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Christopher A. Caldarone - One of the best experts on this subject based on the ideXlab platform.
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The Ongoing Evolution of Sutureless Repairs for Pulmonary Vein Anomalies
Seminars in thoracic and cardiovascular surgery, 2016Co-Authors: Rachel D. Vanderlaan, Christopher A. CaldaroneAbstract:The Sutureless Technique has evolved from an effective treatment modality for postrepair pulmonary venous stenosis to a prophylactic strategy for primary repair of total anomalous pulmonary venous connection. Although conclusive data demonstrating efficacy as a universal prophylactic strategy is lacking, Zhang et al provide evidence that supports the Sutureless Technique as a safe and an effective prophylactic strategy in certain subsets of high-risk patients.
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Primary pulmonary vein stenosis: The impact of Sutureless repair on survival
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Nicola Viola, John G Coles, Abdullah A. Alghamdi, Donald G. Perrin, Gregory J. Wilson, Christopher A. CaldaroneAbstract:Background Primary pulmonary vein stenosis is often associated with relentless restenosis and early death. During the last 2 decades, we have developed a Sutureless repair to improve prognosis. Methods Hospital records for patients undergoing repair of primary pulmonary vein stenosis from 1989 to 2008 were reviewed. Pulmonary vein stenosis was quantified with a pulmonary vein stenosis score. Survival was determined by Kaplan–Meier analysis. Results Twenty-three patients underwent surgical repair. Mean ages at diagnosis and index repair were 23.3 ± 45.6 and 24.1 ± 40.9 months, respectively. Systemic or suprasystemic pulmonary artery pressures were present in 13 of 18 patients (72%). Seven (31%) had single-ventricle circulation. A Sutureless Technique was used in 19 of 23 cases (83%). Other types of repair were used in 4 of 23 (17%). There were 11 recorded deaths (47%). Survivals were 64%, 47%, and 31% at 1, 5, and 10 years, respectively. Five patients (22%) required 1 reintervention. Surgical repair significantly reduced the total pulmonary vein stenosis score (5.6 ± 2.10 before repair, 2.6 ± 2.72 after repair, P = .0057). The preoperative pulmonary vein stenosis score was the only independent predictor of mortality (hazard ratio, 1.732; P Conclusions Mortality and restenosis rates remained high despite the adoption of a Sutureless Technique. A preoperative pulmonary vein stenosis score of greater than 4 was a strong predictor of poor prognosis.
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conventional and Sutureless Techniques for management of the pulmonary veins evolution of indications from postrepair pulmonary vein stenosis to primary pulmonary vein anomalies
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: John G Coles, Osman O Alradi, Vitor C Guerra, Nilto C De Oliveira, Jeffrey F Smallhorn, Rachel M. Wald, William G Williams, Glen S Van Arsdell, Igor E Konstantinov, Christopher A. CaldaroneAbstract:Objective We have previously reported a limited but favorable experience with a novel Sutureless Technique for surgical management of postoperative pulmonary vein stenosis occurring after repair of total anomalous pulmonary venous drainage. Because this Technique requires integrity of the retrocardiac space for hemostasis, extension of the Technique to the primary repair of pulmonary vein anomalies requires evaluation. This analysis reviews our experience with the Sutureless Technique in patients with postrepair pulmonary vein stenosis, as well as our extension of the Technique into primary repair of pulmonary vein anomalies. Methods Retrospective univariable-multivariable analysis of all pulmonary vein stenosis procedures and Sutureless pulmonary vein procedures over a 20-year period was performed. Cox proportional hazards modeling was used to identify variables associated with freedom from reoperation or death. Results Sixty patients underwent 73 procedures, with pulmonary vein stenosis present in 65 procedures. The Sutureless Technique was used in 40 procedures. Freedom from reoperation or death at 5 years after the initial procedure was 49%. Unadjusted freedom from reoperation or death was greater with the Sutureless Technique for patients with postrepair pulmonary vein stenosis ( P = .04). By using multivariable analysis, a higher pulmonary vein stenosis score was associated with greater risk of reoperation or death. After adjustment, the Sutureless repair was associated with a nonsignificant trend toward greater freedom from reoperation or death ( P = .12). Despite the absence of retrocardiac adhesions, operative mortality was not increased with the Sutureless Technique ( P = .64). Techniques to control bleeding (intrapleural hilar reapproximation) and improve exposure (inferior vena cava division) were identified. Conclusion The Sutureless Technique for postrepair pulmonary vein stenosis is associated with encouraging midterm results. Extension of the indications for the Technique to primary repair appears safe with the development of simple intraoperative maneuvers.
