Giovanna Brancato

Immunological reaction and oxidative stress after light or heavy polypropylene mesh implantation in inguinal hernioplasty: A CONSORT-prospective, randomized, clinical trial.

AbstractThe relationship between mesh weight and host tissue reaction has, so far, not been fully investigated. Lightweight meshes (LWM) are thought to give less inflammatory response compared with heavyweight meshes (HWM). The present study is a randomized, controlled, double-blind clinical trial performed in 61 patients who underwent an elective inguinal hernioplasty. The primary outcome of the study was to investigate the relationship between total amount of prosthetic material (polypropylene), immunological reaction, and oxidative stress. The study was double-blinded. Sixty-one patients were recruited for the study and randomly assigned to 2 groups (groups A and B). Levels of inflammation markers (interleukin-6 [IL-6] and tumor necrosis factor-&agr; [TNF-&agr;]) and oxidative stress markers (reduced glutathione [GSH] and lipid hydroperoxides [LOOH]) were determined preoperatively and after undergoing inguinal hernioplasty (after 6, 72, and 288 hours), respectively, with LWM and HWM. There was no significant difference in IL-6 levels between HWM and LWM (P = 0.3, 0.7, 0.8 after 6, 72, and 288 hours, respectively). A statistically significant difference was found after 72 hours for TNF-&agr; (P = 0.01), for GSH after 6 hours (P < 0.01), and after 6 and 72 hours for LOOH (P = 0.05, 0.01, respectively). Oxidative stress occurred at earlier time points and was pore accentuated HWM versus LWM and prodromal to TNF-&agr; increase.Also, in randomized clinical trial, the use of LWM gives advantages in terms of less inflammatory response when compared with HWM. Moreover, there is a significant higher oxidative stress after implantation of HWM. The intensity of oxidative stress seems to be strongly related to the amount of implanted polypropylene. (Trial registration number: NCT01090284).

Incidence of pain after inguinal hernia repair in the elderly. A retrospective historical cohort evaluation of 18-years' experience with a mesh & plug inguinal hernia repair method on about 3000 patients.

BackgroundChronic pain after prosthetic inguinal hernioplasty is one of the most important current issues in the current literature debate. Mechanisms related to pain development are only partially known. Influence of age as well as other factors is still unclear. The aim of this work was to evaluate whether development of chronic pain after open prosthetic plug and mesh inguinal hernioplasty is influenced by age.MethodsAnalysis was retrospectively conducted, dividing our cohort of patients (2,902) who had undergone prosthetic open plug&mesh inguinal hernioplasty from Jannuary 1994 to May 2012, following only the age criterion (cut-off 65 yrs.), into two groups (Gr.A<65 yrs, Gr.B>65 yrs.). All patients were routinely submitted to a postoperative questionnaire. Complications such as analgesic assumption were registered in both groups. Pain intensity was classified following the Visual Analogic Scale (VAS). Incidence of chronic pain, discomfort, and numbness, was assessed in both groups. Statistical significance was assessed by X2-test.ResultsOnly 0.2% of patients suffered from a recurrence in our cohort. Postoperative chronic pain was observed in Gr. A in 0.12% of patients vs Gr.B 0.09% (p>0.05). Incidence of other postoperative symptoms such as discomfort or numbness were slightly prevalent on young patients (respectively p = 0.0286 and p = 0.01), while for hyperesthesia and sensation of foreign body no statistically significant difference of incidence between groups was observed.ConclusionsReal chronic pain after inguinal hernioplasty is a rare clinical entity. Other causes of chronic pain should be accurately researched and excluded. In young patients psychological factors seem to show a slight influence. There was no influence of age on chronic postoperative pain incidence after inguinal hernioplasty.

Locally advanced breast cancer in the elderly: a major challenge requiring effective and appropriate treatment.

Aims and background Breast cancer is the most common tumor in women. As the population above 65 years increases, breast cancer will be a more substantial problem for elderly patients. This work reports our experience in the management of stage III and IV locally advanced breast cancer. Methods Nineteen patients over 65 years of age (mean, 70.3 years) with stage III and IV breast cancers, treated between 1990 and 2000, are considered. The management and outcome are evaluated. Results Nine patients had stage IIIA breast cancer, 7 stage IIIB and 3 stage IV. Sixteen underwent Madden mastectomy and 3 simple mastectomy. Patients at stage HIB and 1 patient at stage IV with T4 tumor received neo-adjuvant chemotherapy. There were no significant postoperative complications. Sixteen patients were given tamoxifen and 10 patients adjuvant chemotherapy. Patients were followed for a median of 36.7 months (range, 6–72 months). In 8 patients with stage III disease, metastasis developed. Two patients had local recurrence of disease. Of the patients at stage IIIA, 6 were free from disease (one died from unrelated causes) and 3 had recurrent disease (2 died). Of the patients at stage IIIB, 2 are disease free and 5 had recurrent disease and died. Of the patients at stage IV, only one is alive. Conclusions Stage and individual characteristics of elderly women influence management. Patients should be managed adequately since most of them are fit enough to undergo treatment.

The extraperitoneal prosthetic repair of abdominal wall defects in the elderly

Background One of the most debated topics in the surgery of the abdominal wall hernias is the type and location of the prosthesis and even the employment of prosthetic materials for some authors is an object of discussion [1,2]. The aim of this work is to present the experience of a specialized center in abdominal wall surgery, showing the results of open extraperitoneal prosthetic repair of the abdominal wall defects in the elderly.

Efficacy of the open anterior prosthetic repair in the surgical management of recurrent inguinal hernia in old patients.

Background To date no standard treatment for recurrent ingunal hernias exists. Open or laparoscopic approaches were proposed with apposition of meshes with reknown advantages and limits [1]. Long term recurrence-rate, postoperative pain, fistulization or prosthetic infection risks remain open questions in this surgery. Aim of this work is to show results of our experience with the open anterior approach in local anesthesia[2] for recurrent inguinal hernia repair in old patients (Age>75 yrs).

Tollerability of incisional hernia repair in local anesthesia for old patients in a day surgery setting

Background Nowadays the gold standard of the incisional hernia surgical treatment seems to be the prosthetic repair. In the last 15 years many Authors published about the advantages of the laparoscopic treatment in front of the Open one, even if this issue till today remains controversial [1]. Anyway our group from 18 years is engaged on a clinical application of a third way of incisional hernias repair with an open prosthetic technique under local anesthesia which feasability was already demonstrated [2]. Other published experiences already exists [2]. At the beginninig of our experience we started with small incisional hernias [3]; over the time we submitted to procedure even incisional hernias with orifice’s diameter till 10 cm. Intraoperative sufferance of patients is questioned. The aim of this work is to show the patient’s tolerance to this open preperitoneal mesh technique of incisional hernia repair in local anesthesia in the elderly.

The surgical treatment of colorectal liver metastasis in the elderly

The recent advances in the surgical treatment (more precise diagnostic features, new surgical devices, advancement in intensive care) allowed in the last 15 years an extension of surgical indication to a liver resection to a larger population of patients also in the elderly. Aim of this work is to evaluate the indication and limits of the surgical treatment of colorectal liver metastases in the elderly.