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ABSTRACT: BACKGROUND: Whether total extraperitoneal inguinal hernia repair (TEP) is associated with worse outcomes than transabdominal preperitoneal inguinal hernia repair (TAPP) continues to be a matter of debate. The objective of this large cohort study is to compare outcomes between patients undergoing TEP or TAPP. METHODS: Based on prospective data of the Swiss association of laparoscopic and thoracoscopic surgery, all patients undergoing unilateral TEP or TAPP between 1995 and 2006 were included. The following outcomes were compared: conversion rates, intraoperative and postoperative complications, duration of operation. RESULTS: Data on 4,552 patients undergoing TEP (n = 3,457) and TAPP (n = 1,095) were collected prospectively. Average age and American Society of Anesthesiologists score were similar in the two groups. Patients undergoing TEP had a significantly higher rate of intraoperative complications (TEP 1.9 % vs. TAPP 0.9 %, p = 0.029) and surgical postoperative complications (TEP: 2.3 % vs. TAPP: 0.8 %, p = 0.003). The postoperative length of stay was longer for patients undergoing TAPP (2.9 vs. 2.3 days, p = 0.002), whereas the duration of the operation was longer for TEP (66.6 vs. 59.0 min, p < 0.001) and the conversion rate was higher (TEP 1.0 % vs. TAPP 0.2 %, p = 0.011). CONCLUSIONS: This study is one of the first population-based analyses comparing TEP and TAPP in a prospective cohort of more than 4,500 patients. Intraoperative and surgical postoperative complications were significantly higher in patients undergoing TEP. TEP is also associated with longer operating times and higher conversion rates. Therefore, on a population-based level, the TAPP technique appears to be superior to the TEP repair in patients undergoing unilateral inguinal hernia repair.
World Journal of Surgery 09/2012; · 2.36 Impact Factor
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ABSTRACT: Whether bilateral total extraperitoneal (TEP) inguinal hernia repair is associated with worse outcomes than unilateral TEP continues to be a matter of debate. This study aimed to compare different outcomes of large cohorts of patients undergoing bilateral versus unilateral TEP.
Based on prospective data of the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS), all patients undergoing elective unilateral or bilateral TEP from 1995 to 2006 were included in the study. The outcomes compared included conversion rates; intraoperative, surgical, and general postoperative complications; duration of operation; and length of hospital stay (LOS). Unadjusted and risk-adjusted multivariable analyses were performed.
Data for 6,505 patients undergoing unilateral (n = 3,457) and bilateral (n = 3,048) TEP were prospectively collected. The average age and the American Society of Anesthesiologists (ASA) score were similar in the two groups. The patients undergoing bilateral TEP repair had a slightly increased rate of intraoperative complications (bilateral, 3.1% vs. unilateral, 1.9%) and surgical postoperative complications (bilateral, 3.2% vs. unilateral, 2.3%). The operation time was longer for bilateral TEP repair (86 vs. 67 min). No significant differences in postoperative LOS, general postoperative complications, or conversion rates were found.
This is the first population-based analysis in the literature to compare different outcomes in a prospective cohort of more than 6,500 patients undergoing bilateral versus unilateral TEP. Although the rates for intraoperative and surgical postoperative complications were slightly higher for the patients undergoing bilateral TEP repair, the absolute differences were small and of minor clinical relevance. Bilateral TEP repair is associated with a minimal increase in operating time and similar LOS, general postoperative complications, and conversion rates. Therefore, for patients with bilateral inguinal hernia, a simultaneous endoscopic approach represents an excellent therapeutic option.
Surgical Endoscopy 11/2011; 26(5):1364-8. · 4.01 Impact Factor
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ABSTRACT: Abdominal pain combined with fever and elevated white blood count as well as c-reactive protein are the main features of any intra-abdominal inflammation or perforation. Since these pathologies are commonly encountered, it is of crucial importance for the primary care doctor as well as the specialist to have basic knowledge about clinical symptoms, diagnostic testing and treatment options in patients with intra-abdominal inflammation or perforation. The following article provides a short summary of the most frequent causes of abdominal pain due to inflammation or perforation.
Therapeutische Umschau 08/2011; 68(8):473-7.
