Search

Endoscopic techniques are commonly used for many different types of surgery. It is claimed that videoendoscopic procedures have the advantage of being less traumatic and of offering higher postoperative patient comfort than conventional open techniques. The extent of tissue trauma can be evaluated on the basis of the inflammatory response observed in the wake of surgery. Available studies that have compared endoscopic and conventional techniques suggest that endoscopic cholecystectomy, laparoscopic colorectal resection, and thoracoscopic pulmonary resection have immunologic advantages over conventional approaches. The objective of this prospective study was to determine whether endoscopic hernia repair techniques are also preferable to conventional procedures and to what extent the anesthetic technique (local or general anesthesia) influences the postoperative inflammatory response. For this purpose, biochemical monitoring of cytokine activity [C-reactive protein (CRP), prostaglandin F1α (PGF1α), neopterin, interleukin-6 (IL-6)] was done prospectively in 101 patients [totally extraperitoneal approach (TEP) n=32, unilateral n=12, bilateral n=20; Shouldice n=69, local anesthesia (LA) n=23, general anesthesia (GA) n=46] before and until 3 days after surgery. The parameters IL-6 and PGF1α suggested that the immune trauma immediately after surgery was significantly higher in the group of patients with endoscopic hernia repair than in the group of patients who received a Shouldice repair. No significant differences were observed after the first postoperative day. A comparison between the TEP group and the patients who received conventional surgery under local anesthesia showed that the TEP approach was also associated with a higher postoperative neopterin level. Within the first 3 days after surgical intervention, bilateral endoscopic hernia repair induced no significantly higher inflammatory response than the surgical treatment of unilateral conditions. The anesthetic procedure that was used in the Shouldice operation had no significant effect on inflammatory response. Unlike other types of endoscopic surgery, the repair of groin hernias using an endoscopic technique cannot be regarded as a minimally invasive procedure that is less traumatic than conventional approaches. Instead, the conventional Shouldice procedure appears to cause the lowest inflammatory response and to be the least traumatic approach to hernia repair, especially when it is performed under local anesthesia. [ABSTRACT FROM AUTHOR]

The inflammatory response following isolated traumatic brain injury (TBI) is characterised by the release of pro- and anti-inflammatory mediators. In order to determine the important mediators regarding survival and outcome of patients with severe traumatic isolated head injuries, we performed this prospective preclinical and clinical study starting upon arrival at the site of the accident. After approval by the local ethics board committee, 94 multiple-injury patients were enrolled. Of these, 72 patients suffered from major injuries; the other 22 patients had a severe isolated brain injury and were allotted to subsets of survival or nonsurvival. Of the pro- and anti-inflammatory mediators (cytokines, arachidonic acid metabolites and soluble adhesion molecules), interleukin-6 (IL-6), IL-12 and malone dialdehyde (MDA) appeared to be of specific importance; maximum IL-6 plasma levels were eightfold higher in cases of nonsurvival than in those of survival. Patients that did not survive TBI were the only ones to express an IL-12 increase, whereas survivors and patients with other major trauma did not show any increase within the first 24 h. An early distinct decrease of MDA showed in patients who did not survive TBI, in contrast to survivor patients who exposed almost constant levels during the first 24 h. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)