B T Heniford

Publications (105)304.74 Total impact

• Article: Pushing the envelope in biomaterial research: initial results of prosthetic coating with stem cells in a rat model.

  Charles J Dolce, Dimitrios Stefanidis, Jennifer E Keller, K C Walters, William L Newcomb, Jessica J Heath, H J Norton, Amy E Lincourt, Kent W Kercher, B T Heniford
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  ABSTRACT: Coating prosthetic for hernia repair with a patient's own cells could improve biocompatibility by decreasing inflammation and adhesion formation and by increasing tissue ingrowth and resistance to infection. The objective of this study was to prove the feasibility of prosthetic coating with stem cells and to assess its resistance to adhesion formation when implanted in an animal model. Adult Lewis rat bone marrow stem cells were harvested and cultured. Stem cells were then implanted on three different prosthetics. The prosthetic with the best stem cell adherence was implanted intraperitoneally into six adult rats. Untreated prosthetic was implanted in control animals (n = 12). After 2 weeks, intra-abdominal adhesions were graded using an adhesion scoring scale by two surgeons who were blinded to the animal group. Data were analyzed using the Wilcoxon rank-sum test. Stem cells demonstrated the best adherence and growth on polyglactin prosthetics. After implantation, the stem cell-coated polyglactin prosthetic had <25% of its surface area covered with adhesions in five (83%) samples, whereas the control polyglactin group had only one sample (8.3%) with <25% adhesions, and seven of its samples (58.3%) had >50% surface area adhesions (p < 0.05). The feasibility of hernia prosthetic coating with stem cells was demonstrated. Furthermore, stem-cell coated polyglactin prosthetic exhibited improved biocompatibility by decreasing adhesion formation in an animal model. Further study is needed to determine the factors that promote stem cell adherence to prosthetics and the in vivo prosthetic biomechanics after stem cell coating. This work is underway in our laboratory.
  Surgical Endoscopy 03/2010; 24(11):2687-93. · 4.01 Impact Factor
• Article: Does Timing of Operative Care during Fellowship Training Impact Patient Care?

  N Agee, P N Montero, W W Hope, A E Lincourt, K W Kercher, D Stefanidis, B T Heniford
  Journal of Surgical Research 02/2010; 158(2):375-6. · 2.25 Impact Factor
• Article: Optimizing operating room time efficiency- additional obstacles to efficient case flow.

  R A Brintzenhoff, P Rucho, D Stefanidis, R Sing, B T Heniford
  Journal of Surgical Research 02/2010; 158(2):369. · 2.25 Impact Factor
• Article: Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients.

  Z Tsereteli, B A Pryor, B T Heniford, A Park, G Voeller, B J Ramshaw
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  ABSTRACT: The aim of this study was to evaluate our experience with LVHR in morbidly obese patients (BMI >40) and to compare their outcomes to those of patients with lower BMI. Data on adult (>18 years old) patients who underwent LVHR with mesh over the last 13 years performed by four experienced surgeons were collected retrospectively and from a previously collected database. Of the 1,071 patients, 901 had completed LVHR and were available for follow-up. One hundred and thirty-four patients (group A) met BMI criteria for morbid obesity (>or=40, mean 46), 767 patients had BMI < 40, mean 30 (group B). The follow-up time ranged from 1 to 91 months. The Wilcoxon rank sum test was used for nonparametric data analysis. Outcomes were stratified on the follow up time and analyzed using Cochran-Mantel-Haenszel methodology. The groups did not differ in terms of ASA score, previous surgery and conversion rate (p=0.22, 0.32 and 0.23). Morbidly obese patients were younger (48.3 vs. 54; p<0.01) and were more often female (p=0.02), but this did not correlate with outcome. Group A also had longer operative time (154 vs. 119 min, p<0.01) and hospital stay (3.6 vs. 2.4 days, p=0.03). Mesh size was significantly larger in group A (449 vs. 349 cm(2), p=002). During mean follow-up time of 19 months hernia recurrence was 8.3% in group A and 2.9% in group B (p=0.003), with an odds ratio of 4.3 (95% CI 1.9-9.9). However, there was no significant difference in the rate of complications (19.7 vs. 15.3%; p=0.46). LVHR in the morbidly obese population is both safe and feasible, although there is a higher, but still acceptable recurrence rate. Despite the increased risk for recurrence, LVHR in morbidly obese patients minimizes the potential wound and mesh complications that frequently occur for open mesh repair in this group of patients.
  Hernia 06/2008; 12(3):233-8. · 1.84 Impact Factor
• Article: Immunohistochemical analysis of host reaction to heavyweight-, reduced-weight-, and expanded polytetrafluoroethylene (ePTFE)-based meshes after short- and long-term intraabdominal implantations.