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a Sutureless Technique for the relief of pulmonary vein stenosis with the use of in situ pericardium
The Journal of Thoracic and Cardiovascular Surgery, 1998Co-Authors: Hani K Najm, Christopher A. Caldarone, Jeffrey F Smallhorn, John G ColesAbstract:Pulmonary vein (PV) stenosis develops as a progressive and usually lethal complication after surgical repair of total anomalous PV connection. Conventional surgical repair for the management of recurrent PV stenosis has been generally unsuccessful because of proliferative neointimal hyperplasia resulting in recurrent PV obstruction. The factors that result in recurrent stenosis after the usual types of patch venoplasty are unknown. We speculated that direct suturing of PVs and patch material may be the substrate for turbulent blood flow triggering intimal hyperplasia and eventual narrowing of the vein. On the basis of these considerations, we developed a Sutureless Technique for repairing PV stenosis with in situ pericardium. We present here its early but promising results. Patients PATIENT 1. Patient 1 was born in January 1995 with infradiaphragmatic total anomalous PV connection and severe obstruction of the descending vertical vein. On day 1, the infradiaphragmatic anomalous vein was ligated and the confluence was anastomosed to the left atrium under conditions of hypothermic circulatory arrest. At 6 months, the child had conspicuous tachypnea. Echocardiography revealed obstructed left PVs with a mean gradient of 7 mm Hg (peak 16 mm Hg) and suprasystemic right ventricular pressure. Angiocardiography demonstrated variable obstruction of all four PVs, with a mean pulmonary artery pressure of 38 mm Hg (systolic 92 mm Hg). At reoperation, obstruction of all PVs was confirmed. Under conditions of circulatory arrest, a pedicled flap of free right atrial wall–superior vena cava junction based at the inferior vena cava was used to patch the right-sided veins and carried behind the aorta to patch the left upper PV. The left lower vein was repaired with a flap created from the left atrial appendage. After that operation, the child had repeated admissions with respiratory tract infections, complicated at 1 year by hemoptysis. Echocardiography revealed recurrence of obstruction. At the second reoperation, atretic left-sided veins and severe stenosis of right-sided veins were noted. The PVs were opened, and an in situ pericardial Sutureless patch was used for reconstruction. Echocardiography a year later showed patent veins, with mean gradients of 4 mm Hg on the right side and 5 mm Hg on the left. The estimated mean pulmonary artery pressure was 10 mm Hg. Perfusion lung scan showed 67% perfusion on the right side and 33% on the left. The child currently has no symptoms. PATIENT 2. Patient 2, a female infant, was born on January 1995 with total anomalous PV connection to coronary sinus with echocardiographic evidence of partial obstruction. At 2 weeks, she underwent repair consisting of unroofing of the coronary sinus, as described by Van Praagh and Harken. On completion of the procedure, the patient could not be weaned from cardiopulmonary bypass. At this time the right ventricular pressure was suprasystemic. The child was placed on extracorporeal membrane oxygenator and subsequently weaned after 3 days, with delayed sternal closure in 10 days as a result of persistent hemodynamic instability. Echocardiographic findings before discharge revealed unobstructed PV confluence–left atrium connection. However, echocardiography 4 months later revealed an obstructed right upper PV with a mean right ventricular pressure of 25 mm Hg. Perfusion scan showed 87% perfusion to the left lung and 13% to the right. Eleven months after the operation, echocardiography and cardiac catheterization revealed pulmonary hypertension, with a mean pulmonary artery pressure of 34 mm Hg and anatomically right PV stenosis. At reoperation, the presence of severe bilateral PV stenosis extending from left atrium a variable distance into the intraparenchymal PVs was confirmed. An in situ pericardial baffle was used for repair, as described here. Cardiac catheterization 6 months later revealed normal venous drainage on the left side and mild obstruction on the right side. The mean pulmonary artery pressure was 16 mm Hg. Perfusion lung scan showed 42% to left lung and 58% to right. The child has no symptoms at 15 months of postoperative follow-up. Technique. Standard cardiopulmonary bypass Technique is used. The incision is made into the left atrium and extended into both upper and lower PV ostia separately (Fig. 1, A). This incision can be carried into the secondary, and if necessary, the tertiary branches of both the upper and lower lobe veins to a level at which the intima appears grossly normal. The pericardium overlying the entrance of the PVs is used to create an enlarged communication between the opened PVs and the left atrium. The neoatrium is created by suturing the pericardium to the epicardium of the left atrium, completely circumscribing the opening in the left atrium and PVs so that the PV effluent is contained by pericardium. The reconstruction is From the Division of Cardiovascular Surgery, Department of Surgery, Hospital of Sick Children, and University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
Tadashi Kitamura - One of the best experts on this subject based on the ideXlab platform.
