The American surgeon
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Incisional hernias after abdominal operations are a significant cause of long-term morbidity and have been reported to occur in 3 to 20 per cent of laparotomy incisions. Traditional primary suture closure repair is plagued with up to a 50 per cent recurrence rate. With the introduction of prosthetic mesh repair recurrence decreased, but complications with mesh placement emerged ushering in the development of laparoscopic incisional herniorrhaphy. ⋯ Complications were seen in 12 per cent patients (six occurrences) and included two small bowel enterotomies, a symptomatic seroma requiring aspirate, a mesh reaction requiring a short course of intravenous antibiotics, and trocar site pain (two patients). There were no recurrences during a mean follow-up of 41 months (range 3-74 months). We conclude that laparoscopic incisional herniorrhaphy offers a safe and effective repair for large primary and recurrent ventral hernia with low morbidity.
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The American surgeon · Jun 2002
An analysis of Eastern Association for the Surgery of Trauma practice guidelines for cervical spine evaluation in a series of patients with multiple imaging techniques.
We conducted a retrospective review of 124 consecutive patients who received all of the following studies between October 1998 and December 1999: three-view plain films (3VPF), full CT survey (CTS), and MRI of the cervical spine. We compared the EAST guidelines for 1) patients with persistent neck pain, 2) those with neurologic deficits (NDs), and 3) those who were obtunded in our study group to determine whether EAST recommendations would risk a significant missed injury rate. The average age was 28 years (range 5 months-78 years). ⋯ Six per cent of these injuries were potentially unstable. Our data support EAST guidelines for patients with persistent neck pain and ND. The guidelines for obtunded patients appear safe in detecting bony injury but may not be sensitive enough for unstable ligamentous injury and significant disc herniations.