Surgical technology international
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Today's surgeon faces multiple decisions for each patient who presents with an inguinal hernia. The natural history of an untreated inguinal hernia is still unclear for a particular individual. Given the low risk of emergency and death from an inguinal hernia, observation alone is now becoming an acceptable approach for many. ⋯ Though many experienced operators proved to have near-flawless results with a given technique, it has been difficult to duplicate these results by all surgeons. Over the past 10 years, there has been a greater emphasis on the prevention of postoperative pain and potential long-term mesh-related issues. Laparoscopic technique and the use of flat, lightweight mesh are showing promise in improving inguinal hernia repair results.
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Review Clinical Trial
Vertical expandable prosthetic titanium rib (VEPTR): indications, technique, and management review.
Surgical correction is generally indicated as the primary form of management in children with severe early onset scoliosis. Even so, conservative, nonsurgical treatment is always considered first, as surgical correction carries significant concomitant consequences, including but not limited to crankshaft phenomenon and, more importantly, inhibition of further spine, lung, and chest growth in skeletally immature patients. Fusionless surgical procedures assuage some of these risks, as they are characteristically associated with techniques necessitating spinal fusion. ⋯ Despite its promising results in correction of severe early onset scoliosis, as well as associated rib and chest wall deformities, the VEPTR nevertheless has a complication rate comparable to other fusionless techniques. Continued modifications and research will hopefully beget a device that permits thoracic and spinal growth in skeletally immature patients yet with fewer postoperative complications. In this chapter, the authors review the clinical experience with VEPTR to date and present their results in 16 children with congenital scoliosis cared for at Shriners Hospital of Philadelphia.
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Access to the posterior inguinal wall is a fundamental part of inguinal hernia repair. The approach to the inguinal canal may affect the course and outcome of the operation. The aim of this study is to compare posterior approach (PA) repair with the standard anterior approach (AA). ⋯ AA patients were able to postoperatively walk sooner than PA patients. Inguinal hernia repair through a PA seems to be less painful, less debilitating, and more easily applicable than the AA. Such advantages may be the reasons to select it as a standard procedure of choice.
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Until relatively recently, few procedures have been developed that restore significant motor and sensory function in individuals with obsolete (ie, chronic), complete spinal cord injury (SCI). Building upon the methodology used to treat brachial root avulsion, the authors have developed peripheral nerve-rerouting procedures that have restored some function in hundreds of patients with such SCI. ⋯ This Chapter summarizes more than a dozen rerouting procedures, which restore function that range from breathing to toe sensation. This summary discusses the indications and criteria for choosing the best donor nerve based on the specific injury level, and emphasizes major procedural features such as the use of selected interfascicular anastomosis, modified end-to-side suture techniques, vascularized donor nerves, a muscle trigger for the synchronized contraction of congenerous muscles, and reconstruction procedures to restore donor-nerve function.
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Review
Minimally invasive therapeutic interventional procedures in the spine: an evidence-based review.
This chapter evaluates the current evidence on common minimally invasive therapeutic spinal procedures based on the Levels of Evidence and Grades of Recommendation developed by the Centre for Evidence-Based Medicine (Oxford, United Kingdom). The results of the evaluation of current clinical evidence allow the following recommendations to be made: epidural adhesiolysis performed repeatedly every 3 months to 4 months is effective in the "post lumbar laminectomy" syndrome; epidural steroid injections may provide only short-term relief from pain in lumbar radiculopathy but have no long-term effect; selective nerve root injections of corticosteroids have no therapeutic effect on the long-term natural history of radiculopathy symptoms; intra-articular facet joint injections of corticosteroids have no therapeutic effect on lower back pain (grade of recommendation: A). ⋯ Finally, there is limited evidence (grade of recommendation: C) of the value of medial branch (facet) neurotomy, sacroiliac joint injection of steroids, and intradiscal electrothermal therapy, as well as of the advantages of percutaneous endoscopic lumbar discectomy over open microdiscectomy. As the level of evidence is generally low, more prospective randomized-controlled studies are needed to establish the value of the considered methods.