Langenbeck's archives of surgery
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The most important wound complications are surgical site infection, wound dehiscence and incisional hernia. Experimental and clinical evidences support that the development of wound complications is closely related to the surgical technique at wound closure. ⋯ Midline incisions should be closed in one layer by a continuous suture technique. A monofilament suture material should be used and be tied with self-locking knots. Excessive tension should not be placed on the suture. Wounds must always be closed with a suture length-to-wound length ratio higher than 4. The only way to ascertain this is to measure, calculate and document the ratio at every wound closure. A high ratio should be accomplished with many small stitches placed 5 to 8 mm from the wound edge at very short intervals.
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Langenbecks Arch Surg · Dec 2012
Comparative StudyChronic pain after open inguinal hernia surgery: suture fixation versus self-adhesive mesh repair.
Chronic pain following inguinal hernia repair is a complex problem. Mesh fixation with sutures may be a contributing factor to this pain. The aim of this study was to compare the incidence of chronic pain and limitation of activities of daily living following inguinal hernia repair using a sutured mesh to a self-adhesive mesh, 6 months and 1 year following surgery. ⋯ Open inguinal hernia repair with a self-adhesive mesh may lead to less chronic pain and less restriction of activities of daily living than a sutured mesh fixation.
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Langenbecks Arch Surg · Dec 2012
Morphological risk factors of stroke during thoracic endovascular aortic repair.
This study aims to identify independent factors correlating to an increased risk of perioperative stroke during thoracic endovascular aortic repair (TEVAR). ⋯ Stroke risk during TEVAR is directly associated with the atheroma burden of the aortic arch and the proximal landing zone. These factors should be considered during patient selection, planning, and implantation strategies of TEVAR.
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Langenbecks Arch Surg · Dec 2012
Risk of wound hematoma at carotid endarterectomy under dual antiplatelet therapy.
This study aims to assess perioperative incidence of wound hematoma and bleeding in patients who underwent carotid endarterectomy (CEA) under dual antiplatelet therapy. ⋯ Dual antiplatelet therapy with combined aspirin and clopidogrel as well as clopidogrel is associated with an increased incidence of perioperative wound hematoma compared to aspirin but on an acceptable low level of incidence. The latter may be achieved by adapting operative procedures to more intensive antiplatelet regimes.
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Langenbecks Arch Surg · Dec 2012
Randomized Controlled Trial Multicenter Study Comparative StudyA randomised, multi-centre, prospective, observer and patient blind study to evaluate a non-absorbable polypropylene mesh vs. a partly absorbable mesh in incisional hernia repair.
The implantation of a polymer mesh is considered as the standard treatment for incisional hernia. It leads to lower recurrence rates compared to suture techniques without mesh implantation; however, there are also some drawbacks to mesh repair. The operation is more complex and peri-operative infectious complications are increased. Yet it is not clear to what extent a mesh implantation influences quality of life or leads to chronic pain or discomfort. The influence of the material, textile structure and size of the mesh remain unclear. The aim of this study was to evaluate if a non-absorbable, large pore-sized, lightweight polypropylene (PP) mesh leads to a better health outcome compared to a partly absorbable mesh. ⋯ The implantation of a non-absorbable, large pore-sized, lightweight PP mesh for incisional hernia leads to similar patient-related outcome parameters, recurrence and complication rates as a partly absorbable mesh.