Mesh Fixation with Fibrin Sealant in Totally Extraperitoneal Hernia Repair.

INTRODUCTION: Repair of inguinal hernia is a common procedure, but there is a lack of consensus as to the optimal repair technique along with the use of mesh and methods of mesh fixation. The objective of this study was to evaluate the efficacy and safety of fibrin sealant for mesh fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. MATERIALS AND METHODS: A study was conducted of the first 200 patients undergoing TEP hernia repair with mesh fixation using fibrin sealant between March 2012 and January 2014. The primary outcome measures were (1) chronic pain (persisting for >3 months), (2) persistence of hernia (recurrence identified within first 2 weeks postoperatively), (3) hernia recurrence, and (4) any additional perioperative complications. The mean follow-up in the series was 34.4 ± 6.1 months (range 22.2-44.1). RESULTS: Of the 278 hernias repaired in 204 patients (74 bilateral, 130 unilateral), 38 were recurrent and 240 were primary. Three patients (1.5%) had a persistent hernia, including one with a planned return to the operating room the next day due to poor visualization. Three patients (1.5%) had a hernia recurrence. Twelve patients (5.9%) reported experiencing chronic pain. The remaining complications were minor and resolved over time. CONCLUSIONS: TEP repair of inguinal hernia using mesh secured with fibrin sealant can be effectively used to treat primary, recurrent, unilateral, and bilateral inguinal hernias in adults with minimal recurrence rates and complications during almost 3 years of follow-up.

Listeria monocytogenes cholecystitis: a possible new syndrome.

The U.S. Food and Drug Administration recently added potentially fatal Listeria monocytogenes infection to the list of opportunistic infections that can occur in patients who receive tumor necrosis factor inhibitor therapy. In this study, the first reported case of L monocytogenes cholecystitis associated with etanercept use is described. It also appears that tumor necrosis factor inhibitor therapy likely increases the risk for Listeria cholecystitis. Clinicians need to be aware of this association when selecting antimicrobial therapy for these patients.

The transposed forearm loop arteriovenous fistula: a valuable option for primary hemodialysis access in diabetic patients.

The distal forearm is the site of first choice for creation of an arteriovenous fistula for hemodialysis. The archetypal procedure, the primary radial-cephalic fistula as described by Brescia, yields excellent functional patency for many patients. Results are much less favorable in patients with diabetes mellitus, for whom non-maturation rates as high as 70% have been reported. This is likely due to inadequate inflow caused by atherosclerotic disease of the forearm arteries in diabetics. Secondary autologous access procedures often involve upper arm configurations such as transposed brachial-basilic fistulas. The present study focuses on a valuable alternative for hemodialysis access in diabetic patients, the transposed forearm loop arteriovenous fistula. Over a 2-year period, 16 forearm loop fistulas were created in 16 diabetic patients who either had a failed radial-cephalic fistula or had arterial anatomy deemed inadequate for wrist fistula formation. In each case, the forearm segment of the basilic or cephalic vein was transposed to form a U-shaped loop and anastomosed to the brachial, proximal radial, or proximal ulnar artery distal to the antecubitai fossa. Functional patency was defined as usability for dialysis. Patency rates were calculated by Kaplan-Meier survival analysis. From our results we determined that the forearm loop fistula is an excellent but underutilized technique that exploits the forearm veins while circumventing the distal arterial supply, thus preserving the upper arm vasculature for future use.