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Conventional repair of total anomalous venous drainage without primary Sutureless Technique: surgical tips to prevent pulmonary vein obstruction
General Thoracic and Cardiovascular Surgery, 2018Co-Authors: Koichi Sughimoto, Kagami Miyaji, Norihiko Oka, Shinzo Torii, Tadashi KitamuraAbstract:Objectives Although primary Sutureless Technique for total anomalous pulmonary venous drainage has been introduced to reduce postoperative pulmonary vein obstruction (PVO), controversy still exists about superiority of the procedure between the conventional repair and primary Sutureless Technique at the initial repair. In our unit, the conventional repair has been consistently used based on four important surgical policies: (1) mark incision lines between 2 chambers to gain anatomically natural alignment, (2) place precise stitches by “intima-to-intima” using monofilament suture, (3) adequate orifice size should be guaranteed in greater than expected mitral valve size, (4) do not hesitate to undertake a redo additional anastomosis by a different approach when an echocardiography shows the velocity more than 1.5 m/s. This study aims to evaluate mid-term outcome of the conventional repair for total anomalous pulmonary venous drainage. Methods Between 2004 and 2016, consecutive 15 patients who underwent the conventional repair without the primary Sutureless Technique were included in this study. Survival, Freedom from reoperation, and PVO were retrospectively reviewed. Results Mean follow-up period was 4.6 ± 3.7 years. Except for one patient who died of uncontrollable pleural effusion, all other patients survived with 5-year survival rate of 93.3%. For the 14 survivors, there was no PVO, nor reoperation. Conclusions Following these policies, the mid-term outcome of the conventional total anomalous pulmonary venous drainage repair was excellent without the primary Sutureless Technique showing no obstruction. The conventional repair can be safely applied at the initial operation when the morphological condition allows for it.
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Conventional repair of total anomalous venous drainage without primary Sutureless Technique: surgical tips to prevent pulmonary vein obstruction.
General thoracic and cardiovascular surgery, 2018Co-Authors: Koichi Sughimoto, Kagami Miyaji, Norihiko Oka, Shinzo Torii, Tadashi KitamuraAbstract:Objectives Although primary Sutureless Technique for total anomalous pulmonary venous drainage has been introduced to reduce postoperative pulmonary vein obstruction (PVO), controversy still exists about superiority of the procedure between the conventional repair and primary Sutureless Technique at the initial repair. In our unit, the conventional repair has been consistently used based on four important surgical policies: (1) mark incision lines between 2 chambers to gain anatomically natural alignment, (2) place precise stitches by “intima-to-intima” using monofilament suture, (3) adequate orifice size should be guaranteed in greater than expected mitral valve size, (4) do not hesitate to undertake a redo additional anastomosis by a different approach when an echocardiography shows the velocity more than 1.5 m/s. This study aims to evaluate mid-term outcome of the conventional repair for total anomalous pulmonary venous drainage.
Koichi Sughimoto - One of the best experts on this subject based on the ideXlab platform.
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Conventional repair of total anomalous venous drainage without primary Sutureless Technique: surgical tips to prevent pulmonary vein obstruction
General Thoracic and Cardiovascular Surgery, 2018Co-Authors: Koichi Sughimoto, Kagami Miyaji, Norihiko Oka, Shinzo Torii, Tadashi KitamuraAbstract:Objectives Although primary Sutureless Technique for total anomalous pulmonary venous drainage has been introduced to reduce postoperative pulmonary vein obstruction (PVO), controversy still exists about superiority of the procedure between the conventional repair and primary Sutureless Technique at the initial repair. In our unit, the conventional repair has been consistently used based on four important surgical policies: (1) mark incision lines between 2 chambers to gain anatomically natural alignment, (2) place precise stitches by “intima-to-intima” using monofilament suture, (3) adequate orifice size should be guaranteed in greater than expected mitral valve size, (4) do not hesitate to undertake a redo additional anastomosis by a different approach when an echocardiography shows the velocity more than 1.5 m/s. This study aims to evaluate mid-term outcome of the conventional repair for total anomalous pulmonary venous drainage. Methods Between 2004 and 2016, consecutive 15 patients who underwent the conventional repair without the primary Sutureless Technique were included in this study. Survival, Freedom from reoperation, and PVO were retrospectively reviewed. Results Mean follow-up period was 4.6 ± 3.7 years. Except for one patient who died of uncontrollable pleural effusion, all other patients survived with 5-year survival rate of 93.3%. For the 14 survivors, there was no PVO, nor reoperation. Conclusions Following these policies, the mid-term outcome of the conventional total anomalous pulmonary venous drainage repair was excellent without the primary Sutureless Technique showing no obstruction. The conventional repair can be safely applied at the initial operation when the morphological condition allows for it.
