Bilateral Herniorrhaphy Research Articles

Humanitarian surgical service utilization by a host country population: comparing surgery patterns between refugees and Tanzanians using an interrupted time-series analysis

BackgroundWhile current estimates suggest that up to three million additional surgical procedures are needed to meet the needs of forcibly displaced populations, literature on surgical care for refugee or forced migrant populations has often focused on acute phase and war-related trauma or violence with insufficient attention to non-war related pathologies. To our knowledge, no study has compared refugee versus host population utilization of surgical services in a refugee camp-based hospital over such an extended period of twenty years. The aim of this paper is to first describe the patterns of surgical care by comparing refugee and host population utilization of surgical services in Nyarugusu refugee camp between 2000 and 2020, then evaluate the impact of a large influx of refugees in 2015 on refugee and host population utilization.MethodsThe study was based on a retrospective review of surgical logbooks in Nyarugusu refugee camp (Kigoma, Tanzania) between 2000 and 2020. We utilized descriptive statistics and multiple group, interrupted time series methodology to assess baseline utilization of surgical services by a host population (Tanzanians) compared to refugees and trends in utilization before and after a large influx of Burundian refugees in 2015.ResultsA total of 10,489 operations were performed in Nyarugusu refugee camp between 2000 and 2020. Refugees underwent the majority of procedures in this dataset (n = 7,767, 74.0%) versus Tanzanians (n = 2,722, 26.0%). The number of surgeries increased over time for both groups. The top five procedures for both groups included caesarean section, bilateral tubal ligation, herniorrhaphy, exploratory laparotomy and hysterectomy. In our time series model, refugees had 3.21 times the number of surgeries per quarter at baseline when compared to Tanzanians. The large influx of Burundian refugees in 2015 impacted surgical output significantly with a 38% decrease (IRR = 0.62, 95% CI 0.46–0.84) in surgeries in the Tanzanian group and a non-significant 20% increase in the refugee group (IRR = 1.20, 95% CI 0.99–1.46). The IRR for the difference-in-difference (ratio of ratios of post versus pre-intervention slopes between refugees and Tanzanians) was 1.04 (95% CI 1.00–1.07), and this result was significant (p=0.028).ConclusionsSurgical care in conflict and post-conflict settings is not limited to war or violence related trauma but instead includes a large burden of obstetrical and general surgical pathology. Host population utilization of surgical services in Nyarugusu camp accounted for over 25% of all surgeries performed, suggesting some host population benefit of the protracted refugee situation in western Tanzania. Host population utilization of surgical services was apparently different after a large influx of refugees from Burundi in 2015.

Surgical findings and clinical outcome after bilateral repair of apparently unilateral perineal hernias in dogs.

To report the short- and long-term outcomes and recurrence rate in dogs treated for apparently unilateral perineal hernia with bilateral herniorrhaphy, castration, colopexy, vas deferens pexy with or without cystopexy in single-stage procedures. Thirty-one client-owned dogs with apparently unilateral perineal hernia were included. Perineal hernias were repaired bilaterally, incorporating internal obturator muscle transposition and the sacro-tuberal ligament, combined with colopexy, vas deferens pexy with or without cystopexy. Preoperative pattern of defaecation, pattern of micturition and rectal alignment were recorded. Surgical time, bilateral surgical perineal findings, postoperative complications, short-, middle- and long-term (>24 months) scores and recurrence rate were documented. A hernia with ectopic tissue and weakness of the pelvic diaphragm was identified bilaterally in all dogs despite the unilateral clinical presentation. The procedure combination was achieved uneventfully in all dogs in 56 to 113 minutes (mean 73 minutes). Complication rate was low, consisting mostly of urinary disorders, most of which resolved within a few days. In all, 93% of dogs were free of clinical signs related to perineal hernia at long-term follow-up (mean 27 months). Recurrence rate was 0%. Our surgical findings suggest that perineal hernia in dogs might be considered a bilateral disease, even when the presentation is of apparently unilateral signs. Recurrence is rare following bilateral herniorrhaphy combined with colopexy and deferens pexy with or without cystopexy.

