The dynamic locking blade plate: seven-year follow-up results of 389 patients with a femoral neck fracture.

PURPOSE: This study aimed to investigate the long-term outcomes of patients with a femoral neck fracture (FNF), treated with the Dynamic Locking Blade Plate (DLBP). METHODS: Retrospective analysis of prospectively collected data of a multicentre cohort of patients with FNFs was conducted, regarding the long-term incidence of revision surgery after DLBP. Implant failure was evaluated using Kaplan-Meier and Cox regression analysis. Secondary outcomes were the indication for revision surgery, complications, time to revision surgery, rate of elective removal of the implant, potential predictors for revision surgery and mortality. RESULTS: Median follow-up of 389 included patients was 98 months; 20.6% underwent revision surgery; 28.8% after treatment of a displaced FNF (dFNF) and 10.0% with a undisplaced FNF (uFNF). 5.7% (n = 22) of the patients had operation related complications and 32.9% (n = 128) deceased during follow-up. Median time to revision surgery was 13 (dFNF) and 18 months (uFNF). 15.7% of the DLBPs were electively removed. In the multivariate Cox regression analysis, female gender (hazard ratio 2.1, 95% CI 1.2-3.7) and a TAD > 25 mm (hazard ratio 2.9, 95% CI 1.7-5) were significant predictors for revision surgery in patients with dFNF. CONCLUSION: This study is the first long-term follow-up study on the outcome of the DLBP. The DLBP demonstrated positive long-term results in the treatment of FNF.

Evaluation of laparoscopic sleeve gastrectomy on weight loss and co-morbidity.

BACKGROUND: The sleeve gastrectomy is a surgical technique to treat morbid obesity by both restrictive and probably hormonal action. Originally developed as a first stage to gastric bypass, it is more and more performed as a sole procedure. Therefore it is important to report results on weight loss and reduction in co-morbidity. METHODS: A consecutive series of 74 morbid obese patients were evaluated. Parameters were operative variables, complications, weight loss and the need for medication for co-morbidity at least six months postoperatively. RESULTS: Six procedures included the removal of a band and twice a vertical banded gastroplasty was performed previously. Median operating time diminished over time to 71 min. Three procedures were converted into open approach. Major complications were rhabdomyolysis (2), bleeding (2) and leakage (4). Four days was the mean hospital stay. The median follow-up was 12 months (range 6-33). The median percentage of excess weight loss was 49.6% (range 22-96%EWL). The median loss in BMI points was 23.1% (range 9-50%BMIL). Three quarters of the patients were able to diminish or stop their medication for diabetes, hypertension and hyperlipedemia. CONCLUSION: The laparoscopic gastric sleeve is effective in reduction of both weight and co-morbidity and has potential as a sole procedure. Patient's selection is, however, recommendable for initial surgical experience and longer follow-up will be necessary.

Inguinal hernia treatment with the Prolene Hernia System in a Dutch regional training hospital.

INTRODUCTION: In this retrospective study results from inguinal hernia repair with the Prolene Hernia System (PHS) in a regional training hospital were analysed. PATIENTS AND METHODS: One-hundred and seventy-eight primary inguinal hernias and thirty-nine recurrent hernias (initial non-mesh repair) were treated with the PHS. The primary endpoint was the recurrence rate. Secondary endpoints were short-term and long-term complications. Pain was evaluated by use of a visual analog scale (VAS, 0-100), and a short-form 36-item questionnaire was used to assess postoperation quality of life. All patients visited the outpatient clinic for a physical examination (100% follow-up). RESULTS: After a median follow-up of 32 months four patients were diagnosed with recurrent herniation (1.8%), three after primary hernia repair (1.6%) and one after recurrent hernia repair (2.6%). Three superficial wound infections (1.3%), three haematomas needing surgical evacuation (1.3%), and two lesions of the spermatic cord (0.9%) were diagnosed. Seven patients (3.2%) suffered from persistent pain (VAS > 40). Average VAS score was 13 (0-80) >24 months after surgery. CONCLUSION: In a regional training hospital, primary and recurrent inguinal hernias were treated with low recurrence and few complications by use of the PHS.