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Conventional repair of total anomalous venous drainage without primary Sutureless Technique: surgical tips to prevent pulmonary vein obstruction.
General thoracic and cardiovascular surgery, 2018Co-Authors: Koichi Sughimoto, Kagami Miyaji, Norihiko Oka, Shinzo Torii, Tadashi KitamuraAbstract:Objectives Although primary Sutureless Technique for total anomalous pulmonary venous drainage has been introduced to reduce postoperative pulmonary vein obstruction (PVO), controversy still exists about superiority of the procedure between the conventional repair and primary Sutureless Technique at the initial repair. In our unit, the conventional repair has been consistently used based on four important surgical policies: (1) mark incision lines between 2 chambers to gain anatomically natural alignment, (2) place precise stitches by “intima-to-intima” using monofilament suture, (3) adequate orifice size should be guaranteed in greater than expected mitral valve size, (4) do not hesitate to undertake a redo additional anastomosis by a different approach when an echocardiography shows the velocity more than 1.5 m/s. This study aims to evaluate mid-term outcome of the conventional repair for total anomalous pulmonary venous drainage.
John G Coles - One of the best experts on this subject based on the ideXlab platform.
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Primary pulmonary vein stenosis: The impact of Sutureless repair on survival
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Nicola Viola, John G Coles, Abdullah A. Alghamdi, Donald G. Perrin, Gregory J. Wilson, Christopher A. CaldaroneAbstract:Background Primary pulmonary vein stenosis is often associated with relentless restenosis and early death. During the last 2 decades, we have developed a Sutureless repair to improve prognosis. Methods Hospital records for patients undergoing repair of primary pulmonary vein stenosis from 1989 to 2008 were reviewed. Pulmonary vein stenosis was quantified with a pulmonary vein stenosis score. Survival was determined by Kaplan–Meier analysis. Results Twenty-three patients underwent surgical repair. Mean ages at diagnosis and index repair were 23.3 ± 45.6 and 24.1 ± 40.9 months, respectively. Systemic or suprasystemic pulmonary artery pressures were present in 13 of 18 patients (72%). Seven (31%) had single-ventricle circulation. A Sutureless Technique was used in 19 of 23 cases (83%). Other types of repair were used in 4 of 23 (17%). There were 11 recorded deaths (47%). Survivals were 64%, 47%, and 31% at 1, 5, and 10 years, respectively. Five patients (22%) required 1 reintervention. Surgical repair significantly reduced the total pulmonary vein stenosis score (5.6 ± 2.10 before repair, 2.6 ± 2.72 after repair, P = .0057). The preoperative pulmonary vein stenosis score was the only independent predictor of mortality (hazard ratio, 1.732; P Conclusions Mortality and restenosis rates remained high despite the adoption of a Sutureless Technique. A preoperative pulmonary vein stenosis score of greater than 4 was a strong predictor of poor prognosis.