Laparoscopic inguinal hernia repair by modified peritoneal leaflet closure: Description and initial results in children

Inguinal hernias are common in infants and children. While the gold standard for hernia repair in the pediatric period has been via an open inguinal incision with dissection and high ligation of the hernia sac, over the past two decades laparoscopic herniorrhaphy has increased in popularity. The advantages of laparoscopy include decreased post-operative pain, improved cosmetic results, ability to easily assess the contralateral side for an open internal inguinal ring, and decreased risk of metachronous hernias. Herein, we describe a modified laparoscopic herniorrhaphy using a peritoneal leaflet closure and report our operative experience with intermediate-term results. We retrospectively reviewed our IRB-approved registry for all children who underwent initial laparoscopic herniorrhaphy at our tertiary care center over a 2.5-year period. All surgeries were performed by a single surgeon using a technique we have termed the peritoneal leaflet closure. This technique involves incising the peritoneum circumferentially around the open internal ring and developing peritoneal leaflets which are then closed together over the ring with a running non-absorbable barbed stitch (Figure). Intraoperative findings and complications, operative times, and post-operative complications were reviewed for all children. A total of 50 initial laparoscopic hernia repairs (4 bilateral, 42 unilateral) were performed in 46 children (43 boys, 3 girls) at a median age of 5.9 years (range 0.5-16.7). Median operative time was 73min (range 48-138) for unilateral and 106min (range 104-135) for bilateral herniorrhaphy. No patient had an intraoperative complication. Two children (4%) had contralateral open rings discovered at time of surgery and underwent unplanned bilateral laparoscopic hernia repair. All patients went home on the same day as the procedure and three children (6%) had minor post-operative complaints (umbilical bulge, thigh pain, and urine holding) that all self-resolved. Thirty-nine children had follow-up data available. Intermediate-term complications occurred in two children (5%): one boy developed a contralateral hydrocele (despite a closed ring at surgery) and one boy had a hernia recurrence that required open repair. Overall, operative success with the modified peritoneal leaflet closure technique was therefore 97% (38 of 39 children with follow-up). All 37 boys who followed up had bilateral descended testes of normal size and consistency. Laparoscopic herniorrhaphy using a peritoneal leaflet closure technique is safe and effective when used in infants and children to close an indirect hernia (i.e. patent processus vaginalis). No intraoperative complications occurred in this cohort and success rate was 97%.

Hernia In South Southern Nigeria: Five Year Retrospective Study.

years 49 (12.7%), 60-69 years 36 (9.3%), 70-79 years 20 (5.2%), 10-19 years 16 (4.1%), 80-89 years and less than 10 years with 4 (1.0%) each respectively. Most of the cases were done by Senior Registrars 221 (57.3%) then Consultants 105 (27.2%), while Registrars did 60 (15.5%). The hernias were mostly inguinal with reducible right inguinal hernia constituting the highest 121(31.1%), Reducible left inguinal hernias 81 (21.0%), Obstructed right inguinal hernias were 44 (11.4%), incisional hernia were 38 (9.8%), umbilical hernia 27 (7.0%), Bilateral inguinal hernias were 26 (6.7%), epigastric hernias were 25 (6.5%), obstructed supraumbilical hernias were 9 (2.3%), left femoral hernias were 5 (1.3%), obstructed left femoral and obstructed epigastric were both 4 (1.0%) each and right femoral and bilateral femoral hernias were 1 (0.3%) each respectively. The type of hernia repair done was nylon darn in 313 (81.1%), those requiring both exploratory laparotomy and herniorrhaphy were 36 (9.3%), bilateral herniorrhaphy was done in 15 (3.9%). Mayo’s type of repair was done in 9 (2.3%) and repair with mesh was done in 4 (1.0%) as well as in herniotomy. Primary repair in layers was in 3 (0.8%). Herniorrhaphy with orchidectomy was 2 (0.5%). The anaestheia done was mostly sub arachnoid block 297 (76.9%), general anaesthesia was done in 69 (17.9%), local infilteration was 18 (4.7%), total intravenous anaesthesia (TIVA) and field block 1 (0.3%) each. Most of the surgery lasted between 50-99 minutes 214 (55.4%), then followed by less than 50 minutes 78 (20.2%), 100-149 minutes 66 (17.1%), 150-199 minutes 19 (4.9%), 200-249 minutes 4 (1.0%), 250-299 minutes 2 (0.5%), 300-349, 350-399 and greater than 400 minutes with 1 (0.3%) respectively. Conclusion: Hernia in South Southern Nigeria has quite a large magnitude of clinical impact in our environment. The indirect inguinal hernia being the most common with male sex preponderace. Sub-aracnoid block is the most common form of anaesthesia utilized with most herniorrhaphies done by the senior registrars.

