Explore the vast range of titles available.

The aim of this study was to systematically analyze the randomized trials comparing tacker mesh fixation with glue mesh fixation (GMF) in laparoscopic inguinal hernia repair (LIHR). Standard electronic database were searched to retrieve relevant randomized trials comparing tacker mesh fixation with GMF in LIHR, which were analyzed systematically using RevMan. Five randomized controlled trials encompassing 1,001 patients were retrieved from the electronic databases. In a random-effects model, operating time, postoperative pain, postoperative complications, length of hospital stay and risk for hernia recurrence were statistically comparable between the 2 techniques of mesh fixation in LIHR. However, GMF was associated with a reduced risk for developing chronic groin pain. GMF in LIHR does not increase the risk for hernia recurrence and reduces the risk for developing chronic groin pain. It is comparable with tacker mesh fixation in terms of operation time, postoperative pain, postoperative complications, length of hospital stay, and risk for hernia recurrence.

Laparoscopic groin hernia repair has evolved to become a mainstay in the treatment of inguinal hernias. Fixation of the mesh in endoscopic totally extraperitoneal hernia repair is a critical step of the procedure as post-operative pain is an undesirable clinical outcome impairing daily activity. The aim of this study is to compare mesh fixation using tacker with non-mechanical fixation using n-butyl cyanoacrylate (NBCA) glue for endoscopic totally extraperitoneal (TEP) hernioplasty. During the study, sixty patients with uncomplicated inguinal hernia underwent standard dissection in TEP by a single surgeon. They were randomized as 30 patients in tacker mesh fixation (group A) and 30 patients in n-butyl 2-cyanoacrylate glue mesh fixation (group B). Post-operative acute and chronic pain was assessed by recording the visual analogue scale scores. Operative time, analgesic requirement in the post-operative period, days for return to normal routine activity, and cost-effectiveness were also compared. Endpoint was recurrence at the end of 6 months. There was no significant difference in VAS scores at all timelines between the tacker and glue group ( p  > 0.05). However, one patient in the tacker group had chronic pain. Consumption of analgesia was slightly higher in group A in early post-operative period (20% in group A, 13% in group B), but no statistical significance was observed ( p  > 0.05). No recurrence was found in either group. Most of the patients were able to return to normal routine within a week. The study concludes that NBCA glue to fix the mesh in endoscopic TEP hernia repair is comparable to tacker and can be safe, feasible, cost-effective, and associated with less post-operative pain as nerve injury can be avoided.

Trans-abdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repairs are the available surgeries for inguinal hernias, with both methods of laparoscopic repairs requiring mesh applications. This study analyzes the correlation between sutured versus stapler mesh fixation in a laparoscopic TAPP for unilateral groin hernia regarding chronic pain during 3-year follow-up. A total of 130 patients with laparoscopic hernia undergoing TAPP repair were randomized into 2 groups based on their fixation technique—one with sutures and the other with stapler. Postoperative complications and chronic groin pain were noted for each technique. Equal number of participants was present in the stapler and suture groups, with the majority having an ASA score of one. The mean age was 42.50 ± 13.86 years, and the body mass index (BMI) was 27.47 ± 5.88. The stapler group presented a shorter mean operative time than the suture group. However, the stapler group had a significantly higher mean VAS score than the suture group. Most participants in the suture group (89.2%) had LOS for 1 day, while a 2-day LOS was significantly higher in the stapler group (12.3%) than in the suture group (9.2%). No patient reported mesh erosion, conversion, recurrence, testicular atrophy, and mesh infection. Early postoperative pain was more in stapler group along with long hospital stay, but both were non-significant. Chronic postoperative pain results and recurrence incidences over 3-year follow-up were also similar. Re-admission rates were minimal, no significant complications occurred.

