Two-year patient-related outcome measures (PROM) of primary ventral and incisional hernia repair using a novel three-dimensional composite polyester monofilament mesh: the SymCHro registry study.

PURPOSE: This study examined patient-related outcome measures (PROMs) after repair of ventral primary or incisional hernias using Symbotex™ composite mesh (SCM), a novel three-dimensional collagen-coated monofilament polyester textile. METHODS: Pre-operative, peri-operative, and post-operative data were obtained from the French "Club Hernie" registry with 12- and 24-month follow-up. RESULTS: One-hundred consecutive patients (mean age 62.0 ± 13.7; 51% female) underwent repair of 105 hernias: primary (39/105, 37.1%, defect area 5.2 ± 5.6 cm2) and incisional (66/105, 62.9%, 31.9 ± 38.7.8 cm2). The mean BMI was 29.7 (± 5.6 kg/m2). American Society of Anesthesiologists classifications were I 39.4%, II 37.4% and III 23.2%. 75% had risk factors for healing and/or dissection. Of 38 primary repairs, 37 were completed laparoscopically (combined approach n = 1), and of 62 incisional hernia repairs, 40 were completed laparoscopically, and 20 by open repair (combined approach n = 2). Laparoscopic was quicker than open repair (36.2 ± 23.5 min vs. 67.4 ± 25.8, p < 0001). Before surgery, 86.3% of hernias were reported to cause discomfort/pain or dysesthesia. At 24 months (93 of 100 patients), 91 (97.8%) reported no lump and 81 (87.1%) no pain or discomfort. Of 91 patients, 86 (94.5%) rated their repair "good" or "excellent." There were nine non-serious, surgeon-detected adverse events (ileus, n = 3; seroma, n = 6) and one hernia recurrence (6-12 months). CONCLUSIONS: Compared to baseline, open and laparoscopic surgery improved PROMs 24 months after primary and incisional hernia repair. Minimal complications and recurrence support the long-term efficacy of SCM.

Risk factors of perioperative morbimortality after laparoscopic sleeve gastrectomy: a club coelio multicenter study.

OBJECTIVES: Postoperative complications after Laparoscopic sleeve gastrectomy (LSG) can dramatically compromise patient's outcome. The aim of this study is to analyze the per- and postoperative short-term outcomes after LSG and to assess predictive risk factors of complications. METHODS: The study group consisted of 790 patients (610 women and 180 men) who underwent LSG In 2014. All interventions were performed by 18 experienced surgeons members of the Club Coelio. Data about preoperative work-up, surgical techniques, 30-days postoperative morbidity and mortality were collected. Endpoints were perioperative morbidity and mortality and assessment of potential risk factors for complications. RESULTS: Mean age and body mass index were respectively 39 years and 41.5kg/m2. Ninety-one patients (11.5%) had previous bariatric surgery. Morbidity rate was 4.7% (37/790) including 16 leaks (2.0%) and 9 bleedings (1.1%) and no deaths. Risk factors for leak were: previous adjustable banding (p = .0051), with no difference between removal of the banding and LSG in 1 or 2 steps, and type of endostapler (p = .0129). CONCLUSIONS: Leakage after Sleeve was rare but still observed even in experienced hands. The leak rate is particularly high when LSG is performed after adjustable gastric banding removal.

Laparoscopic ventral hernia repair using a novel intraperitoneal lightweight mesh coated with hyaluronic acid: 1-year follow-up from a case-control study using the Hernia-Club registry.

PURPOSE: A case-control study was performed to compare laparoscopic ventral hernia repair (LVHR) using the Ventralight ST™ lightweight surgical mesh with LVHR using other types of mesh. METHODS: Adult patients undergoing intraperitoneal implantation of Ventralight ST™ during LVHR (Ventralight ST™ group; VG) over a 2-year period (2011-2013) were identified from the prospective French Hernia-Club registry. Patients undergoing elective LVHR using other types of intraperitoneal mesh in the first semester of 2013 formed the control group (CG). Patient, hernia and surgical characteristics, and postoperative outcomes after 8 days, 1 month, and 1 year were compared between the two groups. RESULTS: The VG comprised 90 LVHRs in 85 patients, and the CG 86 LVHRs in 81 patients. Patient, hernia and surgical characteristics were similar between the two groups, apart from the method of mesh fixation and the number of procedures involving fascial closure. A low rate of minor complications was observed in both groups at 1 month [4.4 % (VG) and 2.3 % (CG)], and the level of postoperative pain was similar in the two groups at Day 8 and 1 month. After 1 year, no complications, recurrences or cases of chronic pain had occurred in either group, and Quality-of-Life outcomes were similar. Patients rated their procedure as excellent or good in 96 % (VG) and 92 % (CG) of cases. CONCLUSIONS: Ventralight ST™ mesh is effective and well tolerated in LVHR, producing very low complication and recurrence rates in the short and medium term. The results are comparable to those achieved with other types of mesh.

