ABSTRACT
Prosthetic materials in surgery have been widely used to repair incisional hernias thus reducing the recurrence rate. The wrong use of such prostheses has been the cause of serious postoperative complications. We propose a tension-free technique which allows the best abdominal wall reconstruction with correct positioning of the mesh even for large parietal defects. A retrospective study was conducted in a series of 64 patients treated with our personal technique using a polypropylene mesh for large incisional hernias. Median follow-up was 32 months. We had 1 case of respiratory discomfort (1.5%) and 4 recurrences (6.25%). No prosthesis infections were reported. The proposed surgical procedure allows correct prosthesis implantation and good short-term and long-term results. This versatile, reproducible technique can also be used for minor incisional hernias.
Subject(s)
Hernia, Ventral/surgery , Adult , Aged , Aged, 80 and over , Female , Hernia, Ventral/pathology , Humans , Male , Middle Aged , Retrospective Studies , Surgical Procedures, Operative/methodsABSTRACT
The aims of surgery in rectal prolapse are various: reducing the prolapse, preventing relapse, clearing up incontinence and avoiding constipation. Among several technical options available, anterior rectopexy would appear to be the most suitable for achieving these aims. A retrospective clinical study was conducted in 32 patients operated on from January 1996 to June 1999. For patient recruitment, the preoperative examinations were clinical evaluation, barium enema, anorectal manometry, and urodynamic tests. Surgical procedures were Orr-Loygue rectopexy in 29 cases and Ripstein rectopexy in 3 cases. A sigmoidectomy was also performed in 9 cases and a Burch cystopexy in 4 cases. Early results are available for all patients; only 29 have been evaluated after a mean follow-up of 47 months (range: 30-72). Rectal tenesmus, faecal incontinence and urinary incontinence improved in all cases. Constipation cleared up in 9 cases after a complementary sigmoidectomy; in 15 of the remaining 20 patients constipation persisted or developed. Indications for surgery for rectal prolapse must be considered with caution. The good results of anterior rectopexy depend on correct surgical technique and prevention of septic and pelvic complications. Sigmoidectomy does not increase the morbility rate. A planned colic resection in patients with delayed transit would prevent postoperative constipation. The good results are stable even over long-term follow-up periods. This procedure is also effective for the treatment of genital prolapses.
Subject(s)
Rectal Prolapse/surgery , Digestive System Surgical Procedures/methods , Follow-Up Studies , Humans , Recovery of Function , Retrospective StudiesABSTRACT
Pain is invariably experienced after haemorrhoidectomy. Internal anal spasm is considered to be a major factor in the genesis of such pain. This prospective randomized study was designed to compare the effectiveness of two manoeuvres (surgical sphincterotomy and chemical sphincterotomy) in reducing post-haemorrhoidectomy pain. Sixty patients (38 males, 22 females) with grade III and IV haemorrhoids were included in this study. In all cases resting anal pressure was reported in the range of 50-100 mm Hg. Group A patients underwent Milligan-Morgan haemorrhoidectomy plus chemical sphincterotomy; group B patients underwent Milligan-Morgan haemorrhoidectomy plus internal left lateral sphincterotomy (0.8-1 cm in length) and group C patients underwent Milligan-Morgan haemorrhoidectomy alone. The postoperative course was carefully evaluated and was found to be better in group B. None of the patients treated by surgical sphincterotomy developed incontinence. Two patients in group C developed anal strictures. When indicated, internal left lateral sphincterotomy (0.8-1 cm) is a safe procedure and reduces post-haemorrhoidectomy pain and stenosis.
