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K A LeBlanc

Publications and source records attributed to K A LeBlanc.

At least 19 recordsLinked to original sources
PubMed2004

Laparoscopic parastomal hernia repair.

Repair of parastomal represents a significant challenge for the hernia surgeon. Repair of these hernias is indicated because of an ill-fitting appliance, cosmetic deformity, inability to maintain proper hygiene and complications from the hernia itself such as incarceration or strangulation. Recent reports in the literature have shown that primary fascial repair can occur in 46% of patients and relocation of the stoma is associated with a 40% recurrence rate. For this reason, the use of polypropylene mesh has been applied to this repair. The recurrence rate with this open technique will still incur a failure rate of 20-29%. Additionally there are other complications such as obstruction, fistulization or mesh erosion with this biomaterial. The laparoscopic approach to this hernia may offer a new choice for this difficult problem. We have used ePTFE to repair 12 parastomal hernias with three different approaches. There have been eight colostomy, two ileostomy and two urostomy hernias. Follow-up ranges from 3-39 months (average 20 months). There has been one recurrence that required two repairs (8%). Other complications included enterotomy (one patient), ileus (one), seroma (one), and death from postoperative aspiration (one). The laparoscopic repair of parastomal hernias appears to be a promising technique for this complex dilemma.

Evaluation Studies as Topic↗
PubMed2004

Laparoscopic incisional and ventral hernia repair: complications-how to avoid and handle.

Complications will occur with any operative procedure. The possibility of this must be considered for laparoscopic incisional and ventral hernia repair (LIVH) as well. The most commonly reported of these include: intraoperative intestinal injury (1-3.5%), infection involving the prosthetic biomaterial (0.7-1.4%), (2.6-100%), postoperative ileus seromas (1-8%), and persistent postoperative pain (1-2%). The incidence of enterotomy can be reduced by careful dissection and judicious use of any energy source. Infection can be minimized by the use of perioperative antibiotics, an antimicrobially impregnated biomaterial, and careful manipulation of the prosthesis during the procedure. Seromas are so common that they should be expected but can be decreased by the use of a postoperative abdominal binder. Aspiration will be necessary in a few instances. Similarly, ileus is expected when there is significant bowel dissection and bleeding. Early ambulation and standard use of postoperative bowel care will aid in the treatment of this problem. Persistent pain will generally occur at the site of a transfascial suture. It cannot be predicted or prevented with certainty. When it occurs, local injection with bupivacaine, steroids, or non-steroidal agents will help, but occasionally, removal of the offending suture(s) will be required. The average recurrence rate for LIVH is approximately 5.6% in the literature. Rates as high as 15.7%, however, have been reported. Recurrence will be increased by inadequate prosthetic overlap of the fascial defect, infection that involves the biomaterial, which then requires its removal, and lack of the use of transfascial sutures. To prevent these risks, the surgeon must assure that there is at least a 3-cm overlap of all portions of the hernia defect and insist that sutures are used at 5-cm intervals to fix the biomaterial. Infection that requires explantation of the patch will generally result in recurrence, as this must be repaired primarily. Alternatively, the use of a collagen prosthesis may allow immediate repair, but this is associated with a high failure rate. A staged repair will be necessary in the future in most patients.

Hernia, Ventral↗
PubMed2003

Comparison of adhesion formation associated with Pro-Tack (US Surgical) versus a new mesh fixation device, Salute (ONUX Medical).

BACKGROUND: We evaluated efficacy and associated adhesion formation of an innovative mesh fixation device versus the helical tack device and analyzed two implantation techniques. METHODS: Six purpose-bred female hounds were evaluated in this 90-day survival study. Six 4-cm round patches of 1-mm thick DualMesh were fixed to the abdominal wall with either 10 Pro-Tack or 10 Salute constructs in each patch. Zero to 4 additional patches were implanted with only Salute constructs. RESULTS: Adhesion severity scores were significantly higher for middle left abdominal wall sites versus lower right and upper left sites. The adhesion dissection score was higher for group T (Pro-Tack) versus group S (Salute). CONCLUSION: No significant effects occurred with adhesion extent scores, but group T developed denser adhesions. The second analysis determined that no significant differences existed relevant to secondary Salute placement, although the total score approached significance (p < 0.09). Salute equipment was easier to handle and allowed repositioning of the patch during operation.

