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Modifications to Rives technique for midline incisional hernia repair

Abstract. Between 1990 and 1997, 284 patients were treated in our hospital for abdominal hernias. In the original group, 239 patients (84.15%) had midline hernia, and 45 (15.8%) had lateral hernia. A total of 152 midline hernia patients (63.5%) were treated using our variant of Rives technique. In all these cases, preperitoneal and retromuscular polypropylene mesh was used as a reinforcement and was subsequently attached by means of absorbable sutures to the external border of the rectus muscles. There were no deaths. A total of 42 of all patients operated on (27.6%) suffered from long-term postoperative pain. In seven cases (4.6%) it was necessary to remove the prosthesis because of chronic infection, and there were two recurrences in patients in whom the prosthesis had to be removed. In our experience, the Rives technique is a suitable and safe treatment for the repair of midline incisional hernias. The use of absorbable sutures and fixation of the mesh to the external oblique aponeurosis can reduce the original problems of abdominal pain and unaesthetic skin scars.

Expression, pharmacological, and functional evidence for PACAP/VIP receptors in human lung

Pituitary adenylate cyclase-activating peptide (PACAP) type 1 (PAC1) and common PACAP/vasoactive intestinal peptide (VIP) type 1 and 2 (VPAC1 and VPAC2, respectively) receptors were detected in the human lung by RT-PCR. The proteins were identified by immunoblotting at 72, 67, and 68 kDa, respectively. One class of PACAP receptors was defined from125I-labeled PACAP-27 binding experiments (dissociation constant = 5.2 nM; maximum binding capacity = 5.2 pmol/mg protein) with a specificity: PACAP-27 ≈ VIP > helodermin ≈ peptide histidine-methionine (PHM) ≫ secretin. Two classes of VIP receptors were established with 125I-VIP (dissociation constants of 5.4 and 197 nM) with a specificity: VIP ≈ helodermin ≈ PACAP-27 ≫ PHM ≫ secretin. PACAP-27 and VIP were equipotent on adenylyl cyclase stimulation (EC50 = 1.6 nM), whereas other peptides showed lower potency (helodermin > PHM ≫ secretin). PACAP/VIP antagonists supported that PACAP-27 acts in the human lung through either specific receptors or common PACAP/VIP receptors. The present results are the first demonstration of the presence of PAC1 receptors and extend our knowledge of common PACAP/VIP receptors in the human lung.Pituitary adenylate cyclase-activating peptide (PACAP) type 1 (PAC(1)) and common PACAP/vasoactive intestinal peptide (VIP) type 1 and 2 (VPAC(1) and VPAC(2), respectively) receptors were detected in the human lung by RT-PCR. The proteins were identified by immunoblotting at 72, 67, and 68 kDa, respectively. One class of PACAP receptors was defined from (125)I-labeled PACAP-27 binding experiments (dissociation constant = 5.2 nM; maximum binding capacity = 5.2 pmol/mg protein) with a specificity: PACAP-27 approximately VIP > helodermin approximately peptide histidine-methionine (PHM) >> secretin. Two classes of VIP receptors were established with (125)I-VIP (dissociation constants of 5.4 and 197 nM) with a specificity: VIP approximately helodermin approximately PACAP-27 >> PHM >> secretin. PACAP-27 and VIP were equipotent on adenylyl cyclase stimulation (EC(50) = 1.6 nM), whereas other peptides showed lower potency (helodermin > PHM >> secretin). PACAP/VIP antagonists supported that PACAP-27 acts in the human lung through either specific receptors or common PACAP/VIP receptors. The present results are the first demonstration of the presence of PAC(1) receptors and extend our knowledge of common PACAP/VIP receptors in the human lung.

The Rives operation for the repair of incisional hernias

Summary63 medium and large incisional hernias were repaired by the Rives method. A multifilament polypropylene mesh was used in all cases. The mesh was fixed to the abdominal aponeurosis with interrupted non-absorbable polypropylene stitches. There was no mortality. The recurrence rate was 1,5% (1 patient) after a median follow-up of 30 months although a high incidence of postoperative pain (17%) in the Spiegelian area was found during the first year. Based on these results we propose this technique for the repair of incisional hernias perhaps also with the use of long-lasting absorbable sutures or a biological glue. These procedures enhance attachment of the mesh to the abdominal wall and thus relieve pain in the lateral abdominal region.

Incisional hernia following appendectomy. Surgical experience

SummaryAppendectomy is a very frequent cause of incisional hernia. In this paper the rate of recurrence after the hernia repair by simple suture and mesh repair was studied. 17 lateral incisional hernias secondary to appendectomy were repaired over a 9 year period. Prosthetic repair was carried out in 9 cases and primary closure in the remaining 8 cases. All the patients were followed over a period that ranged from 1 to 8 years (mean 5.6 years). There was one recurrence, though 2 patients (11.7%) with mesh repair complained about abdominal pain during the first postoperative year. The study concludes that both techniques can be successfully implemented if the correct indications based on the extent of the defect and the clinical characteristics of the patient are respected.

