Hernia : the journal of hernias and abdominal wall surgery
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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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Comparative Study
Laparoscopic incisional hernia repair: evaluation of effectiveness and experiences.
Incisional hernia is the most frequent postoperative complication following abdominal surgery and is a common and costly source of morbidity. Conventional mesh repair is the standard treatment today, but the use of laparoscopic incisional hernia repair (LIHR) seems to be a good alternative. We performed a retrospective analysis comparing open incisional hernia repair with the laparoscopic approach. ⋯ Our results show the tendency that LIHR is associated with less postoperative pain and comparable postoperative complications. The low recurrence rate proves the safety and the good long-term results of this procedure. Laparoscopic hernia repair is an alternative to open procedures in cases of feasibility. Further studies, especially randomized controlled trials, are required to confirm these findings and provide the basis for future treatment guidelines.
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Editorial Practice Guideline
European Hernia Society guidelines on the treatment of inguinal hernia in adult patients.
The European Hernia Society (EHS) is proud to present the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. They have been developed by a Working Group consisting of expert surgeons with representatives of 14 country members of the EHS. ⋯ Working together on this project was a great learning experience, and it was worthwhile and fun. Cultural differences between members were easily overcome by educating each other, respecting different views and always coming back to the principles of evidence-based medicine. The members of the Working Group would like to thank the EHS board for their support and especially Ethicon for sponsoring the many meetings that were needed to finalise such an ambitious project.
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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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Abdominal wall hernias after trauma have been recognized for more than a century, with the first case reported as occurring after a fall. Traumatic abdominal wall hernias (TAWHs) after blunt trauma are uncommon. The timing of definitive repair, early or delayed, is not clear. ⋯ However, damage to all layers of the abdominal wall indicates high-energy trauma. In such cases, the damage is not, in all probability, limited to the integumentary system. For the moment, the timing of surgery in any TAWH should be considered differently according to the trauma, the wall defect, clinical and radiological findings, associated injuries, and the clinical status of the patient.