Animals↗
PubMed2003

Laparoscopic incisional and ventral hernioplasty: lessons learned from 200 patients.

Our first 100 patients and our second 100 patients who underwent a laparoscopic repair of incisional and ventral hernias were compared and evaluated. This analysis revealed that the second group was approximately 9 years older with more comorbid medical conditions. In all, 15% were incarcerated hernias, and 21% were recurrent. Seven operations were converted to the open repair because of adhesions in five patients and either a small or large bowel injury in two patients. There were no complications related to enterotomy. Older and more infirm patients in the second group did not significantly affect outcomes. The average size of the hernia defects was 111 cm2. The average size of the prosthesis was 257.5 cm2. Larger prostheses were used in the second group. With more experience, the recurrence rates have declined from 9% to 4%. The etiology of these recurrences differed in these two groups of patients. Removal of the prosthetic due to infection was a predictable recurrence in two patients. A new hernia below the original hernia has caused us to repair the entire incision that had the initial hernia. Only one technical failure was noted, due to fracture of the suture during transfascial placement and clamping of the suture. It is not recommended to grasp any suture that remains in the patient during this hernioplasty. Recurrences were reduced because of the use of an increased overlap of the biomaterial and the use of dual methods of fixation (tacks and transfascial sutures).

Adult↗
PubMed2002

Management of chronic postoperative pain following incisional hernia repair with Composix mesh: a report of two cases.

There are new prosthetic biomaterials that are used to repair various defects in the abdominal wall. These have been developed within the last several years. The results of many of these products are not yet available. We report on two patients who developed chronic-pain syndromes that could only be related to the use of Composix mesh. This entity may become more conspicuous in the future, thereby presenting the surgeon with difficulty in approaching this new and difficult problem. We believe that shrinkage of the prosthesis was responsible for the pain. Both of these patients responded favorably to resection of the mesh by the open or laparoscopic technique. This was followed by repair of the fascial defect with DualMesh by the open or laparoscopic method. We were successful in the achievement of the relief of the pain and the repair of the hernia in both cases. We believe that this entity can be treated successfully by this approach. The laparoscopic method is favored.

Adult↗
PubMed2002

Tissue attachment strength of prosthetic meshes used in ventral and incisional hernia repair. A study in the New Zealand White rabbit adhesion model.

BACKGROUND: Many prosthetic materials are used in incisional hernia repair, including polypropylene (PP) and expanded polytetrafluoroethylene (ePTFE). However, PP forms severe adhesions and ePTFE has raised concerns about the adequacy of tissue attachment. METHODS: The early tissue attachment strength of PP and two new forms of ePTFE (DLM and DLMC) was compared in a rabbit model (n = 12) in which disks of the three meshes (n = 8 of each material) were implanted against the abdominal wall for 3 days. RESULTS: Tensiometer testing found that DLMC mesh had significantly greater attachment strength than PP (p = 0.02). Histologic studies indicated that this was due to cellular ingrowth. Tissue adhesions were observed with all eight PP disks, one DLMC disk, and none of the DLM disks. CONCLUSION: Modified forms of ePTFE mesh may provide abdominal wall repairs that are as strong or stronger than those obtained with PP, with early tissue attachment and without adhesions.

Animals↗
PubMed2001

Laparoscopic incisional and ventral herniorraphy: our initial 100 patients.

