Laurel J. Blair

Indocyanine Green Historical Context, Current Applications, and Future Considerations

Background. Indocyanine green (ICG) is a dye used in medicine since the mid-1950s for a variety of applications in in cardiology, ophthalmology, and neurosurgery; however, its fluorescent properties have only recently been used in the intraoperative evaluation of tissue perfusion. Method. A literature review was conducted on the characterization and employment of ICG within the medical field. Historical and current context of ICG was examined while also considering implications for its future use. Results. ICG is a relatively nontoxic, unstable compound bound by albumin in the intravascular space until rapid clearance by the liver. It has widespread uses in hepatic, cardiac, and ophthalmologic studies, and its use in analyzing tissue perfusion and identifying sentinel lymph nodes in cancer staging is gaining popularity. Conclusions. ICG has myriad applications and poses low risk to the patient. Its historical uses have contributed to medical knowledge, and it is now undergoing investigation for quantifying tissue perfusion, providing targeted therapies, and intraoperative identification of neurovascular anatomy, ophthalmic structures, and sentinel lymph nodes. New applications of ICG may lead to reduction in postoperative wound-related complications, more effective ophthalmologic procedures, and better detection and treatment of cancer cells.

Computed tomographic measurements predict component separation in ventral hernia repair

BACKGROUND Preoperative imaging with computed tomography (CT) scans can be useful in preoperative planning. We hypothesized that CT measurements of ventral hernia defect size and abdominal wall thickness (AWT) would correlate with postoperative complications and need for complex abdominal wall reconstruction (AWR). MATERIALS AND METHODS Patients who underwent open ventral hernia repair and had preoperative abdominal CT imagining were identified from an institutional hernia-specific surgery outcomes database at our tertiary referral hernia center. Grade III and IV hernias and biologic mesh cases were excluded. CT measures of defect size and AWT were analyzed and correlated to complications and the need for AWR techniques using univariate, multivariate, and principal component (PC) analyses. PC1 and PC2 used five AWT measures, hernia defect width, and body mass index to create a new component variable. RESULTS There were 151 open ventral hernia repairs included in the study. Preoperative findings included 37.7% male; age 55.3 ± 12.5 years; body mass index (BMI) 33.3 ± 7.8 kg/m(2); 60.3% were recurrent hernias with average defect width 8.5 ± 5.0 cm and area 178.3 ± 214 cm(2); AWT at umbilicus 3.5 ± 1.8 cm; and AWT at pubis 7.0 ± 3.2. Component separation was performed in 24.0% of patients and panniculectomy in 34.4%. Wound complications occurred in 13.3% patients, and 2.7% had hernia recurrence. Increasing defect width, length, and area as well as select AWT measurements were associated with increased need for component separation, concomitant panniculectomy, and higher rates of wound and total complications (all P < 0.05). Using multivariate regression, PC1 was associated with wound complications (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.01-1.16); PC2 (hernia defect width) was associated with the need for component separation (OR, 1.16; 95% CI, 1.03-1.30). Hernia recurrence was not predicted by AWT or defect size (OR, 1.00; 95%CI, 0.87-1.15). CONCLUSIONS Preoperative CT measurements of hernia defects and AWT predict wound complications and the need for complex AWR techniques. Obtaining preoperative CT imaging should be a consideration in preoperative planning and may help with patient counseling.

Long-Term Quality of Life Outcomes in Laparoscopic and Open Repair of the Flank Hernia: A Prospective, International Study

RESULTS: Sixty-seven flank hernia repairs, 25 laparoscopic and 42 open, were examined. Patients undergoing laparoscopic vs open repair were similar in age (58.9 vs 61.8 years, p1⁄40.42), BMI (30.2 vs 30.5 kg/m, p1⁄40.78), operative time (97.7 vs 118.1 minutes, p<0.21), and percentage of primary hernias (72.0% vs 76.2%, p<0.70). Open repairs had larger defects (136.0 vs 41.7cm, p<0.068) and longer length of stay (LOS, 5.6 vs 3.0 days, p<0.0012). There were no mesh or wound infections reported in the study population. There was 1 recurrence in each group (3.0% overall). One-year follow-up rates were 84% for laparoscopic and 74% for open; overall mean follow-up was 22.1 months. At 1 year, mesh sensation, pain, and movement limitation were persistent in nearly 30% of patients regardless of operative approach (Table). Overall, of patients endorsing preoperative pain, 56.5% improved, 39.1% stayed the same, and 4.3% worsened by 1 year.