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conventional and Sutureless Techniques for management of the pulmonary veins evolution of indications from postrepair pulmonary vein stenosis to primary pulmonary vein anomalies
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: John G Coles, Osman O Alradi, Vitor C Guerra, Nilto C De Oliveira, Jeffrey F Smallhorn, Rachel M. Wald, William G Williams, Glen S Van Arsdell, Igor E Konstantinov, Christopher A. CaldaroneAbstract:Objective We have previously reported a limited but favorable experience with a novel Sutureless Technique for surgical management of postoperative pulmonary vein stenosis occurring after repair of total anomalous pulmonary venous drainage. Because this Technique requires integrity of the retrocardiac space for hemostasis, extension of the Technique to the primary repair of pulmonary vein anomalies requires evaluation. This analysis reviews our experience with the Sutureless Technique in patients with postrepair pulmonary vein stenosis, as well as our extension of the Technique into primary repair of pulmonary vein anomalies. Methods Retrospective univariable-multivariable analysis of all pulmonary vein stenosis procedures and Sutureless pulmonary vein procedures over a 20-year period was performed. Cox proportional hazards modeling was used to identify variables associated with freedom from reoperation or death. Results Sixty patients underwent 73 procedures, with pulmonary vein stenosis present in 65 procedures. The Sutureless Technique was used in 40 procedures. Freedom from reoperation or death at 5 years after the initial procedure was 49%. Unadjusted freedom from reoperation or death was greater with the Sutureless Technique for patients with postrepair pulmonary vein stenosis ( P = .04). By using multivariable analysis, a higher pulmonary vein stenosis score was associated with greater risk of reoperation or death. After adjustment, the Sutureless repair was associated with a nonsignificant trend toward greater freedom from reoperation or death ( P = .12). Despite the absence of retrocardiac adhesions, operative mortality was not increased with the Sutureless Technique ( P = .64). Techniques to control bleeding (intrapleural hilar reapproximation) and improve exposure (inferior vena cava division) were identified. Conclusion The Sutureless Technique for postrepair pulmonary vein stenosis is associated with encouraging midterm results. Extension of the indications for the Technique to primary repair appears safe with the development of simple intraoperative maneuvers.
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a Sutureless Technique for the relief of pulmonary vein stenosis with the use of in situ pericardium
The Journal of Thoracic and Cardiovascular Surgery, 1998Co-Authors: Hani K Najm, Christopher A. Caldarone, Jeffrey F Smallhorn, John G ColesAbstract:Pulmonary vein (PV) stenosis develops as a progressive and usually lethal complication after surgical repair of total anomalous PV connection. Conventional surgical repair for the management of recurrent PV stenosis has been generally unsuccessful because of proliferative neointimal hyperplasia resulting in recurrent PV obstruction. The factors that result in recurrent stenosis after the usual types of patch venoplasty are unknown. We speculated that direct suturing of PVs and patch material may be the substrate for turbulent blood flow triggering intimal hyperplasia and eventual narrowing of the vein. On the basis of these considerations, we developed a Sutureless Technique for repairing PV stenosis with in situ pericardium. We present here its early but promising results. Patients PATIENT 1. Patient 1 was born in January 1995 with infradiaphragmatic total anomalous PV connection and severe obstruction of the descending vertical vein. On day 1, the infradiaphragmatic anomalous vein was ligated and the confluence was anastomosed to the left atrium under conditions of hypothermic circulatory arrest. At 6 months, the child had conspicuous tachypnea. Echocardiography revealed obstructed left PVs with a mean gradient of 7 mm Hg (peak 16 mm Hg) and suprasystemic right ventricular pressure. Angiocardiography demonstrated variable obstruction of all four PVs, with a mean pulmonary artery pressure of 38 mm Hg (systolic 92 mm Hg). At reoperation, obstruction of all PVs was confirmed. Under conditions of circulatory arrest, a pedicled flap of free right atrial wall–superior vena cava junction based at the inferior vena cava was used to patch the right-sided veins and carried behind the aorta to patch the left upper PV. The left lower vein was repaired with a flap created from the left atrial appendage. After that operation, the child had repeated admissions with respiratory tract infections, complicated at 1 year by hemoptysis. Echocardiography revealed recurrence of obstruction. At the second reoperation, atretic left-sided veins and severe stenosis of right-sided veins were noted. The PVs were opened, and an in situ pericardial Sutureless patch was used for reconstruction. Echocardiography a year later showed patent veins, with mean gradients of 4 mm Hg on the right side and 5 mm Hg on the left. The estimated mean pulmonary artery pressure was 10 mm Hg. Perfusion lung scan showed 67% perfusion on the right side and 33% on the left. The child currently has no symptoms. PATIENT 2. Patient 2, a female infant, was born on January 1995 with total anomalous PV connection to coronary sinus with echocardiographic evidence of partial obstruction. At 2 weeks, she underwent repair consisting of unroofing of the