Inguinal Herniorraphy Research Articles

Auditory function after spinal anaesthesia: the effect of differently designed spinal needles

Recurrent, bilateral or unilateral, persistent or transient, mild or profound hearing loss has been reported after spinal anaesthesia. We studied the effects of the needle type (Quincke, ballpen, pencil-point spinal needles) on hearing loss after spinal anaesthesia with the use of pure-tone audiometry. Forty-five ASA physical status I patients scheduled for elective inguinal herniorraphy with spinal anaesthesia were enrolled in the study. The patients were randomly divided into three groups. Group Q (n = 15) patients received spinal anaesthesia through a 25-gauge (G) Quincke spinal needle, group B (n = 15) patients received the same through a 25-G ballpen spinal needle and those in group P (n = 15) received the same through a 25-G pencil-point spinal needle. Patients were interviewed about postoperative complaints such as postdural puncture headache, vertigo, nausea-vomiting, transient neurological symptoms and major neurological deficits. Pure-tone audiometry was performed by an audiologist at specific time intervals. The number of patients who had greater than 10 dB hearing loss in group Q was significantly more than that found in group B and group P at 250, 500, 4000 and 6000 Hz on postoperative day 1. When group B and group P were compared for change in hearing, no statistically significant difference was detected at any frequency tested. Because the use of ballpen and pencil-point needles reduces hearing loss after spinal anaesthesia, these needles are preferred.

A Case Report: An Adult With Omental Incarceration of a Testicle, an Unexpected Finding at Herniorraphy

Inguinal herniorraphy is the most common surgical procedure in the United States. Intra-abdominal testicles and cryptorchidism can be seen in children with widely patent processus vaginalis. Testicular torsion is a surgical emergency that can be corrected without sacrificing the testicle if treated early and appropriately. No previous case has been reported with an adult's testicle having become incarcerated in the omentum contained within an indirect inguinal hernia sac simulating a possible testicular torsion.

The Effect of Intramuscular Midazolam on Postoperative Pain Resulting from Herniorraphy

The main purpose of this study was to assess the effect of intramuscular midazolam on postoperative pain and to test our hypothesis that the patients are more comfortable and suffering less pain after operation. Eighty male patients with ASA class (I, II), aged 15-60 years whom were scheduled for elective inguinal herniorraphy, were enrolled in this study in a double blind fashion. Patients were randomly assigned to two groups of forty, whom were randomly allocated for this study. Group A the test group received 0.1 mg kg-1 midazolam and group B the control group received 0.02 cc kg-1 saline, intramuscularly, just after inducing anesthesia with fentanyl 3 μg kg-1, thiopental 5 mg kg-1 as well as atracurium 0.5 mg kg-1. Popular McGill questionnaires were filled for pain severity assessment in four stages (1, 2, 3 and 8 h after operation) and the patients' vital signs were charted in five stages (preoperative and 1, 2, 3 and 8 h after operation). The data so obtained was analyzed statistically using Student t-test and Chi-square. First hour after operation, pain score average in group A was 2.3 in comparison with 6.6 in group B (p<0.05). After second and 3rd h of operation scores of 3.6 and 3.8 in comparison with 6.4 and 6.2 were related to group A and group B, respectively (p<0.05). Vital signs of the patients in group A were more stable than group B during the first hour of recovery period (p<0.05). Moreover, the need of intravenous opiate for relieving pain during recovery period in group A was less than group B (p<0.05). Intramuscular midazolam just after inducing anesthesia appears to cause pain relief after herniorraphy, particularly during early recovery period.

The safety of open inguinal herniorraphy in patients on chronic warfarin therapy

The safety of open inguinal herniorraphy in patients on chronic warfarin therapy

Intraoperative Sedation During Epidural Anesthesia: Dexmedetomidine Vs Midazolam

Background: This study evaluated the ability of dexmedetomidine to provide sedation during epidural anesthesia compared with midazolam, examining the cardiorespiratory variables, analgesic requirements and side effects. Patients and Methods: Sixty patients undergoing inguinal herniorraphy under regional anesthesia were randomized into two groups to receive either dexmedetomidine or midazolam for intraoperative sedation. Cardiorespiratory effects, level of sedation, quality of analgesia, time to first analgesic requirement were evaluated. Results: There were significant declines in HR and MAP values compared to baseline in both groups but the difference between groups was not significant. There were higher sedation levels in midazolam group and 16 patients receiving midazolam needed dose adjustment. The time to first analgesic requirement was significantly longer in dexmedetomidine group. Conclusion: Supplement of intravenous dexmedetomidine in patients receiving epidural anesthesia may provide a good sedative effect and postoperative pain management without any clinically important untoward cardiorespiratory reactions.