Background Mesh reinforcement has become the standard of care in the open and laparoscopic repair of inguinal hernia. Chronic pain after inguinal hernia repair is often due to nerve injury by penetrating mesh fixation devices such as staples (ST), tacks, or sutures. In several studies on hernioplasty, atraumatic mesh fixation with fibrin sealant (FS) proved to be efficient in terms of fixation strength and elasticity. Unfortunately, most of these studies did not provide a standardized follow-up and assessment of the development of chronic pain (CP) and the quality of life (QoL). Therefore, a randomized controlled trial comparing CP and QoL after FS fixation of mesh with ST in transabdominal preperitoneal hernioplasty (TAPP) was performed at our department. The primary end point of our study was to assess the patient outcome by using a visual analog scale (VAS) and the short form 36 (SF-36). The evaluation of recurrence rates was the secondary aim. Methods According to the randomization, a macroporous mesh (TiMESH ® ) was fixed in group A (44 patients with 54 inguinal hernias) with FS (TISSEEL) or in group B (45 patients with 56 inguinal hernias) with ST (EMS ® Stapler). The observation period was 1 year with regular clinical check ups and assessment of VAS and SF-36. Results Patient characteristics expressed by BMI, ASA scores, and Schumpelick hernia classification were similar in both treatment groups. In each group there was one recurrence within 8 (FS) and 9 months (ST) postsurgery. The mean preoperative pain values scored by VAS were 1.7 (range = 0–7.5) in the FS group and 2.2 (range = 0–6) in the ST group. Postoperative mean VAS scores measured at 1 year postsurgery were 0.4 (range = 0–3) in the FS group and 0.9 (range = 0–7.5) in the ST group. One year postsurgery there was no significant difference between the two groups with respect to the parameter pain in the SF-36 and VAS. Conclusion Fibrin sealant fixation leads to a low rate of hernia recurrence and avoids tissue trauma. ST provide similar results in the hand of the expert but bear inherent risks of complications due to tissue perforation.

Objective To systematically compare the tacker mesh fixation (TMF) with the suture mesh fixation (SMF) in laparoscopic incisional and ventral hernia (LIVH) repair. Methods Trials evaluating the TMF with the SMF in LIVH repair were analysed using the statistical tool RevMan ® . Combined dichotomous and continuous data were expressed as odds ratio (OR) and mean difference (MD), respectively. Results Four trials (2 randomised and 2 non-randomised) encompassing 207 patients undergoing LIVH repair with TMF versus SMF were retrieved from the standard electronic databases and analysed systematically. Ninety-nine patients underwent TMF and 108 patients underwent SMF in LIVH repair. There was no statistically significant heterogeneity ( p  = 0.27)] among trials. In the fixed-effects model, LIVH repair with TMF was associated with shorter operation time (MD, −23.65; 95 % CI, −31.06, −16.25; z  = 6.26; p  < 0.00001). Four- to six-week postoperative pain score was significantly lower (MD, −0.69; 95 % CI, −1.16, −0.23; z  = 2.92; p  < 0.004) following TMF. Peri-operative complications ( p  = 0.65), length of hospital stay ( p  = 1) and risk of hernia recurrence (OR, 1.54; 95 % CI, 0.38, 6.27; z  = 0.61; p  = 0.54) following TMF and SMF were statistically not different. Conclusion TMF in LIVH repair is associated with shorter operative time and lesser postoperative pain. TMF is comparable with SMF in terms of peri-operative complications, length of hospital stay and hernia recurrence. Therefore, TMF may be used in LIVH repair. However, further randomised trials recruiting higher number of patients are required to validate these findings.

PurposeSurgical treatment of jumper’s fractures is a highly demanding situation for the surgeon due to its rareness and frequent association with severe concomitant injuries. There is no current consensus regarding a standard treatment approach, thus reducing quality of care. Our objectives were to describe, apply and assess a novel surgical technic.MethodsThe presented research is an observational retrospective study of patients who underwent the described novel surgical intervention in a level 1 trauma center. We conducted analyses of the patient cohort using patient-related outcome measures at least 1 year after surgery, as well as investigating pain, quality of life and the clinical effectiveness of the procedure.ResultsA total of 24 patients (17 male and 7 female) with an average age 47 ± 16.3 years were included. ISS scores ranged from 9 to 66 with a mean ISS of 40 ± 15. Clinical scores exist of 15 out of 24 patients (62.5%). The mean VAS score was 53.7 ± 12.9. The mean EQ-5D index was 0.68 ± 0.22. Significant negative correlation existed between the ISS value and the EQ-5D index (r =  − 0.704; p < 0.005) and EQ-5D VAS (r =  − 0.809; p < 0.001). Anatomical reduction was achieved in all patients (n = 24). Radiological follow-up was performed in 58%.ConclusionWe present one of the largest studies with operatively treated jumper’s fractures of the sacrum. The technique is capable of reproducibly restoring the physiological anatomy of the patient and allows pain-adapted mobilization.

