Cambal M

Comparison of self-gripping mesh with mesh fixation with fibrin-glue in laparoscopic hernia repair (TAPP).

AIM Comparison of self-gripping mesh with fibrin-glue mesh fixation for laparoscopic hernia repair using TAPP technique. MATERIALS AND METHODS The trial has a prospective randomized design. The primary end-point was the evaluation of pain at 2 days, 1 month, and 3 months after surgery. The pain occurring 3 months after the surgery was considered as chronic pain. RESULTS We have compared a group of 50 patients with self-gripping mesh with a group of 50 patients with fibrin glue mesh fixation using TAPP technique. There was no statistical difference between the basic group parameters (sex distribution, average age). There was no significant difference between the groups in terms of postoperative pain 1 month and 3 months after the surgery (p>0.05). There was no patient with chronic pain at 3-month follow-up in our trial. The mean operation time was 44 minutes in the group with self-gripping mesh and 48.5 minutes in the group with fibrin glue mesh fixation. There was a significant difference between both groups (p=0.006) CONCLUSION Both fixation methods appear to be a well-tolerated alternative to classical methods for mesh fixation with clips. According to our trial there is no difference in the postoperative pain incidence in self-gripping mesh and fibrin glue mesh fixation groups for laparoscopic hernia repair. Our data has showed that self-gripping mesh represents a tendency to a faster technique in comparison with fibrin-glue fixation. Both techniques are easy-to-use. There is no superior technique according to our trial (Tab. 2, Fig. 2, Ref. 23).

The Effect of Salivary Gland Extract of Lucilia sericata Maggots on Human Dermal Fibroblast Proliferation within Collagen/Hyaluronan Membrane In Vitro: Transmission Electron Microscopy Study

BACKGROUND: Lucilia sericata maggots are applied to chronic wounds to aid healing when conventional treatments have failed. After their application into a necrotic wound, they potentially influence wound healing with a combination of specific proteinases that are involved in the remodeling of extracellular matrix. These proteases cause changes in fibroblast adhesion and spread upon extracellular matrix protein surfaces, affecting integrity of the protein surfaces—especially fibronectin—while maintaining cell viability. OBJECTIVE: This study focused on in vitro monitoring of the effect of homogenate substances prepared from maggot salivary gland of L sericata on the ultrastructure of human neonatal fibroblasts. METHODS: Collagen/hyaluronan membrane was used as the synthetic substitute of extracellular matrix. The cultured human neonatal fibroblasts B–HNF-1 were seeded on the surface of the collagen/hyaluronan membrane and cultured with maggot salivary gland extract (SGE) at a concentration of 2.4 glands/1 mL. RESULTS: The authors observed increased cell metabolism and protein production (euchromatic nucleus, voluminous nuclear membrane, large reticular nuclei, distended and filled cisterns of rough endoplasmic reticulum, Golgi apparatus with saccules, and vesicles packed with fine fibrillar material) after incubating the cells in culture medium with SGE. CONCLUSION: The authors believe that increased cell metabolism and protein production corresponded with formation of microfibrillar net used for migration of fibroblasts in culture, but mainly for proper production of extracellular matrix. The authors suggest that their results may help explain the effect of SGE on wound healing and support implementation of maggot therapy into human medicine.

Growth and Survival of Bagged Lucilia sericata Maggots in Wounds of Patients Undergoing Maggot Debridement Therapy

Maggot debridement therapy (MDT) is an established method of debridement of nonhealing wounds. Despite intense clinical research about its efficacy and effects of substances produced by the larvae, growth and development of maggots in the wounds remain largely unexplored. In the present study, the bags with larvae (n = 52), which had been used to debride traumatic, ischemic, diabetic and venous ulcers, were collected and examined. Survival, length, width and larval instar of the maggots within each bag were recorded and analyzed with respect to the wound type and duration of the treatment. Survival of maggots after a 48-h cycle of MDT ranged between 63.6 and 82.7%. Maggots in venous ulcers had on average 9–19% higher mortality than maggots within traumatic, ischemic, and diabetic ulcers. Length of larvae after 48 h cycle of MDT reached on average 7.09–9.68 mm, and average width varied between 1.77 and 2.26 mm. Larvae in venous ulcers were significantly smaller after 48 h, but not after 72 h treatment compared to the other wound types. Further studies should be aimed to identify other patient-associated factors which might influence growth and survival of the larvae during maggot debridement therapy.

