Purpose. Synthetic meshes are now widely used for a repair of various tissue defects. Polypropylene meshes (PPMs), the type most frequently used for repair of abdominal wall defects, have some disadvantages, therefore the development of new mesh materials for reconstructive surgery is an important topic. A TiNibased alloy superelastic mesh implant has been compared with a PPM in the Wistar rat model. Experimental. A midline resection abdominal wall defect (2 cm×3 cm) was treated with a mesh implant (2.5 cm×3.5 cm). Three groups of 20 animals were assessed: (1) a TiNi-based alloy mesh (TNM) group with the defect managed by a TiNi-based wire woven implant; (2) a PPM group with the defect repaired by Optomesh®; and (3) a no-mesh (NM) group treated without the use of any prosthetic material for systemic reaction to implant control. Evaluation of both mesh implantations was carried out on days 14, 28, 56 and 90 after surgery. The following data were compared: general condition of the animals, macroscopic evaluation of the implant area and microscopic evaluation of the tissue surrounding the mesh with the use of scanning electron and light optical microscopy. Results. All the animals from NM group developed hernias. The PPM group showed satisfactory results, although some complications like implant dislocation (6/20) and hernia recurrence (5/20) were noted. In the TNM group neither shrinkage nor implant dislocation were observed. Compared with the PPM group, the TNM group was characterized by no inflammation reaction and better integration with tissues. Conclusions. Suppression of inflammation response together with a more physiological wall remodeling process than with PPM makes TNM an attractive concept for abdominal wall defect reconstruction. Since there was neither shrinkage nor dislocation of the TNM itself it may be suitable for intraperitoneal management. The essence of enhanced biocompatibility is due to stress-strain mechanical behavior of TNM and its surface oxycarbonitride layer, which facilitate its incorporation. Summarizing, TNM was found to be a very promising material for the repair of abdominal wall defects in clinical practice. Ideally TNM would be applied in circumstances when there are indications for the management of large hernias by PPM.
Background Regional lymph node metastases are the main adverse prognostic factor in patients with rectal cancer without distant metastases. There are discrepancies, however, regarding additional risk factors in the group of ypN + M0 patients. The purpose of the study was to assess clinical and pathological factors affecting long-term oncological outcomes in the group of ypN + M0 patients after radical rectal anterior resection. Methods 112 patients with ypN + M0 rectal cancer after neoadjuvant therapy and radical anterior resection were subject to a retrospective analysis. The effect of potential factors on survival was assessed with the use of Kaplan–Meier curves together with a log-rank test and multiple factor Cox proportional hazards model. Results In the multiple factor Cox analysis, adverse factors affecting disease-free survival (DFS) were: the use of angiotensin-converting enzyme inhibitors (ACEIs) (hazard ratio HR: 3.11, 95% CI 1.01–9.56, p = 0.047), presence of perineural invasion (HR: 7.27, 95% CI 2.74–19.3, p < 0.001) and occurrence of postoperative complications (HR: 6.79, 95% CI 2.09–22.11, p = 0.001), while a positive factor was the negative lymph node (NLN) count > 7 (HR: 0.33, 95% CI 0.12–0.88, p = 0.026). In the disease-specific survival (DSS) analysis, an adverse factor was the use of ACEIs (HR: 4.275, 95% CI 1.44–12.694, p = 0.009), while a positive effect was caused by NLN > 5 (HR: 0.22, 95% CI 0.082–0.586, p = 0.002). Conclusions The use of ACEIs may have a negative effect on long-term treatment outcomes in patients with ypN + M0 rectal cancer. In this group of patients, the NLN count seems to be an important prognostic factor, as well.
Background: Regional lymph node metastases are the main adverse prognostic factor in patients with rectal cancer without distant metastases. There are discrepancies, however, regarding additional risk factors in the group of ypN+M0 patients.The purpose of the study was to assess clinical and pathological factors affecting long-term oncological outcomes in the group of ypN+M0 patients after radical rectal anterior resection.Methods: 112 patients with ypN+M0 rectal cancer after neoadjuvant therapy and radical anterior resection were subject to a retrospective analysis. The effect of potential factors on survival was assessed with the use of Kaplan-Meier curves together with a log-rank test and multiple factor Cox proportional hazards model.Results: In the multiple factor Cox analysis, adverse factors affecting OS were: the use of angiotensin-converting enzyme inhibitors (ACEIs) (HR: 3.059, 95% CI: 1.349-6.934, p= 0.007) and past <=3 cycles of adjuvant chemotherapy (HR: 2.833, 95% CI: 1.289-6.229, p= 0.01). For DFS, significant adverse factors were: the use of ACEIs (HR: 3.11, 95%CI: 1.01-9.56, p= 0.047), presence of perineural invasion (HR: 7.27, 95% CI: 2.74-19.3, p< 0.001) and occurrence of postoperative complications (HR: 6.79, 95% CI: 2.09-22.11, p= 0.001), while a positive factor was the negative lymph node (NLN) count >7 (HR: 0.33, 95% CI: 0.12-0.88, p= 0.026). Conclusions: The use of ACEIs may have a negative effect on long-term treatment outcomes in patients with ypN+M0 rectal cancer. In this group of patients, the NLN count seems to be an important prognostic factor, as well.
Different types of sutures, staples and sutureless anastomoses have been used to create anastomoses. The ideal device should ensure good serosal apposition without requiring either transgression of the bowel wall or the presence of foreign material for an extended period of time [2]. Healing occurs when the surgical wound is clean and sharp, Anastomotic dehiscence and leaks are major problems in gastrointestinal surgery and result in increased morbidity and mortality, thus decreasing overall survival. Intestinal anastomosis healing depends on the operative technique, the underlying medical condition, medical treatment and other individual, often unknown, factors AbstractBackground. Anastomotic dehiscence and leaks are major problems in gastrointestinal surgery and result in increased morbidity and mortality. The ideal device to create anastomoses should ensure good serosal apposition without requiring either transgression of the bowel wall or the presence of foreign material for an extended period of time. Objectives. The aim of this experimental study was to evaluate the safety and efficacy of a new compression anastomosis clip (CAC) for jejunojejunostomies and ileocolostomies by comparing CAC anastomoses with hand-sewn (HS) anastomoses in pigs in terms of healing, breaking strength and the time to create anastomoses. Material and Methods. The 11 pigs in the study underwent side-to-side CAC and HS jejunojejunostomies and ileocolostomies, for a total of 88 anastomoses. The pigs were sacrificed on postoperative day 5 (5 pigs) or 7 (6 pigs). Macroscopic, histopathological and breaking-strength examinations were performed. The time to create the anastomoses was recorded. Results. Neither group had anastomotic complications such as leakage or obstruction. Macroscopic examination showed no statistically significant differences between the groups. In the CAC group, the healing process was characterized by a lesser inflammatory reaction (p < 0.05) and very thin scar tissue at the anastomotic line (less collagen deposition and better epithelial regeneration), while the HS group had a much thicker anastomotic line. The breaking strength was significantly greater in the CAC group compared with the HS group (p < 0.05). The anastomosis time was shorter in the CAC group than in the HS group (p < 0.01). Conclusions. Anastomosis using a CAC appears to be safe and less time-consuming than HS; it was also characterized by a good healing process with little inflammatory reaction and a high breaking strength compared with HS anastomosis (Adv Clin Exp Med 2015, 24, 6, 000-000).
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