Aim The treatment of tibial fractures with an intramedullary nail is an established procedure. However, torsional control remains challenging using intraoperatively diagnostic tools. Radiographic tools such as the Cortical Step Sign (CSS) and the Diameter Difference Sign (DDS) may serve as tools for diagnosing a relevant malrotation. The aim of this study was to investigate the effect of torsional malalignment on CSS and DDS parameters and to construct a prognostic model to detect malalignment. Methods A proximal tibial shaft fracture was set in human tibiae. Torsion was set stepwise from 0° to 30° in external and internal torsion. Images were obtained with a C-arm and transferred to a PC for measuring the medical cortical thickness (MCT), lateral cortical thickness (LCT), tibial diameter (TD) in AP and the anterior cortical thickness (ACT) as well as the posterior cortical thickness (PCT) and the transverse diameter (TD) of the proximal and the distal main fragment. Results There were significant differences between the various degrees of torsion for each of the absolute values of the examined variables. The parameters with the highest correlation were TD, LCT and ACT. A model combining ACT, LCT, PCT and TD lateral was most suitable model in identifying torsional malalignment. The best prediction of clinically relevant torsional malalignment, namely 15°, was obtained with the TD and the ACT. Conclusion This study shows that the CSS and DDS are useful tools for the intraoperative detection of torsional malalignment in proximal tibial shaft fractures and should be used to prevent maltorsion.

BackgroundThe reported range of seroma formation in the literature after TEP repair is between 0.5 and 12.2% and for TAPP between 3.0 and 8.0%. Significant clinical factors associated with seroma formation include old age, a large hernia defect, an extension of the hernia sac into the scrotum, as well as the presence of a residual indirect sac. Seroma formation is a frequent complication of laparoendoscopic mesh repair of moderate to large-size direct (medial) inguinal hernia defects. This present analysis of data from the Herniamed Hernia Registry now explores the influencing factors for seroma formation in male patients after TAPP repair of primary unilateral inguinal hernia.MethodsIn total, 20,004 male patients with TAPP repair of primary unilateral inguinal hernia were included in uni- and multivariable analysis.ResultsUnivariable analysis revealed the highly significant impact of the fixation technique on the seroma rate (non-fixation 0.7% vs. tacks 2.1% vs. glue 3.9%; p < 0.001). Multivariable analysis showed that glue compared to tacks (OR 2.077 [1.650; 2.613]; p < 0.001) and non-fixation (OR 5.448 [4.056; 7.317]; p < 0.001) led to an increased seroma rate. A large hernia defect (III vs. I: OR 2.868 [1.815; 4.531]; p < 0.001; II vs. I: OR 2.157 [1.410; 3.300]; p < 0.001) presented a significantly higher risk of seroma formation. Likewise, medial compared to lateral inguinal hernias had a higher seroma rate (OR 1.272 [1.020; 1.585]; p = 0.032).ConclusionsMesh fixation with tacks or glue, a larger hernia defect, and medial defect localization present a higher risk for seroma development in TAPP inguinal hernia repair.

Legume plants host nitrogen-fixing endosymbiotic Rhizobium bacteria in root nodules. In Medicago truncatula, the bacteria undergo an irreversible (terminal) differentiation mediated by hitherto unidentified plant factors. We demonstrated that these factors are nodule-specific cysteine-rich (NCR) peptides that are targeted to the bacteria and enter the bacterial membrane and cytosol. Obstruction of NCR transport in the dnf1-1 signal peptidase mutant correlated with the absence of terminal bacterial differentiation. On the contrary, ectopic expression of NCRs in legumes devoid of NCRs or challenge of cultured rhizobia with peptides provoked symptoms of terminal differentiation. Because NCRs resemble antimicrobial peptides, our findings reveal a previously unknown innovation of the host plant, which adopts effectors of the innate immune system for symbiosis to manipulate the cell fate of endosymbiotic bacteria.

BackgroundThe mesh fixation technique used in repair of hiatal hernias and subxiphoid ventral and incisional hernias must meet strenuous requirements. In the literature, there are reports of life-threatening complications with cardiac tamponade and a high mortality rate on using tacks. The continuing practice of tack deployment for mesh fixation to the diaphragm and esophageal hiatus should be critically reviewed.MethodsIn a systematic search of the available literature in May 2017, 23 cases of severe penetrating cardiac complications were identified. The authors became aware of two other cases in which they acted as medical experts. Furthermore, the instructions for use issued by the manufacturers of the tacks were reviewed with regard to their deployment in the diaphragm.ResultsTwenty-three of 25 cases (92%) with severe cardiac injuries and subsequent cardiac tamponade were triggered by the use of tacks in the diaphragm. In six cases (24%), these related to ventral and incisional hernias with extension to the subxiphoid area, and in 19 cases (76%) to mesh-augmented hiatoplasty. Twelve of 25 (48%) patients died as a result of pericardial and/or heart muscle injury with cardiac tamponade despite heart surgery intervention. In the tack manufacturers’ instructions for use, their deployment in the diaphragm, in particular in the vicinity of the heart, is contraindicated. Likewise, the existing guidelines urgently advise against the use of tacks in the diaphragm, recommending instead alternative fixation techniques.ConclusionsTacks should not be used for mesh fixation in the diaphragm above the costal arch.