PubMed Health⌕ Search

Biomedical subjects

G Voeller

Publications and source records attributed to G Voeller.

11 recordsLinked to original sources
PubMed2003

Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases.

BACKGROUND AND OBJECTIVES: Laparoscopic ventral incisional hernia repair involves intraabdominal placement of a synthetic mesh, and the possibility of formation of severe visceral adhesions to the prosthesis is a principal concern. Little clinical information based on reoperative findings is available about adhesions to biomaterials placed intraabdominally. We conducted a multi-institutional study of adhesions to implanted expanded polytetrafluoroethylene (ePTFE) mesh at reoperation in patients who had previously undergone laparoscopic incisional hernia repair done with the same mesh implantation technique. METHODS: Nine surgeons retrospectively assessed the severity of adhesions to ePTFE mesh at reoperation in 65 patients. For each case, adhesions were assigned a score of 0 to 3, with 0 indicating no adhesions and 3 severe adhesions. RESULTS: The mean time from mesh implantation to reoperation was 420 days (range, 2-1 739 days). No adhesions were observed in 15 cases. Forty-four cases received an adhesion score of 1, and 6 cases a score of 2; no scores of 3 were assigned. Thus, 59 patients (91 %) had either no or filmy, avascular adhesions. No enterotomies occurred during adhesiolysis. CONCLUSIONS: In this large series of reoperations after laparoscopic incisional hernia repair, no or minimal formation of adhesions to implanted ePTFE mesh was observed in 91 % of cases, and no severe cohesive adhesions were found. Comparative analyses of newer materials based on clinical reoperative findings are warranted to assess the safety of intraabdominally placed meshes.

Adult↗
PubMed2002

Polyester (Parietex) mesh for total extraperitoneal laparoscopic inguinal hernia repair: initial experience in the United States.

Polypropylene mesh is the most commonly used mesh for open and laparoscopic hernia repair in the United States. A variety of newly developed polyester mesh products have recently become available. This is the first U.S. multiinstitutional study evaluating the initial experience of polyester mesh use for total extraperitoneal (TEP) laparoscopic inguinal hernia repair. Between January 2000 and June 2001, 337 patients underwent 495 TEP laparoscopic inguinal hernia repairs using polyester mesh. There were 309 men and 28 women in the study, whose average age was 45 years (range, 17-80 years). The average operative time for all cases was 54.3 min (range, 18-157 min). There were no conversions to open repair and no mortality. Complications included 12 seromas/hematomas (six aspirated), chronic pain in three patients, urinary retention in two patients, and one incidence each of the following: epididimitis, prostatitis, hydrocele, and port-site cellulitis. Additionally, one patient had carbon dioxide (CO2) in the Foley bag at the end of the surgery, but a normal cystogram showed no identified bladder injury. There has been one recurrence (0.2%), occurring 4 months after surgery, which was repaired using a transabdominal laparoscopic approach. The mean follow-up period was 11 months (range, 2-22 months). There have been no documented infections of the mesh, and no mesh has been removed. This study documents a favorable initial experience with polyester mesh for TEP laparoscopic inguinal hernia repair. There were no complications related to the mesh. There may be technical and long-term advantages with the use of polyester mesh for laparoscopic inguinal hernia repair. Longer follow-up evaluation and additional studies are warranted to evaluate these potential advantages.

Adolescent↗
PubMed2000

Laparoscopic ventral and incisional hernia repair in 407 patients.