Prevention of parastomal hernia by intraperitoneal onlay mesh reinforcement at the time of stoma formation.

PURPOSE: Parastomal hernia (PSH) is a very frequent complication after creation of a permanent colostomy. The aim of this study is to assess the safety and prophylactic effect of intraperitoneal onlay mesh (IPOM) reinforcement of the abdominal wall at the time of primary stoma formation to prevent PSH occurrence. MATERIALS AND METHODS: This multicentre prospective study concerned 20 patients operated for low rectal carcinoma between 2008 and 2010. Those patients had an elective and potentially curative abdominoperineal excision associated with IPOM reinforcement of the abdominal wall with a round composite mesh centred on the stoma site and covering the lateralised colon. There were 8 men and 12 women with a median age of 69 years (range: 44-88) and a body mass index of 27 (range: 21-35). The major outcomes analysed in the study were operative time, complications related to mesh and PSH occurrence. Patients were evaluated 1 month after surgery and then every 6 months with physical examination and computed tomography scan (CT-scan). For PSH, we used the classification of Moreno-Matias. RESULTS: Surgery was performed by laparoscopy in 17 patients and by laparotomy in 3; 12 had an extraperitoneal colostomy, and 8 had a transperitoneal colostomy. The median size of the mesh was 15 cm (range: 12-15). The median operative time was 225 min (range: 175-300), and specific time for mesh placement was 15 min (range: 12-30). One month after surgery, one patient presented with a mild stoma stenosis that was treated successfully by dilatation. With a median follow-up of 24 months (range: 6-42), no other complication potentially related to the use of the mesh was recorded and no mesh had to be removed. On clinical examination, one patient (1/20 = 5 %) had a stoma bulge that appeared a few months after surgery, but was not associated with symptoms. CT-scan evaluation confirmed that all the patients with a normal clinical examination had no PSH and revealed that the patient with the stoma bulge had a stoma loop hernia (type 1a hernia). This patient was followed up for 36 months, no clinical or radiological aggravation of the stoma loop hernia was observed, and he remained totally asymptomatic. CONCLUSIONS: With 95 % of excellent results, IPOM reinforcement at the time of end colostomy formation in selected patients is a very promising procedure. A drawback of this technique is the possibility of developing a stoma loop hernia due to sliding of the exiting colon between the covering mesh and the abdominal wall. However, this risk is low, and no adverse clinical consequence for the patient was noted in our series.

Laparoscopic resorbable mesh fixation. Assessment of an innovative disposable instrument delivering resorbable fixation devices: I-Clip(TM). Final results of a prospective multicentre clinical trial.

BACKGROUND: The aim of this study was to assess the performance and tolerance of an innovative disposable instrument delivering resorbable clips (I-Clip, Sofradim, France) intended for mesh fixation in inguinal, incisional and umbilical hernias of the abdominal wall. The fixation device was designed to be resorbable in 1 year, with reduced trauma to the underlying tissues or the mesh, and with initial mechanical properties equivalent to those of conventional metal staples. METHODS: The study involved 105 patients with inguinal, umbilical or incisional hernias enrolled from 11 centres. Inguinal totally extra peritoneal (TEP) or trans abdomino pre-peritoneal (TAPP) repair was performed with Parietex mesh, incisional or umbilical hernias were treated via the intraperitoneal route with Parietex composite. I-Clips were used for mesh fixation in both indications according to the surgeon's habits. Efficacy was the principal assessment criteria evaluated by two parameters: quality of fixation evaluated subjectively at the time of procedure and recurrence rate according to the follow up at 1, 6 and 12 months. Pain evaluated by the patients using a visual analogue scale (VAS) was the principal secondary assessment criteria. Other tolerance criteria were also evaluated during surgery and follow up. RESULTS: The surgeons' evaluation of the fixation quality was assessed as good to very good in 100% of ventral hernias and good to very good in 85-92% of inguinal hernias. At 1 month, 90% of patients (94/104) were totally pain-free (VAS score: 0) and only ten patients reported low pain (VAS scores: 0.3-3.1). At 1 year, the pain described by those ten patients finally disappeared, 98% of patients (102/104) were totally pain-free. The rate of minor complications not related to the device concerned 5% of the patients at 1 month, which was reduced to 2% at one year and no recurrence or mesh sepsis was observed. CONCLUSIONS: The ease of use of this device, combined with the absence of recurrence related to the investigated device and the good pain-free outcome in this group of patients confirmed the effectiveness and tolerance of the resorbable fixation concept of I-Clip(TM).

Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial.