Incidence and concurrent laparoscopic repair of hypertrophic pyloric stenosis and patent processus vaginalis.

Incidence and concurrent laparoscopic repair of hypertrophic pyloric stenosis and patent processus vaginalis.

Laparoscopic Herniorrhaphy in the Pediatric Age Group: What About the Learning Curve?

To evaluate the learning curve of pediatric laparoscopic herniorrhaphy (LH), the authors report a retrospective analysis comparing results obtained with this technique and the traditional herniotomy to determine how many procedures are necessary to obtain the results described in the literature. From May 2008 to February 2012, a total of 140 patients (110 boys and 30 girls) with uncomplicated inguinal hernia (IH) consecutively underwent surgery. Patients were divided in two groups: The "Open" group of 83 patients (M:F 64:19) with a mean age of 33.2 months who were operated on with traditional herniotomy and the "Lap" group of 57 patients (M:F 46:11) with a mean age of 34.5 months who were operated on with LH. Operative time and complications of the techniques were analyzed statistically. In the Open group, the mean operative time for monolateral repair was 35.4 ± 17.7 minutes compared with the Lap group time of 29.9 ± 15.9 minutes; for bilateral repair, the mean operative time for the Open group was 56.2 ± 19.3 minutes compared with the Lap group time of 41.5 ± 10.4 minutes. The analysis shows a shorter operative time for the laparoscopic repair for both monolateral (P=0.73) and bilateral (P=0.0001) hernia. Recurrences occurred in one (0.9%) patient in the Open group and in two (2.7%) patients in the Lap group (P=0.577). This experience shows that LH is a reliable technique. Retrospective analysis revealed a shorter mean operative time for the laparoscopic intervention both for monolateral and bilateral IH repair. Recurrences in the Lap group occurred in the first 10 patients treated, and the mean operative time was reached in 20 monolateral LHs and after 15 bilateral herniorrhaphies. From this analysis, the learning curve for the LH needs a minimum of 20 procedures.

Single-Site Surgery for Simultaneous Totally Extraperitoneal Bilateral Herniorrhaphy and Transperitoneal Radical Nephrectomy in One Patient

This study reports a case undergoing laparoendoscopic totally extraperitoneal herniorrhpahy and transperitoneal laparoscopic radical nephrectomy through transumbilical single-site incisions. A 56-year-old man presented with incidental left renal tumor and bilateral inguinal hernia. Accordingly, a homemade single-port in subumbilicus was applied for totally extraperitoneal herniorrhpahy, following which the incisional wound was extended upward for transperitoneal radical nephrectomy as well. No extraumbilical port was required. Pathology confirmed the diagnosis of renal cell carcinoma. The peri- and postoperative course was quite smooth with rapid recovery, and the patient was discharged home on the fifth postoperative day. The laparoendoscopic single-site surgery with homemade single-port allowed extraperitoneal and transperitoneal procedures to be carried out at the same time, which was feasible and safe with negligible complications. Performing 2 procedures with single-site incision greatly diminished the number of port site incisions and offered obvious cosmetic advantage.

Acute ST changes during anesthesia induction 10 months after norwood procedure

After the Norwood procedure for palliation of hypoplastic left heart syndrome, there is still significant interstage and late mortality with often unclear etiology. An important, but possibly under-recognized complication of the Norwood operation is the potential for coronary insufficiency from pre-coronary stenosis due to kinking or scarring at the anastomosis between the native and neo-aorta. We report a case of a clinically thriving 10-month old infant status post bidirectional Glenn who had acute ischemic changes on electrocardiogram (ECG) during induction of anesthesia for elective bilateral herniorrhaphy. A discrete narrowing in the native aorta to neo-aorta anastomosis was identified. A stent was placed emergently to restore adequate coronary blood flow after failure of simple angioplasty to adequately improve the stenosis.