coronary sinus, as described by Van Praagh and Harken. On completion of the procedure, the patient could not be weaned from cardiopulmonary bypass. At this time the right ventricular pressure was suprasystemic. The child was placed on extracorporeal membrane oxygenator and subsequently weaned after 3 days, with delayed sternal closure in 10 days as a result of persistent hemodynamic instability. Echocardiographic findings before discharge revealed unobstructed PV confluence–left atrium connection. However, echocardiography 4 months later revealed an obstructed right upper PV with a mean right ventricular pressure of 25 mm Hg. Perfusion scan showed 87% perfusion to the left lung and 13% to the right. Eleven months after the operation, echocardiography and cardiac catheterization revealed pulmonary hypertension, with a mean pulmonary artery pressure of 34 mm Hg and anatomically right PV stenosis. At reoperation, the presence of severe bilateral PV stenosis extending from left atrium a variable distance into the intraparenchymal PVs was confirmed. An in situ pericardial baffle was used for repair, as described here. Cardiac catheterization 6 months later revealed normal venous drainage on the left side and mild obstruction on the right side. The mean pulmonary artery pressure was 16 mm Hg. Perfusion lung scan showed 42% to left lung and 58% to right. The child has no symptoms at 15 months of postoperative follow-up. Technique. Standard cardiopulmonary bypass Technique is used. The incision is made into the left atrium and extended into both upper and lower PV ostia separately (Fig. 1, A). This incision can be carried into the secondary, and if necessary, the tertiary branches of both the upper and lower lobe veins to a level at which the intima appears grossly normal. The pericardium overlying the entrance of the PVs is used to create an enlarged communication between the opened PVs and the left atrium. The neoatrium is created by suturing the pericardium to the epicardium of the left atrium, completely circumscribing the opening in the left atrium and PVs so that the PV effluent is contained by pericardium. The reconstruction is From the Division of Cardiovascular Surgery, Department of Surgery, Hospital of Sick Children, and University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
G. P. Ferulano - One of the best experts on this subject based on the ideXlab platform.
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Sutureless hernioplasty with light-weight mesh and fibrin glue versus Lichtenstein procedure: a comparison of outcomes focusing on chronic postoperative pain
Hernia, 2012Co-Authors: R. Lionetti, B. Neola, S. Dilillo, D. Bruzzese, G. P. FerulanoAbstract:Purpose Groin hernia is one of the most common disease requiring surgical intervention (8–10% of the male population). Nowadays, the application of prosthetic materials (mesh) is the Technique most widely used in hernia repair. Although they are simple and rapid to perform, and lower the risk of recurrence, these Techniques may lead to complications. The aim of the present study is to assess the incidence and degree of chronic pain, as well as the impairment in daily life, in two procedures: (1) the “Lichtenstein Technique” with polypropylene mesh fixed with non-absorbable suture, and (2) the “Sutureless” Technique carried out by using a partially absorbable mesh (light-weight mesh) fastened with fibrin glue. Methods This was a study conducted over a period of 3 years from July 2006 to July 2009. A total of 148 consecutive male patients suffering from groin hernia were divided randomly into two groups: (1) Group A: patients operated with “Sutureless” Technique with partially absorbable mesh and plug fastened with 1 ml haemostatic sealant; (2) Group B: patients operated with Lichtenstein Technique using non-absorbable mesh and plug anchored with polypropylene suture. Follow-up took place after 7 days, and 1, 6 and 12 months and consisted of examining and questioning patients about chronic pain as well as the amount of time required to return to their normal daily activities. Results No major complications or mortality were observed in either group. In group A there was a faster return to work and daily life activities. Six patients (7.8%) in group B suffered from chronic pain, whereas no patient in group A demonstrated this feature. Conclusions Our experience shows that the combined use of light-weight mesh and fibrin glue gives significantly better results in terms of postoperative pain and return to daily life.
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Sutureless hernioplasty with light-weight mesh and fibrin glue versus Lichtenstein procedure: a comparison of outcomes focusing on chronic postoperative pain.
Hernia : the journal of hernias and abdominal wall surgery, 2011Co-Authors: R. Lionetti, B. Neola, S. Dilillo, D. Bruzzese, G. P. FerulanoAbstract:Purpose Groin hernia is one of the most common disease requiring surgical intervention (8–10% of the male population). Nowadays, the application of prosthetic materials (mesh) is the Technique most widely used in hernia repair. Although they are simple and rapid to perform, and lower the risk of recurrence, these Techniques may lead to complications. The aim of the present study is to assess the incidence and degree of chronic pain, as well as the impairment in daily life, in two procedures: (1) the “Lichtenstein Technique” with polypropylene mesh fixed with non-absorbable suture, and (2) the “Sutureless” Technique carried out by using a partially absorbable mesh (light-weight mesh) fastened with fibrin glue.
