Some groups have reported a history of smoking having a

Some groups have reported a history of smoking, having a BMI of less than 23 kg/m2, previous unilateral inguinal hernioplasty, postoperative anastomotic stricture, and prolonged use of self-retaining retractor during operation as risk factors of post-RP IH formation. However, Abe et al reported that the previous IH history, urethral structure, blood loss and operative time failed to identify any potential risk factors between patients with or without a postoperative IH in the RRP and LRP groups. Factors such as coughing, Wnt-C59 outlet obstruction, constipation, pregnancy and heavy lifting are causes of raised intra-abdominal pressure and may cause an existing small and unnoticed IH to expand and become more obvious. In this series, we also found that a simple suture was enough in subclinical IHs with a small internal inguinal ring. However, positioning of the mesh was needed in symptomatic IHs or in patients with large defects. The extra operative time was less than 15 minutes for inguinal repair during a RALP, especially in patients with a subclinical IH. Sun et al followed-up 5478 men, post-RRP, for the outcome of the IH repair rates. They reported that the IH repair rates at 1, 2, 5 and 10 years after their RP were 4.4%, 6.7%, 11.7% and 17.1%, respectively. In the light of our present experience, the incidence of IHs after a RALP is lower than RRPs in our institute (3% vs. 12.4%). The follow-up periods in this study were similar for both groups (32.42 ± 11.76 months for the RALP group, and 35.06 ± 18.23 months for the RRP group, p = 0.772). This phenomenon can be explained in three ways. First, it is easier to detect an occult IH under high pressure of the peritoneal cavity during a RALP than during an RRP. Second, the realistic 3D imaging and steady view of the da Vinci robotic system are more helpful for the surgeon to inspect small inguinal defects with LRPs. Third, the precise dissection of lesser muscle injuries during a RALP decreases the incidence of IH formation. It is concluded that routine RALHs for occult IHs during a RALP are safe with minimum extra operative time.
Introduction Osteochondritis dissecans (OCD) is a subchondral bone lesion that mainly affects juveniles and young adults. Several hypotheses exist that explain the cause of OCD, including inflammation, ossification abnormalities, ischemia, and repetitive microtrauma. In the majority of cases, adult OCD is thought to be due to persistence of an unresolved juvenile OCD lesion. Most patients who have OCD of the knee may complain of locking, soreness, and activity-related anterior knee pain. Healing rates of stable OCD lesions treated by nonoperative methods were reported to be between 50% and 94%. The clinical staging system of OCD is mainly based on the findings of arthroscopy, magnetic resonance imaging (MRI), and radiographs, as first published by John D. Dipaola, David W. Nelson and Mark R. Colville. The Stage I OCD lesion was classified as a stable lesion. Stage II and III lesions were classified as unstable lesions. Stage II is defined as the period of time with articular cartilage breached with a definable but not displaceable fragment. Stage III is defined to be the same as Stage II but with a displaceable fragment. Stage IV is for a loose body. Unstable lesions were thought to require surgical fixation, including drilling, debridement, bone grafting, and fixation with implant. Healing rates have also been affected by skeletal immaturity, lesion size, and lesion location on the medial femoral condyle. The main goal of our study was to analyze the clinical outcome of patients who were diagnosed to have unstable OCD and treated with internal fixation with a Zimmer Herbert cannulated bone screw (Zimmer Inc., Warsaw, IN, USA).
Materials and methods We reviewed 25 patients who had arthroscopic drilling under the diagnosis of OCD between November 1995 and December 2007. We excluded patients who had Stage II to Stage III OCD at sites other than the knee joint, and had received a bone graft, allograft or other implant insertion except a Herbert cannulated bone screw. Eight patients were included in our study (Table 1). The lesions were located in the medial condyle of seven patients and in the lateral condyle of only one patient. The disease was diagnosed by clinical presentation, radiography and MRI. All the patients had pain, locking, effusion, and giving way of the involved knee joint. As regards imaging, MRI revealed an obvious OCD lesion in each patient. The arthroscopic procedure was performed in a normal manner with patients under regional anesthesia and the use of a tourniquet according to the report of Makino et al. The arthroscope was in the anterior lateral portal and the operation instrument via the anterior medial portal. A probe was used for palpating the OCD lesion, with care taken not to disrupt the medial chondral hinge. The osteochondral fragment was separated from the subchondral bed and a superficial debridement was performed to remove the interposing fibrous tissue on the crater and the fragment. Multiple small drill holes were then made over the crater for increasing vascularity. No patients required bone grafting, and once the reduction was deemed congruent, the preliminary guide wire was prescribed for securing the fragment in situ. A cannulated calibrated drill was used for making a tunnel, and a small guide pin was used for facilitating the insertion of the cannulated screw. A taper was not used, and the screw was driven via a cannulated screw driver. We fixed all the fragments with one to three Zimmer Herbert cannulated bone screws with the range of length from 12 mm to 18 mm, perpendicular to the fragment according to the operator’s decision during the operation. The patient should maintain nonweight bearing for 6 weeks postoperatively. Full-range motion of the involved knee joint was allowed immediately after the operation.