Hernia : the journal of hernias and abdominal wall surgery
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Prosthetic mesh reinforcement is standard practice for inguinal hernia repair but can cause considerable pain and stiffness around the groin and affect physical functioning. This has led to various types of mesh being engineered, with a growing interest in a lighter weight mesh. The aim of this prospective study was to compare the outcome after laparoscopic totally extra-peritoneal (TEP) inguinal repair using new lightweight or traditional heavyweight mesh performed in a single specialist centre. ⋯ Laparoscopic TEP inguinal hernia repair with a lightweight mesh improves functional outcome in the short and long term. There was significantly less interference with all aspects of physical activity with the lightweight mesh. Pain in both groups was very mild, highlighting the benefits of laparoscopic 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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Laparoscopic repair of iatrogenic diaphragmatic hernias after sternectomy and pedicled omentoplasty.
During sternectomy and pedicled omental flap transposition for the treatment of deep sternal wound infections, an ectopic diaphragmatic aperture is created. This may be the site of an iatrogenic diaphragmatic hernia, which may result in the herniation of intra-abdominal organs, and is difficult to repair. Although this complication was described as early as 1991, no effective treatment for this condition has been described previously. ⋯ We describe a laparoscopic technique to repair this difficult diaphragmatic hernia used in four patients, with a good clinical and computed tomographic outcome at 12 months.
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To determine the complication and infection risks following extra-peritoneal onlay mesh placement in parastomal hernia repair. ⋯ Parastomal hernia repair using a prosthetic mesh is a safe and effective method, with the lowest recurrence rates and acceptably low infection rates. Prosthetic materials should not be used in cases of fecal contamination.
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Clinical Trial
Factors determining the doses of local anesthetic agents in unilateral inguinal hernia repair.
Today, local anesthesia is used in specialized hernia clinics in most cases. The technique for establishing local anesthesia for inguinal surgery may differ among surgeons. Few articles to date have mentioned the exact doses of local agents. This prospective study aimed to research the doses of local anesthetic agents needed in practice and determine the patient-related and other factors which affected those doses. ⋯ This prospective study showed, again, the feasibility of local anesthesia in elective inguinal hernia repair in all patient groups with different characteristics. The mean and maximum doses of local anesthetic agents were well within safety limits, even in recurrent and large hernias. Younger age, large hernias, recurrent hernias, omental mass in the hernia sac, high BMI, and duration of operation might be the factors affecting local anesthetic doses. The significant independent parameters in the multivariate analysis were duration of operation, sac content, and BMI for lidocaine dose, whereas the duration of operation and sac content were determinative for the sum volume of lidocaine and bupivacaine.