A review of our initial 100 patients upon whom we attempted a laparoscopic repair of either a ventral and incisional hernia is presented. The average follow-up period of these individuals was 51 months. The operation was completed with the laparoscopic technique in 96 cases. The average defect size was 155 cm2 and the average prosthetic biomaterial size to repair these defects was 214.8 cm2. The major complication rate was 4.1%. The incidence of recurrence in these patients was 9.3%. In all of these cases of recurrence, the method of attachment was that of staples or spiral tacks alone. In 5 patients, it appeared that the prosthesis was too small to cover the defect adequately. We believe that this is an effective operation but one that has two technical mandates. The prosthetic biomaterial (DualMesh) must cover the fascial edges by a minimum of a three-centimeter overlap. Additionally, the attachment of the patch by staples or tacks alone is inadequate; consequently, the herniorraphy must include the use of through and through sutures to assure adequate fixation of the prosthesis.

Adult↗
PubMed2001

Complications associated with the plug-and-patch method of inguinal herniorrhaphy.

The inguinal hernia continues to challenge general surgeons as evidenced by the variety of new surgical techniques developed to treat this malady. The persistence of recurrence rates ranging from 0.5% to as high as 20% provides the impetus to find the "best" repair. Surgeons continue to pursue an easy approach to this condition that will provide minimal patient discomfort and low to absent recurrence rates. Open tension-free and laparoscopic repairs have been shown to produce less discomfort and lower recurrence rates than conventional repairs under tension. Some of these repairs are relatively complex and difficult to learn. The use of laparoscopy can add a significant cost to the repair. Rutkow and Robbins described a tension-free technique in 1993 that promised minimal dissection, rapid return to regular activities and low recurrence rates. The plug-and-patch repair has become a very popular method of herniorrhaphy. It is a quick procedure that is relatively easily learned. Since the initial description of the procedure, there have been anecdotal reports in the surgical literature describing an occasional interesting complication of this repair. There have been no comprehensive reviews of these occurrences. It appears that there are a significant number of patients who experience prolonged pain after this operation. Additionally, this plug often will shrink to a degree that results in a recurrence of the hernia. The most important finding of this study is that, as with other surgical procedures, attention to detail must be made to mitigate against adverse events.

Equipment Failure↗
PubMed2001

The critical technical aspects of laparoscopic repair of ventral and incisional hernias.

Several authors have revealed the utility of the laparoscopic approach to hernia defects that involve the ventral surface of the abdominal wall. The results of these series have been favorable. These authors all have recognized that appropriate sizing and fixation are important components of this operation. The pitfalls of the laparoscopic repair of incisional hernias are few but are significant. The most important technical considerations are dissection of all adhesions and clear identification of the fascial defect, prosthesis overlap of 3 cm in all directions, and fixation by through and through sutures and spiral tacks. The attention to these factors will diminish the risk of the immediate and long-term complications of the repair of these fascial defects.

Biocompatible Materials↗
PubMed2000

Laparoscopic incisional and ventral herniorrhaphy in 100 patients.

BACKGROUND: Laparoscopic incisional and ventral herniorrhaphy, a procedure first described 7 years ago, continues to gain acceptance. A series of about 100 patients who underwent the operation is described. Follow-up in this series was longer (mean 51 months) than that in previously reported series. METHODS: A retrospective review was conducted of operative and follow-up records of a series of patients scheduled to undergo laparoscopic incisional or ventral herniorrhaphy between 1992 and 1997. RESULTS: Laparoscopic repair was completed in 96 of 100 patients. The complication rate was 14%, with seromas accounting for half of the postoperative problems. Mean hospital stay was 1 day. The late recurrence rate was 9%, with 4 of the 9 recurrences developing >2 years postoperatively. CONCLUSIONS: Laparoscopic incisional and ventral herniorrhaphy is safe and effective. Most patients require hospitalization for </=24 hours. Use of an adequately sized prosthesis secured with more than one method is essential. Patients should be observed >/=3 years.