  Y W Novitsky, J A Cristiano, A G Harrell, W Newcomb, J H Norton, K W Kercher, B T Heniford
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  ABSTRACT: Prosthetic meshes induce a variety of inflammatory changes in the host, which may lead to excessive scarring with detrimental clinical consequences, especially in the long term. This study aimed to characterize the degree of short- and long-term inflammatory changes induced by common prosthetic meshes. Twenty 4 x 4-cm samples each of expanded polytetrafluoroethylene (ePTFE), heavyweight polypropylene (hPP), ePTFE/heavyweight polypropylene (ePTFE/hPP), and reduced-weight polypropylene/regenerated cellulose (rPP) were implanted intraperitoneally in 40 rabbits for 4 or 12 months. After explantation, samples of mesh/tissue complex were analyzed for the degrees of cellular apoptosis (enzyme-linked immunoassay [ELISA]) and cellular turnover (mouse monoclonal antibody). In the short term, the degree of apoptosis in the hPP mesh was significantly higher than in the ePTFE and rPP groups. Similarly, it was higher in the ePTFE/hPP group than in either the ePTFE or the rPP group. The amount of Ki-67-positive cells was significantly higher in the hPP group than in the ePTFE or rPP group. The cell turnover in the ePTFE/hPP group was similar to that in the hPP group, but significantly higher than in either the ePTFE or the rPP group. The rPP group, in turn, had a higher Ki-67 score than the ePTFE group. In the long term, both the degree of apoptosis and Ki-67 positivity were significantly lower in the rPP and ePTFE groups than in either the ePTFE/hPP or the hPP group. A significant decrease in Ki-67 scores between the short and long-term groups was found only in the rPP group. In the short term, heavyweight polypropylene-based meshes were associated with significantly higher cell proliferation and death. A significantly higher degree of apoptosis and cell turnover were associated with heavyweight polypropylene-based meshes even 1 year after implantation, indicating ongoing inflammation and scar remodeling. On the other hand, ePTFE and reduced-weight polypropylene meshes were associated with nearly physiologic levels of inflammatory markers. Overall, an exaggerated and persistent host foreign body response to heavyweight polypropylene-based meshes indicates poor biocompatibility, with potential detrimental clinical sequela.
  Surgical Endoscopy 05/2008; 22(4):1070-6. · 4.01 Impact Factor
• Article: Laparoscopic parastomal hernia repair using a nonslit mesh technique.

  G J Mancini, D A McClusky, L Khaitan, E A Goldenberg, B T Heniford, Y W Novitsky, A E Park, S Kavic, K A LeBlanc, M J Elieson, G R Voeller, B J Ramshaw
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  ABSTRACT: The management of parastomal hernia is associated with high morbidity and recurrence rates (20-70%). This study investigated a novel laparoscopic approach and evaluated its outcomes. A consecutive multi-institutional series of patients undergoing parastomal hernia repair between 2001 and 2005 were analyzed retrospectively. Laparoscopy was used with modification of the open Sugarbaker technique. A nonslit expanded polytetrafluoroethylene (ePTFE) mesh was placed to provide 5-cm overlay coverage of the stoma and defect. Transfascial sutures secured the mesh, allowing the stoma to exit from the lateral edge. Five advanced laparoscopic surgeons performed all the procedures. The primary outcome measure was hernia recurrence. A total of 25 patients with a mean age of 60 years and a body mass index of 29 kg/m2 underwent surgery. Six of these patients had undergone previous mesh stoma revisions. The mean size of the hernia defect was 64 cm2, and the mean size of the mesh was 365 cm2. There were no conversions to open surgery. The overall postoperative morbidity was 23%, and the mean hospital length of stay was 3.3 days. One patient died of pulmonary complications; one patient had a trocar-site infection; and one patient had a mesh infection requiring mesh removal. During a median follow-up period of 19 months (range, 2-38 months), 4% (1/25) of the patients experienced recurrence. On the basis of this large case series, the laparoscopic nonslit mesh technique for the repair of parastomal hernias seems to be a promising approach for the reduction of hernia recurrence in experienced hands.
  Surgical Endoscopy 10/2007; 21(9):1487-91. · 4.01 Impact Factor
• Article: Severely disordered esophageal peristalsis is not a contraindication to laparoscopic Nissen fundoplication.