Intraperitoneal positioning of conventional parietal mesh provides efficient reconstruction but causes visceral adhesion formation in 80-100% of the cases. The purpose of this clinical trial was to assess the performance and tolerance of a new generation of polyester mesh protected by a hydrophilic resorbable film. Eighty patients were included in a prospective multicenter clinical trial. Patients were treated for ventral hernia via an open approach (64%) or laparoscopically (36%). All meshes were implanted in a midline intraperitoneal location. The main objective was to evaluate the anti-adhesive capability of the mesh in relation to the viscera. In order to assess the absence of visceral adhesion objectively, an ultrasound (US) specific examination was initially validated (pre-operative prediction vs. per-operative findings) and then used during the follow-up. The usual clinical parameters were also collected to follow the patients on a period up to 4 years. Pre-operative US prediction vs. per-operative macroscopic findings: sensitivity 79%, overall accuracy 76%, negative predictive value 85%. After 12 months, 86% of the patients were ultrasonically adhesion free. Early post-operative complications were: seroma/hematoma (16%), subcutaneous infection (4%), cutaneous necrosis (1%) and occlusions (outside the mesh) (2.5%). No mortality was reported. Clinically, after 12-month follow-up, no complication related to post-operative adhesions to the mesh was noted: (occlusion 0%, fistula 0%). Late complications were: mesh sepsis (1%), new defects (4%) and recurrence (2.5%). Finally, 56 patients (75.7%) were clinically evaluated with a mean follow-up of 48+/-6 months. One direct recurrence was noted while six patients experienced new defect outside the mesh. No long-term severe complication such as occlusion or enterocutaneous fistula was observed. Based on a mean clinical follow-up of 4 years, the results of this prospective multicenter clinical trial demonstrate the safety and the efficiency of this composite mesh in the intraperitoneal treatment of incisional and umbilical hernia. In particular there was no early or long-term main complication due to the intraperitoneal location of the mesh.

Diode laser emission linewidth determination: application to H2O line profile studies in the 5 and 1.4 microm regions.

In order to study absorption line profiles using the stabilized diode laser spectrometer of Laboratoire de Physique Moléculaire et Applications (LPMA), a reliable determination of the emission line shape of different diodes laser is needed. In the near infrared region (1.39 and 1.66 microm) we used Distributed Feed Back diode lasers which operate around room temperature and in the middle infrared (5 and 8 microm) we used lead salt diode lasers cooled in a helium closed cycle cryostat or in a liquid nitrogen dewar. Some results obtained in H2O line profile studies in the 1.39 and 5 microm regions are presented as examples demonstrating how absorption line profile measurements can lead to erroneous values of the spectroscopic parameters when the contribution of the diode laser emission line width is neglected.

Pressure broadening study at low temperature: application to methane.

We studied the R(0) line profile in the CH4 v4 band from room temperature to 188 K with N2 as a perturber, to 100 K with O2 as perturber, and from room temperature to 15 K using He as a perturber. The N2 and O2 measurements were performed over a total pressure range of 15-110 mbar, and for the He measurements the maximum sample pressure at 15 K was 1.10 mbar. Broadening parameters were determined, taking into account the confinement narrowing (Dicke effect), and narrowing parameters, deduced from the soft or hard collision model, are compared with the dynamic friction coefficient calculated values. We also obtained preliminary values for the temperature dependence of the N2, O2 and He line broadening parameters for this transition.

A multicentric comparison of transabdominal versus totally extraperitoneal laparoscopic hernia repair using PARIETEX meshes.

The authors report a series of 1972 inguinal hernias treated between 1993 and 1997 by the insertion of a PARIETEX mesh via either a transabdominal-preperitoneal (TAPP) (1,290 procedures) or a totally extraperitoneal TEP approach (682 procedures). Pain scores were equivalent in both groups, while the hospital stay and time to return to normal activity was lower in the TEP group than in the TAPP group (p<0.001). In both groups, the average incidence of the total reported events (complications) was around 10% with no statistical difference. This ratio seemed to compare favorably to previously published reports. Chronic pain was extremely rare (0.6% and 0.7% in the TAPP and TEP groups, respectively). Whatever the approach was, sepsis was also very rare (1/1,526 laparoscopic procedures). These findings illustrate the local tolerance of the mesh. Recurrence rates were below 1% with no statistical difference between groups. This retrospective study demonstrates the clinically apparent local tolerance of this type of mesh. Prospective and long-term clinical results will be necessary to demonstrate that the optimized short-term tolerance of PARIETEX mesh will influence the long term functional results.

Absolute Line Intensities in the 2nu(0)(2) Band of Cyanogen Chloride at 12.8 µm.

Absolute line intensities were measured at high resolution with a tunable diode laser. This work concerns the 2nu(0)(2) band of cyanogen chloride ClCN in the region 780 cm(-1). Thirty-two absorption lines were recorded for the isotopomer (35)ClCN and 26 lines for (37)ClCN. From the analysis of these lines, we determined the bandstrengths: S(0)(v) = 19.14 cm(-2) atm(-1) for (35)ClCN and S(0)(v) = 17.84 cm(-2) atm(-1) for (37)ClCN. Copyright 2000 Academic Press.

