ABSTRACT
SUMMARY: Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to gain the initial working space in totally extraperitoneal endoscopic (TEP) hernioplasty, but this increases its cost. Forty-four men with bilateral, primary or recurrent inguinal hernias were randomized to undergo TEP with or without dissection balloon. There were two conversions to transabdominal preperitoneal hernioplasty, or open herniorrhaphy, in the group with balloon and four in the group without balloon. There was no difference in the postoperative morbidity or operation time between the two groups, and there were no major complications in either group. The recurrence rate was 4.3% in the group with the balloon and 7.1% in the group without the balloon. There were no statistically significant differences between the groups. Although our study population is too small to detect small differences between the groups, it seems that the use of a dissection balloon is not beneficial in a bilateral TEP.
Subject(s)
Hernia, Inguinal/diagnosis , Hernia, Inguinal/surgery , Laparoscopy/methods , Surgical Equipment , Adult , Aged , Catheterization , Follow-Up Studies , Humans , Laparoscopes , Male , Middle Aged , Probability , Reference Values , Statistics, Nonparametric , Sweden , Treatment OutcomeABSTRACT
BACKGROUND: Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to facilitate the creation of the initial working space in totally extraperitoneal endoscopic hernioplasty (TEP), but their use adds to the cost of the operation. METHODS: A total of 322 men with unilateral, primary, or recurrent inguinal hernias were randomized to undergo TEP with or without a dissection balloon. RESULTS: In the group with the balloon, three of 161 patients (2.5%) required conversion to transabdominal preperitoneal hernioplasty (TAPP), or open herniorraphy, whereas 17 of 161 patients (10.6%) were converted to TAPP or open herniorraphy in the group without the balloon (p = 0.002). The mean operation time was 55 min in the group with the balloon and 63 min in the group without the balloon (p = 0.004). There was no difference between them in postoperative morbidity, and there were no major complications in either group. The recurrence rate was 3.1% in the group with the balloon and 3.7 % in the group without the balloon (p = 0.8). CONCLUSION: The use of a dissection balloon in TEP reduces the conversion rate and may be especially beneficial early in the learning curve.
Subject(s)
Endoscopy/methods , Hernia, Inguinal/surgery , Adult , Aged , Humans , Male , Middle Aged , Surgical Equipment/statistics & numerical data , Treatment OutcomeABSTRACT
A new disposable device for colostomy control is described. It is a two-piece system consisting of an adhesive base plate and a disposable colostomy plug, attachable to the plate. The plug is made of a soft, pliable plastic material with open cells, containing a carbon filter which allows flatus to pass odour-free. It is packed and compressed in a water-soluble film, which disintegrates immediately after insertion, allowing the plug to expand and prevent the passage of faeces. The device has been tested in 53 patients. Faecal continence and the passage of flatus without noise or odour was achieved in 90%. The median application period until the plug became obstructed with mucus or faeces was 8 h (range 5-24 h or more), the application period being somewhat longer for patients who used bowel irrigation. Patients not using bowel irrigation applied a colostomy bag during the night.
Subject(s)
Colostomy/instrumentation , Disposable Equipment , Adult , Aged , Female , Humans , Male , Middle Aged , Time FactorsABSTRACT
In a prospective, randomized blind study either 400 mg doxycycline or 1500 mg metronidazole were given intravenously in a single preoperative dose to 147 consecutive patients before elective colorectal surgery. Septic complications mainly caused by a mixed flora of aerobes and anaerobes occurred in 13% of the patients in the doxycycline group. Septic complications occurred in 29% of the patients in the metronidazole group and were caused by E. coli and coliform rods. Bacteriological studies showed a marked reduction of anaerobes in peroperative samples in this group. Most postoperative infections were superficial and mild wound infections. The inactivity of metronidazole against aerobes resulted in an unacceptable high frequency of septic complications caused by aerobic bacteria. For chemoprophylaxis metronidazole should therefore be combined with an antimicrobial agent against aerobic bacteria.
Subject(s)
Doxycycline/therapeutic use , Intestine, Large/surgery , Metronidazole/therapeutic use , Premedication , Surgical Wound Infection/prevention & control , Clinical Trials as Topic , Humans , Prospective Studies , Random Allocation , Sepsis/prevention & controlABSTRACT
Questionnaires were sent to 48 ileostomy patients to evaluate the effects on sexual life of an ileostomate before and after conversion to a continent ileostomy. Forty-two patients (88 per cent) returned their questionnaires. Ninety-eight per cent of the patients had sometimes felt embarrassed, uncertain or inhibited by the conventional stoma, whereas only 24 per cent had these reactions after conversion to a continent ileostomy. About 80 per cent of the patients thought that the conventional ileostomy disturbed their sexual life because of the risk of leakage, odor, noise or such inhibitory influence to the continent ileostomy. Four men (31 per cent) and 15 women (52 per cent) reported that their sexual activity was reduced or absent when they had their conventional ileostomy. After conversion to a continent ileostomy all but one man and one woman considered their sexual activity to be normal. One-third of the patients claimed that the partner was embarrassed by the conventional ileostomy, but no partner admitted a negative reaction towards the continent ileostomy. Conversion to a continent ileostomy improved the quality of sexual life in about 85 per cent of both men and women.
Subject(s)
Ileostomy/psychology , Sexual Behavior , Social Adjustment , Adult , Aged , Emotions , Female , Humans , Ileostomy/adverse effects , Male , Middle Aged , Retrospective Studies , Sex , Sexual Dysfunction, Physiological/etiology , Surveys and QuestionnairesABSTRACT
The authors report excellent results with Vivasorb in the treatment of 9 patients with enterocutaneous fistulae. During exclusive alimentation with Vivasorb, there was a spontaneous closure in all 9 cases. With this form of therapy, all the risks of a long-term complete parenteral nutrition can be avoided.
Subject(s)
Intestinal Fistula/diet therapy , Adult , Colectomy , Colitis, Ulcerative/diet therapy , Crohn Disease/diet therapy , Female , Humans , Ileostomy , Intestinal Fistula/etiology , Male , Postoperative ComplicationsABSTRACT
Two and a half years' experience of a new type of tantalum clip for ligation and indication in general surgery is reported. 200 cholecystectomies were followed up without noting any complications due to the use of the clips. Other indications for the use of tantalum clips are discussed.
