Elective Inguinal Herniorrhaphy Research Articles

Factors influencing postoperative urinary retention in patients undergoing elective inguinal herniorrhaphy

We retrospectively studied 295 men who had undergone herniorrhaphy under spinal or general endotracheal anesthesia to determine the incidence of postoperative urinary retention and to assess factors influencing it. The type and location of hernia had no effect on retention. In contrast, the use of general anesthesia, patient age above 53 years, and perioperative administration of more than 1,200 mL of fluid were significantly associated with an increase in retention. Our results suggest that urinary retention after herniorrhaphy may be prevented by limiting the amount of fluid given perioperatively and by using a spinal anesthetic, especially in older patients.

Preoperative barium contrast enema in patients with inguinal hernia.

Whether patients over age 40 should have a barium contrast enema (BCE) examination for possible identification of an unsuspected colon carcinoma before elective inguinal herniorrhaphy remains an unanswered question. We reviewed the medical records of all patients over age 40 who had inguinal herniorrhaphy at our institution between January 1980 and December 1984. Of 80 patients, 46 received a preoperative barium enema. One asymptomatic colon carcinoma (2.1%) was discovered. The reported incidence of asymptomatic colon cancer found by BCE in association with inguinal hernia ranges from 0 to 2.5%. We conclude that if there is a cause and effect relationship between asymptomatic colon cancer and inguinal hernia, the mechanism is as yet unknown.

Clearance and action of insulin during general or epidural anaesthesia

Surgery performed under general anaesthesia induces impaired glucose tolerance together with comparatively low levels of insulin. This contrasts with the normal glucose tolerance and normal insulin levels found in patients operated upon under epidural anaesthesia. The aim of this study was to investigate insulin clearance and insulin action during surgery. Sixteen non-diabetic patients admitted for elective inguinal herniorrhaphy were operated under general anaesthesia (thiopentone, N 2O/O 2 ( 2 1 ), fentanyl, pancuronium bromide) or after high epidural blockade with mepivacaine. The clearance and hypoglycemic action of insulin were determined after a 2.5 min infusion of a physiologic dose of insulin. All patients were studied the day before operation and during surgery. The hypoglycemic action of insulin, expressed as % decrement from the pre-test blood glucose level, was unchanged during epidural anaesthesia but reduced during general anaesthesia (22.4 ± 1.8% pre-operatively vs 7.5 ± 1.3% intra-operatively, p < 0.01). The insulin resistance during general anaesthesia was associated with a decreased clearance of insulin (20.3 ± 0.8 ml min −1 kg −1 pre-operatively vs 12.7 ± 1.1 ml min −1 kg −1 intra-operatively, p < 0.01), whereas insulin clearance was normal during epidural anaesthesia. It is concluded that general anaesthesia, but not epidural anaesthesia, induces a reduction in both clearance and hypoglycemic action of insulin.

Elective Inguinal Herniorrhaphy After Myocardial Infarction

A history of myocardial infarction should not be a deterrent to the performance of an elective inguinal herniorrhaphy. This operation has been proved to be safe for this patient population and is attended by a low and quite acceptable complication rate. Thorough preoperative evaluation ensures optimal management in both the perioperative and postoperative period. In stark contrast with elective inguinal herniorrhaphies, emergency procedures are associated with an alarming morbidity and mortality, often the result of cardiovascular complications. In the postinfarction patient with an inguinal hernia, the dual goals of complete cardiac rehabilitation and improved quality of life can be facilitated in a safe and sure manner by elective inguinal herniorrhaphy under local anesthesia.

Age and Immune Response to a Surgical Stress

• We studied the effects of age and a relatively standardized stress (elective inguinal herniorrhaphy) on immune response. The patients included 20 men, ten at least 60 years old and ten younger, who were free of infection and illness and had not had prior surgery. Immune responses were measured one day before and five and 30 days after operation. We determined immunoglobulin levels, performed three delayed-hypersensitivity skin tests and a test for neutrophil chemotaxis, and measured lymphocyte responses to autologous cells, phytohemagglutinin-P (PHA), concanavalin A (Con A), and pokeweed. We also studied responses in 40 controls matched for age and sex. The responses to PHA and Con A were significantly lower in older patients than in controls at five days after operation; responses to Con A were still significantly lower at 30 days. Morbidity correlated with depressed immune responses in both age groups, even when there was no difference between older and younger patients. (Arch Surg1983;118:405-409)

Ventilatory Capacity after Three Methods of Anaesthesia for Inguinal Hernia Repair

One hundred consecutive male patients undergoing elective inguinal herniorrhaphy were randomized to receive general, epidural or local anaesthesia, and the patterns of ventilation were studied before and after operation. General anaesthesia caused more depression of FEV1 and FVC than the other two methods, but no important arterial hypoxia or clinical chest complications ensued. One patients suffered minor staphylococcal wound infection, and one died of massive pulmonary embolism on the eleventh day.

