Résumé
Introduction: Surgical repair of the inguinal hernia is themost common general surgery procedure performed today.Even today inguinal hernias pose a great burden on thehealthcare system. Hence even modest improvements inclinical outcomes are warmly welcomed. This study describesthe technique of Prolene Hernia System (PHS) in its simplifiedform for the beginners to learn it quickly.Material and methods: A prospective study was conductedin 50 patients in a tertiary centre from April 2010 to Oct 2011for period of 18 months. Patients’ demographic data wascollected and patient selected as per the selection criteria. ThePHS mesh repair was performed as described by Gilbert etal3 with some simplification and modification as described.Absorbable sutures were used to fix the mesh in the describedfour stitch technique. All data collected from study wereentered in the database for statistical analysis.Results: All participants were males and most of them werefrom manual labour background (38 patients (76%). Most ofthe patients belonged to 26-35 year age group (18 patients(36%). 40 participants were found to have indirect hernias(80%). Right sided hernia was found more common (33patients (66%). The mean duration of surgery was 31.96 min(SD – 2.303). Intraoperative complication included 2 cases ofnerve damage (4%). The mean pain score in first 24 hours was6.82/10 (SD – 1.848). None of the patients reported recurrenceof hernia (0% recurrence).Conclusion: The PHS mesh, consisting of an underlay patch,an overlay patch, and a joining connector, has potentialbenefits over the traditional Lichtenstein, Mesh Plug Repair(MPR) and Laparoscopic repairs. The PHS mesh providescomplete coverage of the entire myopectineal orificethrough the underlay placed in the preperitoneal space, theoverlay placed in the inguinal canal and the connector whichmaintains the mesh in position. In our study we also found thatuse of absorbable sutures helped in relieving neuralgia andlessened chronic groin pain by causing less permanent nerveentrapment without affecting the recurrence rate.
Résumé
Background: Which are the different ways of stabilizing connective tissue grafts (CTGs) for root coverage and gingival augmentation by means of placement of sutures? There are various defined and undefined ways of stabilizing CTGs depending on experience and personal preferences. Most of the techniques profess use of absorbable sutures in separate interrupted fashion (sutures at the corners of the graft wherever possible). Aim: This paper describes a new suturing method, “the lingually-tied horizontal mattress contouring suture,” for stabilization of CTGs with or without epithelialized collar at the recipient site, for use with papilla retention and sparing techniques to treat marginal tissue recessions. Methods and Material: The suturing technique is described in detail. It can be indicated for good number of root coverage cases, with additional objectives of gingival augmentation, specifically developed for papilla sparing and papillary buccal de-epithelialization recipient site preparations. Results: Over a period of last 16 years this suturing technique showed promising results in terms of graft stabilization and survival. The main advantage of this technique lies in the use of cost-effective nonabsorbable sutures that usually retain some amount of tension on the soft tissues longer. Conclusion: The primary objective of the suturing technique, per se, is to stabilize the CTG firmly along the contours of the root surface and to expedite a very close adaptation to the interdental soft tissues as well. The secondary objective of the article or publication is to disseminate the knowledge acquired through long periods of performance and observation for the benefit of the periodontal community as whole. Further validation is advocated.
Résumé
Objective To explore the operation skills of laparoendoscopic single site surgery ( LESS) of total hysterectomy , to expand the application of LESS in the field of in gynecologic surgery . Methods A total of 23 cases of total hysterectomy were completed under laparoendoscopic single site surgery in Peking Union Medical College Hospital from January 2012 to August 2013, applying with combination of the traditional laparoscopic and special LESS apparatuses , intelligent electronic coagulation and excision device and the self-fixed absorbable sutures ( V-LOC).The datas of the patients during the operations and the follow-up were recorded and analyzed Results Twenty-three cases LESS-TH are accomplished.The weight of uterus was (230+38) g.The operation time was (73+22) minutes, with the intraoperative blood loss (99 ±53) ml.The postoperative intestinal function recovery time was (13 +4) hours, and postoperative hospitalized time was ( 1.8 ±0.6 ) days, with the postoperative pain visual analogue scale 3.9 ±1.6.There were no complications reported during intraoperative and postoperative time.All of our patients was finished the follow-up from 14 d to 2 months.As usual, vaginal discharge is normal, wound healed well, most of the wounds healing (19/23) hidden in umbillicus, no obvious scar, vaginal stub wound healed well Conclusions ( 1 ) LESS can accomplish total hysterectomy of uterus of gestational age less than 8 weeks safely and effectively .( 2 ) Combination of traditional laparoscopic and special LESS appatatuses , the use of intelligent energy devices and V-LOC to suture vaginal stub could make the total hysterectomy by LESS much easier and safer .