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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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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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.