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京都大学 / 新制・課程博士 / 博士(医学) / 甲第24472号 / 医博第4914号 / 新制||医||1062(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 今中 雄一, 教授 山本 洋介, 教授 小濱 和貴 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Inguinal hernia repair (IHR) is a common ambulatory surgery procedure performed in Canada, after which many patients experience moderate to severe pain. Limited research has been found that examines interventions to reduce pain following ambulatory surgery, and none specifically for patients undergoing IHR. This trial evaluated the effectiveness of an individualized Hernia Repair Education Intervention (HREI) for patients following this ambulatory surgery. Participants (N= 82) were randomized to either the intervention or usual care group pre-operatively in the pre-admission clinic. The HREI included a booklet about managing pain and face-to-face session to discuss its content, and two telephone support calls (before surgery and 24 hours after surgery). The primary outcome was WORST 24 hour pain intensity on movement on post-operative day 2. Secondary outcomes included pain intensity at rest and movement, pain–related interference with activities, pain quality, analgesics taken, and adverse effects at post-operative days 2 and 7. At day 2, the intervention group reported significantly lower scores for all pain intensity outcomes, including WORST 24hr pain on movement (t (df) = 4.7 (73), p< 0.001), WORST 24 hr pain at rest (t (df) = 3.8 (73), p < 0.001), pain NOW at rest (t (df) = 3.3 (73), p = 0.001) and on movement (t (df) = 3.4 (73), p = 0.001). Also on day 2, pain-related interference scores for the intervention group were lower than the usual care group but not significantly different with the bonferroini correction (t (df) = 2.1 (73), p=0.04). The intervention group took significantly fewer opioids on day 2 (t (df) = 3.0 (73), p=0.004). Although there were no differences in any of the pain or interference outcomes on day 7, 36% (n=26) of the total sample reported moderate-severe pain at day 7. Constipation was the adverse effect identified most often, by both groups, on both days 2 and 7.This intervention was effective at post-operative day 2 but revisions need to be made to the intervention to assess for outcomes over a longer period of time.

Inguinal hernia repair (IHR) is a common ambulatory surgery procedure performed in Canada, after which many patients experience moderate to severe pain. Limited research has been found that examines interventions to reduce pain following ambulatory surgery, and none specifically for patients undergoing IHR. This trial evaluated the effectiveness of an individualized Hernia Repair Education Intervention (HREI) for patients following this ambulatory surgery. Participants (N= 82) were randomized to either the intervention or usual care group pre-operatively in the pre-admission clinic. The HREI included a booklet about managing pain and face-to-face session to discuss its content, and two telephone support calls (before surgery and 24 hours after surgery). The primary outcome was WORST 24 hour pain intensity on movement on post-operative day 2. Secondary outcomes included pain intensity at rest and movement, pain–related interference with activities, pain quality, analgesics taken, and adverse effects at post-operative days 2 and 7. At day 2, the intervention group reported significantly lower scores for all pain intensity outcomes, including WORST 24hr pain on movement (t (df) = 4.7 (73), p< 0.001), WORST 24 hr pain at rest (t (df) = 3.8 (73), p < 0.001), pain NOW at rest (t (df) = 3.3 (73), p = 0.001) and on movement (t (df) = 3.4 (73), p = 0.001). Also on day 2, pain-related interference scores for the intervention group were lower than the usual care group but not significantly different with the bonferroini correction (t (df) = 2.1 (73), p=0.04). The intervention group took significantly fewer opioids on day 2 (t (df) = 3.0 (73), p=0.004). Although there were no differences in any of the pain or interference outcomes on day 7, 36% (n=26) of the total sample reported moderate-severe pain at day 7. Constipation was the adverse effect identified most often, by both groups, on both days 2 and 7.This intervention was effective at post-operative day 2 but revisions need to be made to the intervention to assess for outcomes over a longer period of time.

