Background: In laparoscopic cholecystectomy, gall bladder extraction via different ports has always been a matter of concern for the surgeons. This study is designed so as to determine the difference in the rate of pain and infection in gall bladder extraction via umbilical and epigastric port.Methods: A prospective randomized study was done from January 2015 to December 2015 at S. N. Medical College, Agra in which 200 patients of cholelithiasis were considered. The patients were randomly selected in the operation theatre for gall bladder extraction via epigastric port (designated as Group-A with n = 100 patients) and gall bladder extraction via umbilical port (designated as Group-B with n = 100 patients).Results: Post-operative pain at 24 hours, in terms of VAS was 3.67±1.42 in Group-A while 2.47±1.17 in Group-B with 10 being the worst pain. The p-value was calculated as .000048. The result is significant at p< .05. A total of eight patients out of two hundred patients suffered port site infections amongst which five were from Group-A (5%) and three were from Group-B (3%).Conclusions: This study thus indicates that in laparoscopic cholecystectomy, gall bladder retrieval through the umbilical port is a better alternative to gall bladder extraction via epigastric port in terms of post-operative pain and port site infection. Our study recommends gall bladder extraction via umbilical port rather than epigastric port.
Background: The main principle of abdominal incisional hernia repair is to restore the anatomical and physiological integrity of the abdominal wall by reconstructing the midline. Ideally, midline structural support is restored by midline approximation of local musculo-aponeurotic tissues. Approximation of these tissues without tension on the suture line will restore the elasticity and flexibility of the abdominal wall. However, 30% to 50% of defects larger than 6 cm recur after primary closure, because of the tension on the suture line. Insertion of an alloplastic material to decrease or eliminate tension on the suture line can reduce the incidence of recurrence to 10% or less. But inorganic prosthetic materials have been associated with a high risk of complications such as protrusion, extrusion, infection, and intestinal fistulization. With the availability of biological materials, surgeons are increasingly using these materials for effective surgical management of abdominal incisional hernia The aim of this study was to determine the feasibility and efficacy of repairing large abdominal incisional hernias by reconstructing the midline using bilateral abdominis rectus muscle sheath (ARS) relaxing incisions and a biological material onlay. Methods: Between January 2002 and December 2009, 104 patients underwent repair oflarge incisional hernias at 2 community hospitals. After replacement of hernia sac contents into the peritoneal cavity, a relaxing incision was made in the ARS bilaterally. Then the midline was closed primarily. The biological material was onlaid and sutured to the lateral edges of the relaxed ARS. Main outcome measures were postoperative complications and hernia recurrence. Results: Median age 61 years (range, 39-86) years. Body mass index was 34 (range, 23-44). Of the 104 patients, 37 had undergone I or more previous repairs. In 19 patients (18%), mesh had been used. In 14 patients the mesh had been placed as a sub lay, and in 5 patients the mesh had been placed laparoscopically. We removed the mesh in all 19 cases. Size of the defect was 195 (range, 150-420) cm 2 • Median operation time was 125 (range, 75-255) minutes. Four patients (3.8%) had a large wound hematoma that required operative drainage. Four (3.8%) patients developed skin necrosis at the edge of the wound, exposing the biological material; they were treated conservatively with dressings and oral antibiotics and discharged 9 days after surgery. Three (2.8%) developed urinary tract infection, which was treated successfully with appropriate oral antibiotics. One (0.9%) developed pneumonia postoperatively; this was successfully treated with appropriate antibiotics and the patient was discharged 10 days after surgery. Wound seroma occurred in 57 (55%) patients. In all cases, the seroma was suspected by physical examination and both confirmed and managed by fine needle aspiration, with or without sonography. The median time between surgery and diagnosis of seroma was 19 days (range, 12-42). The mean time to complete resolution was 52 days...
Aim to study the early and long-term outcomes of the abdominal wall reconstruction (AWR) of complex incisional hernias. Material & Methods We retrospectively reviewed prospectively collected data from 121 patients with 1 to 7 years of follow-up, who underwent midline AWR between 2015 and 2022. The complexity of hernia was determined according to the criteria of N. J. Slater et all. All patients had a hernia gate width ≥10cm (W3). “Loss of domain”≥20% had 38% of patients, a recurrence after previously performed mesh-reinforced AWR (R1–5) - 36%, purulent fistulas, trophic ulcers and chronic seromas - 9%. Three laparotomies or more in anamnesis had 48.7% patients. Obesity had 74.4%; type II diabetes mellitus - 26.5%; COPD - 15.7%. Mesh-reinforced fascial repairs were used in 73 (60.33%) cases, bridged repairs were used in 48 (39.67%) cases. Results Wound complications in the early postoperative period were observed in 48 (40.5%) patients. Long-term outcomes: recurrence hernia - 7 (5.8%), ligature fistula - 3 (2.5%), chronic wound - 2 (1.6%), pseudocyst - 3 (2.5%), building of the mesh - 7 (5.8%). Mesh-reinforced AWRs with primary fascial coaptation resulted in fewer hernia recurrences (2.7% vs 10.4%) and fewer wound (31.5% vs 52.2%) and overall (5.5% vs 16.6%) complications than bridged repairs. At the same time, bridged repairs resulted in fewer postoperative pain (9.6% versus 4.2%) than mesh-reinforced AWRs. Conclusions Surgical treatment of patients with complex incisional hernias requires the use of combined techniques for AWR using a mesh, which reduces the recurrence to 5.8%.
Massive localized lymphedema (MLL) is a rare disease caused by the obstruction of lymphatic vessels with specific clinical morphologic and radiological characteristics. People with morbid obesity are mainly affected by MLL. Lymphedema is easily confused with soft tissue sarcoma and requires differential diagnosis, both the possibility of an MLL and also carcinoma manifestations in the soft tissues. The possible causes of massive lymphedema include trauma, surgery, and hypothyroidism. This report is the first case of MLL treated surgically in the Russian Federation. A detailed computed tomography (CT) characteristics, and an electron microscope picture of MLL are discussed. A 50-year-old woman (BMI of 43 kg/m2) with MLL arising from the anterior abdominal wall was admitted to the hospital for surgical treatment. Its mass was 22.16 kg. A morphological study of the resected mass confirmed the diagnosis of MLL. We review etiology, clinical presentation, diagnosis, and treatment of MLL. We also performed an electron microscopic study that revealed interstitial Cajal-like cells – telocytes not previously described in MLL cases. We did not find similar findings in the literature. It is possible that the conduction of an ultrastructural examination of MLL tissue samples will further contribute to the understanding of MLL pathogenesis.
Mesenchymal stromal cells (MSCs) are a promising tool in regenerative medicine. MSC migra tion to damaged inflammatory sites (homing) is essential for tissue repair. We have studied the migration properties of adipose tissue derived MSCs (AT MSC) after their cocultivation with activated monocytes from the THP 1 cell line. We observed the increased migration rate of AT MSC in vitro with the lack of chemoattractant gradient and to the platelet derived growth factor (PDGF BB), which is a well known chemoattractant for cells of mesenchymal origin. Moreover, the rate of directional AT MSC migration through fibronectin was also increased. We demonstrated that signaling via PDGFR β activated through the binding of integrin receptors with an extracellular matrix is a possible mechanism for stimulation of cellular migration under simulated inflammatory conditions.
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