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Biomedical subjects

P K Amid

Publications and source records attributed to P K Amid.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Biomaterials and hernia surgery. Rationale for using them].

UNLABELLED: A study was made of the distinct biomaterials used in surgery and the requirements to be fulfilled and principles applied for their use in the repair of abdominal wall hernias. The biomaterials most frequently used in hernia surgery are: politetrafluorethylene (PTFE) sheet (Gore-Tex), the multifilament PTFE mesh (Teflon), the multifilament polypropylene mesh (Surgipro), the mono-filament polypropylene mesh (Marlex), the double filament polypropylene mesh (Prolene) and the multi-filament polyester mesh (Mersilene). Requirements for use in hernia surgery: the material must be inert, permanent and non-reabsorbable, resistant to infection, becomes rapidly fixed and incorporated into the host tissues, and not adhere to abdominal viscera. Principles for use: based on the overlapping of the mesh with the aponeurotic plane such that abdominal pressure aids fixation to this plane; contact with abdominal viscera must be avoided. CONCLUSIONS: based on the published experimental and clinical experience of the authors and other researchers, polypropylene is judged to be the most appropriate material for the repair of abdominal hernias.

Biocompatible Materials↗
PubMed1995

[Lichtenstein's "tension-free" operation for inguinal hernia under local anesthesia].

Lichtenstein's technique for surgical cure of primary inguinal hernia using local anaesthesia is described. Since 1984, 3250 primary hernia operations were performed at the Lichtenstein Hernia Institute. There were 4 recurrences due to technical errors which are described. This tension-free technique is a reliable, simple and effective procedure. Patients return to normal activity within 2 to 14 days. Studies one 22300 operations performed by several surgeons produced similar results for post-operative recurrence and complications.

Anesthesia, Local↗
PubMed1995

Mesh between the oblique muscles is simple and effective in open hernioplasty.

Controversy exists as to the best position for insertion of the mesh patch in open inguinal herniorrhaphy. The "inlay" mesh graft, which is laid under the transversalis fascia, has been considered preferable by some authors. But in the Lichtenstein open tension-free inguinal hernia repair, the mesh is preferably placed under the external oblique aponeurosis. It is not an "onlay graft" because it lies under the external oblique and over the internal oblique muscles and transversalis fascia. The possible development of an "interstitial" hernia is without basis and has never been seen. This particular "onlay graft" (more correctly an intermuscular graft) is much simpler to apply and has resulted in almost no recurrences and side effects. Placing the patch between the two oblique muscles is therefore recommended for open tension-free primary inguinal hernioplasties.

Hernia, Inguinal↗
PubMed1995

Biomaterials for "tension-free" hernioplasties and principles of their applications.

Although decreasing, there exists an unjustified fear of mesh for the repair of inguinal and incisional hernias. This is due to the negative experience of the past when ideal biomaterials were not available. At the time of introduction of Marlex mesh by Francis Usher, three decades ago, ideal suture material for fixation of the mesh was not available and created undesirable complications. This compounded the fear of mesh for the repair of abdominal wall hernias. With the variety of prosthetic and suture materials available today, the importance of biomaterials in abdominal wall hernia surgery is increasingly appreciated. The purpose of this paper is to discuss some important requirements of ideal biomaterials and principles of their surgical application.

Animals↗
PubMed1995

The Lichtenstein open "tension-free" mesh repair of inguinal hernias.

All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and thus accounts for an unacceptable number of failures. A total reinforcement of the inguinal floor with a sheet of suitable biomaterial and the employment of a "tension-free" technique is a more effective approach. Since June of 1984, 4,000 primary inguinal hernias have been repaired on an outpatient basis and under local anesthesia at the Lichtenstein Hernia Institute by the open "tension-free" technique using Marlex mesh. The patients were followed from one to 11 years (mean of 5 years) by physician examination. The follow-up rate was 87%. There were four recurrences. The causes of recurrence and how to avoid them are discussed herein. Three of the recurrences occurred at the public tubercle and were caused by placing the mesh in juxtaposition to the tubercle. This error has since been corrected by overlapping the mesh at the public bone. One recurrence was caused by disruption of the lower edge of the mesh from the shelving margin of Poupart's ligament. The error here was the utilization of a patch that was too narrow and therefore under tension. It became apparent that a wider patch, fixed in place with an appropriate degree of taxity, was required.