Tratamiento de la enfermedad hemorroidal mediante desarterialización y hemorroidopexia. Experiencia de varias unidades especializadas

INTRODUCTION Milligan-Morgan and Ferguson haemorrhoidectomy has been the gold standard treatment for symptomatic haemorrhoids for many years. However, escisional techniques are associated with a significant morbidity rate. In recent years, diverse techniques have been described in an attempt to decrease these complications. The guided transanal haemorrhoidal dearterialization THD) doppler is one of these techniques. We report our experience with this new technique. METHODS We performed a prospective study of 475 patients from 5 hospitals from the National Health System, in Spain. The majority of these patients suffered from third grade haemorrhoids (256 [56%]) and underwent THD. We analyse and compare preoperative and postoperative results as well as the homogeneity of the technique between hospitals. RESULTS Spinal anaesthesia was the most elected procedure by the anaesthetist (81.0%). Statistically significant differences were found between pre and postoperative symptoms (P=.03), with an overall improvement after surgery. The average hospitalization was 0.4±0.3 days. The mean number of days of oral analgesics was 8.8±2.7 days. The cumulative complication rate is 16%. CONCLUSION THD is a safe and easily reproducible procedure. Postoperative outcomes demonstrated a low rate of morbidity and recurrence together with early discharge; therefore, a rapid incorporation to daily activities was noted.

SINGLE-DOSE CEFMINOX VERSUS TRIPLE-DOSE CEFOXITIN AS ANTIMICROBIAL PROPHYLAXIS IN SURGICAL TREATMENT OF PATIENTS WITH COLORECTAL CANCER

The efficacy of single-dose cefminox versus multiple-dose cefoxitin as antimicrobial prophylaxis in surgical treatment for colorectal cancer was compared in a prospective, randomized, single-masked, Phase III clinical trial. A total of 124 patients were entered into the study, and 31 were withdrawn after randomization. Of the 93 assessable patients, 47 received cefminox (2 g intravenously at induction of anesthesia) and 46 received cefoxitin (2 g intravenously at induction of anesthesia with subsequent doses 4 and 8 hours later). The incidence of postoperative infectious complications was similar in both groups: wound infection, 5 patients (10.6%) with cefminox and 3 (6.5%) with cefoxitin; intra-abdominal infection, 1 (2.1%) in the cefminox group and 1 (2.2%) in the cefoxitin group. Adverse events were few, and we found no statistical difference between antibiotic regimens. We concluded that single-dose cefminox 2-g monotherapy offers good prophylaxis in elective colorectal surgery. In this setting, cefminox is as effective as cefoxitin 6 g (2 g/4 h).

Tratamiento quirúrgico del enterocele mediante la resección del saco peritoneal y reparación protésica del espacio rectovaginal. Estudio prospectivo y validación de una nueva técnica quirúrgica

Resumen Introduccion El tratamiento quirurgico del enterocele constituye actualmente un tema de debate, no habiendose conseguido la unificacion de criterios en cuanto a la idoneidad de su via de abordaje y tratamiento. La idea de este estudio prospectivo es evaluar los resultados del tratamiento quirurgico del enterocele, mediante una nueva tecnica disenada personalmente y consistente en la reseccion del saco peritoneal redundante y la reparacion protesica del espacio rectovaginal. Material y metodos Se estudian 13 pacientes diagnosticadas de enterocele entre junio 1997 y diciembre de 2000, mediante exploracion clinica y posterior confirmacion con proctografia de evacuacion. Se realiza en todos los casos la extirpacion del saco peritoneal redundante colocando una protesis de polipropileno anclada en el espacio interrectovaginal. La edad media de las pacientes fue de 64 anos (rango 54-86). Se analiza en todas ellas el grado de enterocele, las alteraciones en la defecacion, la asociacion con otras enfermedades del suelo pelvico, asi como la posible repercusion de las mismas en la clinica del enterocele. Resultados La tolerancia a la malla de polipropileno fue perfecta en todos los casos, no observandose infecciones de la malla que nos obligaran a su extraccion. La obliteracion del espacio rectovaginal fue completa en todos los casos, como se comprobo en las proctografias de evacuacion realizadas en los controles posteriores. Los grados de enterocele mayor tuvieron mejor respuesta clinica a la mayoria delos parametros estudiados, que los grados menores de enterocele, no obstante en todas ellas los sintomas fueron menores que antes de la cirugia. Conclusiones En pacientes con malestar pelvico y alteraciones en la defecacion, el enterocele puede ser considerado como un importante factor. El estudio proctografico y el grado de enterocele es fundamental a la hora de plantearnos un tratamiento quirurgico. La reseccion del saco peritoneal redundante del enterocele y la posterior colocacion de una malla protesica de polipropileno parece ser un tratamiento adecuado para estas pacientes.

Adenoma de la vía biliar extrahepática

Las neoplasias biliares extrahepáticas benignas son una entidad rara, con una incidencia menor del 0,1%1. Estas neoplasias benignas tienen riesgo de transformación maligna, y la exéresis local de la lesión se asocia con un elevado porcentaje de recurrencias. Presentamos un caso tratado en nuestro servicio en el que se diagnosticó una neoplasia benigna de la vía biliar como causa de la ictericia obstructiva.