BACKGROUND: Recurrence rates after primary repair of ventral and incisional hernias range from 25% to 52%. Recurrence after open surgery is less likely if mesh is used, but the wide fascial dissection and required flap creation increase complication rates. Laparoscopic techniques offer an alternative. STUDY DESIGN: To assess the safety and efficacy of laparoscopic ventral and incisional herniorrhaphy, we reviewed the records of all our patients who underwent such a procedure from November 1993 to August 1999. A laparoscopic approach was attempted in all patients considered to require a mesh repair. Patient demographic characteristics, operative details, and outcomes were recorded. RESULTS: Of 415 patients scheduled to undergo laparoscopic ventral or incisional herniorrhaphy, conversion to an open procedure was necessary in 8. All the remaining 407 patients (205 men and 202 women; mean age 53.2 years; range 13 to 88 years) were included in the study. Mean fascial defect size was 100.1 cm2 (range 1 to 480 cm2). In 97% of patients, expanded polytetrafluoroethylene mesh was used. Mean operating time was 97 minutes (range 11 to 270 minutes). Mean estimated blood loss was 35 mL (range 10 to 150 mL). Average hospital stay was 1.8 days (range 0 to 17 days). There were 53 complications (13.0%), including cellulitis of a trocar site, infection requiring mesh removal, prolonged suture pain, persistent seroma, intestinal injury, hematoma or postoperative bleeding, prolonged ileus, urinary retention, respiratory distress, fever, intraabdominal abscess, and trocar site herniation. There were no deaths. During a mean followup time of 23 months (range 1 to 60 months), there were 14 hernia recurrences (3.4%), 6 in patients in whom only a stapling device (no sutures) had been used to secure the mesh to the abdominal wall. CONCLUSIONS: Laparoscopic repair was completed in 98.1% of patients in whom it was attempted. The complication rate was acceptable. A short hospital stay and minimal blood loss were documented. The recurrence rate was 3.4%. Laparoscopic ventral and incisional hernia repair appear to be safe and effective.

Adolescent↗
PubMed1998

Developments in hernia repair.

Traditionally, inguinal hernia repair uses autogenous tissues (Shouldice, Bassini, Cooper's). While dedicated hernia clinics have shown low recurrence rates using autogenous tissues, most studies show recurrence rates in the 5% to 15% range. In addition, these tension producing repairs may lead to a longer recovery due to increased discomfort. For these reasons, the recent trend in inguinal hernia surgery has been towards using a mesh-based tensionless repair. There are three main tension-free approaches using mesh that are presently receiving the majority of attention:

Journal Article↗
PubMed1997

Efficacy of electrical stimulation at frequencies higher than basal rate in canine stomach.

The optimum frequency for electrically stimulating motility in the stomach is still in question. Some studies of gastric electrical stimulation (GES) at near physiologic frequencies have reported gastric electrical entrainment but with little efficacy in improving motility. In this study we examined the effectiveness of electrical stimulation at a broad range of frequencies in entraining gastric electrical activity (GEA) and eliciting contractions in a canine model. The stomachs of six dogs, each implanted with four pairs of stainless steel electrodes and two strain gauges were stimulated at frequencies ranging from 3 to 30 cycles/min. GEA and contractions were monitored before and during electrical stimulation. The ability of GES at different frequencies to reverse the effect of glucagon was also investigated. GEA was entrained in most animals at frequencies close to the intrinsic rate as well as at four to five times the intrinsic rate. At other stimulation frequencies, the recorded electrical control activity either remained unchanged, uncoupled, or became dysrhythmic. Contractile response to stimulation at four to five times the intrinsic rate were significantly higher than those at frequencies close to the intrinsic rate (P < 0.05). GES did not alter the effect of glucagon. Stimulation at a frequency of four times the basal rate of 5/min elicited the largest motility index in dogs. Stimulation at frequencies much higher than the physiologic rate warrants further study as a possible optimum range for GES.

Animals↗
PubMed1994

Measurement of gastric and small bowel electrical activity at laparoscopy.

Recordings of gastric electrical activity can be employed in the diagnosis of certain gastric motility disorders. Since the best recordings are obtained from electrodes implanted at laparotomy, the scope of application of this technique is limited. The current study details a method of measuring gastric electrical activity at laparoscopy. The patients were 3 Caucasian women whose age range was 16 to 30 years. Their pertinent history included symptoms of nausea, vomiting, constipation, and abdominal pain. Gastric and small bowel electrical activity was measured with stainless steel electrodes implanted into the serosa of the stomach and small bowel at laparoscopy. Laparoscopy was performed for small bowel biopsy, bowel resection, or feeding tube placement. The recorded signals were evaluated by manual analysis. Good quality gastric and small bowel electrical activities were obtained. Amplitude, frequency, rhythmicity, and direction of propagation information were readily obtained by visual inspection. Laparoscopic measurement of gastric electrical activity produces excellent quality recordings comparable with recordings from electrodes implanted at laparostomy. The technique combines the advantage of laparoscopy with the usefulness of serosal measurement of gastrointestinal electrical activity.

