Removal of Benign Superficial Masses Using the TriVex System: Preliminary Clinical Results.

BACKGROUND AND OBJECTIVE: Transilluminated powered phlebectomy using the TriVex system is a new procedure for minimally invasive varicose vein surgery. We used the TriVex system for the removal of benign superficial subcutaneous soft tissue masses, and we also achieved satisfactory clinical effects. The objective of this study was to explore the feasibility, benefits, and technique-related complications of using the TriVex system for the removal of benign superficial masses as a novel and minimally invasive surgical technique. METHOD: Between January 2010 and August 2016, 452 patients with benign superficial soft tissue masses underwent surgical removal of masses using the TriVex II system in our department. The surgical complications, postoperative cosmetic outcome, and personal satisfaction were reviewed at a mean follow-up of 24 months. RESULTS: The TriVex procedure was successfully completed in all patients using only local tumescent anesthesia without any technical problem and serious complications. The mean operation duration was 8.5 minutes, and the average blood loss was 5 mL. Surgical complications were observed in 69 cases (15.3%) of subcutaneous ecchymosis, 34 cases (7.5%) of skin perforation, 14 cases (3.1%) of subcutaneous hematoma, 13 cases (2.9%) of wound infection, and 7 cases (1.5%) of induration of operation area. Eleven patients (2.4%) showed recurrence during the follow-up and were cured by reoperation by the TriVex system. Overall, the majority of patients (N = 436, 96.5%) were very satisfied or satisfied with the outcome. CONCLUSION: The TriVex procedure for the removal of benign superficial masses is simple, safe, and effective with advantages of short operation time, small incisions, and good cosmetic outcome, which is predicted as a new minimally invasive surgery of superficial masses.

Prosthetic Mesh Repair in the Emergency Management of Acutely Strangulated Groin Hernias with Grade I Bowel Necrosis: A Rational Choice.

The aim of this study was to determine the feasibility of prosthetic mesh repair according to the degree of bowel necrosis in the emergency management of acutely strangulated groin hernias. Emergency prosthetic mesh repair versus primary suture repair was randomly performed in 208 consecutive strangulated groin hernia patients with bowel necrosis between January 2005 and August 2016. The degree of bowel necrosis of each patient was determined according to a modified three-grade classification system. Patient characteristics sorted by repair method were analyzed by using Pearson's chi-squared tests. Correlations between mortality and wound-related morbidity with bowel necrosis grade and repair method were analyzed. There was no difference in gender, age, body mass index, comorbid diseases, hernia type (left or right, primary or recurrent), necrosis grade, and mortality between the mesh repair and suture repair groups (all P > 0.05). However, with regard to wound-related morbidity, there was significant difference between the two groups (P < 0.05). Mortality and wound-related morbidity showed significant relationship with necrosis grade, especially with regard to postoperative wound infection (P < 0.001). The wound infection rate with mesh repair was significantly higher than that with primary suture in Grade II and III necrosis patients (P < 0.05), but there was no difference in Grade I patients (P > 0.05). The use of prosthetic mesh in the emergency repair of acutely strangulated groin hernias seems to be as safe as suture-only repair in patients with noninfected strangulated bowel (Grade I necrosis). The use of prosthetic mesh repair is a rational choice made based on the degree of bowel necrosis in the emergency management of acutely strangulated hernias.