TEP Group Research Articles

Deformidade angular adquirida no carpo de muares: diagnóstico, incidência e tratamento

O objetivo deste trabalho foi diagnosticar, tratar e monitorar a ocorrência de DA adquirida no carpo de muares. O tratamento instituído nos animais portadores de DA foi determinado pelo desvio angular mensurado em imagens radiológicas. Membros com desvio ≤3° foram submetidos ao casqueamento (TC); desvios >3° e ≤7° foram tratados com transecção e elevação de periósteo e casqueamento (TEP); desvio >7° foram submetidos às mesmas medidas adotadas no grupo TEP, associadas ao uso de grampo trans-fisário (GTF). Os desvios foram monitorados através de radiografias obtidas 45 dias antes (T0), no início do tratamento (T1) e com 30 (T2) e 60 (T3) dias após a sua instituição. A incidência de animais acometidos no plantel estudado foi de 37,1%, sendo a demanda por tratamento cirúrgico maior do que a relatada em equinos. O fator determinante para a incidência de DA neste plantel foi o programa de treinamento instituído. Entre T0 e T1, não houve variação da DA. No grupo TEP, a redução a partir de T2 foi semelhante à relatada nos equinos, porém a melhora ocorreu em menos tempo e em muares com idade de 7,9 meses. Não foi obtida redução satisfatória do desvio no grupo GTF, provavelmente, devido à média de idade elevada desse grupo. Conclui-se que os exercícios acarretaram na incidência de DA nos muares. O tratamento instituído no grupo TEP foi capaz de reduzir a DA, apesar da idade dos muares.

Primary versus Delayed Tracheoesophageal Puncture in Patients with Free Flap Reconstruction of Laryngopharyngectomy Defects

Results Thirty patients (22%) had a primary TEP performed at the time of TL, 27 patients (20%) received secondary punctures (>3 months post TL), and 80 patients (58%) never received a TEP. Patient and operative demographics were similar between groups (p>0.05), apart from proportionately more hypopharyngeal tumors in the ‘no TEP’ group (p=0.002). Similar numbers of patients in primary and secondary TEP groups achieved functional speech (67% vs 71%, p=0.82). Median time to voice acquisition was 56 days for the primary group and 200 days for the secondary group. Salvage surgery and non-patch radial forearm free flap reconstruction both trended towards increased early postoperative complication rates (p=0.09).).

Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair

Chronic postoperative pain is a major drawback of inguinal hernia repair. This study compared the frequency of chronic pain after laparoscopic (totally extraperitoneal patch, TEP) and open (Lichtenstein) repairs. A randomized multicentre study with 5 years' follow-up was conducted on men with a primary inguinal hernia. Chronic pain was categorized as mild, moderate or severe by blinded observers. A subgroup analysis was performed on 121 patients who experienced moderate or severe pain at any time during follow-up. Overall, 1370 of 1512 randomized patients underwent surgery, 665 in the TEP and 705 in the Lichtenstein group. The total incidence of chronic pain was 11.0 versus 21.7 per cent at 1 year, 11.0 versus 24.8 per cent at 2 years, 9.9 versus 20.2 per cent at 3 years and 9.4 versus 18.8 per cent at 5 years in the TEP and Lichtenstein groups respectively (P < 0.001). After 5 years, 1.9 per cent of patients in the TEP and 3.5 per cent in the Lichtenstein group reported moderate or severe pain (P = 0.092). Of the 121 patients, 72 (59.5 per cent) no longer reported pain a median of 9.4 (range 6.7-10.8) years after operation. Five years after surgery only a small proportion of patients still report moderate to severe chronic pain. Laparoscopic inguinal hernia repair leads to less chronic pain than open repair. NCT00568269 (http://www.clinicaltrials.gov).