Modified lightwand intubation in a child with spondyloepiphyseal dysplasia congenita

This is the case report on a 1-year 9-month-old boy suffering from spondyloepiphyseal dysplasia congenita who was successfully intubated with our modified lightwand intubation procedure for general anesthesia to undergo bilateral herniorrhaphy despite the great likelihood of facing a difficult airway because of unstable cervical spine. We bent the pediatric wand after it was encased in an endotracheal (ET) tube of appropriate diameter. The light tip of the wand was let to protrude just out of the bevel of the ET tube. Once the light bulb properly transilluminated the trachea, the ET tube was threaded gently into the trachea. The patient recovered from anesthesia smoothly and was discharged on the next day. This maneuver can facilitate both visual and tactile confirmations of the position and proper tube size. The effectiveness and safety of our modified lightwand intubation procedure is well demonstrated.

Fifteen years experience in laparoscopic inguinal hernia repair in pediatric patients. Results and considerations on a debated procedure

Laparoscopic inguinal hernia repair is rarely reported in pediatric patients. We report our 15-year experience on this topic to show the long-term results of this technique. During a 15-year period, we operated 596 boys for unilateral inguinal hernia using laparoscopy. The age range was variable from 6months to 15years (median, 54months), with a median body weight of 18.5 (range, 8-54) kg. Preoperatively, 352 boys had a right hernia and 172 had a left hernia. We always used three trocars. We used the laparoscopic herniorrhaphy described by our group 15years ago; it consists of sectioning the sac distally to the inguinal ring and performing a pursestring suture around the periorificial peritoneum using a 4/0 nonresorbable suture. The median operating time was 19min. All procedures were performed in a day-hospital setting. As for laparoscopic findings in 95 of 596 patients (15.9%), we found a contralateral patency of the processus vaginalis. In these 95 cases, we performed bilateral herniorrhaphy. In 7 of 596 patients (1.2%), we discovered a direct hernia. With follow-up between 1 and 15years, we have only 11 recurrences (1.5%)-all reoperated by laparoscopy. We believe that laparoscopic repair of inguinal hernia performed by expert hands is a safe and effective procedure to perform with long-term follow-up. Its ability to repair simultaneously all forms of inguinal hernias together with contralateral patencies has cemented its role as a viable alternative to conventional repair.

A prospective, randomized comparison of skin adhesive and subcuticular suture for closure of pediatric hernia incisions: cost and cosmetic considerations

Purpose In this study, we compared the skin adhesive 2-octylcyanoacrylate to subcuticular suture for closure of pediatric inguinal hernia incisions to determine if skin adhesive improves wound cosmesis, shortens skin closure time, and lowers operative costs. Methods We prospectively randomized 134 children undergoing inguinal herniorrhaphy at our institution to have skin closure with either skin adhesive (n = 64) or subcuticular closure (n = 70). Data collected included age, sex, weight, type of operation, total operative time, and skin closure time. Digital photographs of healing incisions were taken at the 6-week postoperative visit. The operating surgeon assessed cosmetic outcome of incisions using a previously validated visual analog scale, as well as an ordinate scale. A blinded assessment of cosmetic outcome was then performed by an independent surgeon comparing these photographs to the visual analog scale. Operating room time and resource use (ie, costs) relative to the skin closure were assessed. Comparisons between groups were done using Student's t tests and χ 2 tests. Results Children enrolled in the study had a mean ± SE age of 3.7 ± 0.3 years and weighed 16 ± 0.8 kg. Patients were predominantly male (82%). Patients underwent 1 of 3 types of open hernia repair as follows: unilateral herniorrhaphy without peritoneoscopy (n = 41; 31%), unilateral herniorrhaphy with peritoneoscopy (n = 55; 41%), and bilateral herniorrhaphy (n = 38; 28%). Skin closure time was significantly shorter in the skin adhesive group (adhesive = 1.4 ± 0.8 minutes vs suture = 2.4 ± 1.1 minutes; P = .001). Mean wound cosmesis scores based on the visual analog scale were similar between groups (adhesive = 78 ± 21; suture=78 ± 18; P = .50). Material costs related to herniorrhaphy were higher for skin adhesive (adhesive = $22.63 vs suture = $11.70; P < .001), whereas operating room time costs for adhesive skin closure were lower (adhesive = $9.33 ± 5.33 vs suture = $16.00 ± 7.33; P < .001). Except for a 7% incidence of erythema in both groups, there were no complications encountered. Conclusions There is no difference in cosmetic outcome between skin adhesive and suture closure in pediatric inguinal herniorrhaphy. Material costs are increased because of the high cost of adhesive relative to suture. This is partially offset, however, by the cost savings from reduction in operating room time.

