fibrin and Hernia--Inguinal

The use of fibrin for mesh fixation in laparascopic hernioplasty has theoretical advantages in that it could result in reducing postoperative pain. The objective of this study is to demonstrate this improvement in postoperative pain with the highest level of evidence possible.. Unicenter single surgeon prospective randomized double-blind study of transabdominal preperitoneal (TAPP) bilateral hernioplasties comparing autologous fibrin sealant (FG) used for mesh fixation on one side and staples (SG) on the other. Data were collected regarding anthropometric measures, costs, complications and pain evaluation at postoperative days 7, 30 and 180 using a visual analogue scale. The patients were also asked to answer the following simple question: "On which side do you have more pain?". Twenty-two eligible patients were included in the study. Both groups were comparable. The operating time was significantly longer (30 min more) in the FG. The incidence of seroma was similar in both groups, and that of hematoma was higher in the SG (0 vs. 9.1%). At 1 week, the visual analogue scale scores were significantly lower in the FG (median: 1.7 vs. 4.5; MWU:103.5, p < 0.05). At 1 month, this difference became clinical and statistically insignificant. 72.7% of the patients referred more pain on the side with staples at 1 week, 38% at 1 month, and 0% at 6 months (after patients with hernia recurrence were excluded). The recurrence rate was higher in the FG (9.9 vs. 13.6%). A hernia in the FG cost 200 Euros more than that in the SG, or even more if a complete economic study is considered.. The use of fibrin produces less postoperative pain in the first week, but prolongs operating time and increases costs. Moreover, there appears to be a higher recurrence rate and a lower incidence of hematoma, while the incidence of seroma remains unchanged.

Topics: Adult; Aged; Double-Blind Method; Fibrin; Health Care Costs; Hernia, Inguinal; Humans; Laparoscopy; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies; Recurrence; Seroma; Surgical Mesh; Surgical Stapling; Tissue Adhesives; Treatment Outcome

To evaluate the utility of peritoneal pathologic samples, unrelated to peritoneal dialysis (PD) treatment, for the study of peritoneal fibrosis and inflammation.. Comparative morphologic and immunohistochemical study of peritoneal pathologic samples unrelated to PD with peritoneal biopsies from PD patients with special emphasis on the expression of myofibroblastic and epithelial-to-mesenchymal transition markers.. Regarding morphology, PD-related simple fibrosis was less cellular, with greater stromal hyalinization, determining a homogeneous, hypocellular aspect of the submesothelium. In contrast, non-PD fibrosis was more cellular with an extracellular matrix showing a dense and fibrillar quality with wide bundles of collagen. Hylinazing vasculopathy was only present in PD samples. Myofibroblastic differentiation and epithelial-to-mesenchymal transition were common findings in all situations of peritoneal fibrosis. Calponin and calretinin are useful cellular markers to study such fibrogenic mechanisms and correlate with other well-known markers such as a -SMA and cytokeratins. Their expression was much more intense in those samples showing acute inflammation (peritonitis).. Non-PD models of peritoneal fibrosis seem very useful to evaluate important features of human peritoneal pathology such us fibrogenesis, and inflammation. Fibrogenic events such as myofibroblastic differentiation and epithelial-to-mesenchymal transition are evident in these tissue samples allowing us to use them as an accessible source for in vivo and ex vivo studies. Both events show their maximal expression in situations of acute inflammation supporting the important role that peritonitis episodes play in the progression of fibrosis.

Topics: Actins; Biomarkers; Biopsy; Calbindin 2; Calcium-Binding Proteins; Calponins; Case-Control Studies; Cell Differentiation; Edema; Epithelium; Fibrin; Fibroblasts; Fibrosis; Hernia, Inguinal; Humans; Hyalin; Keratins; Microfilament Proteins; Neutrophils; Peritoneum; S100 Calcium Binding Protein G; Sclerosis; Tissue Adhesions

Topics: Cellulitis; Fibrin; Hernia, Inguinal; Humans; Male; Middle Aged; Peritonitis; Postoperative Complications; Rupture, Spontaneous

Mesothelial cells of the normal human peritoneum of the anterior abdominal wall are covered with numerous surface microvilli. These cells become partially denuded inside the sacs of direct and indirect inguinal hernias and so lose the protective property the microvillar covering may impart on them. These mesothelial cells of hernial sacs also acquire an extensive surface coat of fibrin-like material, presumably due to the loss of that protective property, which may as a result subject them to adhesions. There is a considerable collagen build-up in the subserosal fibrous tissue of sacs of both direct and indirect inguinal hernias. Such a build-up is at variance with the accepted current surgical concept which suggests a defect in collagen synthesis, rather than a build-up, as the cause of direct hernia.

Topics: Collagen; Female; Fibrin; Hernia, Inguinal; Humans; Male; Microscopy, Electron, Scanning; Microvilli; Peritoneum; Stress, Mechanical

Topics: Aged; Anuria; Cystitis; Diverticulum; Duodenal Ulcer; Female; Fibrin; Hernia, Inguinal; Humans; Ileum; Laparotomy; Male; Necrosis; Peritonitis; Rupture, Spontaneous; Tuberculosis, Urogenital; Urinary Bladder Calculi; Urinary Bladder Diseases; Urinary Bladder Neoplasms; Urination Disorders; Urography