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Biomedical subjects

A I Gilbert

Publications and source records attributed to A I Gilbert.

12 recordsLinked to original sources
PubMed1997

Sutureless technique: second version.

Mesh repairs have revolutionized hernia surgery. When used to patch or plug a musculoaponeurotic abdominal wall defect, the results have been much better than traditional pure tissue repairs. The difference is simple: patch and plug techniques avoid tension on tissues. The improved sutureless repair not only avoids tissue tension, it obviates the need to suture the mesh. Fixation is achieved by intra-abdominal pressure, the same force that caused the hernia. Thorough dissection of the inguinal canal and the indirect sac is essential to avoid early failure. Whereas various repairs can be used with excellent results, there is no substitute for a complete dissection of the peritoneal sac well into the iliac fossa. The improved sutureless repair offers 2 advantages over the original version: (a) type III hernias can now be repaired without opening the canal's posterior wall, and (b) the incidence of clinically evident seroma has been reduced by 90%. Most primary and recurrent groin hernias can be repaired under local or regional anesthesia on an outpatient basis. Immediate ambulation and prompt recovery accompany this technique. Most patients resume full activity and employment by the end of the first week. The procedure is simple to learn, easy to perform and less costly than other techniques.

Anesthesia, Conduction↗
PubMed1993

Medical/legal aspects of hernia surgery. Personal risk management.

Professional liability is an unavoidable part of every physician's work; and sound practice management is the bedrock of protection against litigation. This article gives an overall assessment of the medical/legal problem, some commonly used legal terms and concepts, and a personal risk management code that has served the author well for more than 30 years.

Defensive Medicine↗
PubMed1993

Infection in inguinal hernia repair considering biomaterials and antibiotics.

Synthetic biomaterials have been incriminated for promoting wound infection. Perioperative antibiotics have received praise for reducing the rate of infection after certain operations. These claims were tested in a cooperative multicenter prospective study of 2,493 inguinal hernia repairs. This study was done to examine the effect of prophylactic antibiotics in primary and recurrent inguinal hernia repaired with synthetic biomaterials. Clinical signs and symptoms of wound infection and the results of each infected repair are reported. The rate of infection was about 1 percent, whether or not biomaterials or antibiotics were used. More than 70 percent of wound infections occurred in patients 60 years of age or older. Removal of biomaterials from the infected wounds was not necessary and generally is not recommended. Recurrence has not occurred in any of the infected repairs. With or without prosthetic repair, the treatment of infected inguinal hernia wounds was relatively simple, of reasonable cost and concluded with a good result. The expense incurred for routine prophylactic antibiotic treatment in inguinal hernia operation could not be reconciled by any benefits obtained.

Adolescent↗
PubMed1992

Sutureless repair of inguinal hernia.

Sutureless repair is successful for all but the largest of indirect inguinal hernias. After reduction of the peritoneal sac, the presenting indirect component of the hernia is immediately resolved by placement of a polypropylene mesh through the internal ring. The posterior wall is reinforced with a second swatch of Prolene mesh to prevent herniation, which often results from future degenerative changes. Both swatches of mesh are held in place in separate tissue planes by the body's internal hydrostatic forces. Being sutureless, no tension is placed on any layer; there is no damage to tissues from an errant suturing technique. This procedure has been used in 412 of the 1,091 inguinal hernia repairs over the past 36 months.

Adolescent↗
PubMed1989

An anatomic and functional classification for the diagnosis and treatment of inguinal hernia.

A simple classification of inguinal hernias is presented which can be valuable to surgeons as a (1) blueprint for dissecting the canal, (2) means for choosing the most appropriate operative procedure, (3) means for evaluating and correlating the prognosis of postoperative symptoms, time of convalescence, and degree of disability, and (4) method of identifying and communicating the exact anatomic derangement found so that accurate and consistent follow-up studies and statistics can be prepared. Diligent follow-up is essential for verifying the true results of hernia surgery techniques. Such follow-up requires that the surgeon be dedicated to examining his patients for many years, as well as to understanding, recording, and referencing the exact anatomic and functional defects found and the repairs used to correct them. Only with these factors identified and recorded can there be a basis for meaningful reporting and valuable conclusions. The classification of inguinal hernias presented here is intended to provide surgeons an opportunity to better evaluate their own methods and to more clearly communicate results with colleagues. As Oliver Wendell Holmes once said, "Many times ideas grow better when they are transplanted from one mind to another."

Adult↗
PubMed1987

Overnight hernia repair: updated considerations.

Since 1976 we have repaired 2,325 inguinal or femoral hernias in 1,517 patients; 90% of these patients were admitted on the morning of surgery, and 91% were discharged the day after surgery. To better address the problem of declining strength in repaired tissues, we now use onlay or underlay grafts of synthetic material to enhance each repair. During the past year, 283 cases were done adding Marlex mesh. We have seen no infection or graft rejection in this group, though a few patients had a seroma needing aspiration. Ninety-five percent of these 1,517 patients had returned to their usual work or activity by the end of the first postoperative week. While a sound and lasting repair is the primary concern, patient satisfaction and cost-effectiveness continue to be valuable by-products of this procedure.

Evaluation Studies as Topic↗
PubMed1979

Inguinal herniorrhaphy: reduced morbidity, recurrences, and costs.

Costs, morbidity, and recurrences have been reduced in the repair of inguinal hernias. In 18 months 135 repairs were done using local anesthetics, prompt ambulation, and minor variations in the Shouldice technic. Men and women aged 22 to 84 years were operated upon. No recurrences have been reported, and urinary catheterization has not been necessary. Significant savings are available by abbreviated hospital stay. The majority of patients require only 24 hours for repair of a unilateral inguinal hernia and the observation period following it. The same basic repair is used for direct and indirect sliding hernias. Rebuilding the floor of the inguinal canal is essential. Postoperative pain has been minimal. Use of long-acting local anesthetics has proven helpful.

Adult↗
PubMedDate not supplied

Day surgery for inguinal hernia.

Historical developments of groin herniorrhaphy date from Bassini's contributions through many present-day simplified tension-free techniques. Availability of sterile-packaged prosthetic mesh has currently given every surgeon an inexhaustible "tissue bank" for hernia repair surgery. The value of using a local anesthetic is unequaled in verifying the completeness of a repair. Same-day surgery has many advantages including lowered rates of infection, quicker ambulation, and more rapid return to regular activities. The sutureless umbrella plug technique is discussed. It is the simplest technique to permanently repair indirect inguinal hernias. Taking advantage of Nature' window through the internal inguinal ring, the properitoneal space can be reached. By dissecting the peritoneal sac high on its neck and shoulders, the retromuscular properitoneal space can be actualized. It allows a permanent repair to be done by simply protecting the internal ring with a swatch of polypropylene mesh shaped as an umbrella. The body's natural forces that created the hernia work to repair it by transversalis fascia. The procedure is easy to perform, done with local anesthesia, inexpensive, safe, and has minimal recurrence and complication rates.

Ambulatory Surgical Procedures↗