the extrapneumoperitoneum, and the peritoneum was separated with a laparoscopic TEP approach; the mesh was placed using a modified Sugarbaker technique.Results: All patients had an oncologic etiology for stoma creation. The mean (±SD) size of the hernia defect was 3.1 ± 2.7 cm and the mesh size was 303.4 ± 96.8 cm2. The mean operative time was 195.5 ± 20.7 min and average length of hospital stay after surgery was 4.8 ± 2.1 days. One patient had intraoperative subcutaneous emphysema. The average follow-up time was 8.5 ± 2.7 months; mild pain occurred in 2 patients, 3 experienced seroma formation (with no special treatment required), and 1 had early intestinal obstruction (which was treated with conservative care). There was no hernia recurrence, wound complications, or infections of the surgical site or mesh during follow-up.Conclusion: A laparoscopic TEP technique is technically challenging but feasible. Modified laparoscopic Sugarbaker repair of a parastomal hernia with the TEP technique is safe and effective, although the recurrence rate and late complications require confirmation in more cases with long-term follow-up.

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

2021 ◽  
pp. 107110072110130
Author(s):  
Kyeong-Hyeon Park ◽  
Chang-Wug Oh ◽  
Joon-Woo Kim ◽  
Hee-June Kim ◽  
Dong-Hyun Kim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Kirschner Wire ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Simple Method ◽  
Wire Fixation ◽  
The Mean ◽  
Radiographic Union

Background: Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. Methods: We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. Results: The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of −22 degrees (range, −109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. Conclusion: Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. Level of Evidence: Level IV, retrospective case series.

scholarly journals OV18 ENDOSCOPIC RETRO-MUSCULAR REPAIR OF PARASTOMAL HERNIA - A TANTALIZING NEW TECHNIQUE

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Jan Roland Lambrecht
Keyword(s):  
Hernia Repair ◽  
Parastomal Hernia ◽  
Abdominal Wall Hernia ◽  
Transversus Abdominis ◽  
Prophylactic Mesh ◽  
Parastomal Hernia Repair ◽  
Abdominal Wall Hernia Repair ◽  
Video Demonstration ◽  
Mesh Technique

Abstract Development of retro muscular space with transversus abdominis release has reached maturity in endoscopic surgery. Next-level reconstruction is adaptation to parastomal hernia repair alone or in conjunction with another abdominal wall hernia repair. We aim to present this extraperitoneal modified mesh technique based on the Sugarbaker principle with video demonstration and share clinical data and results from twenty-four patients operated with this technique within two years from the spring of 2019 to the spring of 2021. 77% patients had para-colostomy hernia and 41% of the patients had accessory repairs for midline or opposite flank hernia. 18% had prophylactic mesh at index operation, 27% were recurrent parastomal hernia and ostomies were formed median 32 months prior to parastomal hernia repair. 72% of the patients were operated robotically and 28% laparoscopically. Median follow up at time for presentation will be 17 months.

scholarly journals Autologous full-thickness skin graft as reinforcement in parastomal hernia repair: a feasibility study

2020 ◽  
Author(s):  
V. Holmdahl ◽  
U. Gunnarsson ◽  
K. Strigård
Keyword(s):  
Hernia Repair ◽  
Skin Graft ◽  
Parastomal Hernia ◽  
Complication Rates ◽  
Full Thickness ◽  
Full Thickness Skin Graft ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Parastomal Hernia Repair

Abstract Background Parastomal hernia is a common complication of stoma formation and the methods of repair available today are unsatisfactory with high recurrence and complication rates. To improve outcome after surgical repair of parastomal hernia, a surgical method using autologous full-thickness skin grafts as intraperitoneal reinforcement has been developed. The purpose of this study was to evaluate the feasibility of this novel surgical technique in the repair of parastomal hernia. Methods A pilot study was conducted between January 2018 and June 2019 on four patients with symptomatic parastomal hernia. They had a laparotomy with suture reduction of the hernia and reinforcement of the abdominal wall with autologous full-thickness skin. They were then monitored for at least 1 year postoperatively for technique-related complications and recurrence. Results No major technique-related complications were noted during the follow-up Two patients developed a recurrent parastomal hernia at the long term follow-up. The other two had no recurrence. Conclusions Autologous full-thickness skin graft as reinforcement in parastomal hernia repair is feasible and should be evaluated in a larger clinical trial.