Cephalad migration of intrathecal clonidine in an infant undergoing bilateral herniorrhaphy

To the Editor, Intrathecal clonidine is often added to bupivacaine to prolong the duration of spinal anesthesia in the pediatric population. However, there may be important central nervous system (CNS) effects due to cephalad spread of clonidine following intrathecal administration of a clonidine–bupivacaine mixture. A 3 -month-old full-term male infant (51 weeks postconception) weighing 5 kg was scheduled for bilateral inguinal hernia repair. Preoperative evaluation was unremarkable, except for the presence of an asymptomatic atrial septal defect measuring 4.5 mm in diameter. After obtaining written parental consent, the infant was sedated with propofol (10 mg bolus and infusion at 25 lg kg min). A lumbar puncture was performed using a 25 mm, 25 G spinal needle (Beckton Dickinson, Madrid, Spain) with the patient in the left lateral position. Intrathecal clonidine 5 lg and hyperbaric bupivacaine 2.5 mg (0.5%) were administered in a volume of 0.53 mL. The infant was then turned supine. The height of spinal block was T3 after five minutes. Within eight minutes, the infant was deeply sedated and propofol sedation was discontinued. However, the infant continued to be deeply sedated and lethargic, and there was flaccidity with no spontaneous movement of either upper limb. No clinically significant hypotension, bradycardia, or desaturation were observed, but the patient’s respiratory efforts were inadequate with intermittent apneic episodes. Therefore, tracheal intubation was performed after administration of thiopental 10 mg iv, and anesthesia was maintained with sevoflurane and nitrous oxide. The duration of surgery was 62 min. The inhalational agents were then discontinued, and the patient was transferred to the postanesthesia care unit where mechanical ventilation was maintained. Return of movement in the infant’s upper limbs was first noted 7 hr and 26 min after administration of spinal anesthesia, with complete recovery of motor function in all limbs 8 hr after block administration. The trachea was then extubated. The first need for rescue analgesia was at 8 hr and 17 min. The patient was observed for 72 hr in the step-down unit where no apneic episodes, desaturation, or hemodynamic instability were noted. Intrathecal doses of bupivacaine 0.5 mg kg and clonidine 1 lg kg, normally provide spinal blockade without adverse effects. The total volume given was 0.53 mL or approximately 0.1 mL kg. In infants, volumes of up to 0.2 mL kg have been used without significant adverse effects. The flaccidity of limb muscles, prolonged sedation, and respiratory depression suggests the occurrence of CNS toxicity with clonidine. Such toxicity has been observed with various routes of administration of clonidine, including eye drops. Common clinical features of clonidine toxicity are variable and include somnolencelethargy (96%), miosis (56%), and respiratory depression (48%), with treatment being mainly supportive. Children seem to be unusually sensitive to the depressant effects of clonidine. In this case, the intrathecally administered clonidine–bupivacaine mixture might have caused CNS toxicity due to cephalad spread of clonidine. As a result, CNS manifestations, such as somnolence, hypotonia, and respiratory depression, were produced without effects on other organ systems. On its own, a high level of spinal anesthesia produces sedation, but the block is expected to S. V. Rakesh, MBBS S. Rajeev, MD Y. K. Batra, MD (&) K. L. N. Rao, MCh Postgraduate Institute of Medical Education and Research, Chandigarh, India e-mail: ykbatra@glide.net.in