Cette thèse présente une approche probabiliste de la modélisation de la mécanique des matériaux et des structures. Le dimensionnement est influencé par l'incertitude des paramètres d'entrée. Le travail est interdisciplinaire et les méthodes décrites sont appliquées à des exemples de biomécanique et de génie civil. La motivation de ce travail était le besoin d'approches basées sur la mécanique dans la modélisation et la simulation des implants utilisés dans la réparation des hernies ventrales. De nombreuses incertitudes apparaissent dans la modélisation du système implant-paroi abdominale. L'approche probabiliste proposée dans cette thèse permet de propager ces incertitudes et d’étudier leurs influences respectives. La méthode du chaos polynomial basée sur la régression est utilisée dans ce travail. L'exactitude de ce type de méthodes non intrusives dépend du nombre et de l'emplacement des points de calcul choisis. Trouver une méthode universelle pour atteindre un bon équilibre entre l'exactitude et le coût de calcul est encore une question ouverte. Différentes approches sont étudiées dans cette thèse afin de choisir une méthode efficace et adaptée au cas d’étude. L'analyse de sensibilité globale est utilisée pour étudier les influences des incertitudes d'entrée sur les variations des sorties de différents modèles. Les incertitudes sont propagées aux modèles implant-paroi abdominale. Elle permet de tirer des conclusions importantes pour les pratiques chirurgicales. À l'aide de l'expertise acquise à partir de ces modèles biomécaniques, la méthodologie développée est utilisée pour la modélisation de joints de bois historiques et la simulation de leur comportement mécanique. Ce type d’étude facilite en effet la planification efficace des réparations et de la rénovation des bâtiments ayant une valeur historique. / This thesis presents a probabilistic approach to modelling the mechanics of materials and structures where the modelled performance is influenced by uncertainty in the input parameters. The work is interdisciplinary and the methods described are applied to medical and civil engineering problems. The motivation for this work was the necessity of mechanics-based approaches in the modelling and simulation of implants used in the repair of ventral hernias. Many uncertainties appear in the modelling of the implant-abdominal wall system. The probabilistic approach proposed in this thesis enables these uncertainties to be propagated to the output of the model and the investigation of their respective influences. The regression-based polynomial chaos expansion method is used here. However, the accuracy of such non-intrusive methods depends on the number and location of sampling points. Finding a universal method to achieve a good balance between accuracy and computational cost is still an open question so different approaches are investigated in this thesis in order to choose an efficient method. Global sensitivity analysis is used to investigate the respective influences of input uncertainties on the variation of the outputs of different models. The uncertainties are propagated to the implant-abdominal wall models in order to draw some conclusions important for further research. Using the expertise acquired from biomechanical models, modelling of historic timber joints and simulations of their mechanical behaviour is undertaken. Such an investigation is important owing to the need for efficient planning of repairs and renovation of buildings of historical value.

No description available.

Background and objectives: TISSIUM light-activated adhesive was investigated as an alternative to tissue-penetrating products to fix meshes in intraperitoneal laparoscopic ventral hernia repair. The objective of this study was to ensure efficient polymer light activation through commercial meshes and to assess the acute and chronic fixation strength of the light-activated adhesive in a porcine model in comparison to commercial fixation products. Methods: A spectroscopic analysis was conducted on the light-activated adhesive through three different meshes (1, 2, and 3) to quantify the acrylate conversion associated with the level of polymer cross-linking. Two setups were implemented: a static (light source fixed over a drop of polymer) and a dynamic (light source rotated around a pattern of polymer to mimic the surgical procedure). Hernia defects were created in porcine models and repaired either using the light-activated adhesive or a commercial product (A, B, C, and D) to fix a mesh. For each tested condition, the acute and chronic (3 months) fixation strength performances were assessed using burst ball and t-peel mechanical tests. Results: The light activation proved to be effective (more than 90% of the acrylates converted) in static in 7 seconds through the three meshes and in dynamic between 3 min and 5 min 32 sdepending on the considered mesh. In a burst ball test, the light-activated adhesive reached between 42 and 84% of the commercial products’ acute performance with the three meshes (between 75,9 and 95,9 N) and reached 88% of the commercial product A’s chronic performance with mesh 1 (610,1 N). A t-peel test demonstrated similar strength of ingrowth for the repairs using the light-activated adhesive or the commercial product A at the 3-month timepoint with mesh 1 (2,55 and 2,37 N/cm respectively). Conclusions: Data suggest the light-activated adhesive has the potential to be used in intraperitoneal laparoscopic ventral hernia repair. In a reasonable time, the adhesive is efficiently light-activated through commercial meshes. The light-activated adhesive’s performances to fix commercial meshes, both acute and chronic, are similar to commercial products, but with a strong advantage of not being tissue penetrating.

