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Biomedical subjects

G E Wantz

Publications and source records attributed to G E Wantz.

30 records · Page 2Linked to original sources
PubMed1989

Giant prosthetic reinforcement of the visceral sac.

One hundred and seventy-nine patients with 237 hernias of the groin who were at high risk for recurrence after classic hernioplasty were operated upon; the procedure of giant prosthetic reinforcement of the visceral sac (GPRVS) was used. The patients in this series had predominantly recurrent and re-recurrent hernias. However, a few were obese with bilateral primary direct hernias and some had associated connective tissue disorders, such as Marfan and Ehlers-Danlos syndromes. GPRVS eliminates hernias of the groin by rendering the peritoneum inextensible by placing, in the preperitoneal space, a large prosthesis that extends far beyond the borders of the myopectineal orifice. The myopectineal orifice is the weak spot at which all hernias of the groin begin and is bounded by the rectus, oblique abdominal and iliopsoas muscles and the pectin of the pubis. In bilateral GPRVS, the peritoneum of both groins is reinforced with a single prosthesis inserted in the preperitoneal space through the midline. In unilateral GPRVS, the mesh envelops the peritoneum of a single groin. This simplifies the operation and makes it suitable for surgical centers that perform outpatient operations. The prosthesis with the best physical characteristics for GPRVS is Mersilene (polyester fiber). Unsutured prostheses of polypropylene and Teflon (polytetrafluoroethylene) may not adhere at the far edges, leading to a failure and recurrence. The over-all recurrence rate in this series of problem hernias was 3.7 per cent, which is extremely good. However, the rate becomes outstanding if recurrences resulting from meshes unsuitable for GPRVS are excluded.

Hernia, Inguinal↗
PubMed1984

Complications of inguinal hernial repair.

The complications specific to inguinal hernioplasty are addressed with an emphasis on their incidence, importance to the patient, and avoidance, if possible. The major portion of this article discusses ischemic orchitis, as this complication may be very disappointing to the patient if it results in testicular atrophy.

Atrophy↗
PubMed1982

Testicular atrophy as a risk inguinal hernioplasty.

In my experience, the complication of testicular atrophy after primary hernioplasty occurred only in patients in whom a complete indirect inguinal hernia sac was dissected from the spermatic cord. Avoiding this dissection by leaving the distal part of the sac in place reduces the incidence of the complication. All patients with scrotal inguinal hernias and all patients with recurrent inguinal hernias should have the complications of ischemic orchitis and testicular atrophy explained to them in depth because of the litigious nature of some of the men in whom this condition occurs. Patients who had undergone two or more operations for inguinal hernia should give prior written permission for orchiectomy even though this procedure is rarely necessary. In these patients, the performance of preperitoneal inguinal hernioplasty will permit the surgeon to avoid dissecting previously mobilized spermatic cords and should reduce the incidence of testicular atrophy in men fearful of this complication.

Atrophy↗
PubMedDate not supplied

The Canadian repair: personal observations.

The Canadian hernioplasty is the modern equivalent of the original Bassini operation. Most of the criticism of the repair is unjustified, even the fact that the repair does not address the femoral canal. The incidence of the femoral type of recurrence that typically occurs in the first year was only 0.14% among the 4,366 primary Canadian hernioplasties performed by one surgeon in the years 1970 to 1987. There were a total of 58 recurrences for a raw recurrence rate of 1.3%. About half of the recurrences were considered to be failures of the hernioplasty, and the remaining ones were attributable to continued deterioration of the patient's tissues. This huge experience of one surgeon demonstrates that recurrence rates, to a great extent, depend on the skills of the surgeon. Recurrence rates decrease as a surgeon's experience with the procedure increases. It also demonstrates the importance of technique and how a minor change in the method of beginning the continuous suture reduced suture tension and eliminated the well-known pubic tubercle type of recurrence seen after all hernioplasties. The recurrence rate for 639 recurrent and rerecurrent hernias repaired by Canadian hernioplasty was 7.2%. This rate is unsatisfactory, and a preperitoneal repair with a polyester prosthesis is preferred for these difficult problems. A local agent neutralized with sodium bicarbonate is the anesthetic of choice, and simultaneous left and right hernioplasties with the patient going home the same day as the procedure are now commonplace.

Canada↗
PubMedDate not supplied

Changes in basement membrane thickening and pulse volume concomitant with improved glucose control and exercise in patients with insulin-dependent diabetes mellitus.

Ten patients with type I diabetes mellitus were enrolled in a program of exercise and carbohydrate "control" using self-monitored glucose determinations and self-adjusted insulin. Glucose control was improved for the group, although normoglycemia was not uniformly achieved. Pulse volume measurements performed at the onset and after 8-10 mo documented a drop in systolic arm blood pressure with increases in the ankle-arm index (P < 0.001). Quadriceps biopsy was successfully performed at the beginning and after 8-10 mo for analysis of basement membrane thickening (BMT) in seven patients. Six patients showed a decrease in basement thickening on rebiopsy (P = 0.02). One patient showed increased BMT. This was the only patient to maintain a mean hemoglobin A1c of greater than 10% for the duration of the study. These observations indicate that abnormalities of BMT and pulse volume recordings may be more labile measurements than previously thought and may be amenable to therapeutic intervention. The relationship of these variables to the severe micro- and macrovascular sequelae of diabetes mellitus remains to be established.

Adolescent↗
PubMedDate not supplied

Testicular atrophy as a sequela of inguinal hernioplasty.

Testicular atrophy is a sequela of inguinal hernioplasty which angers men of all ages. The complication is due to thrombosis of the veins of the spermatic cord from the trauma of surgical dissection intrinsic in all inguinal hernioplasties and is not due to incorrect reconstruction of the inguinal rings or to some intangible infection. Trauma to the cord from surgical dissection can be minimized and the incidence of testicular atrophy reduced by leaving, whenever possible, the distal part of all but the smallest of indirect inguinal hernia sacs in place, undissected and attached to the cord.

Atrophy↗
PubMedDate not supplied

[Technique of properitoneal hernioplasty. Unilateral reinforcement of the visceral sac with Mersilene giant prosthesis].

358 hernias of the groin (340 patients), predominantly recurrent and re-recurrent, were treated by this procedure, similar to bilateral hernioplasty, specifically developed for ambulatory surgery. There were 16 recurrences of which most were due to flaws in the original procedure. This was overcome by widening and extending the distal lateral corner of the mesh.

Female↗