Laparoscopic Totally Extraperitoneal Hernia Repair Versus Open Lichtenstein Hernia Repair: Results and Complications

Whereas open Lichtenstein inguinal herniorrhaphy is generally accepted as a safe, well-understood method with a high success rate, the laparoscopic repair of a inguinal hernia is a fairly recent technique. Although the laparoscopic approach to a hernia repair procedure is associated with less pain and faster recovery than open repair, many surgeons are not familiar with this technique owing to technical demands and a long learning curve. This study compares the results and complications between open tension-free mesh (Lichtenstein) repair and laparoscopic total extraperitoneal (TEP) repair. The study cohort was comprised of 345 consecutive patients who underwent an inguinal herniorraphy procedure. An open hernia repair was performed on one group of patients (n = 233), whereas TEP repair was performed on the other (n = 112), and then the comparison of intra- and postoperative complications and results obtained from both techniques was done. The mean hospital stay was similar in both groups. The average operative time in the TEP group was 58.6 +/- 18.1 minutes, and the average operative time in the open group was 58.2 +/- 17.8 minutes. There was no difference in postoperative complication rates between the two groups, except for urinary retention, which patients who underwent TEP repair were more likely to get. The following major complications were recorded: 2 cases of urinary bladder perforation-1 during TEP repair and the other during Lichtenstein repair, but both with good postoperative outcome-and 1 case of pneumothorax, which occurred during the TEP procedure. Despite the fact that TEP is a demanding procedure, it may be performed efficiently with an acceptable operating time and a low complication rate.

Minimally invasive surgery fellows would perform a wider variety of cases in their “ideal” fellowship

With the increase in minimally invasive surgery (MIS) fellowships, the concept of the ideal and standardized training curriculum is emerging in importance. The authors hypothesize that the procedure mix in current MIS training is different from what current MIS fellows would expect for their "ideal" fellowship. An anonymous survey of current MIS fellows examined their perceptions of the case diversity and volume they expect to perform in their fellowships as compared with an ideal fellowship. Differences between expected and ideal case volume were analyzed using Wilcoxon tests. A total of 32 questionnaires were returned. Current MIS fellows believe their expected training will exceed the ideal volume of laparoscopic cholecystectomies (p = 0.002). They believe their expected training is equivalent to ideal training in laparoscopic gastric bypass, ventral herniorraphy, inguinal herniorraphy, antireflux procedures, appendectomy, and diagnostic endoscopy (nonsignificant difference). However, current expected training falls short of their "ideal" case volume in laparoscopic gastric banding, colectomy, common bile duct exploration, gastrectomy, esophagectomy, splenectomy, adrenalectomy, hepatectomy, nephrectomy, and pancreatectomy (p < 0.05). The current MIS fellows also expect that their thoracoscopic, therapeutic endoscopy, and robotic procedure volume will be less than "ideal" (p < 0.05). In 13 of 20 procedure types, current MIS fellows expect to perform a smaller case volume than in an "ideal" fellowship. The ideal case volume in the MIS fellowship curriculum needs to be defined better.

Histopathological alterations of the vas deferens in rats exposed to polypropylene mesh

To assess the histological and physiological effects of polypropylene mesh for inguinal herniorraphy, as it can cause lesions in the vas deferens in 0.3-2.0%, leading to infertility, and induces an inflammatory process and adjacent fibrosis, strengthening the posterior inguinal wall. In all, 40 male albino rats (3 months old) had bilateral vas deferens dissection followed by mesh implantation on one side; the contralateral side was used as the control. The rats were killed 90 (group 1) and 120 (group 2) days later, and the vas deferens, epididymides and testicles assessed histopathologically. There was a foreign-body reaction after mesh implantation, but not in the controls. The mean lumen dilatation in regions proximal to the mesh in groups 1 and 2 was 0.468 and 0.371 mm(2), respectively, and all the sections had spermatozoids. The mean dilatation in control groups 1 and 2 was 0.239 and 0.170 mm(2), respectively, with spermatozoids present in 58% and 75%, respectively (significant, P < 0.05). In group 1 the wall thickness of mesh-implanted segments reduced to 0.177 mm, and in segments proximal to the mesh to 0.099 mm; the control segment was 0.298 mm (P < 0.05). In group 2 the mean thickness of mesh-implanted and proximal segments was 0.134 and 0.224 mm, respectively, while in the control it was 0.284 mm (not significant). There was loss of mucosal folding in all segments proximal to the mesh but not in the control. The epididymides and testicles were unchanged. Polypropylene mesh induces a foreign-body reaction, with histological changes in the vas deferens that cause functional obstruction, with dilatation and spermatozoid repression.