Submitted by Celso Magalhaes (celsomagalhaes@ufrrj.br) on 2017-08-23T12:00:12Z No. of bitstreams: 1 2016 - Siria da Fonseca Jorge.pdf: 4082208 bytes, checksum: 0cf00af2f5c5490e467e6dfd2ecf8938 (MD5) / Made available in DSpace on 2017-08-23T12:00:12Z (GMT). No. of bitstreams: 1 2016 - Siria da Fonseca Jorge.pdf: 4082208 bytes, checksum: 0cf00af2f5c5490e467e6dfd2ecf8938 (MD5) Previous issue date: 2016-12-07 / Hernioplasties are included in the most performed surgeries in Human Medicine. Despite the high frequency, its complications and recurrences still make them the great challenge of modern surgery. Currently several types of screens are available for hernioplasties, it is emphasized that its application in the correction of hernia defects has been exhaustively tested in order to achieve an ideal prosthesis in every sense, with biocompatibility, little or no formation of peritoneal adhesions, texture And flexibility, providing the necessary strength for protection of the viscera and yet allowing perfect movement of the abdomen. The present study had as main objective to evaluate the efficacy and local reaction of the implant using low density polyethylene (LDPE) bullous lamina, bubble wrap and frog-bull skin for correction of hernia defects in the abdominal wall of Rattus norvegicus, Wistar variety. A total of 40 male rats were divided into two groups, one received the blister plastic implant and the other frog skin implant. A follow-up of 3.0 cm in the longitudinal axis by 1.0 cm was taken on the transverse axis including all planes of the abdominal musculature, from the midline towards the left side of the abdominal wall, creating a fault that was covered by one of the prostheses proposed according to the group in question. The animals were evaluated through monitoring of clinical, thermographic, macroscopic, histological and histopathological parameters at 7, 15, 30 and 90 postoperative days. Clinically, none of the two prostheses tested presented alterations such as abscesses, entero-cutaneous fistulas, eventrations or eviscerations. Macroscopically, all the animals had adhesions considered to be mild, mainly in the region of the suture of the prostheses. Infrared thermography proved effective as an evaluation method of inflammation and involution of the prostheses together with the morphological analysis. After analyzing all the results it was concluded that the bullfrog skin caused an initial inflammatory process that was reduced until the cure at 90 postoperative days, being considered a promising biomaterial for hernioplasties and the lamellar PEPD bullous produced a An initial inflammatory process that regressed up to 30 postoperative days, but tripled at 90 postoperative days, being considered a good material for temporary implants up to a maximum of 30 days and new studies with longer implantation periods of this biomaterial So that it is used safely in corrections of hernia defects definitively / As hernioplastias incluem-se nas cirurgias mais realizadas na Medicina Humana. Apesar da alta frequ?ncia, suas complica??es e recorr?ncias ainda as tornam o grande desafio da cirurgia moderna. Atualmente v?rios tipos de telas est?o dispon?veis para hernioplastias, ressalta-se que sua aplica??o na corre??o de defeitos herni?rios tem sido exaustivamente testada com o prop?sito de conseguir uma pr?tese ideal em todos os sentidos, com biocompatibilidade, pouca ou nenhuma forma??o de ader?ncias peritoneais, textura e flexibilidade compat?veis, proporcionando a resist?ncia necess?ria para a prote??o das v?sceras e ainda assim, permitindo a perfeita movimenta??o do abdome. O presente estudo teve como principal objetivo avaliar a efic?cia e rea??o local do implante utilizando polietileno de baixa densidade (PEBD) laminar bolhoso, pl?stico bolha e pele de r?-touro para corre??o de defeitos herni?rios em parede abdominal de Rattus norvegicus, variedade Wistar. Foram utilizados 40 ratos, machos divididos em dois grupos, um recebeu o implante de pl?stico bolha e o outro implante de pele de r?. Foi retirado um seguimento de 3,0 no eixo longitudinal por 1,0 cm no eixo transversal incluindo todos os planos da musculatura abdominal, a partir da linha m?dia em dire??o ao lado esquerdo da parede abdominal, criando-se uma falha que foi recoberta por uma das pr?teses propostas de acordo com o grupo em quest?o. Os animais foram avaliados atrav?s de acompanhamento de par?metros cl?nicos, termogr?ficos, macrosc?picos, histol?gicos e histopatol?gicos aos 7, 15, 30 e 90 dias de p?s-operat?rio. Clinicamente nenhuma das duas pr?teses testadas apresentou altera??es como abscessos, f?stulas entero-cut?neas, eventra??es ou eviscera??es. Macroscopicamente todos os animais apresentaram ader?ncias consideradas leves, principalmente, na regi?o da sutura das pr?teses. A termografia infravermelha se mostrou eficaz como m?todo avaliativo de inflama??o e da involu??o das pr?teses em conjunto com a an?lise morfol?gica. Ap?s a an?lise de todos os resultados concluiu-se que a pele de r?-touro provocou um processo inflamat?rio inicial que foi reduzindo at? a cura aos 90 dias de p?s-operat?rio, sendo considerada um biomaterial promissor para hernioplastias e o PEBD laminar bolhoso produziu um processo inflamat?rio inicial que regrediu at? os 30 dias de p?s-operat?rio, entretanto triplicou aos 90 dias de p?s-operat?rio sendo considerado um bom material para implantes tempor?rios de at? no m?ximo 30 dias e sendo necess?rio novos estudos com per?odos de implanta??o mais longos deste biomaterial para que seja utilizado com seguran?a nas corre??es de defeitos herni?rios de modo definitivo.