Analysis of O2-Broadening of 12CH3F Lines in the 6.8-µm Spectral Region.

Using a tunable diode-laser spectrometer, we have measured the O2-broadening coefficients for 45 lines of methyl fluoride in the QP and QR branches of the nu2 parallel band, and in the PP, PQ, PR, RP, RQ, and RR branches of the nu5 perpendicular band. These lines with J values ranging from 1 to 23 and K from 0 to 9 (K

Collisional-Broadening Coefficients in the nu6 Band of 12CH3F Perturbed by Ar.

Ar-broadening coefficients are measured for 29 lines of CH3F in the RQ0 and RQ6 branches of the nu6 band, using a tunable diode-laser spectrometer. The collisional widths obtained by fitting Rautian profiles to the measured shapes of the lines are significantly larger, especially for the overlapping lines at low-J values, than those obtained from Voigt profiles. The broadening coefficients for the lines belonging to the same low-J transitions (J = 7-10) appear to be greater in the RQ0 branch than in the RQ6 branch. Comparisons have been made with calculated results based on a semiclassical model including adjustable potential parameters. Copyright 1998 Academic Press.

Absolute Absorption Intensities in the Fundamental nu2 and nu5 Bands of 12CH3F.

The absolute strengths of 93 lines belonging to the nu2 and nu5 bands of methyl fluoride were measured in the range of 1416-1503 cm-1 using a tunable diode-laser (TDL) spectrometer. These experimental line intensities were obtained from the equivalent width method. The intensities were analyzed within a dyad system, required to account properly for the strong Coriolis coupling between nu2 and nu5. The fit to the experimental data led to the determination of the dipole moment derivatives partial differentialµ/ partial differentialq2 and partial differentialµ/ partial differentialq5, as well as the first-order Herman-Wallis correction in K to partial differentialµ/ partial differentialq5. The intensities were reproduced with an overall standard deviation of 1.44%, to be compared with a mean experimental uncertainty equal to 1.58%. The values derived for the vibrational band strengths of nu2 and nu5 are 2.124 (18) cm-2.atm-1 and 36.96 cm-2.atm-1 at 296 K, respectively. Copyright 1998 Academic Press.

Correlated and Noncorrelated Lineshape Models under Small Lineshift Condition: Analysis of Self-Perturbed CH3D

The 14 transitions belonging to the P branch of the nu3 band of CH3D, near 1250 cm-1, have been measured with a tunable diode-laser spectrometer. These lines, recorded at a total pressure ranging from 1 to 60 mbar, have been analyzed by means of soft and hard collision lineshape models. We emphasize the equivalence between the correlated and noncorrelated profiles, when the collisional lineshift may be neglected. As a result, new measurements of linestrengths, collisional self-broadening coefficients, and other parameters related to the Dicke effect are provided at room temperature. It is also shown that the instrumental distortions must be properly taken into account to avoid systematic errors on the fitted lineshape parameters, especially at low pressure. The broadening coefficients are compared with results calculated from a semiclassical theory, performed by considering, in addition to electrostatic interactions involving the octopole and hexadecapole moments of CH3D, the dispersion contributions. Copyright 1998 Academic Press.

Diode-Laser Measurements of He-Broadening Coefficients in the nu6 Band of 12CH3F

He-broadening coefficients are measured for 28 lines of 12CH3F in the RQ0 (Ki = 0, DeltaK = 1, DeltaJ = 0) and RQ6 (Ki = 6, DeltaK = 1, DeltaJ = 0) branches of the nu6 band, using a tunable diode laser spectrometer. The collisional widths obtained by fitting Rautian profiles to the measured shapes of the lines are slightly larger than those derived from Voigt profiles. The broadening coefficients for the lines belonging to the same low J transitions are significantly greater in the RQ0 branch than in the RQ6 branch. Moreover, they decrease on the whole with increasing J in the RQ0 branch and tend to increase from J varying from 7 to 10 in the RQ6 branch. These trends may be approximately reproduced by calculations based on a semiclassical impact theory of collisional broadening. Copyright 1997 Academic Press. Copyright 1997Academic Press

Line Intensities in the nu6 Band of CH3F at 8.5 µm

Infrared absolute line intensities of the nu6 band of CH3F have been measured around 8.5 µm using a diode-laser spectrometer. These line strengths were obtained by the equivalent width method and, for 13 lines, by fitting a Rautian profile to the measured shape of the lines. From these results, we have deduced the vibrational band strength to be S0v = 9.66 +/- 0.13 cm-2 atm-1 at 296 K and the first Herman-Wallis factors.