Effects of Persistent CO2Insufflation During Different Laparoscopic Inguinal Hernioplasty: A Prospective, Randomized, Controlled Study

The aims of this study were to investigate the effects of carbon-dioxide (CO(2)) insufflation on hemodynamic and respiratory function during laparoscopic inguinal hernioplasty and to evaluate the safety of transabdominal preperitoneal hernia repair (TAPP) and extraperitoneal hernia repair (TEP). Forty patients with inguinal hernia were admitted for laparoscopic inguinal hernia repair in our study. The patients were randomly assigned to undergo TAPP (TAPP group, n = 20) or TEP (TEP group, n = 20). Hemodynamic and respiratory parameters, including heart rate, blood pressure, end-tidal CO(2) (EtCO(2)), and blood-gas parameters, were observed and compared between the two groups. There was no significant difference between the two groups in terms of sex, age, American Society of Anesthesiology degree, body-mass index, type of hernia, operation time, hospital stay, and postoperative pain score. In both groups, 5 minutes into the operation, blood pressure, EtCO(2), PaCO(2), and HCO(3)(-) increased significantly, whereas heart rate and pH decreased significantly (P < 0.05). The above tendency became significant with the operation prolonged. All parameters recovered to normal levels at the end of surgery. No significant difference was found between the TAPP and TEP groups. Both TAPP and TEP procedures can result in CO(2) accumulation, acidosis, increased blood pressure, and decreased heart rate. But, these effects were transient and could be well controlled by appropriate treatments during the operation. The laparoscopic TAPP and TEP techniques are safe for patients by proper perioperative management.

Lichtenstein Hernioplasty Versus Totally Extraperitoneal Laparoscopic Hernioplasty in Treatment of Recurrent Inguinal Hernia—A Prospective Randomized Trial

To compare the Lichtenstein hernioplasty with a totally extraperitoneal preperitoneal laparoscopic technique (TEP) in treatment of recurrent inguinal hernias. Only a few studies thus far have compared an open and laparoscopic approach with the treatment of recurrent inguinal hernia in a prospective randomized study setting. Ninety-nine patients undergoing surgery for recurrent inguinal hernia were prospectively randomized into having either open or laparoscopic mesh repair. Pre, peri- and postoperative factors were recorded in addition to 3-year follow-up data at the outpatient clinic. At 5-10 years, the patients were interviewed via telephone for recurrent symptoms. The primary end-points chosen were hernia recurrence and chronic pain. Preoperative factors did not differ between the 2 groups. Rerecurrence rates were 3 in the Lichtenstein group and none in the TEP group (6.4% versus 0.0%, respectively), but this difference was statistically not significant. Chronic pain was more prevalent in the Lichtenstein group compared with the TEP group (13 [27.7%] versus 4 [8.2%] patients, respectively, P = 0.02). Postoperatively, the Lichtenstein group needed more pain medication than the TEP group (4.4 versus 3.0 doses, respectively, P = 0.02) and returned to work later (17.9 versus 14.8 days, respectively, P = 0.05). The laparoscopic technique with mesh in the treatment of recurrent inguinal hernia was proven superior to the open mesh repair in several important clinical aspects, with concomitant improvement in patient satisfaction.

Predefined Massive Transfusion Protocols are Associated With a Reduction in Organ Failure and Postinjury Complications

Massive transfusion (MT) protocols have been shown to improve survival in severely injured patients. However, others have noted that these higher fresh frozen plasma (FFP):red blood cell (RBC) ratios are associated with increased risk of organ failure. The purpose of this study was to determine whether MT protocols are associated with increased organ failure and complications. Our institution's exsanguination protocol (TEP) involves the immediate delivery of products in a 3:2 ratio of RBC:FFP and 5:1 for RBC:platelets. All patients receiving TEP between February 2006 and January 2008 were compared with a cohort (pre-TEP) of all patients from February 2004 to January 2006 that (1) went immediately to the operating room and (2) received MT (>or=10 units of RBC in first 24 hours). Two hundred sixty-four patients met inclusion (125 in the TEP group, 141 in the pre-TEP). Demographics and Injury Severity Score were similar. TEP received more intraoperative FFP and platelets but less in first 24 hours (p < 0.01). There was no difference in renal failure or systemic inflammatory response syndrome, but pneumonia, pulmonary failure, open abdomens, and abdominal compartment syndrome were lower in TEP. In addition, severe sepsis or septic shock and multiorgan failure were both lower in the TEP patients (9% vs. 20%, p = 0.011 and 16% vs. 37%, p < 0.001, respectively). Although MT has been associated with higher organ failure and complication rates, this risk appears to be reduced when blood products are delivered early in the resuscitation through a predefined protocol. Our institution's TEP was associated with a reduction in multiorgan failure and infectious complications, as well as an increase in ventilator-free days. In addition, implementation of this protocol was followed by a dramatic reduction in development of abdominal compartment syndrome and the incidence of open abdomens.