Introduction: Transabdominal laparoscopic (TAPP) approach in the therapy of inguinal hernia is a suitable alternative to classical open inguinal hernia repair mainly in the hands of an experienced surgeon. TAPP repair offers the possibility of gentle dissection with implantation of the mesh from posterior approach. Hypothesis and objectives of the work: The fixation of mesh through penetrating techniques using staples, clips or screws is associated with a significantly increased risk of developing a post-herniotomy inguinal pain syndrome (CPIP). The aim of the thesis is to review options of self-fixating meshes in laparoscopic TAPP procedure without additional fixation. Furthermore to evaluate effect of this technique on development of the chronic postoperative groin pain and also on frequency of hernia recurrence and mesh migration. Patients and methods: Data analysis included all patients, who underwent inguinal hernia surgery at our Surgical Department within the period from 1.10.12 to 31.12.14 and fulfilled the inclusion criteria. Standard surgical technique was used. Data were entered and subsequently analyzed on Herniamed platform. Results: There were 241 patients enrolled to the group of which 396 inguinal hernias were repaired. The minimal follow up was at 12 months. At the assessment in one...

Introduction: Transabdominal laparoscopic (TAPP) approach in the therapy of inguinal hernia is a suitable alternative to classical open inguinal hernia repair mainly in the hands of an experienced surgeon. TAPP repair offers the possibility of gentle dissection with implantation of the mesh from posterior approach. Hypothesis and objectives of the work: The fixation of mesh through penetrating techniques using staples, clips or screws is associated with a significantly increased risk of developing a post-herniotomy inguinal pain syndrome (CPIP). The aim of the thesis is to review options of self-fixating meshes in laparoscopic TAPP procedure without additional fixation. Furthermore to evaluate effect of this technique on development of the chronic postoperative groin pain and also on frequency of hernia recurrence and mesh migration. Patients and methods: Data analysis included all patients, who underwent inguinal hernia surgery at our Surgical Department within the period from 1.10.12 to 31.12.14 and fulfilled the inclusion criteria. Standard surgical technique was used. Data were entered and subsequently analyzed on Herniamed platform. Results: There were 241 patients enrolled to the group of which 396 inguinal hernias were repaired. The minimal follow up was at 12 months. At the assessment in one...