scholarly journals The modified anterior ellipsoidal cap titanium cable tension band for comminuted patellar fractures

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987401
Author(s):  
Fasheng Wang ◽  
Tianyi David Luo ◽  
Chunyong Chen ◽  
Yun Xie ◽  
Zhangxiong Lin ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Tension Band ◽  
High Rate ◽  
Wound Complications ◽  
Functional Rehabilitation ◽  
Postoperative Function ◽  
Patella Fractures ◽  
The Mean ◽  
Patellar Fractures

Purpose: The purpose of this study was to assess the outcomes in a series of patients, who underwent cerclage and figure-of-eight tension band wiring using a single titanium cable for comminuted patellar fractures. Methods: We describe a modified tension band technique using a single titanium cable to create an ellipsoidal cap structure that combines the circumferential and figure-of-eight wrapping in the fixation of closed Association for the Study of Internal Fixation/Orthopaedic Trauma Association 34C2 and 34C3 patellar fractures. We retrospectively reviewed 25 patients (16 males and 9 females, mean age 54 years) who underwent the described fixation technique between 2015 and 2017. Postoperative function was evaluated using the Böstman score. Results: At the mean follow-up of 25 months (range 17–39 months), the mean Böstman score was 27.3 ± 2.6 points (range 23–30). Eighteen patients (72%) had excellent results (score ≥28); seven patients (28%) had good results (score 20–27); and no patients had an unsatisfactory result (score < 20). All surgical incisions healed without major wound complications. Two patients reported minor complications (soft tissue irritation, cellulitis). No patients demonstrated loss of reduction or implant failure during the follow-up period. Conclusion: The modified anterior ellipsoidal cap tension band using a single titanium cable created an effective tension band structure in the treatment of comminuted patella fractures. It is a simple operative technique that produced a stable fixation construct, which allowed early functional rehabilitation and weight-bearing with a high rate of excellent outcomes at 2 years after surgery.

scholarly journals The use of Tranexamic Acid in Total Elbow Replacement to Reduce Post-Operative Wound Infection

2018 ◽  
Vol 3 (2) ◽  
pp. 104-107 ◽  
Author(s):  
Syed Mannan ◽  
Mohammed Ali ◽  
Lukasz Mazur ◽  
Mei Chin ◽  
Ahmed Fadulelmola
Keyword(s):  
Wound Healing ◽  
Tranexamic Acid ◽  
Case Series ◽  
Wound Complications ◽  
Reduce Blood Loss ◽  
Total Elbow Replacement ◽  
Elbow Fractures ◽  
The Mean ◽  
Elbow Replacement

Abstract. Background: Incidence of infection following total elbow replacement (TER) is recognised to be higher compared to hip or knee arthroplasty. Extensive swelling following TER can complicate the wound healing which might lead to infection. Tranexamic Acid (TXA) is proven to reduce blood loss peri-operatively which might contribute to better healing outcomes. Our aim is to assess the effect of TXA in wound healing following TER.Methods: A retrospective review of a single surgeon case series. 10 patients had TER mainly for complicated elbow fractures, four of them were relatively immune-supressed. All patients had 2 grams of TXA and antibiotics intra-operatively. All were reviewed at two weeks following surgery for wound check and removal of surgical clips.Results: Seven females and three males with a mean age of 81.5 had TER and TXA. The mean level of pre-operative haemoglobin was 134.40 g/l and the mean post-operative level was 122.70g/l. No patient in this series required blood transfusion. At two weeks and six weeks follow-up, all wound healed up with no signs of infection.Conclusion: TXA has been proven to be safe an effective way of reducing peri-operative bleeding. TXA maintains haemostasis after releasing the tourniquet and therefore reduces the swelling and wound complications post-operatively

scholarly journals Distal Chevron Osteotomy vs The Simple, Effective, Rapid, Inexpensive Technique (SERI) for Mild to Moderate Isolated Hallux Valgus: A Randomized Controlled Study

