Hernia : the journal of hernias and abdominal wall surgery
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In Edinburgh a group of surgeons agreed to convert to a lightweight, composite mesh (Ultrapro-Ethicon) for totally extraperitoneal (TEP) inguinal hernia surgery. The aim of this study was to compare the outcome following the use of a new lightweight vs a standard heavyweight mesh during TEP hernia repair. ⋯ In view of increased patient comfort, we continue to recommend LWM for laparoscopic inguinal hernia surgery but would recommend that, in larger hernias and possibly for all, the surgeon should improve mesh adhesion.
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Many centers use local anesthesia for adult inguinal hernia surgery in the setting of day-case surgery. There are no reports on, or guidelines for, use of anesthesia for inguinal hernia surgery in adolescents. We describe our initial experience with the use of local anesthesia and intravenous sedation for inguinal hernia surgery in adolescents in the setting of a day-surgery facility. ⋯ The use of local anesthesia with intravenous sedation for inguinal hernia repair in the adolescent age group seems feasible and requires further prospective study.
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Comparative Study
Outcomes of emergency and elective femoral hernia surgery in four district general hospitals: a 4-year study.
A large number of femoral herniae present as emergencies accounting for significant morbidity and mortality, which have remained unchanged over the last decade. Reports of outcomes in femoral hernia surgery are scarce, even more so in district general hospitals where a significant proportion of surgeries are performed. This study compares results of emergency and elective femoral hernia surgery in four district general hospitals against published rates up to a decade ago. ⋯ The proportion of femoral herniae presenting as emergencies remained unchanged. This accounts for the morbidity and mortality in femoral surgery, which remains high and similar to a decade ago. Early diagnosis by clinicians and general practitioners and elective surgery are required to reduce mortality. Further investigation into the effect of the opposition technique on femoral vein compression and deep venous thrombosis is warranted.
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Comparative Study
Analysis of post-surgical pain after inguinal hernia repair: a prospective study of 1,440 operations.
Pain remains a significant clinical problem after inguinal hernia repair. We prospectively assessed post-surgical pain following herniorrhaphy in 1,440 operations with the aim of describing the characteristics and identifying predisposing factors for pain. ⋯ Our study confirms that herniorrhaphy frequently produces chronic pain, which can reduce quality of life. The SF-MPQ is a useful instrument to administer to all patients and provides important information about qualitative properties of the pain.
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Randomized Controlled Trial
The role of hernia sac ligation in postoperative pain in patients with elective tension-free indirect inguinal hernia repair: a prospective randomized study.
Tension-free inguinal hernia repair is one of the so-called painless operations. Mild or medium postoperative pain, however, even in the mesh repair era, is common and usually due to ilioinguinal nerve entrapment or mesh fixation in the periostium of the pubic tubercle. Especially in indirect inguinal hernia repair, however, hernia sac ligation and excision may be the cause of pain. The aim of this study was to conduct a single-center prospective randomized trial with a view to clarify this issue on a scientific basis. ⋯ From the results of this study, it appears that we are able to demonstrate a significant benefit from the omission of high hernia sac ligation and excision on postoperative pain in patients who undergo tension-free indirect inguinal hernia mesh repair.