Kyosuke Miyazaki

Comparison of Bassini Repair and Mesh-Plug Repair for Primary Inguinal Hernia: A Retrospective Study

Abstract The purpose of this study was to compare the mesh-plug repair with the Bassini repair for the treatment of primary unilateral inguinal hernias. Patients with primary unilateral inguinal hernias who underwent a Bassini repair (n = 118) between January 1992 and May 1996 and a mesh-plug repair (n = 113) between July 1996 and April 1998 were retrospectively reviewed. We recorded information regarding the types of hernia according to Nyhus classification, operation time, complications, postoperative recovery, and recurrence after surgery. The two groups were comparable regarding age, sex, side of hernia, types of hernia, and the follow-up interval. The operation time was 55 ± 20 min for Bassini repair and 54 ± 18 min for mesh-plug repair. There was no incidence of mesh infection in the mesh-plug repair cases. The amount of diclofenac sodium (suppository) was 307 ± 222 mg in the Bassini repair group and 132 ± 182 mg in the mesh-plug repair group (P < 0.0001). The length of hospital stay was 8.2 ± 2.0 days in the Bassini repair group and 4.3 ± 2.7 days in the mesh-plug repair group (P < 0.01). Nine patients (7.6%) in the Bassini repair group had recurrence, compared with one patient (0.9%) in the mesh-plug repair group. The recurrence-free survival in the mesh-plug repair group was significantly longer than that in the Bassini repair group (P = 0.03). In conclusion, patients with primary unilateral inguinal hernias who undergo a mesh-plug repair recover more rapidly and have less recurrence in comparison with those who undergo a Bassini repair.

Gianturco stents for the venous system: A detailed pathological study

This study was designed to examine the short-term performance of Gianturco stents placed in the venous system, in comparison with that of stents placed in the arterial system. Single-bodied modified Gianturco stents were surgically placed in six dogs (group 1), while in another six dogs, only exposure of the vessels was performed (group 2). Segments with an outer diameter 0.9 times smaller than those of the stents were targeted in the infrarenal inferior vena cava (IVC), the portal vein (PV), and the infrarenal abdominal aorta (AA). The animals were killed 4 weeks postoperatively for pathological analysis. All the segments were patent in both groups. Although the stents placed in the infrarenal IVC and PV were completely covered with neointima, those placed in the infrarenal AA were only partially covered. Furthermore, the venous stents were deeply embedded in the media, while the aortic stents remained in the intima. Medial hyperplasia occurred in the venous stents, while intimal hyperplasia occurred in the aortic stents. In conclusion, Gianturco stents placed in the IVC and PV performed better in the short term than the stents placed in the AA.

Portal vein reconstruction with conventional polytetrafluoroethylene grafts: an experimental study in dogs.

The purpose of this study was to examine the short- and long-term performance of conventional polytetrafluoroethylene (PTFE) grafts for portal vein reconstruction. The grafts were placed as a portal vein replacement in 11 mongrel dogs. At 1 month and 6 months, the grafts were then retrieved and examined for patency, while also undergoing a pathological analysis. During the observation period (at 55 days), one dog died of an unknown cause with a patent graft. The patency rates of the other 10 grafts were 83% (5/6) at 1 month and 100% (4/4) at 6 months. However, the neointima formation was incomplete even 6 months after implantation. In conclusion, although conventional PTFE grafts may be used as a synthetic alternative to autogenous vein grafts, every effort should be made to use autogenous vein grafts before considering conventional PTFE grafts.

Experimental replacement of the thoracic inferior vena cava with a high-porosity expanded polytetrafluoroethylene graft wrapped in an omental pedicle flap

We examined the patency and healing of a highporosity expanded polytetrafluoroethylene (ePTFE) graft implanted as an interposition graft in the thoracic inferior vena cava (IVC) and wrapped in an omental pedicle flap. High-porosity ePTFE grafts of 60 μ fibril length, with an internal diameter of 10 mm and a length of 4 cm, were implanted in 12 mongrel dogs. In 6 dogs, the grafts were wrapped in omental pedicle flap, and in the remaining 6 the grafts were unwrapped. The animals were killed 4 weeks after the replacement and the grafts were removed for examination. Patency of the graft in both groups was 100%; however, the thrombusfree area in the omentum-wrapped group was significantly larger (P<0.05) than that in the unwrapped group. Light microscopy revealed the marked infiltration of cells and capillaries within the graft interstices in the omentum-wrapped group. These findings suggest that encapsulation of the highporosity ePTFE graft is promoted by an omental pedicle flap.