The combined algorithm of venous ulcer therapy.

AIM This prospective study was undertaken to find a new combined algorithm to help patients suffering from long-term chronic non-healing venous ulcers. METHODS A total number of 20 patients suffering from chronic venous ulcers and important co-morbidities such as diabetes mellitus or cardiac failure and not responding to other therapeutic modalities were treated at our surgical department with a combination of compressive sclerotherapy, and maggot debridement therapy (MDT) using larvae of green blowfly Lucilia sericata. RESULTS Using the combined therapy we have achieved a significant clinical effect in 19 patients (95 %). In 1 patient, this effect was only impermanent while 5 patients (25 %) were completely cured. Eleven patients (55 %) benefited despite incomplete healing of the ulcer. With three of our patients we have lost contact. CONCLUSIONS Even though the number of patients in our study is not large, we have achieved remarkable results with the combined algorithm of venous ulcer therapy. We start the healing process with compressive sclerotherapy and when this kind of therapy does not bring about the expected effect, we continue with Maggot debridement therapy. This combination of therapeutic modalities appears to be very effective and efficient (Fig. 2, Ref. 16).

The results of 1 day surgery in proctological practice

Abstract In the last 9 years the authors have operated on 745 patients with proctological problems in the out-patient department under local regional or caudal peridural anaesthesia. These included 432 haemorrhoidectomies, 29 lateral internal sphincterotomies, 166 anal stretches, 56 trans-sphincteric fistulas, 41 ischiorectal abscesses and 21 rectal prolapses. Patients were discharged home after a mean stay of 5.3 h. About 6.4% (48) of operated patients had some problems in the first 24 h (bleeding, pain, discharge, retention of urine). All patients were checked after 3, 7 and 14 days. About 87% of patients were satisfied with their surgical treatment. Most proctological diseases could be operated on as 1 day surgery cases safely. Day surgery is an attractive alternative to impatient surgery as it lowers cost without increasing morbidity.

Reccurent bleeding from Meckel's diverticulum - surgeon's challenge.

The authors of this paper want to share their experience with diagnostic and therapeutic problems in case of chronic small intestinal bleeding from Meckels diverticulum, which ended with acute episode of massive gastrointestinal bleeding requiring emergent surgery.Despite the progress achieved in diagnosing the sources of gastrointestinal bleeding, the diagnosis of small intestinal bleeding is very frequently beyond the ability of making it right, and thus emergent surgery is often the only possibility of saving the patients life on the one hand, and allowing stating the correct diagnosis on the other (Fig. 1, Ref. 6).

Rare conditions of gastrointestinal bleeding.

The aim of this paper is to analyze and discuss an infrequent topic, i. e. rare conditions of gastrointestinal bleeding.Bleeding from gastrointestinal system is a common cause of acute abdomen and the most frequent causes are generally known.Clinicians, first of all emergency medicine staff, surgeons and internists (gastroenterology specialists), general practitioners, or less frequently other specialists, sometimes meet with less common causes of acute or chronic bleeding from gastrointestinal organs. It is quite important to be aware of the possibility the bleeding being caused by some rare condition, which is not so often met in medical practice, because of their great diagnostic and therapeutic problem. The low index of expectation of such a rare etiological unit could be the reason why destiny of such patients can be extremely problematic and why clinicians may fail at management of these patients (Fig. 4, Ref. 8).