  Y W Novitsky, J Wong, K W Kercher, D E M Litwin, L L Swanstrom, B T Heniford
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  ABSTRACT: Laparoscopic Nissen fundoplication (LNF) is the preferred operation for the control of gastroesophageal reflux disease (GERD). The use of a full fundoplication for patients with esophageal dysmotility is controversial. Although LNF is known to be superior to a partial wrap for patients with weak peristalsis, its efficacy for patients with severe dysmotility is unknown. We hypothesized that LNF is also acceptable for patients with severe esophageal dysmotility. A multicenter retrospective review of consecutive patients with severe esophageal dysmotility who underwent an LNF was performed. Severe dysmotility was defined by manometry showing an esophageal amplitude of 30 mmHg or less and/or 70% or more nonperistaltic esophageal body contractions. In this study, 48 patients with severe esophageal dysmotility underwent LNF. All the patients presented with symptoms of GERD, and 19 (39%) had preoperative dysphagia. A total of 10 patients had impaired esophageal body contractions, whereas 32 patients had an abnormal esophageal amplitude, and 6 patients had both. The average abnormal esophageal amplitude was 24.9 +/- 5.2 mmHg (range, 6.0-30 mmHg). The mean percentage of nonperistaltic esophageal body contractions was 79.4% +/- 8.3% (range, 70-100%). There were no intraoperative complications and no conversions. Postoperatively, early dysphagia occurred in 35 patients (73%). Five patients were treated with esophageal dilation, which was successful in three cases. One patient required a reoperative fundoplication. Overall, persistent dysphagia was found in two patients (4.2%), including one patient with severe preoperative dysphagia, which improved postoperatively. Abnormal peristalsis and/or distal amplitude improved postoperatively in 12 (80%) of retested patients. There were no cases of Barrett's progression to dysplasia or carcinoma. During an average follow-up period of 25.4 months (range, 1-46 months), eight patients (16%) were receiving antireflux medications, with six of these showing normal esophageal pH study results. The LNF procedure provides low rates of reflux recurrence with little long-term postoperative dysphagia experienced by patients with severely disordered esophageal peristalsis. Effective fundoplication improved esophageal motility for most of the patients. A 360 degrees fundoplication should not be contraindicated for patients with severe esophageal dysmotility.
  Surgical Endoscopy 07/2007; 21(6):950-4. · 4.01 Impact Factor
• Article: Laparoscopic ventral hernia repair: a single center experience.

  W S Cobb, K W Kercher, B D Matthews, J M Burns, N H Tinkham, R F Sing, B T Heniford
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  ABSTRACT: A retrospective chart review at the Carolinas Medical Center was performed on all patients who underwent laparoscopic ventral hernia repair (LVHR) from July 1998 through December 2003. LVHR was successfully completed in 270 of the 277 patients, or 98%, in whom it was attempted. Half of the patients (138/277) had at least one previous failed repair. The average defect measured 143.3 cm(2), and mesh was used in all repairs. The mean operating time was 168.3 min, mean blood loss was 50 cc, and average length of hospitalization was 3.0 days. Thirty-four complications occurred in 31 patients (11%). Only two mesh infections occurred (0.7%). At a mean follow-up period of 21 months, the rate of hernia recurrence was 4.7%. As experience grows and length of follow-up expands, LVHR may become the preferred approach for ventral hernia in difficult patients, especially obese patients and patients who have failed prior open repairs.
  Hernia 07/2006; 10(3):236-42. · 1.84 Impact Factor
• Article: In vitro infectability of prosthetic mesh by methicillin-resistant Staphylococcus aureus.