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ABSTRACT: Because of superior soft-tissue contrast compared to other imaging techniques, non-invasive abdominal magnetic resonance imaging (MRI) is ideal for monitoring organ regeneration, tissue repair, cancer stage, and treatment effects in a wide variety of experimental animal models. Currently, sophisticated MR protocols, including technically demanding procedures for motion artefact compensation, achieve an MRI resolution limit of < 100 microm under ideal conditions. However, such a high spatial resolution is not required for most experimental rodent studies. This article describes both a detailed imaging protocol for MR data acquisition in a ubiquitously and commercially available 1.5 T MR unit and 3-dimensional volumetry of organs, tissue components, or tumors. Future developments in MR technology will allow in vivo investigation of physiological and pathological processes at the cellular and even the molecular levels. Experimental MRI is crucial for non-invasive monitoring of a broad range of biological processes and will further our general understanding of physiology and disease.
Methods 09/2007; 43(1):46-53. · 4.01 Impact Factor
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ABSTRACT: The Molecular Adsorbent Recirculating System (MARS) represents an attractive artificial liver support system for the treatment of liver insufficiency. However, neither indications for MARS treatment (i.e., after extended liver resection) nor criteria for discontinuation of therapy have been evaluated. Therefore, we analyzed the clinical data of all our surgical patients who received MARS treatment for acute liver failure (n = 7). The aim of the study was to identify prognostic indicators for survival. Four of 174 patients resected for hepatic malignancy at our institution received a total of 13 MARS treatments. Two additional patients were successfully bridged to orthotopic liver transplantation with seven MARS treatments and one patient was MARS supported after liver transplantation of a steatotic graft with three MARS treatments. Five of the seven patients survived and were dismissed an average of 31 days, ranging from 17 to 47 days, after the final MARS treatment. No technical complications or adverse effects were observed during the MARS treatments. Important prognostic factors for hepatic recovery and survival were indocyanin green plasma disappearance rates greater than 5%/min and an increase in clotting factor V levels after each MARS treatment. We conclude that MARS therapy can be an effective treatment of postoperative liver insufficiency in the surgical hepatobiliary unit.
Journal of Gastrointestinal Surgery 12/2005; 9(8):1155-61; discussion 1161-2. · 2.83 Impact Factor
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ABSTRACT: Direct and repetitive noninvasive determination of the time course and the strain-specific hepatic regenerative capacity after partial hepatectomy can extend our knowledge about the basic mechanisms of liver regeneration and repair. The aim of this study was to develop a magnetic resonance (MR)-based volumetric procedure to measure the hepatic volume in the regenerating mouse liver. In Balb-C mice (n = 14), varying amounts of liver tissue were resected and MR imaging was performed 24 hours later in a 1.5 Tesla Magnet Unit. Three dimensional (3D) T1- (volumetric interpolated breath-hold examination [VIBE] sequence) and T2-weighted images were acquired with continuous 1-mm thin slices. Animals with and without intravenous administration of paramagnetic contrast agents were compared. Immediately after MR examination, mice were euthanized and livers were weighted. The liver volume was determined on MR images using Cavalieri's method and linear regression analysis was performed from the data obtained. Correlation coefficients between the liver volume measured by MR and the liver weight were 0.98 (T1) and 0.94 (T2) in the group without paramagnetic contrast injection and 0.70 (T1) and 0.96 (T2) after paramagnetic contrast application. We conclude that MR-based liver volumetry allows precise liver volume measurement during hepatic regeneration after partial hepatectomy in mice and can be a valuable tool with regard to experimental hepatology.
Journal of Gastrointestinal Surgery 12/2004; 8(7):806-11. · 2.83 Impact Factor
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ABSTRACT: Because of superior soft-tissue contrast compared to other imaging techniques, non-invasive abdominal magnetic resonance imaging (MRI) is ideal for monitoring organ regeneration, tissue repair, cancer stage, and treatment effects in a wide variety of experimental animal models. Currently, sophisticated MR protocols, including technically demanding procedures for motion artefact compensation, achieve an MRI resolution limit of <100 μm under ideal conditions. However, such a high spatial resolution is not required for most experimental rodent studies. This article describes both a detailed imaging protocol for MR data acquisition in a ubiquitously and commercially available 1.5 T MR unit and 3-dimensional volumetry of organs, tissue components, or tumors. Future developments in MR technology will allow in vivo investigation of physiological and pathological processes at the cellular and even the molecular levels. Experimental MRI is crucial for non-invasive monitoring of a broad range of biological processes and will further our general understanding of physiology and disease.
Methods.