Late abscess formation following indirect hernia repair utilizing silk suture

Inguinal hernia repair is the most common operation performed by pediatric surgeons. The critical portion of the operation is high ligation of the hernia sac, which is classically performed with silk suture. This foreign body has the potential to serve as a nidus for latent infection/rejection that may result in an abscess long after the operation. This complication has rarely been described in the literature. We have cared for six children who have presented with latent inguinal or pelvic abscesses following high ligation of the inguinal hernia sac with silk suture. The purpose of this report is to examine the varied presentations by which latent complications following herniorraphy may manifest. The pediatric surgeon should recognize that not every inguinal mass following a previous inguinal herniorraphy represents a recurrent hernia! A retrospective review of the charts of six patients with late abscess formation following antecedent inguinal hernia repair was undertaken. The details of the initial and operative endeavors were recorded with specific attention to the details of the initial operative hernia repair as well as the suture material utilized. Inguinal hernia repair continues to be the most common operation performed by pediatric surgeons. Utilization of braided, non-absorbable silk suture may result in latent abscess formation and the need for operative drainage of inguinal or pelvic abscess. Today, as other types of suture material are likely equally efficacious in the ability to effectively close the patent processus vaginalis, pediatric surgeons should consider utilizing non-braided, or absorbable suture material for high ligation of the indirect hernia sac to potentially prevent this complication.

P177: Training general surgery residents in pediatric surgery: Analysis of time and cost

Background: Resident participation in the pediatric surgery service is essential to their training. The impact with regard to operative time and hospital cost is not well-defined. Hypothesis: Training general surgery residents in pediatric surgery significantly increases operative time and hospital cost. Methods: A retrospective analysis of operative times was performed for three common pediatric operations: unilateral inguinal herniorraphy, bilateral inguinal herniorraphy, and open pyloromyotomy. All cases occured between July 2004 and July 2006. In Group 1 all operations were performed by a single attending pediatric surgeon. Group 2 involved the same attending surgeon directing a 3rd -year general surgery resident through the operations. Operative time was defined as the time from skin incision to placement of the final dressing. Surgery schedules and a cost analysis were also analyzed for the 2 groups. Statistical analysis was performed using student t-test. Results: Demographics between the two groups were similar. Mean operative time was shorter in Group 1 with respect to unilateral and bilateral herniorraphy. Mean operative time for pyloromyotomy was similar between the 2 groups. No perioperative complications or recurrent hernias occured in either group. Surgery schedules (number of operations per day) were similar between the 2 groups. Furthermore, decreased time in performing herniorraphy without surgery residents would not lead to more operative cases performed per day, thus hospital cost and surgeon fees are similar between the 2 groups. Conclusion: Training general surgery residents in pediatric surgery increased operative time with respect to unilateral and bilateral herniorraphy. There was no increase in operative with respect to pyloromyotomy. Increased operative time to train general surgery residents did not influence surgical scheduling, thus there was no increase in cost to the hospital or surgeon. Tabled 1Operative time (minutes) between the 2 groups Group 1 Group 2 p Unilateral herniorraphy 31.2 ± 10.4 (n=41) 40.1 ± 15.2 (n=35) 0.003 Bilateral herniorraphy 44.9 ± 13.4 (n=30) 54.0 ± 16.6 (n=20) 0.04 Pyloromyotomy 32.9 ± 9.6 (n=10) 34.6 ± 7.4 (n=15) 0.61 Open table in a new tab

Caudal Block Reduces Demand of Sevoflurane for Adequate Depth of Anesthesia in Children

Background: It is generally known that neuraxial anesthesia for adults reduces the demand for hypnotics needed for adequate sedation. Therefore, this study examined the effect of a preoperative caudal block on the general anesthetic requirements for an adequate depth of anesthesia in children. Methods: Twenty children aged 3-5 years, who were set to undergo inguinal herniorraphy, were divided into 2 groups of 10 children each, normal saline and lidocaine groups. Tracheal intubation was performed. After setting up the bispectral index (BIS) monitor, a caudal block was administered to both groups differently, normal saline 0.7 ml/kg was administered to the normal saline group and 1.5% lidocaine 0.7 ml/kg was administered to lidocaine group. The end-tidal concentration of sevoflurane was maintained at 1.5 vol% for 10 minutes in the first patient in both groups, and the BIS value, was measured 6 times every 10 seconds, and averaged. When the BIS was ≥ 50, the end-tidal concentration of sevoflurane was increased by 0.2 vol% in the subsequent patient. When the BIS was less than or equal to 50, the end-tidal concentration of sevoflurane was decreased by 0.2 vol% in the subsequent patient. The MACBIS50 in both groups was calculated using probit analysis. Relative median potency analysis was used to compare the results in both groups. Results: The MACBIS50 of sevoflurane was significantly lower with a 1.5% lidocaine caudal block (1.40 vol% [95% CI, 1.25-1.55 vol%]) compared with the normal saline group (1.77 vol% [95% CI, 1.61-2.00 vol%]). Conclusions: A preoperative caudal block reduces the demand for sevoflurane required for an adequate depth of anesthesia, as measured by the BIS in children. (Korean J Anesthesiol 2007; 52: 29～33)