  A G Harrell, Y W Novitsky, K W Kercher, M Foster, J M Burns, T S Kuwada, B T Heniford
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  ABSTRACT: Although mesh use is important for effective herniorrhaphy in adults, prosthetic infections can cause serious morbidity. Bacterial adherence to the mesh is a known precursor to prosthetic infection. We compared the ability of common mesh prosthetics to resist bacterial adherence. The meshes studied included polypropylene (Marlex, expanded polytetrafluoroethylene (PTFE) with and without silver chlorhexidine coating (DualMesh Plus and Dualmesh) composite meshes (Composix E/X, Proceed, and Parietex Composite) and lightweight polypropylene meshes (TiMesh, Ultrapro, and Vypro). Fifteen samples of each mesh type were individually inoculated with a suspension of 10(8 )methicillin-resistant Staphylococcus aureus (MRSA) in tryptic soy broth. After incubation at 37 degrees C for 1 h, the mesh pieces were then removed and serially washed. The colony-forming units (CFU) of MRSA present in the initial inoculum, at the end of the 1-h warm-water bath (broth count), and the pooled washes (wash count), were determined using serial dilutions and spot plating. The bacteria not accounted for in the broth or wash counts were considered adhered to the mesh. Samples of each mesh type were also analyzed using scanning electron microscopy (SEM). Data are presented as the mean percentage adherence with ANOVA and Tukey's test used to determine significance (P<0.05). The DualMesh Plus mesh had no detectable MRSA in the broth or the pooled wash samples. Dualmesh had less adherence compared with Marlex, Proceed, and Vypro (P<0.05). Conversely, Vypro had a statistically higher adherence (96%, P<0.05) as compared to TiMesh, Ultrapro, Composix E/X, and Parietex Composite. SEM confirmed bacterial adherence to all the mesh types except DualMesh Plus. The ability of a biomaterial to resist infection has an important clinical significance. DualMesh Plus, due to its antimicrobial coating, is the only mesh type of the nine tested that demonstrated a bactericidal property. Standard PTFE (Dualmesh) also had less bacterial adherence. Vypro demonstrated an increase in bacterial adherence; this was possibly due to the multifilament polyglactin 910 weaved within the prolene component of the mesh.
  Hernia 05/2006; 10(2):120-4. · 1.84 Impact Factor
• Article: Susceptibility of prosthetic biomaterials to infection.

  A M Carbonell, K W Kercher, R F Sing, B T Heniford
  Surgical Endoscopy 01/2006; 19(12):1670. · 4.01 Impact Factor
• Article: Thrombosis in the portal venous system after elective laporoscopic splenectomy.

  Y W Novitsky, K W Kercher, W S Cobb, A G Harrell, T S Kuwada, R F Sing, B T Heniford
  Surgical Endoscopy 11/2005; 19(10):1420-1; author reply 1422. · 4.01 Impact Factor
• Article: Multimedia article. Laparoscopic management of median arcuate ligament syndrome.

  A M Carbonell, K W Kercher, B T Heniford, B D Matthews
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  ABSTRACT: Median arcuate ligament syndrome is a rare disorder resulting from luminal narrowing of the celiac artery by the insertion of the diaphragmatic muscle fibers or fibrous bands of the celiac nervous plexus. The syndrome is characterized by weight loss, postprandial abdominal pain, nausea, vomiting, and an epigastric bruit. Surgical management entails complete division of the median arcuate ligament. The video demonstrates the laparoscopic release of the median arcuate ligament in a patient with median arcuate ligament syndrome. The patient is a 22-year-old male with a 6-month history of epigastric abdominal pain, nausea, vomiting, a 140-lb. weight loss, and an epigastric bruit on physical exam. Aortography demonstrated a >or=90% extrinsic compression of the celiac artery. A full laparoscopic skeletonization of the celiac artery and branch vessels was performed. Intraoperative duplex U/S demonstrated flow rate reduction after the median arcuate ligament release. A postoperative CT angiogram demonstrated no residual stenosis. The patient was discharged on postoperative day 3 and remained asymptomatic after 7 months of follow-up. Laparoscopic release of the median arcuate ligament is a novel approach to the management of celiac artery compression syndrome. The role of minimally invasive techniques to manage median arcuate ligament syndrome is evolving but they appear to be a safe alternative to open surgery.
  Surgical Endoscopy 06/2005; 19(5):729. · 4.01 Impact Factor
• Article: Do patient or hospital demographics predict cholecystectomy outcomes? A nationwide study of 93,578 patients.