2020 ◽  
Author(s):  
Ezequiel Palmanovich ◽  
Nissiom Ohana* - equal first author contribution ◽  
Ilan Small ◽  
Iftach Hetsroni ◽  
Eyal Amar ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Controlled Study ◽  
Wound Complications ◽  
Invasive Technique ◽  
Control Group ◽  
Chevron Osteotomy ◽  
The Mean ◽  
One Year

Abstract Background Hallux valgus is a common foot deformity that leads to functional disability with serious sequelae. Minimally invasive surgery is often used to treat hallux valgus in order to reduce wound complications and improve recovery time. The objective of this study was to compare a Simple, Effective, Rapid, Inexpensive (SERI) technique with a simple Chevron technique in patients with minimum of one-year follow. Methods and Materials Between the years 2014-2015 we performed a prospective study comparing the SERI minimally invasive technique to treat symptomatic hallux valgus with a standard chevron osteotomy technique. All procedures were performed by a single fellowship trained foot and ankle surgeon. Twenty-one patients were randomized to the SERI cohort and 15 to the standard Chevron technique. Results The mean pre-operative intermetatarsal angle (IMA) of the SERI group was 14.8 ± 1.9 (11.9 - 22.9). The mean pre-operative IMA of the Chevron control group was 13.3 ± 2.3 (10.4 -18.2) (p = 0.038). The mean IMA two weeks after surgery was 6.0 ± 2.3 (2.4-12) in the SERI group, and 6.1 ± 3 (2.6-13.1) in the control group. At the two week and one year follow up, there was no significant difference found in the IMA between the two groups (p = 0.871). Neither groups reported symptomatic transfer metatarsalgia throughout the follow up period. The SERI group had increased metatarsophalangeal joint (MTPJ) motion (p < 0.001) however, all other parameters with similar. Conclusion The SERI technique provided comparable outcomes at up to one year follow up when compared to a standard Chevron osteotomy for moderate hallux valgus. This study demonstrated good reproducible results using the SERI technique for moderate hallux valgus.

scholarly journals Parastomal hernia repair with onlay mesh remains a safe and effective approach

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Marie Shella De Robles ◽  
Christopher J. Young
Keyword(s):  
Mesh Repair ◽  
Parastomal Hernia ◽  
Loop Ileostomy ◽  
Wound Complication ◽  
Loop Colostomy ◽  
Wound Complications ◽  
Parastomal Hernia Repair ◽  
Significant Difference ◽  
Onlay Mesh ◽  
Midline Approach

Abstract Background Parastomal hernia (PSH) management poses difficulties due to significant rates of recurrence and morbidity after repair. This study aims to describe a practical approach for PSH, particularly with onlay mesh repair using a lateral peristomal incision. Methods This is a retrospective review of consecutive patients who underwent PSH repair between 2001 and 2018. Results Seventy-six consecutive PSH with a mean follow-up of 93.1 months were reviewed. Repair was carried out for end colostomy (40%), end ileostomy (25%), ileal conduit (21%), loop colostomy (6.5%) end-loop colostomy (5%) and loop ileostomy (2.5%). The repair was performed either with a lateral peristomal incision (59%) or a midline incision (41%). Polypropylene mesh (86%), biologic mesh (8%) and composite mesh (6%) were used. Stoma relocation was done in 9 patients (12%). Eight patients (11%) developed postoperative wound complications. Recurrence occurred in 16 patients (21%) with a mean time to recurrence at 29.4 months. No significant difference in wound complication and recurrence was observed based on the type of stoma, incision used, type of mesh used, and whether or not the stoma was repaired on the same site or relocated. Conclusion Onlay mesh repair of PSH remains a practical and safe approach and could be an advantageous technique for high-risk patients. It can be performed using a lateral peristomal incision with low morbidity and an acceptable recurrence rate. However, for patients with significant adhesions and very large PSH, a midline approach with stoma relocation may also be considered.

scholarly journals Keyhole versus Sugarbaker techniques in parastomal hernia repair following ileal conduit urinary diversion: a retrospective nationwide cohort study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elisa Mäkäräinen-Uhlbäck ◽  
Jaana Vironen ◽  
Markku Vaarala ◽  
Pia Nordström ◽  
Anu Välikoski ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hernia Repair ◽  
Urinary Diversion ◽  
Complication Rate ◽  
Parastomal Hernia ◽  
Ileal Conduit ◽  
Hernia Recurrence ◽  
Complication Rates ◽  
Parastomal Hernia Repair