Cortisol sérico e glicemia em cadelas tratadas com tramadol e submetidas à ovário-histerectomia

O tramadol é um analgésico opióide usado em medicina veterinária, embora existam poucos estudos sobre este fármaco. O objetivo deste trabalho foi avaliar o efeito analgésico promovido pela administração do tramadol, mensurando o cortisol sérico e a glicemia de cadelas. Para isso, foram utilizadas 15 fêmeas, submetidas a ovário-histerectomia sob anestesia geral com isofluorano. Os animais foram divididos em três grupos. Grupo 1 (Tep) receberam tramadol pela via epidural (1,0mg kg-1 diluído em água bidestilada ao volume final de 3,0mL) e, após 15 minutos, 3,0mL de água bidestilada pela via intravenosa. No grupo 2 (Tiv), foi administrado 3,0mL de água bidestilada pela via epidural e, após 15 minutos, tramadol pela via intravenosa (1,0mg kg-1 diluído em água bidestilada ao volume final de 3,0mL). No grupo 3 (CT), os animais receberam 3,0mL de água bidestilada pela via epidural e, após 15 minutos, 3,0mL de água bidestilada pela via intravenosa. A eficácia de cada regime analgésico foi avaliada durante 12 horas após a administração da injeção epidural. Não houve diferença significativa entre os grupos experimentais para as variáveis estudadas (P&gt;0,05). Foram observadas diferenças significativas dentro de cada tratamento. No grupo Tep houve aumento do cortisol sérico aos 25 minutos do trans-operatório (M3), em relação ao valor obtido imediatamente após a indução anestésica (M2) (P&gt;0,05). Nos tratamentos Tiv e CT, verificou-se elevação das variáveis, duas (M4) e quatro (M5) horas da injeção epidural (P&lt;0,05), quando comparadas ao pré-tratamento (M1). Nesses períodos, as variáveis estudadas no tratamento Tep foram estatisticamente semelhantes ao pré-tratamento (M1). Com base nos resultados, conclui-se que: 1) a metodologia empregada foi sensível para determinar os momentos de maior estresse cirúrgico, dentre os estudados e 2) o tramadol por via epidural produz analgesia mais duradoura quando comparado à administração intravenosa.

Is endoscopic totally extraperitoneal hernioplasty justified for the repair of groin hernia in female patients?

Groin hernia is an uncommon surgical pathology in females. The efficacy of the endoscopic approach for the repair of female groin hernia has yet to be examined. The current study was undertaken to compare the clinical outcomes of female patients who underwent open and endoscopic totally extraperitoneal inguinal or femoral hernioplasty (TEP). From July 1998 to June 2004, 108 female patients who underwent elective repair of groin hernia were recruited. The patients were divided into TEP (n = 30) and open groups (n = 78) based on the type of operation. Clinical data and outcome parameters were compared between the two groups. The mean ages and hernia types were comparable between the two groups. All TEPs were successfully performed. The mean operative times were 52 min for unilateral TEP and 51 min for open repair. The difference was not statistically significant. Comparisons of the length of hospital stay, postoperative morbidity, pain score, and time taken to resume normal activities showed no significant differences between the two groups. A single patient in the TEP group experienced recurrence of hernia. The findings show equivalent postoperative outcomes after TEP and open repair of groin hernia in female patients. Because the wound scar after open repair is well concealed beneath the pubic hair and no superior clinical benefits are observed after TEP, open repair appears to be the technique of choice for the management of primary groin hernia in females. The TEP approach should be reserved for female patients with recurrent or multiple groin hernia.

Preperitoneal repair for recurrent inguinal hernia: laparoscopic and open approach.