  A M Carbonell, A E Lincourt, K W Kercher, B D Matthews, W S Cobb, R F Sing, B T Heniford
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  ABSTRACT: The purpose of this study was to examine the influence of patient and hospital demographics on cholecystectomy outcomes. Year 2000 data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was obtained for all patients undergoing inpatient cholecystectomy at 994 nationwide hospitals. Differences (p < 0.05) were determined using standard statistical methods. Of 93,578 cholecystectomies performed, 73.4% were performed laparoscopically. Length of hospital stay (LOS), charges, morbidity, and mortality were significantly less for laparoscopic cholecystectomy (LC). Increasing patient age was associated with increased LOS, charges, morbidity, mortality, and a decreased LC rate. Charges, LOS, morbidity, and mortality were highest for males with a lower LC rate than for females Mortality and LOS were higher, whereas morbidity was lower for African Americans than for whites. Hispanics had the shortest LOS, as well as the lowest morbidity and mortality rates. Laparoscopic cholecystectomy was performed more commonly for Hispanics than for whites or African Americans, with lower charges for whites. Medicare-insured patients incurred longer LOS as well as higher charges, morbidity, and mortality than Medicaid, private, and self-pay patients, and were the least likely to undergo LC. As median income decreases, LOS increases, and morbidity decreases with no mortality effect. Teaching hospitals had a longer LOS, higher charges, and mortality, and a lower LC rate, with no difference in morbidity, than nonteaching centers. As hospital size (number of beds) increased, LOS, and charges increased, with no difference in morbidity. Large hospitals had the highest mortality rates and the lowest incidence of LC. Urban hospitals had higher LOS and charges with a lower LC rate than rural hospitals. After control was used for all other covariates, increased age was a predictor of increased morbidity. Female gender, LC, and intraoperative cholangiogram all predicted decreased morbidity. Increased age, complications, and emergency surgery predicted increased mortality, with laparoscopy and intraoperative cholangiogram having protective effects. Patient income, insurance status, and race did not play a role in morbidity or mortality. Academic or teaching status of the hospital also did not influence patient outcomes. Patient and hospital demographics do affect the outcomes of patients undergoing inpatient cholecystectomy. Although male gender, African American race, Medicare-insured status, and large, urban hospitals are associated with less favorable cholecystectomy outcomes, only increased age predicts increased morbidity, whereas female gender, laparoscopy, and cholangiogram are protective. Increased age, complications, and emergency surgery predict mortality, with laparoscopy and intraoperative cholangiogram having protective effects.
  Surgical Endoscopy 06/2005; 19(6):767-73. · 4.01 Impact Factor
• Article: Evaluation of adhesion formation, mesh fixation strength, and hydroxyproline content after intraabdominal placement of polytetrafluoroethylene mesh secured using titanium spiral tacks, nitinol anchors, and polypropylene suture or polyglactin 910 suture.

  C S Joels, B D Matthews, K W Kercher, C Austin, H J Norton, T C Williams, B T Heniford
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  ABSTRACT: The purpose of this study is to evaluate fixation methods for polytetrafluoroethylene (ePTFE) mesh with an in vivo model of laparoscopic ventral hernia repair. In 40 New Zealand white rabbits, a 4 x 4-cm ePTFE mesh (n = 80, two per animal) was attached to an intact peritoneum with polyglactin 910 (PG 910) (n = 20) or polypropylene (PP) (n = 20) suture, titanium spiral tacks (TS) (n = 20), or nitinol anchors (NA) (n = 20). Mesh was harvested at 8 and 16 weeks for fixation strength testing, adhesion assessment, and collagen (hydroxyproline) content. Fixation strength on day 0 was determined with mesh attached to harvested abdominal wall. Statistical significance was determined as p < 0.05. There was no difference in fixation strength between PP (39.1 N) and PG 910 (40.0 N) sutures at time zero. At week 8, PP (25.7 N) was significantly stronger (p < 0.05) than PG 910 (11.4 N) suture, but not at week 16. The fixation strength of TS and NA (day 0, 15.4 vs 7.4 N; week 8, 17.5 vs 15.3 N; week 16, 19.1 vs 13.8 N) was not significantly different. Fixation with PP suture was significantly (p < 0.05) stronger than that with TS and NA at day 0 (39.1, 15.4, and 7.4 N, respectively) but not at weeks 8 or 16. The fixation strength of suture decreased significantly (p < 0.05) from day 0 to week 16 (PP: day 0 = 39.1 N, week 8 = 25.7 N, week 16 = 21.4 N; PG 910: day 0 = 40.0 N, week 8 = 11.4 N, week 16 = 12.8 N). The fixation strength of NA and TS did not change significantly (NA: day 0 = 7.4 N, week 8 = 15.3 N, week 16 = 13.8 N; TS: week 0 = 15.4 N, week 8 = 17.5 N, week 16 = 19.1 N). There were no differences in adhesion area based on fixation device used; however, there were more (p < 0.05) mesh samples using NA with adhesions compared to TS and adhesion tenacity was greater (p < 0.05) compared to that of TS, PP, and PG. Hydroxyproline content at weeks 8 and 16 was similar for all fixation devices. The initial fixation strength for nonabsorbable suture is significantly greater than that of the metallic fixation devices, but after 8 weeks there is no difference. Laparoscopic ventral hernia repair without transabdominal suture fixation may be predisposed to acute failure. The metallic devices have similar fixation strength, although the incidence of adhesions and tenacity of adhesions appear to be greater with the nitinol anchors. Since these devices have similar fixation strengths and most likely provide adequate supplementation to transabdominal sutures for mesh fixation after laparoscopic ventral hernia repair, their use should be based on other factors, such as their propensity for adhesions, ease of application, and cost.
  Surgical Endoscopy 06/2005; 19(6):780-5. · 4.01 Impact Factor
• Article: Cirrhosis is not a contraindication to laparoscopic surgery.

