How to deal with complications after laparoscopic ventral mesh rectopexy: lessons learnt from a tertiary referral centre.

AIM: Laparoscopic ventral mesh rectopexy (LVMR) is increasingly recognized as having utility in rectal prolapse, obstructive defaecation syndrome (ODS), faecal incontinence (FI) and multicompartment pelvic floor dysfunction (PFD). This study aimed to highlight gaps in service provision and areas for improvement by examining a cohort of patients with complications referred to a tertiary centre. METHOD: Examination was carried out of a password-protected electronic database of all LVMRs operated on in one institution. RESULTS: Fifty patients (45 women), median age 54 (range, 24-71) years, were referred with early symptomatic failure (n = 27) following an inadequate LVMR or major mesh complications (erosion into another organ, fistulation or stricturing) (n = 23). All were amenable to remedial laparoscopic surgery. Functional improvements were found in pre- and postoperative ODS, Wexner (FI) scores (two-tailed t-test; P < 0.0001) and quality of life (Birmingham Bowel and Urinary Symptoms Questionnaire-22) scores at 3 months (two-tailed t-test; P < 0.001) and normalization at 1 year (P < 0.015). This was mirrored by improved linear bowel symptom severity visual analogue scale scores (two-tailed t-test; P < 0.0001 at 3 months and P = 0.015 at 1 year) . CONCLUSION: LVMR can be associated with technical complications arising from inadequate technique or from operation-specific complications that are amenable to complex revisional laparoscopic surgery with significant improvement in quality of life and function.

A rapid microbiopsy system to improve the preservation of biological samples prior to high-pressure freezing.

A microbiopsy system for fast excision and transfer of biological specimens from donor to high-pressure freezer was developed. With a modified, commercially available, Promag 1.2 biopsy gun, tissue samples can be excised with a size small enough (0.6 mm x 1.2 mm x 0.3 mm) to be easily transferred into a newly designed specimen platelet. A self-made transfer unit allows fast transfer of the specimen from the needle into the specimen platelet. The platelet is then fixed in a commercially available specimen holder of a high-pressure freezing machine (EM PACT, Leica Microsystems, Vienna, Austria) and frozen therein. The time required by a well-instructed (but not experienced) person to execute all steps is in the range of half a minute. This period is considered short enough to maintain the excised tissue pieces close to their native state. We show that a range of animal tissues (liver, brain, kidney and muscle) are well preserved. To prove the quality of freezing achieved with the system, we show vitrified ivy leaves high-pressure frozen in the new specimen platelet.

An oscillating cryo-knife reduces cutting-induced deformation of vitreous ultrathin sections.

A new oscillating cryo-knife for producing uncompressed vitreous sections is introduced. The knife is a modified cryo diamond knife that is driven by a piezo translator. Optimal setting for the oscillation was found to be in the inaudible frequency range of 20-25 kHz. Yeast cells and polystyrene spheres were used as model systems to describe compression in the vitreous sections. We found that compression could be reduced by a factor of about 2 when the knife was oscillating. When the oscillator was turned off, sections were compressed by 40-45%. However, only 15-25% compression was obtained when the knife was oscillating. In some cases completely uncompressed sections of yeast cells were produced. It was also found that the amount of compression depends on the specimen itself and on its embedding medium. With the results shown here, we demonstrate that the oscillating knife can produce high-quality vitreous sections with minimum cutting artefacts.

Amorphous solid water produced by cryosectioning of crystalline ice at 113 K.

Amorphous solid (vitreous) water can be obtained by a number of methods, including quick freezing of a very small volume of pure water, low pressure condensation of water vapour on a cold substrate or transformation of hexagonal ice (the ice which is naturally formed) under very high pressure at liquid nitrogen temperature. Larger volumes can be vitrified if cryoprotectant is added or when samples are frozen under high pressure. We show that a sample of 17.5% dextran solution or mouse brain tissue, respectively, frozen under high pressure (200 MPa) into cubic or hexagonal ice can be transformed into vitreous water by the very process of cryosectioning. The vitreous sections obtained by this procedure differ from cryosections obtained from vitreous samples by the irregular aspect of the sections and by small but significant differences in the electron diffraction patterns. For the growing community of cryo-ultramicrotomists it is important to know that vitrification can occur at the knife edge. A vitreous sample is considered to show the best possible structural preservation. The sort of vitrification described here, however, can lead to bad structural preservation and is therefore considered to be a pitfall. Furthermore, we compare these sections with other forms of amorphous solid water and find it similar to high density amorphous water produced at very high pressures (about 1 GPa) from hexagonal ice and annealed close to its transformation temperature at 117 K.

A new approach for cryofixation by high-pressure freezing.

A newly designed high-pressure freezing machine for cryofixation was established and tested (Leica EMPACT), based on ideas originally proposed by Moor & Riehle in 1968. The new machine, essentially an improved version of our prototype, pressurizes the sample to 2000 bar in a small container (using methylcyclohexane as hydraulic fluid) and at the same time cools the outer surface of the container with a jet of liquid nitrogen. The advantage of this approach is that the machine uses little liquid nitrogen and can be built small and light. The machine is able to vitrify and freeze well a variety of specimens, for example, plant leaves, yeast cells, liver or nerve tissue (more samples are shown at: http://www.ana.unibe.ch/empact). Cooling efficiency is the same as in the traditional machines that use liquid nitrogen to pressurize and simultaneously cool the sample.

Onchocerca fasciata Railliet and Henry, 1910 and its nodule development in camels in Saudi Arabia.

A total of 192 male camels of three age groups (young, adult and old) from Saudi Arabia were examined for Onchocerca fasciata infection by detection of microfilariae in skin snips and nodules in the nuchal ligaments and subcutaneous tissues of the neck and shoulder. The overall prevalence rates were 10.9 and 33.3%, respectively. The prevalence rate by the skin snip technique and the number of microfilariae per gram of skin were higher in young and adult camels than in old camels. However, the prevalence rate by the detection of nodules and the number of nodules per infected camel, increased with increase in age of the camels. An increase in size and weight of nodules was reported with an increase in age of the camels. Nodules varied in diameter from 2 to 36 mm and in weight from 0.5 to 5.0 g. The overall percentage of soft viable and calcified nodules was 42.5 and 57.5%, respectively. The viability of worms decreased, but calcification increased with increased age of the camels. Four levels of degeneration and calcification of worms were described following scanning electron microscopy.