The aim of this study was to investigate the outcome of preperitoneal repair using laparoscopic (TEP) and open (OPM) approach in recurrent inguinal hernia. We performed a prospective controlled nonrandomized clinical study in 188 patients with 207 recurrent inguinal hernias over a period of 5 years. TEP repair was employed for 86 repairs, and OPM was used in 121 procedures. The main outcome measurements were: recurrence rate, operating time, hospital stay, and postoperative complications. There were three recurrences (1.7%). Two in the OPM group (1.8%) and one (1.3%) in the TEP group [ P=NS (not significant)]. The TEP procedure was faster than OPM for unilateral repair (40.8 vs 46.3 min) (P<0.001). Postoperative complications were more frequent in the OPM group (23.9%) than the TEP group (13.9%) ( P=NS). Hospital stay was significantly shorter in the TEP group (1.2 vs 3.9 days) (P<0.001). Preperitoneal approach (open or laparoscopic) seems to be a good option in recurrent inguinal hernia when these procedures are done by experienced surgeons.

Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair.

Surgeons who favor the laparoscopic repair of groin hernias must limit the additional costs associated with this technique, which is not universally acknowledged to be superior to other less expensive open tension-free repairs. This retrospective study compared outcome and costs between laparoscopic and open tension-free hernia repair in 320 patients with inguinal hernias. Patients underwent either (a) transabdominal preperitoneal procedure (TAPP; 60 patients, 72 procedures), (b) totally extraperitoneal procedure (TEP; 174 patients, 202 procedures), or (c) open tension-free procedure (86 patients, 105 procedures). Regarding important postoperative complications there were two (3.3%) recurrences in the TAPP group and one (0.6%) in the TEP group, and six (9.9%) transient neuralgias in the TAPP group and one (1.2%) in the tension-free group. There were no deaths, no testicular atrophies, and no wound or mesh infections. The mean hospital postoperative stay was the same in the three groups (1 day). Mean operating time was shorter in the tension-free group concerning the unilateral cases and shorter in the TEP group concerning the bilateral cases. Fewer patients required analgesia during the first 6 h after the operative procedure in the TEP group than in the other two groups. The mean total costs were 483.90 euros in the open tension-free repair, 763.20 euros in the TAPP repair, and 572.50 euros in the TEP repair. The open procedure was the cheaper for the hospital. Laparoscopic hernia repair and tension-free repair as described by Gilbert are comparable in postoperative complications. TEP hernia repair is associated with less postoperative pain and earlier return to normal activities, but it is more expensive and continues to be a difficult procedure. Open tension-free repair is the least expensive method and is easier to learn than the other two procedures.

Collagen type I metabolism after bone surgery.

This study follows the postoperative course of serum collagen type I metabolites in patients after uncomplicated implantation of a cemented total hip endoprothesis (TEP; n = 12, mean age: 69.3 years), a cemented hemiendoprothesis (HEP; n = 13, mean age 79.7 years), a dynamic condylar or hip screw (DCS/DHS; n = 12, mean age 75.1 years) and osteosynthetic treatment of a Weber B or C fracture (OS; n = 17, mean age 54.3 years). The course of the propeptide of human type I procollagen (PICP) as an anabolic marker as well as of I-carboxyterminal telopeptide (ICTP) as a catabolic marker of bone metabolism was characterized. Measurements were done preoperatively and weekly for 3 weeks after surgery. The concentrations of both markers increased and reached a maximum in the 2nd or 3rd week after surgery. However, the PICP values differed, depending on the kind of surgical intervention and the type of bone healing. Secondary fracture healing with formation of callus occurred in the DCS/DHS group, which developed the highest median PICP concentrations (initial 83 microg/l, second week 337 microg/l; P < 0.001). In contrast, the primary bone healing in the OS group showed increasing ICTP but unchanged PICP concentrations. Patients in the cemented TEP and HEP groups as a kind of artificial bone healing had comparable concentrations. To consider the effective metabolism of collagen type I, the PICP/ICTP ratio was calculated. Although the median PICP and ICTP concentrations of the studied groups differed, the PICP/ICTP ratios were similar. In comparison to 54 young and healthy volunteers (median PICP/ICTP ratio: 37), the ratios of the studied groups were still normal but low (median ratios: < 20). This could be an effect of decreasing collagen type I metabolism with age. Although the results are in agreement with animal studies and histomorphometric investigations, the clinical use of PICP and ICTP determination as a tool for the detection of complicated bone healing is limited by the marked interindividual variability and the uncertain bone specificity.