  W S Cobb, B T Heniford, J M Burns, A M Carbonell, B D Matthews, K W Kercher
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  ABSTRACT: Cirrhosis of the liver contributes significantly to morbidity and mortality in abdominal surgery. The proven benefits of laparoscopy seem especially applicable to patients with this complex disease. This study evaluates the safety and efficacy of laparoscopic procedures in a series of consecutively treated patients with biopsy-proven cirrhosis. The medical records of all patients with biopsy-proven cirrhosis undergoing laparoscopic surgery at the authors' medical center between January 2000 and December 2003 were retrospectively reviewed. A total of 50 patients (27 men and 23 women) underwent 52 laparoscopic procedures. Among these 50 patients were 39 patients with Child-Pugh classification A cirrhosis, 10 with classification B, and 1 with classification C, who underwent a variety of laparoscopic procedures including cholecystectomy (n = 22), splenectomy (n = 18), colectomy (n = 4), diagnostic laparoscopy (n = 3), ventral hernia repair (n = 1), Nissen fundoplication (n = 1), Heller myotomy (n = 1), Roux-en-Y gastric bypass (n = 1), and radical nephrectomy (n = 1). There were two conversions (4%) to an open procedure. The mean operative time was 155 min. Estimated blood loss averaged 124 ml for all procedures, and 20 patients (40%) required perioperative transfusion of blood products. One patient required a single blood transfusion postoperatively because of anemia. No one experienced hepatic decompensation. Overall morbidity was 16%. There were no deaths. The mean length of hospitalization was 3 days. Although technically challenging because portal hypertension, varices, and thrombocytopenia frequently coexist, basic and advanced laparoscopic procedures are safe for patients with mild to moderate cirrhosis of the liver.
  Surgical Endoscopy 04/2005; 19(3):418-23. · 4.01 Impact Factor
• Article: A novel technique of lumbar hernia repair using bone anchor fixation.

  A M Carbonell, K W Kercher, L Sigmon, B D Matthews, R F Sing, J S Kneisl, B T Heniford
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  ABSTRACT: Lumbar hernias are difficult to repair due to their proximity to bone and inadequate surrounding tissue to buttress the repair. We analyzed the outcome of patients undergoing a novel retromuscular lumbar hernia repair technique. The repair was performed in ten patients using a polypropylene or polytetrafluoroethylene mesh placed in an extraperitoneal, retromuscular position with at least 5 cm overlap of the hernia defect. The mesh was fixed with circumferential, transfascial, permanent sutures and inferiorly fixed to the iliac crest by suture bone anchors. Five hernias were recurrent, and five were incarcerated; seven were incisional hernias, and three were posttraumatic. Back and abdominal pain was the most common presenting symptom. Mean hernia size was 227 cm(2) (60-504) with a mesh size of 620 cm(2) (224-936). Mean operative time was 181 min (120-269), with a mean blood loss of 128 ml (50-200). Mean length of stay was 5.2 days (2-10), and morphine equivalent requirement was 200 mg (47-460). There were no postoperative complications or deaths. After a mean follow-up of 40 months (3-99) there have been no recurrences. Our sublay repair of lumbar hernias with permanent suture fixation is safe and to date has resulted in no recurrences. Suture bone anchors ensure secure fixation of the mesh to the iliac crest and may eliminate a common area of recurrence.
  Hernia 04/2005; 9(1):22-5. · 1.84 Impact Factor
• Article: Effect of carbon dioxide pneumoperitoneum and wound closure technique on port site tumor implantation in a rat model.