ROBOTIC ASSISTED LAPAROSCOPY FOR INGUINAL VASOVASOSTOMY AFTER BILATERAL HERNIORRHAPHY WITH MESH

You have accessJournal of Urology1 Apr 2009ROBOTIC ASSISTED LAPAROSCOPY FOR INGUINAL VASOVASOSTOMY AFTER BILATERAL HERNIORRHAPHY WITH MESH Richard C Bennett, Jon A Rumohr, Richard E Link, and Larry I Lipshultz Richard C BennettRichard C Bennett More articles by this author , Jon A RumohrJon A Rumohr More articles by this author , Richard E LinkRichard E Link More articles by this author , and Larry I LipshultzLarry I Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)61083-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "ROBOTIC ASSISTED LAPAROSCOPY FOR INGUINAL VASOVASOSTOMY AFTER BILATERAL HERNIORRHAPHY WITH MESH." The Journal of Urology, 181(4S), p. 383 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 383 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Richard C Bennett More articles by this author Jon A Rumohr More articles by this author Richard E Link More articles by this author Larry I Lipshultz More articles by this author Expand All Advertisement PDF downloadLoading ...

Rapidly progressing, late-onset obstructive azoospermia linked to herniorrhaphy with mesh

To report a case of a man presenting with rapidly progressing inguinal vasal obstruction 5 years after bilateral herniorrhaphy with polypropylene mesh. Case report with a review of the scientific literature. Male infertility clinic, Kobe University Hospital (Kobe, Japan). A 30-year-old patient who had undergone bilateral inguinal herniorrhaphy using polypropylene mesh 5 years previously. The patient underwent bilateral vasography and left testicular sperm extraction (TESE). Long-term effects of the adult inguinal herniorrhaphy with polypropylene mesh. Rapid progression of vas deferens obstruction occurred within several months. We performed left TESE for intracytoplasmic sperm injection (ICSI) and retrieved many motile sperm. Before azoospermia, men who undergo inguinal herniorrhaphy using polypropylene mesh need to rapidly cryopreserve their sperm for future fertility; TESE-ICSI is also a selectable treatment.

Laparoscopic Inguinal Herniorrhaphy Complicating Radical Cystoprostatectomy

This report describes 2 patients who underwent cystoprostatectomy for bladder cancer after bilateral laparoscopic inguinal herniorrhaphy by using a sheet of mesh that obliterated the space of Retzius. Two men who had undergone bilateral laparoscopic herniorrhaphy with a sheet of polypropylene mesh presented with muscle-invasive bladder cancer. Their operative findings are presented. Despite reports suggesting that prostatectomy and, by implication, cystectomy could not be safely performed in this setting, both men underwent surgical exploration because of the lack of adequate potentially curative alternatives. Nerve sparing was possible in one man, leading to recovery of erections after surgery. Extended lymphadenectomy was possible in one man but was not completed in the other because of scarring throughout the pelvis that precluded safe removal of traditional node templates. Unlike prostate cancer, which is amenable to nonextirpative therapeutic options, bladder cancer is most definitively treated with removal of the bladder and prostate. Despite reports that prostatectomy could be impossible in this setting, we found that cystoprostatectomy was substantially more difficult but could be performed in this setting.

Hernie Vésicale

Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or computerized tomography confirm the diagnosis. We report a case of bilateral inguinal hernia involving the bladder at the right side in a 87 years old man who had a surgical history of transvesical adenomectomy of the prostate. The diagnosis was done on the retrograde urethrocystography. We performed bilateral herniorrhaphy with herniated bladder reduction. The postoperative history was uneventful.

THE EFFECT OF PREVIOUS TRANSPERITONEAL LAPAROSCOPIC INGUINAL HERNIORRHAPHY ON TRANSPERITONEAL LAPAROSCOPIC RADICAL PROSTATECTOMY