Adult↗
PubMed1998

In vivo study of meshes implanted over the inguinal ring and external iliac vessels in uncastrated pigs.

BACKGROUND: The effects of placing a prosthesis directly on the internal inguinal ring and external iliac vessels in inguinal hernia repair are unknown. We compared tissue responses to five prostheses implanted in this position in uncastrated male pigs. METHODS: Three types of polypropylene and two types of expanded polytetrafluoroethylene (ePTFE) mesh were implanted in 20 pigs (n = 8 for each prosthesis type). Specimens of the implants and surrounding tissue were obtained 30 and 90 days after implantation and assessed histologically. RESULTS: The polypropylene implants had more adhesions, more surface area covered by adhesions, and more tenacious adhesions than did the ePTFE implants. Perivascular cuffing was observed in eight polypropylene and one ePTFE specimen; ossification, necrosis, and testicular venous congestion were seen in polypropylene specimens. CONCLUSIONS: Abnormal healing processes after implantation of polypropylene mesh may increase complications of the transabdominal preperitoneal and total extraperitoneal approaches in laparoscopic inguinal hernia repair, whereas the minimal response to ePTFE meshes may make them safer for use in the preperitoneal space.

Animals↗
PubMed1993

Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings.

Laparoscopic techniques were used in five cases to repair incisional abdominal hernias ranging in size from 1.5 to 6 cm2. Four to five trocars were used in each case, one in the upper midline and three or four placed laterally. All repairs were made using 1-mm-thick expanded polytetrafluoroethylene patches inserted intraperitoneally and stapled to the anterior abdominal wall over the defects, making use of intra-abdominal pressure to secure the repair. The surgical technique is an extension of our current laparoscopic techniques for repairing inguinal hernias and potentially offers a significant decrease in morbidity.

Adult↗
PubMed1993

Avoiding complications with laparoscopic herniorrhaphy.

Before laparoscopic inguinal hernia repair can be widely adopted, general surgeons must become familiar with the laparoscopic presentation of the inguinal anatomy and must obtain practice with an effective technique that follows the surgical tenets of a good repair. This paper discusses some of the possible pitfalls of performing laparoscopic hernia repair and presents recommendations for success, including a brief description of a technique that has been used successfully in > 60 cases.

Groin↗
PubMed1988

Modification of the end-to-end stapled anastomosis utilizing intersecting staple lines.

There have been many technical advances involving intestinal stapling instruments. We have modified the method of the end-to-end anastomosis (EEA) stapling instrument. This requires the use of an intersecting staple line in a manner not previously described, to our knowledge. We report our technique that has been successful in the ten patients in whom it has been used; there have been no complications.

Anastomosis, Surgical↗
PubMed1987

Management of a large skull defect utilizing a vascularized free omental transfer.

A patient who underwent prior cranial surgery and radiation therapy and had the loss of his bone and skin flaps is presented. Basal cell carcinoma of a skin graft, placed on the dura mater and osteomyelitis of the surrounding cranium subsequently occurred. This problem of infection, neoplasia, cerebral protection, coverage, and cosmesis was managed successfully with a complex repair. The repair utilized autogenous fascia lata for the replacement of dura mater, rib and iliac crest bone for an autogenous cranioplasty, a free vascularized omental transfer for soft tissue bulk overlying the cranioplasty, and an autogenous split thickness skin graft over the omentum for coverage. Subsequent partial resorption of the autogenous cranioplasty necessitated the placement of a methyl methacrylate cranioplasty.

Adult↗
PubMed1985

Prophylactic antibiotics and closed tube thoracostomy.

A prospective randomized study of 85 patients who had sustained trauma to the chest requiring closed tube thoracostomy is reported. They were segregated into two groups, one of which did not receive prophylactic cephapirin sodium. Although the series is somewhat abbreviated, it would appear that the use of prophylactic antibiotics merely for the presence of a chest tube is an unsettled issue and of no definitely proved benefit.

Adolescent↗