Topical Agents in Postoperative Toxic Shock Syndrome

ABSTRACT To the Editor.— The recent report by Bartlett et al (1982;247:1448) of wound-associated toxic shock syndrome (TSS) highlights many interesting aspects to this serious condition.I was recently involved in the care of a young woman who had TSS develop one week after an elective inguinal herniorrhaphy. Despite intensive intravenous (IV) fluid therapy, parenteral antistaphylococcal antibiotics, and local wound drainage, she continued to demonstrate symptomatic evidence of continuing toxin production. Improvement occurred after institution of topical antibacterial agents to eradicate persistently positive wound cultures of Staphylococcus aureus.Report of a Case.— A 24-year-old woman underwent an elective right inguinal hernia repair and was discharged after three days of hospitalization. Two days later, shaking chills developed. The next morning she noted a rash that began on her trunk, spreading rapidly during 24 hours to involve her extremities and face. She complained of a sore throat, nausea, headache, myalgia, and redness of

EFFECT OF EARLY RETURN TO WORK AFTER ELECTIVE REPAIR OF INGUINAL HERNIA: CLINICAL AND FINANCIAL CONSEQUENCES AT ONE YEAR AND THREE YEARS

Since January, 1976, male patients undergoing elective unilateral inguinal herniorrhaphy have been included in a trial to see whether early return to normal activity is associated with an increased recurrence rate and to investigate economic consequences. By June, 1981, 500 patients had been reviewed at one year. 2 patients had defaulted. The first 200 patients had been examined at one year and three years. Recurrence was assessed independently, and recurrences were found of which the patient was unaware. The acceptable definition of recurrence was need for reoperation or a truss. The overall recurrence rate at one year was 3·9%. At three years no further recurrences were detected in the first 200 patients. There was no difference in the recurrence rate for those in the "early" group with 8 recurrences in a total of 246 patients and

Sickness absence after inguinal herniorrhaphy.

Eight hundred and ninety-nine men were studied, aged 16-65 inclusive, who underwent an elective inguinal herniorrhaphy during 1970 and 1971 in eight hospitals in Wessex, and under nine consultant surgeons. There was a significant variation in postoperative inpatient stay and total sickness absence between hospitals and between consultants. The physical activity involved in the patient's occupation, his age at operation, previous sickness absence, bilateral herniorrhaphy, attendance at follow-up outpatients' clinic, type of repair, and the influence exerted by three hospitals and two consultants accounted for only 21% of the variation in total sickness absence. The general practitioners who had referred patients to the hospitals for herniorrhaphy, and the consultant surgeons who carried out the operations, were sent a questionnaire to ascertain their attitudes towards follow-up outpatient appointments and the various factors identified in the first part of the study as significantly influencing total sickness absence. A higher proportion of GPs who felt that an outpatient appointment was necessary before return to work was found in relation to the patients who had the longest mean total sickness absences than among the GPs who looked after the patients with shorter total sickness absences.

Costs, Risks, and Benefits of Surgery.

Human life has traditionally been regarded as priceless. Therefore, no cost should be spared if a life can be saved. However, life-saving methods have now been developed that may well be beyond the capacity of society to pay for them. Perhaps coronary artery bypass surgery and renal transplantation cost more for society as a whole than society is willing to purchase. This book, using the methods of decision theory and cost-benefit analysis aims to clarify thinking rather than to be merely critical. The first part, background and general principles, introduces the methods of conditional probability, decision trees, and economic analysis. A second section, entitled Surgical Innovation, shows historically that surgical procedures were devised in the past on the basis of intuition and insight of singular individuals. Distinguished foreign visitors to this country had an enormous impact on surgical practice. For example, Arbuthnot Lane, in 1909, explained an elaborate pathology of abdominal bands and adhesions. Symptoms produced by these included headache, lassitude, mental distress, poor temper control, and diminution of libido. These, caused by autointoxication, could be relieved by lysis of adhesions and ileosigmoidostomy, with resection of all the colon proximal to this anasto¬ mosis. In surgery, before 1945, the concept of control in evaluation of methods seemed totally unknown to surgeons. In modern surgery, advances have been made in experimental design of clinical investigations, so that review of surgical innovations, al¬ though not perfect, is vastly improved. A third section of this book assesses risks and benefits of established proce¬ dures by decision analysis. For exam¬ ple, elective inguinal herniorrhaphy is critically assessed, as is life expectancy after cholecystectomy for silent gall stones and after hysterectomy for uterine dysfunction. Surprisingly, al¬ though the indications for inguinal herniorrhaphy are generally agreed on, the analysis in this volume casts doubt on the life-saving efficacy of the opera¬ tion as performed in the elderly. Wisely, the authors suggest that the unchallenged status of the operation is based on its effectiveness in improving quality of life, rather than the quantity of survival of the patient. The results of analysis of this operation show the difficulties of cost-benefit analysis in surgical decision-making. The fourth section focuses on costly procedures that have appeared recently on the medical scene. The data show, in general, that coronary artery bypass surgery is not particularly efficient in the use of scarce health resource funds. An exception to this generalization might be a young man with a strong heart with severe angina who under¬ goes this form of surgery. An estimate is made of the premium that might be paid each year by American men to

APPARENT IMPROVEMENT IN POSTOPERATIVE LUNG VOLUMES BY USING THE ENTONOX APPARATUS: A Preliminary Report

SUMMARY After elective inguinal herniorrhaphy, 35 patients were given either Entonox or intramuscular morphine as required for postoperative pain. Entonox was associated with a mean 9% increase in functional residual capacity (FRC) after surgery whereas the morphine group showed a mean decrease of 15%.

A one month old infant who was premature at birth and now weighs 7 pounds 6 ounces is scheduled for an elective inguinal herniorrhaphy. What are your considerations in the management of this infant for the surgical procedure?

A one month old infant who was premature at birth and now weighs 7 pounds 6 ounces is scheduled for an elective inguinal herniorrhaphy. What are your considerations in the management of this infant for the surgical procedure?

INGUINAL HERNIA SIMULATING CARCINOMA OF THE COLON ON ROENTGENOLOGIC EXAMINATION AFTER BARIUM ENEMA.

A report is made of an inguinal hernia which mimicked a carcinoma of the sigmoid flexure on x-ray study after administration of a barium enema. A simple technic of examination is suggested whereby error of interpretation might be avoided in the routine preoperative sigmoidoscopic and roentgenologic examination of the colon in patients undergoing elective inguinal herniorrhaphy.