Abstract Background Previous research on parastomal hernia repair following ileal conduit urinary diversion is limited. This nationwide cohort study aims to present the results of keyhole and Sugarbaker techniques in parastomal hernia repair in the setting of ileal conduit urinary diversion. Method All patients in this cohort underwent primary elective parastomal hernia repair following ileal conduit urinary diversion in four university hospitals and one central hospital in Finland in 2007–2017. Retrospective clinical data were collected from patient registries to compare keyhole and Sugarbaker parastomal hernia repair techniques. The primary outcome was parastomal hernia recurrence during the follow-up from primary surgery to the last confirmed follow-up date of the patient. The secondary outcomes were reoperations during the follow-up and complication rate at 30 days’ follow-up. Results The results of 28 hernioplasties were evaluated. The overall parastomal hernia recurrence rate was 18%, the re-operation rate was 14%, and the complication rate was 14% during the median follow-up time of 30 (21–64) months. Recurrence rates were 22% (4/18) after keyhole repair and 10% (1/10) after Sugarbaker repair. Re-operation rates referred to keyhole repair were 22% and Sugarbaker repair 0% during follow-up. The majority of reoperations were indicated by recurrence. Complication rates were 17% after keyhole and 10% after Sugarbaker repair during the 30 days’ follow-up. Conclusion The results of parastomal hernia repair in the setting of ileal conduits are below optimal in this nationwide cohort comparing keyhole to Sugarbaker repair in elective parastomal hernia repair. Nonetheless, the Sugarbaker technique should be further studied to confirm the encouraging results of this cohort in terms of recurrence.

scholarly journals Endoscopic Totally Extraperitoneal Repair of Parastomal Hernia: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Huiyong Jiang ◽  
Dil Momin Thapa ◽  
Chun Ma ◽  
Xiangjun Cai ◽  
Mofei Wang
Keyword(s):  
Case Report ◽  
Open Surgery ◽  
Parastomal Hernia ◽  
Surgical Repair ◽  
Late Complication ◽  
Endoscopic Repair ◽  
Totally Extraperitoneal ◽  
History Of ◽  
Totally Extraperitoneal Repair

A parastomal hernia is a type of incisional hernia that occurs in abdominal integuments in the proximity of a stoma. It is a frequent late complication following colostomy. Surgical repair is currently the only treatment option for parastomal hernia. Here we present the case of a 74-year-old patient with parastomal hernia and a history of open surgery treated with a totally extraperitoneal (TEP) endoscopic approach. There was no recurrence of the hernia at the 3-month follow-up. We discuss the feasibility and possible operative approaches for endoscopic repair of parastomal hernia with the TEP technique.

scholarly journals Parastomal hernia repair: Bielañski hospital experience

2006 ◽  
Vol 53 (2) ◽  
pp. 99-102 ◽  
Author(s):  
Marek Szczepkowski ◽  
Grzegorz Gil ◽  
Adam Kobus
Keyword(s):  
Parastomal Hernia ◽  
Rectus Muscle ◽  
Post Operative Period ◽  
Stoma Formation ◽  
Hernia Formation ◽  
Preoperative Mapping ◽  
Parastomal Hernia Repair ◽  
Mode Of Operation ◽  
Stoma Diameter

The most common occurred long-term stoma complication is parastomal hernia (PH). The incidence of this complication reaches 50% and, according to Goligher1, the parastomal hernia is an inevitable consequence in a certain percentage of all cases of stoma formation. The factors that may affect the incidence of parastomal hernia include the site of stoma, particularly its position relative to the rectus muscle of abdomen, preoperative mapping out of the stoma site, stoma diameter, intraperitoneal or extraperitoneal bringing out of the intestine and its fixation to fascia, closing of the area around the stoma opening, the mode of operation - planned or emergency, and finally the kind of stoma - ileostomy, colostomy, end stoma and loop stoma. None of these factors, however, has been identified to have the key importance in parastomal hernia formation. It seems that the only factor that significantly increases the incidence of parastomal hernia is the length of post-operative period.

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