  J M Burns, B D Matthews, H S Pollinger, G Mostafa, C S Joels, C E Austin, K W Kercher, H J Norton, B T Heniford
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  ABSTRACT: The purpose of this study was to evaluate the effects of carbon dioxide (CO2) pneumoperitoneum and wound closure technique on port site tumor implantation. A standard quantity of rat mammary adenocarcinoma (SMT2A)was allowed to grow in a flank incision in Wistar-Furth rats (n = 90) for 14 days. Thereafter, 1-cm incisions were made in each animal in three quadrants. There were six control animals. The experimental animals were divided into a 60-min CO2 pneumoperitoneum group (n = 42) and a no pneumoperitoneum (n = 42) group. The flank tumor was lacerated transabdominally in the experimental groups. The three wound sites were randomized to closure of (a) skin; (b) skin and fascia; and (c) skin, fascia, and peritoneum. The abdominal wounds were harvested en bloc on postoperative day 7. Histologic comparison of the port sites in the pneumoperitoneum and no-pneumoperitoneum groups did not demonstrate a statistically significant difference in tumor implantation for any of the closure methods. Evaluation of the closure techniques showed no statistical difference between the pneumoperitoneum group and the no-pneumoperitoneum group in the incidence of port site tumor implantation. Within the no-pneumoperitoneum group, there was a significant increase (p = 0.03) in tumor implantation with skin closure alone vs all three layers. Additionally, when we compared all groups by closure technique, the rate of tumor implantation was found to be significantly higher (p = 0.01) for skin closure alone vs closure of all three layers. This study suggests that closure technique may influence the rate of port site tumor implantation. The use of a CO2 pneumoperitoneum did not alter the incidence of port site tumor implantation at 7 days postoperatively.
  Surgical Endoscopy 04/2005; 19(3):441-7. · 4.01 Impact Factor
• Article: The susceptibility of prosthetic biomaterials to infection.

  A M Carbonell, B D Matthews, D Dréau, M Foster, C E Austin, K W Kercher, R F Sing, B T Heniford
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  ABSTRACT: Despite the use of a sterile technique and the administration of prophylactic antibiotics during surgical procedures, mesh infection continues to complicate the use of biomaterials. The purpose of this study was to compare the susceptibility to infection of prosthetic biomaterials in a live-animal model. The following seven prosthetic mesh biomaterials were used in this study. Expanded polytetrafluoroethylene (ePTFE) with silver/chlorhexidine (DM+), ePTFE (DM), porcine intestinal submucosa (S), polypropylene (M), ePTFE/polypropylene (X), hyaluronate/carboxymethylcellulose/polypropylene (SM), and human acellular dermal matrix (A). Lewis rats (n = 108) underwent creation of a single ventral hernia; 105 of them were repaired with a different mesh (2-cm2 piece). Twelve pieces of each mesh were inoculated at the time of hernia repair with 10(8) Staphylococcus aureus (n = 84). Three pieces of each mesh were placed without bacterial inoculation (n = 21). In three animals, no mesh was placed; instead, the peritoneum of the hernia defect was inoculated (n = 3). After 5 days, the animals were killed and the mesh was explanted (peritoneum for the nonmesh control). The mesh was vortex-washed and incubated in tryptic soy broth. Bacterial counts were determined using serial dilutions and spot plates and quantified in colony-forming units (CFU) per square centimeter of mesh present in the vortex wash fluid (wash count) and the soy broth (broth count). Data are presented as the mean log(10), with analysis of variance (ANOVA) and Tukey's test used to determine significance (p < 0.05). The DM+ material had no detectable live bacteria in the wash or broth counts in 10 of 12 tested samples (p = 0.05). Of the samples that showed bacterial growth, the peritoneum control group had a lower wash count than A (p = 0.05) and the lowest broth count of all the materials except for DM+ (p = 0.05). In addition, SM had a significantly lower wash count than A (p = 0.05), with no broth count difference. In regard to wash and broth counts, DM, M, X, SM, S, and A were no different (p = NS). The DM+ material was the least susceptible to infection. Impregnation with silver/chlorhexidine killed the inoculated bacteria, preventing their proliferation on the mesh surface. Other than DM+, native peritoneal tissue appears to be the least susceptible to infection. Silver/chlorhexidine appears to be an effective bactericidal agent for use with mesh biomaterials.
  Surgical Endoscopy 04/2005; 19(3):430-5. · 4.01 Impact Factor
• Article: The laparoscopic repair of suprapubic ventral hernias.

