Ercüment Kuterdem

Effect of Single-Dose Prophylactic Ampicillin and Sulbactam on Wound Infection After Tension-Free Inguinal Hernia Repair With Polypropylene Mesh: The Randomized, Double-Blind, Prospective Trial

ObjectiveTo assess the value of single-dose, intravenous, prophylactic ampicillin and sulbactam (AS) in the prevention of wound infections during open prosthetic inguinal hernia repair by a double-blind, prospective, randomized trial. Summary Background DataThe use of antibiotic prophylaxis during open prosthetic inguinal hernia surgery is controversial, and no prospective trial has been conducted to examine this issue. MethodsPatients undergoing unilateral, primary inguinal hernia repair electively with the Lichtenstein technique using polypropylene mesh were randomized to receive 1.5 g intravenous AS before the incision or an equal volume of placebo according to a predetermined code of which the surgeons were unaware. Patients with recurrent, femoral, bilateral, giant, or incarcerated hernias or any systemic diseases were excluded. Age, sex, body mass index, American Society of Anesthesiologists score, type of hernia, type of anesthesia, duration of surgery, and use of drains were recorded. Infection was defined according to the criteria of Centers for Disease Control. Patients were evaluated 1 week, 1 month, 6 months, and 1 year after surgery by an independent surgeon. All complications were recorded. Results were assessed using chi-square, Fisher’s exact, and Student t tests as appropriate. ResultsBetween September 1996 and July 1998, 280 patients (140 AS, 140 placebo group) entered the protocol. Four patients from the AS group and seven from the placebo group were excluded because of inadvertent antibiotic administration or follow-up problems. Groups were well matched for all the variables studied and postoperative complications, excluding wound infections, which occurred at a rate of 0.7% in the AS group and 9% in the placebo group (P = .00153). Twelve patients in the placebo group developed wound infections, requiring five repeat hospital admissions in three patients. These three patients suffered deep infections reaching the graft, which resulted in graft loss in two. The single infected patient in the AS group had his graft removed as well because of deep persistent infection. ConclusionsThis study documented a significant (10-fold) decrease in overall wound infections when single-dose, intravenous AS was used during Lichtenstein hernia repair. Deep infections and wound infection-related readmissions were also reduced by the use of AS. Proponents of mesh repairs may therefore be advised to use prophylactic single-dose intravenous antibiotic coverage in the light of the results of this trial. AS proved to be an effective antimicrobial agent.

REPAIR OF MIDLINE INCISIONAL HERNIAS USING POLYPROPYLENE GRAFTS

We report herein our results of routinely performing tension-free repair for midline incisional hernias larger than 3 cm using a woven polypropylene graft between January 1990 and December 1995. Included in this study were 45 patients, 34 (73.1%) of whom had previously undergone a primary repair which had failed. The follow-up period ranged from 3 to 56 months with a mean of 36 months. Only one patient (2.2%) suffered a recurrence of the hernia. Although three (6.6%) developed a wound infection, one (2.2%) developed a wound sinus, and two (4.4%) developed wound seroma, none of these complications required removal of the graft. The findings of this study led us to conclude that Prolene grafts could be used as routine prosthetic material in the repair of incisional hernias. Moreover, during the follow-up period we observed that the modifications we made in the operative technique had a significantly positive effect on the outcome of the patients.

Outcome of the patients with chronic mesh infection following open inguinal hernia repair

Purpose Hernia repairs are the most common elective abdominal wall procedures performed by general surgeons. The use of a mesh has become the standard for hernia repair surgery. Herein, we discuss a management strategy for chronic mesh infections following open inguinal hernia repair with onlay prosthetic mesh. Methods In this study, 15 patients with chronic mesh infections following open inguinal hernia repairs were included. The medical records of these patients were retrospectively reviewed and information regarding presentation, type of previous hernia repair, type of mesh, operative findings and bacteriological examination results were obtained. In all cases, the infected mesh was removed completely and the patients were treated with antibiotic regimens and local wound care. Results Fifteen mesh removals due to chronic infection were performed between January 2000 and March 2012. The mean interval of hernia repair to mesh removal was 49 months. All patients were followed up for a median period of 62 months (range, 16 to 115 months). In all patients, the infections were resolved successfully and none were persistent or recurrent. However, one patient developed recurrent hernia and one developed nerve injury. Conclusion Chronic mesh infection following hernia repair mandates removal of the infected mesh, which rarely results in hernia recurrence.

The Adverse Effects of Octreotide on the Healing of Colonic Anastomoses in Rats

Octreotide, a long-acting somatostatin analogue, is widely used in gastrointestinal hypersecretory states and also for endocrine tumors in an attempt to inhibit the paracrine hormones. Although it is well known that octreotide inhibits trophic and anabolic hormones, no research has been conducted on its adverse effects on wound healing. In the present study, groups of rats were given 20 mcg/kg/day octreotide and 100 mg/kg/day hydrocortisone, the latter being the negative control group, starting 5 days preoperatively. The colonic anastomoses were assessed for healing on postoperative days (PODs) 5 and 8 by detemining the bursting pressure of the anastomoses, performing histopathological analysis, and measuring the hydroxyproline content of the anastomotic tissues. Octreotide was found to affect anastomotic healing negatively on both PODs 5 and 8, but the negative effect of hydrocortisone was significant only on POD 8. No significant difference was found between the adverse effects of the two agents on POD 8. These findings indicated that octreotide has an adverse effect on the healing of colonic anastomoses in rats.

Effect of Recombinant Human Granulocyte/Macrophage Colony-Stimulating Factor on the Healing of Colonic Anastomosis in Rats

The purpose of this study was to investigate the efficacy of recombinant human granulocyte/macrophage colony-stimulating factor (rHuGM-CSF) on the wound healing of colonic anastomosis in rats. In total, 40 male Wistar rats were taken into this study. The control group (n = 20) received subcutaneous saline injection. The experiment group (n

Effect of thyroid hormones on stress ulcer formation

Background:  Stress ulcers are gastric mucosal lesions that may cause life‐threatening upper gastrointestinal bleeding. Although it is known that hyperthyroid status prevents stress ulcer formation, the effect of thyroid hormones given just as the stress is beginning has not been studied. The aim of this study was to assess the effect of thyroid hormone supplementation on gastric stress ulcers at the beginning of the restraint stress.

Lymphangiomas of the Ileum: A Report of Two Cases and a Review of the Literature

Lymphangiomas of the gastrointestinal tract are seen very rarely, especially in adults. We herein present two cases of ileal lymphangioma which were found during surgery. One case was a 43-year-old man with a palpable mass, and the other was a 19-year-old man who presented with symptoms of pyloric stenosis. Although radiologic studies helped us, we could only be certain about the diagnosis after both the operation and histopathologic studies. We performed a total excision with ileal resection in both cases.