Adult↗
PubMed1994

Experimental evaluation of a new composite mesh with the selective property of incorporation to the abdominal wall without adhering to the intestines.

This preliminary study examined the possibility of preventing intestinal adhesions to biomaterials while preserving their incorporation with the abdominal wall. White New Zealand rabbits received intraperitoneal implants of different biomaterials for repair of defects created on the abdominal wall. The following biomaterials were used: polypropylene, polyester, expanded polytetraflueroethylene, polypropylene mesh/polypropylene sheeting (polypropylene mesh covered with polypropylene sheeting on the peritoneal side), polypropylene/silastic, polypropylene/polyglactin, polypropylene/polyglycolic acid, and polypropylene/fibrin. All biomaterials evaluated caused adhesions to the intestines except for polypropylene mesh/polypropylene sheeting and polypropylene mesh/silastic composites. Because adhesion of the intestine to the biomaterial is the first stage of biomaterial-related intestinal fistula, its prevention is logical for the elimination of this complication. Composites with the selective property of adhering to the abdominal wall, yet sparing the viscera, would facilitate thoracic and abdominal wall surgeries, as well as intraperitoneal laparoscopic hernioplasties.

Abdominal Muscles↗
PubMed1994

Biomaterials for abdominal wall hernia surgery and principles of their applications.

This article focuses special attention on the porosity, cellular permeability and molecular permeability of biomaterials and their effect on infection, host tissue incorporation and seroma formation when mesh is used for the repair of abdominal wall hernias. Furthermore, the general principles of the application of biomaterials, regardless of the technique used for their employment, is discussed.

Abdominal Muscles↗
PubMed1994

Patch or plug for groin hernia--which?

Prosthetic mesh is becoming widely used in the management of both primary and recurrent groin hernias. Confusion exists as to when to choose which of the two popular forms: patch or plug. Here are presented the indications for each type of tension-free hernia repair based on the experience of over 20 years in the exclusive surgery of groin hernias.

Adult↗
PubMed1994

Local anesthesia for inguinal hernia repair step-by-step procedure.

OBJECTIVE: The authors introduce a simple six-step infiltration technique that results in satisfactory local anesthesia and prolonged postoperative analgesia, requiring a maximum of 30 to 40 mL of local anesthetic solution. SUMMARY BACKGROUND DATA: For the last 20 years, more than 12,000 groin hernia repairs have been performed under local anesthesia at the Lichtenstein Hernia Institute. Initially, field block was the mean of achieving local anesthesia. During the last 5 years, a simple infiltration technique has been used because the field block was more time consuming and required larger volume of the local anesthetic solution. Furthermore, because of the blind nature of the procedure, it did not always result in satisfactory anesthesia and, at times, accidental needle puncture of the ilioinguinal nerve resulted in prolonged postoperative pain, burning, or electric shock sensation within the field of the ilioinguinal nerve innervation. METHODS: More than 12,000 patients underwent operations in a private practice setting in general hospitals. RESULTS: For 2 decades, more than 12,000 adult patients with reducible groin hernias satisfactorily underwent operations under local anesthesia without complications. CONCLUSIONS: The preferred choice of anesthesia for all reducible adult inguinal hernia repair is local. It is safe, simple, effective, and economical, without postanesthesia side effects. Furthermore, local anesthesia administered before the incision produces longer postoperative analgesia because local infiltration, theoretically, inhibits build-up of local nociceptive molecules and, therefore, there is better pain control in the postoperative period.

Anesthesia, Local↗
PubMed1994

A simple stapling technique for prosthetic repair of massive incisional hernias.