  A M Carbonell, K W Kercher, B D Matthews, R F Sing, W S Cobb, B T Heniford
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  ABSTRACT: The complexity of dissection and the close proximity of the hernia to bony, vascular, nerve, and urinary structures make the laparoscopic repair of suprapubic hernias (LRSPH) a formidable operation. We performed a prospective evaluation of the outcomes of patients undergoing LRSPH. The study population comprised 36 patients undergoing LRSPH from July 1996 to January 2004. Patient demographics, hernia sizes, mesh types and sizes, perioperative outcomes, and recurrences were documented. After our early experience with this operation, the repair evolved to include transabdominal suture fixation to the pubic bone, Cooper's ligament, and above the iliopubic tract. There were 26 women and 10 men. They had a mean age of 55.9 years (range, 33-76) and a mean body mass index (BMI) of 31.0 kg/m2 (range, 22-67). Twenty-two (61%) of the repairs were for recurrent hernias, with an average of 2.3 previously failed open repairs each (range, 1-11). The mean hernia size was 191.4 cm2 (range, 20-768), and the average mesh size was 481.4 cm2 (range, 193-1,428). All repairs were performed with expanded polytetrafluoroethylene (ePTFE) mesh. Mean operating time was 178.7 min (range, 95-290). Mean blood loss was 40 cc (range, 20-100). One patient undergoing her fifth repair required conversion due to adhesions to a polypropylene mesh. Hospital stay averaged 2.4 days (range, 1-7). Mean follow-up was 21.1 months (range, 1-70). Complications (16.6%) included deep venous thrombosis (n = 1), prolonged pain for >6 weeks (n = 1), trocar site cellulitis (n = 1), ileus (n = 1), prolonged seroma (n = 1), and Clostridium difficile colitis (n = 1). Hernias recurred in two of our first nine patients, for an overall recurrence rate of 5.5%. Since we began using the technique of applying multiple sutures directly to the pubis and Cooper's ligament (in the subsequent 27 patients), no recurrences have been documented. Although technically demanding and time-consuming, the LRSPH is safe and technically feasible. Moreover, it results in a low recurrence rate and is applicable to large or multiply recurrent hernias. Transabdominal suture fixation to the bony and ligamentous structures produces a more durable hernia repair.
  Surgical Endoscopy 03/2005; 19(2):174-7. · 4.01 Impact Factor
• Article: Gastrointestinal stromal tumors of the stomach.

  B D Matthews, C S Joels, K W Kercher, B T Heniford
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  ABSTRACT: Gastrointestinal stromal tumors (GIST) comprise a rare group of neoplasms of unpredictable malignant potential with an annual incidence of 4/million persons. The stomach is the most common site of occurrence in the gastrointestinal tract. A combination of prognostic factors (patient age, histologic grade, mitotic rate, tumor size, and DNA analysis) have been utilized to predict their biologic behavior. Lymphatic spread of gastrointestinal stromal tumors is uncommon therefore a formal lymph node dissection is not standard surgical management. Consequently, complete surgical resection of the primary tumor is the most definitive treatment. An increasing number of cases have been reported utilizing a combination of laparoscopic and endoscopic techniques to resect these tumors. The manuscript will characterize the biologic behavior of gastrointestinal stromal tumors of the stomach, discuss the preoperative evaluation and minimally invasive surgical management of these patients, and review recent, encouraging adjuvant treatment strategies.
  Minerva chirurgica 07/2004; 59(3):219-31. · 0.77 Impact Factor