Previous laparoscopic herniorrhaphy has been considered a contraindication to laparoscopic radical prostatectomy (LRP). In this study we analyzed the impact of previous laparoscopic or open inguinal hernia repair on the outcome of transperitoneal laparoscopic radical prostatectomy using the Heilbronn technique. In our database of 1,089 patients with LRP we identified 20 who underwent transperitoneal LRP and had a history of transperitoneal laparoscopic inguinal herniorrhaphy using prosthetic mesh (group 1). The outcome in that group was compared to that of 20 matched pair patients of a total of 95 in whom LRP was performed following open inguinal herniorrhaphy (group 2) and 20 matched pair patients of a total of 771 without previous surgery (group 3). Perioperative parameters (operative time, blood donation and complications) and postoperative results (duration and amount of analgesic treatment, catheterization and the continence rate) were analyzed. According to the matched pair algorithm the 3 groups did not differ with respect to age (63.8, 66.2 and 63.0 years, p = 0.226), prostate volume (47.2, 43.3 and 47.7 gm, p = 0.501) or body mass index (26.1, 25.8 and 26.2 kg/m, respectively, p = 0.641). Ten pelvic lymphadenectomies and 8 nerve sparing (4 unilateral and 4 bilateral) procedures were performed per group. Ten and 12 patients in groups 1 and 2 had a history of bilateral herniorrhaphy, while previous unilateral herniorrhaphy was noted in the remaining 10 and 8, respectively. Mean operative time +/- SD (203.3 +/- 3.54, 196.7 +/- 43.7 and 214.7 +/- 37.7 minutes, p = 0.346) and mean catheterization time (8.1 +/- 2.8, 7.7 +/- 2.5 and 7.4 +/- 2.1 days, respectively, p = 0.684) did not differ significantly among the 3 groups. However, the mean amount of narcotic analgesic was significantly higher in group 1 compared with groups 2 and 3 (32.1 +/- 11.9, 21.8 +/- 11.9 and 19.5 +/- 10.1 mg, respectively, p = 0.002). Continence rates were similar in the groups at 88%, 87% and 92%, respectively, 1 year after surgery. Previous laparoscopic inguinal herniorrhaphy using prosthetic mesh does not adversively affect the operative outcomes or functional results of LRP, while the total amount of narcotic analgesics was significantly higher, reflecting increased postoperative morbidity.

Recombinant Factor VIIa Is Effective for Bleeding and Surgery in Patients With Glanzmann Thrombasthenia

AbstractRecombinant activated factor VII (rFVIIa) was found to be effective and safe in treating 24 bleeding episodes and to prevent bleeding during one bilateral herniorrhaphy in four children with Glanzmann thrombasthenia. One of the patients had alloantibodies to platelet membrane glycoprotein (GP) IIb/IIIa and was refractory to platelet transfusion. rFVIIa was administered at 89 to 116 μg/kg per injection every 2 hours, in association with antifibrinolytic drugs. Bleeding stopped in all cases, but platelet transfusion was required in one. Two bleeding episodes recurred 36 and 63 hours after discontinuation of rFVIIa, but were successfully treated with additional doses. No adverse effects of rFVIIa were observed. Although the number of patients is small, our study suggests that rFVIIa may be an alternative to platelet transfusions in patients with a severe congenital thrombocytopathy.

Recombinant Factor VIIa Is Effective for Bleeding and Surgery in Patients With Glanzmann Thrombasthenia

Recombinant activated factor VII (rFVIIa) was found to be effective and safe in treating 24 bleeding episodes and to prevent bleeding during one bilateral herniorrhaphy in four children with Glanzmann thrombasthenia. One of the patients had alloantibodies to platelet membrane glycoprotein (GP) IIb/IIIa and was refractory to platelet transfusion. rFVIIa was administered at 89 to 116 μg/kg per injection every 2 hours, in association with antifibrinolytic drugs. Bleeding stopped in all cases, but platelet transfusion was required in one. Two bleeding episodes recurred 36 and 63 hours after discontinuation of rFVIIa, but were successfully treated with additional doses. No adverse effects of rFVIIa were observed. Although the number of patients is small, our study suggests that rFVIIa may be an alternative to platelet transfusions in patients with a severe congenital thrombocytopathy.

Laparoscopic Diagnosis of Bilateral Femoral Hernias

ABSTRACT Femoral hernias are rare in children, probably accounting for less than 0.2% of all groin hernias. Bilateral femoral hernias are even more unusual. Because of this and the difficulty in establishing the diagnosis in young children by examination, the correct preoperative diagnosis of this condition is rare. We report 2 patients in whom the diagnosis of bilateral femoral hernias was established by laparoscopy. Each patient complained of bilateral groin bulges. The first patient had previously undergone 3 unilateral inguinal explorations for what had been felt to be an indirect inguinal hernia with multiple recurrences, while the second patient had unusually located bilateral bulges. Each patient had bilateral hernias located medial to the inferior epigastric vessels and under the inguinal ligament clearly demonstrated by laparoscopy. Each patient then underwent open bilateral femoral herniorrhaphies.