This article introduces a simpler, faster, and safer method of performing the Stoppa procedure with an articulating stapler. It also encourages use of preperitoneal repair instead of the often unsuccessful onlay mesh repair. The latter repair involves placing the mesh over the abdominal aponeurotic layer and can result in a high incidence of infection, seroma accumulation, and chronic fibrous cyst formation. In the preperitoneal repair technique, the same force that created the hernia--the intraabdominal hydrostatic pressure--keeps the mesh tightly in place and prevents recurrence of the hernia. The authors base their recommendation of the stapling technique on the experience of 54 large incisional hernias successfully repaired by preperitoneal insertion of a large sheet of Marlex mesh (Stoppa's procedure). In 29 of the 54 patients, the mesh was fixed in place with hand suturing. In the other 25, articulating staplers attached the mesh. The authors have found the stapling technique to be both simpler to accomplish and safer for the patient.

Abdomen↗
PubMed1994

[A five-step technique for local anesthesia in inguinal hernia repair].

One century ago, in his 1990 Annals of Surgery article, Cushing indicated that except for children, all hernias can be repaired under local anesthesia [1]. Since then, local anesthesia has been successfully used for the repair of all reducible groin hernias in adult patients at many centers. For the last 25 years, more than 12000 groin hernia repairs have been performed under local anesthesia at the Lichtenstein Hernia Institute. Initially, field block was our method of choice for achieving local anesthesia. During the last 5 years, a simple infiltration technique has been used because the field block was more time consuming and required larger volume of the local anesthetic solution. Furthermore, because of the blind nature of the procedure, it did not always result in satisfactory anesthesia and at times accidental needle puncture of the ilio-inguinal nerve resulted in prolonged postoperative pain, burning, or electric shock sensation within the field of the ilio-inguinal nerve innervation. The purpose of this article is to introduce a simple 5-step infiltration technique that results in satisfactory local anesthesia and prolonged post-operative analgesia requiring a maximum of 30-40 cc of local anesthetic solution.

Anesthesia, General↗
PubMed1994

[Lichtenstein herniotomy].

All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and accounts for an unacceptable number of failures. Total reinforcement of the inguinal floor with a sheet of suitable biomaterial and employment of a "tension-free" technique is a more effective approach. Since June 1984, 3250 primary inguinal hernias have been repaired at the Lichtenstein Hernia Institute by the open tension-free technique using Marlex mesh. All operations were performed under local anesthesia. Patients were discharged from the hospital within two or four hours after the operation. The patients were followed from one to 8 years by physician examination. The follow-up rate was 87%. There were four recurrences. The causes of recurrence and how to avoid them are discussed.

Adult↗
PubMed1993

Critical scrutiny of the open "tension-free" hernioplasty.

Tension-free hernioplasty is rapidly gaining worldwide acceptance. Since June 1984, 3,125 consecutive adult male primary inguinal hernias have been repaired by employment of an open tension-free prosthetic repair without approximation of the margins of the defect. Since the original publication of our technique in the 1989 February issue of The American Journal of Surgery, we have encountered four recurrences. These recurrences were caused by technical errors early in our experience and have since been corrected. The purpose of this paper is to bring those errors to the attention of surgeons, as well as to suggest certain modifications to further simplify the operation. Three of the recurrences occurred at the pubic tubercle and were caused by placing the mesh in juxtaposition to the tubercle. This error has since been corrected by overlapping the mesh at the pubic bone. One recurrence was caused by disruption of the lower edge of the mesh from the shelving margin of Poupart's ligament. The error here was utilization of a patch that was too narrow and therefore under tension. It became apparent that a wider patch, fixed in place with an appropriate degree of laxity, was required.

Evaluation Studies as Topic↗
PubMed1993

The cause, prevention, and treatment of recurrent groin hernia.

At present, groin hernia repair is associated with a 10% recurrence rate. Despite innumerable modifications of the Bassini technique, this depressing figure remains essentially unimproved. This article documents the two major reasons for failure and presents techniques that are simple, can be performed under local anesthesia in an outpatient setting, allow patients to return home within hours of their surgery, encourage rapid return to unrestricted activity, and are associated with a recurrence rate approaching 0%.

Hernia, Femoral↗