Transient Femoral Nerve Palsy Following Field Block For Inguinal Herniorraphy

Transient Femoral Nerve Palsy Following Field Block For Inguinal Herniorraphy

Mixoma em átrio esquerdo associado a doença arterial coronariana obstrutiva

We describe a case of a 67 year-old patient with obstructive coronary artery disease that, in the preoperative survey for inguinal herniorraphy surgery, discovered, by a two-dimensional echocardiogram, a tumor in left atrium, mobile, non-obstructive. The patient underwent a cineangiocoronariography showing severe stenosis in the left anterior descending artery, moderate stenosis in the left circumflex artery, near the origin of the first marginal branch, and a non-obstructive plaque in the right coronary artery. There was also moderate left ventricular dysfunction. After that, the patient has gone coronary artery bypass surgery and resection of the left atrial tumor. The histological exam revealed that the tumor was, in fact, a myxoma.

Transient Femoral Nerve Palsy Following Field Block For Inguinal Herniorraphy

Transient femoral nerve palsy (TFNP) is a potential complication of ilio-inguinal nerve blockade for inguinal herniorraphy. Speculation has occurred to its cause and prevention. We report a case of TFNP after field blockade at conclusion of inguinal herniorraphy, with following review of potential causative mechanisms and prevention.

The safety of open inguinal herniorraphy in patients on chronic warfarin therapy

Background The perioperative management of warfarin therapy increases the complexity of open inguinal herniorraphy. Methods One thousand consecutive patients undergoing open inguinal herniorraphy were retrospectively reviewed. Patients on warfarin therapy were categorized into 3 groups: continued warfarin (CW), discontinued warfarin (DW), and discontinued warfarin with anticoagulation bridge (DWB). Results Eighty-eight patients were on chronic warfarin therapy. Warfarin was continued in 19 patients, discontinued in 54, and discontinued with bridge in 15 patients. Operative times were similar between the 3 groups. Length of stay was longest in the discontinued warfarin with bridge group (CW 0.74, DW 0.54, and DWB 3.33 days; P < .0001). There was no significant difference in postoperative complications. The incidence of surgical site hematoma was higher in the continued warfarin and discontinued warfarin with bridge groups (CW 11%, DW 2%, and DWB 13%; P = .14). Conclusions Continuation of warfarin may be a safe alternative to discontinuation of warfarin therapy in select patients undergoing open inguinal herniorraphy.

O sistema Apache II e o prognóstico de pacientes submetidos às operações de grande e pequeno porte

OBJETIVO: Geral: avaliar o desempenho do sistema APACHE II no pré-operatório de operações de grande e pequeno porte como indicador prognóstico. Os objetivos secundários são: (a) avaliar o sistema no pré-operatório para predizer morbidade; (b) comparar resultados entre os dois grupos e; (c) comparar a mortalidade observada com a esperada, calculada pela Equação de Knaus. MÉTODO: Estudo de coorte prospectivo, por 30 meses. No Grupo 1, correspondente à operação de pequeno porte, incluídos 30 pacientes submetidos a herniorrafia inguinal. No Grupo 2, correspondente à operação de grande porte, incluídos 50 casos, sendo: 20 submetidos à esofagectomia, 20 à gastrectomia e 10 à duodenopancreatectomia cefálica. RESULTADOS: A média do APACHE II no Grupo 1 foi de 2,5 pontos (0 a 8 pontos).No Grupo 2 teve média de 3,9 pontos (0 a 12 pontos). A morbidez tanto geral quando calculada de acordo com índice de pontos baixo, moderado e alto, apresentaram significância na comparação de ambos grupos pelo teste quiquadrado (p&lt;0,00001). A mortalidade geral e o índice alto de pontos, no cálculo quiquadrado corrigido Yates, apresentaram diferença entre os grupos (p&lt;0,001 e p&lt;0,0005). Estratificada a mortalidade por classe de pontos, esta não foi diferente nas classes de baixa e moderada pontuação. CONCLUSÕES: O sistema demonstrou tendência para predizer desfecho a pacientes submetidos à operação de grande porte. Pacientes apresentando, no pré-operatório de operações de grande porte, APACHE II acima de oito apresentam índice elevado de morbidez e mortalidade.