Adolescent↗
PubMed1990

Surgical management of perforated Crohn's disease.

The records of 102 patients operated on by one of the authors for Crohn's disease during the past 15 years were reviewed. Twenty-seven patients with confined (abscess present) or free perforation were evaluated. The average age was 31 years and the mean duration of disease was four years. Only two of the 27 patients had had previous surgery. All patients presented with a combination of pain, weight loss, and diarrhea. Twenty-three patients were afebrile, 17 had abdominal tenderness, and 6 had an abdominal mass. The average serum albumin was 3.7, the average hematocrit was 35 per cent and the average WBC was 13,000. Radiologic tests were abnormal in 23 of the 27 patients. All patients had been on medical treatment for Crohn's disease, and 19 of 27 were on high-dose steroids at the time of surgery. Ten of the 27 had a bowel prep before surgery and all had preoperative and postoperative antibiotics. All patients were surgically managed by resection and primary anastomosis without proximal diversion or delayed reconstruction. Drains were used in one third of the patients. Intraoperative cultures revealed gram-negative rods with Escherichia coli, enterococcus, and Enterobacter the most common. One enterocutaneous fistula, two superficial wound infections, and one death were recorded. Based on these results, the authors believe that an aggressive one-stage surgical approach for these complicated problems can be recommended. The low morbidity and mortality justifies this approach that results in considerable improvement in lost work time, length of hospital stay, number of readmissions, and significant cost control.

Abscess↗
PubMed1989

Silent deep vein thrombosis in immobilized multiple trauma patients.

Although few trauma patients sustain fatal pulmonary embolism, a large population is at risk from nonfatal embolism due to unrecognized deep vein thrombosis (DVT). Thirty-eight of 39 immobilized trauma patients at bed rest for 10 days or longer had venographic study of their lower extremities to evaluate for the presence of silent DVT. Sixty percent of patients had silent DVT, with thrombi extending above the knee in half the patients with clot. DVT was documented in 67 percent of patients with major lower extremity fractures and 59 percent of patients without major fractures. DVT increased with increasing age but not with injury severity score.

Adult↗
PubMedDate not supplied

Recurrences in laparoscopic incisional hernia repairs: a personal series and review of the literature.

OBJECTIVES: Laparoscopic repair of incisional ventral hernias with ePTFE mesh continues to evolve, with variable reporting of surgical techniques and outcomes. This report of 34 cases discusses, with a literature review of laparoscopic incisional hernia repair, specific factors associated with three recurrences. METHOD: Retrospective analysis and review of the literature. RESULTS: Thirty-two patients (16 female, 16 male), underwent 34 laparoscopic repairs: average age-54 years (27-80), average weight-207 lbs (100-300). Nineteen patients (62%) were undergoing first time repairs, 38% were redo cases and 5 cases (14%) involved previous mesh. Operating times averaged 101 minutes (45-220), and average length of stay was 1.9 days (0.6 days excluding 5 patients who required readmission), with 13 patients (38%) being discharged same-day. Two patients developed cellulitis (6%) treated without patch removal. Two enterotomies occurred (6%) both requiring patch removal. Five patients required readmission (14%), and one patient died postoperative day 29 secondary to end-stage liver disease. Three recurrences developed (9%): one secondary to missed enterotomy with reoperation, patch removal and hernia recurrence; one due to omission of suspension suture fixation; and one recurrence developed in a section of the intact old previous incision that extended beyond the original patch. Follow up has averaged 20 months (4-36). CONCLUSIONS: The laparoscopic repair of ventral and incisional hernias utilizing transabdominal placement of ePTFE patch can achieve excellent results with low morbidity in comparison with open surgical approaches. In reviewing the experience of other investigators, adequate fixation of the mesh, extension to cover the entire previous incision and standardizing the placement interval of the sutures are critical to the success of the repair.

Adult↗