Post-partum abdominal wall insufficiency syndrome (PPAWIS): lessons learned from a single surgeon's experience based on 200 cases.

BACKGROUND: Post-partum abdominal wall insufficiency (PPAWI) with rectus diastasis is present in over 30% of women after pregnancy. Little is known about how PPAWI affects the social, sexual life and self-esteem of patients. This study was designed to evaluate the safety of onlay mesh combined with abdominoplasty and its impact on the well-being of the patients. METHOD: Two hundred patients with PPAWI underwent surgery with onlay mesh and abdominoplasty. The safety of the procedure was assessed by postoperative complications, time of hospitalization and time of drainage. Before the operation and 6 months later, a questionnaire asking about the patient's sexual and social life and the presence of back pain was completed. The final cosmetic effect was assessed separately. RESULTS: The onlay procedure with abdominoplasty was found to be safe and fast. The mean operation time was 82 min, and the drainage time was 2.1 days. In this group < 2% postoperative complications were noted. There were no recurrences within the 6 month. Significant improvements in social and sexual life and the level of self-esteem were noted. Back pain was relieved or minimalized in all patients. The final cosmetic effect was insufficient for 2 patients (1%). CONCLUSION: PPAWI can be treated safely with onlay mesh and abdominoplasty. The patients' symptoms were strongly correlated with the morphological status of the front abdominal wall and improved after the procedure. Describing the psychological and social consequences of PPAWI should lead the surgical societies to propose a definition of a new disease called PPAWIS (post-partum abdominal wall insufficiency syndrome).

Pulsed Radiofrequency Neuromodulation Contributes to Activation of Platelet-Rich Plasma in In Vitro Conditions.

OBJECTIVES: Recent years have brought new developments in interventional chronic pain management, namely regenerative orthopedics utilizing platelet-rich plasma (PRP) as well as further evolution of pulsed radiofrequency neuromodulation (PRF). Both methods have been used separately. Here, we investigated whether PRF may potentiate the activation of platelets in PRP samples when both these techniques are combined together in in vitro conditions. MATERIALS AND METHODS: Studies were performed on concentrated PRP samples (PRPs) obtained from acid citrate dextrose-treated blood taken from 11 healthy volunteers. PRPs were divided into four groups: 1) nonactivated PRP; 2) thrombin-activated PRP as a positive control for maximal platelets activation; 3) PRF-treated PRP exposed for 20 min to PRF energy generated by neurotherm radio frequency generator at 500 kHz, with a voltage of 40 V and maximal temperature of 42°C; and 4) a combination of groups 2 and 3. RESULTS: PRF-induced platelet activation measured by platelet factor 4 (PF4) and ATP release from PRPs was significantly higher compared to nonactivated PRPs, and similar to PF4 and ATP release from thrombin-activated PRPs. Thrombin activation did not potentiate PF4 release in PRF samples and even reduced ATP level. Additionally, PRF neither induced any platelet membrane damage measured by lactic dehydrogenase release from PRP nor modified any platelets viability or metabolism measured by MTT. CONCLUSIONS: We confirmed that PRF may activate PRP without additional platelet activators. So, a combination of both methods PRF and PRP application may provide a more effective opportunity for tissue regeneration in dentistry, surgery, dermatology, or in orthopedics.

A randomized, double-blind, placebo-controlled trial of preemptive analgesia with bupivacaine in patients undergoing mastectomy for carcinoma of the breast.

BACKGROUND: In this prospective, randomized, placebo-controlled, double-blinded clinical trial we tested the hypothesis that preemptive analgesia with bupivacaine applied in the area of the surgical incision in patients undergoing mastectomy for breast cancer would reduce post-operative acute pain and would reduce the amount of analgesics used during surgery and in the post-operative period. MATERIAL/METHODS: Participants were assigned into 1 of 2 groups--with bupivacaine applied in the area of surgical incision or with placebo. We assessed the intraoperative consumption of fentanyl, the postoperative consumption of morphine delivered using a PCA method, and the subjective pain intensity according to VAS score reported by patients in the early post-operative period. RESULTS: Out of 121 consecutive cases qualified for mastectomy, 112 women were allocated randomly to 1 of 2 groups--group A (bupivacaine) and group B (placebo). The final study group comprised 106 breast cancer cases. Between the groups, a statistically significant difference was observed with respect to: lower fentanyl consumption during surgery (p = 0.011), lower morphine (delivered by means of a PCA) consumption between the 4-12th postoperative hours (p = 0.02) and significantly lower pain intensity assessed according to VAS score at the 4th and 12th hours after surgery (p = 0.004 and p = 0.02 respectively) for the group A patients. CONCLUSIONS: Preemptive analgesia application in the form of infiltration of the area of planned surgical incisions with bupivacaine in breast cancer patients undergoing mastectomy decreases post-operative pain sensation, limits the amount of fentanyl used during surgery, and reduces the demand for opiates in the hours soon after surgery.

Does the Pain-free hospital certification improve the management of pain following hernioplasty?

BACKGROUND: Postoperative pain still poses a serious problem for 80% of patients undergoing surgery. We assessed the effects of the implementation of standards of postoperative analgesia, according to the guidelines of the "Pain-free hospital" project, and PROSPECT group recommendations, in the daily practice of a general surgical hospital ward. METHODS: One hundred adult patients, scheduled for elective inguinal or umbilical hernia surgery, were included in the study and allocated to two groups, to receive analgesics on demand (control), or postoperative analgesia according to the introduced programs. The number of additional interventions and patients' satisfaction were chosen as primary end points to assess the clinical value of the introduced standards. Additionally, the type and dose of analgesics, and duration of hospital stay were noted. RESULTS: One additional intervention (2%) was required in the treated group, and 9 (18%) - in the control group (p=0.023). In the treated group, the patient satisfaction (0 to 10) score was rated 9 by 39 patients (78%) and 10 by 11 patients (22%). The duration of hospitalisation was similar in both groups. CONCLUSION: We confirmed the success of introducing the standards of pain treatment into the daily practice of a surgical ward.

[Groin hernia in the patients receiving CAPD]. / Przepukliny pachwiny u chorych leczonych dializa otrzewnowa.

Continuous ambulatory peritoneal dialysis (CAPD) is a popular way of treatment of the patients with renal failure. There were 1365 patients on CAPD in Poland in the year 2001. Higher frequency of groin and abdominal hernias was reported in those patients. 10% of dialysed patients developed hernia in the first five years of the therapy. The main problems of hernia repair in the CAPD patients are: increased pressure in abdominal cavity caused by dialysate volume, higher risk of peritonitis, poor prognosis in the complicated cases temporarily or permanently converted to hemodialysis (HD) and the insufficiency of healing process. Complications accorded to hernia repair are the third most often reason of conversion to HD. Conducted studies on hernia repair did not lead to the introduction of the world standard. Authors propose to introduce an unified protocol to improve treatment results. Main guidelines of hernia treatment in CAPD patients are: 1) consultation of the surgeon cooperating with dialysis center in qualification to CAPD, and in the case of hernia symptoms in CAPD patients, 2) application of tension-free methods (PHS recommended), 3) administration of antibiotic prophylaxis, 4) application of local or epidural anesthesia, 5) no necessity of discontinuation of CAPD procedures.