Comparison of unilateral and conventional spinal anaesthesia for outpatient inguinal herniorraphy

Kallel, N.; Ghrab, B.; Smaoui, M.; Khemakhem, K.; Sow, A.; Frikha, M.; Salhi, M. S.; Karoui, A. Author Information

Predictive factors comparison of complications and recurrences in three tension-free herniorraphy techniques

Inguinal herniorraphy is one of the most common surgeries performed. Avoiding hernia recurrence is a primary concern. Hence, it is necessary to analyze the predictive factors of postoperative complications and recurrence. To compare the predictive factors of postoperative complications and recurrences of hernias among three tension-free open herniorraphy techniques. Five hundred and fifty-one inguinal hernia patients, operated on with one of three tension-free anterior approach herniorraphy techniques, were included in a cohort study. The three techniques were: Lichtenstein (n=214), Mesh-Plug (n=201) and Prolene Hernia System (PHS, n=136). The patients were evaluated at 15 days, 1 month, 6 months and then every year up to 5 years after hernioplasty. The variables evaluated were recurrences and postoperative complications. Relative risk was estimated from a univariate analysis of the presumable risk values, after which a multivariate analysis was carried out. Complications [n=27, (4.9%)] were more frequently associated with incarcerated hernia, a coexisting disease at the time of operation, hospitalization longer than 1 day, previous herniorraphy, a herniary ring larger than 4.5 cm and a history of postoperative complications. Recurrence was greater for the Mesh-Plug group [n=5 (2.5%), RR: 4.35 (CI: 0.85-22.23)] than for the Lichtenstein [n=2 (0.9%), RR: 0.63 (0.06-3.87)] and PHS [n=0 (0%), RR de 0 (0-2.39)] groups. The presence of coexisting disease during hernioplasty, incarcerated hernia and an extended hospital stay are predictive factors for hernia complications. Previous herniorraphy, a herniary ring larger than 4.5 cm and postoperative complications are predictive factors for hernia recurrence.

SOMATIC ANGIOTENSIN CONVERTING ENZYME IN VARICOCELE

The ACE is found as two isozymes in the body. A somatic isozyme found in blood and several other tissues, and a testis-specific isozyme found only in developing spermatids and mature sperm. In this study, we investigated the ACE activity in left spermatic vein blood samples of infertile patients with varicocele and its correlation to spermatologic parameters. The somatic ACE activities were determined in the peripheral and left spermatic vein blood samples from 31 infertile patients who underwent variococelectomy, and 11 fertile control subjects underwent left inguinal herniorraphy. The somatic ACE activity was measured by kinetic spectrophotometric assay. Semen analyses were performed according to WHO guidelines. The mean somatic ACE activities of peripheral and left spermatic veins of the varicocele group were 60.3 +/- 23.0 and 60.2 +/- 23.2 U/L, respectively. In control group, peripheral and left spermatic vein ACE activities were found as 56.8 +/- 17.1 and 56.5 +/- 15.5 U/L, respectively. There was no significant difference between the ACE activity in peripheral and left spermatic vein blood sample from the varicocele and control group. There was no statistically significant correlation between the spermatologic parameters and ACE activities in the spermatic and peripheral vein in both of varicocele and control groups. As a result, it may be suggested that the somatic ACE has no causative role in pathophysiology of varicocele and varicocele related infertility.

Spinal Anesthesia for a Formerly Premature Infant with Unilateral Vocal Cord Paralysis Undergoing Inguinal Herniorrhaphy: A case report

In premature infants, the incidence of inguinal hernia has been reported to be 14-30%. It is generally accepted that inguinal hernia should be repaired as soon as possible, as the incidence of incarceration is higher in infant than in children. However, the risk of life-threatening apnea after surgery is significant in this age group. Spinal anesthesia in premature infants offer a safe alternative to general anesthesia, especially if intubation should be avoid because of coexisting disease. We present a case of successful spinal anesthesia for inguinal herniorraphy in a premature female infant at a postconceptual age 44 + 6 weeks weighing 2,620 g with coexisting unilateral vocal cord paralysis to illustrate technical details and feasibility of this technique even in very low birth weight (birth weight ＜ 1,500 g) infants. (Korean J Anesthesiol 2006; 51: 252~6)