Hernia : the journal of hernias and abdominal wall surgery
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Randomized Controlled Trial
'Dissectalgia' following TEP, a new entity: its recognition and treatment. Results of a prospective randomized controlled trial.
To find the effect of pre-peritoneal instillation of bupivacaine on 'dissectalgia' (pain over a wide area corresponding to the area of pre-peritoneal dissection) and return to work following totally extraperitoneal (TEP) repair for groin hernia in labor-active males. ⋯ Dissectalgia following TEP deserves its due recognition. Pre-peritoneal bupivacaine instillation significantly reduces its occurrence, although the time of patients' resuming their jobs remains unaffected.
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Randomized Controlled Trial
A prospective, randomized, comparative trial of a COX-2 selective nonsteroidal anti-inflammatory drug versus placebo in inguinal herniorrhaphy patients.
The standard opioid treatment for postoperative pain can be associated with nausea, vomiting, and constipation. In addition, opioids often provide insufficient pain relief. The purpose of this study was to compare postoperative pain and functional outcomes in patients undergoing inguinal herniorrhaphy who receive a COX-2 selective nonsteroidal anti-inflammatory drug (COX-2) or placebo preoperatively and for 4 days postoperatively. ⋯ Administration of a COX-2 selective nonsteroidal anti-inflammatory drug prior to and following outpatient inguinal herniorrhaphy improves functional outcomes when compared with placebo and increases patient satisfaction. These results suggest that multimodal pain therapy with COX-2 inhibitors may have a role in outpatient inguinal hernia repair.
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Randomized Controlled Trial Comparative Study
Postoperative pain management after inguinal hernia repair: lornoxicam versus tramadol.
In this randomized and prospective study, we compared the analgesic effects of lornoxicam and tramadol in patients after inguinal hernia repair. ⋯ Lornoxicam 8 mg i.v. and b.i.d., tramadol 1 mg/kg at the end of the surgery and every 6 h up to 24 h after inguinal hernia repair provided rapid and effective analgesia and was well tolerated.
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Randomized Controlled Trial Comparative Study
Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision.
To determine whether a transverse incision is an alternative to a midline incision in terms of incisional hernia incidence, surgical site infection, postoperative pain, hospital stay and cosmetics in cholecystectomy. Incisional hernias after midline incision are commonly underestimated but probably complicate between 2 and 20% of all abdominal wall closures. The midline incision is the preferred incision for surgery of the upper abdomen despite evidence that alternatives, such as the lateral paramedian and transverse incision, exist and might reduce the rate of incisional hernia. A RCT was preformed in the pre-laparoscopic cholecystectomy era the data of which were never published. ⋯ In light of our results a transverse incision should, if possible, be considered as the preferred incision in acute and elective surgery of the upper abdomen when laparoscopic surgery is not an option.
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Randomized Controlled Trial
Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients.
Incisional hernia is one of the major elements of morbidity after abdominal surgery, with high incidence in vertical midline abdominal incisions. However, the risk of developing an incisional hernia can be increased due to the patient's related factors; therefore, more consideration has to be given to the choice of incision, wound closure and wound healing to protect against incisional hernia, especially in high-risk patients. In this study, we used prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients to detect whether fixing the wound with mesh is risky on a short-term basis and whether it is protective on a long-term basis. ⋯ Prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients can be used safely and effectively to provide extrinsic strength of the wound without relying too much on the defective development of its own intrinsic strength and to prevent subsequent incisional hernia. There was no risk in the use of the mesh regarding local and systemic complication. However, the final statement should await the outcomes of the long-term follow up of the studied cases.