scholarly journals 1598 Local Anaesthetic or General Anaesthetic: The Optimal Choice for Inguinal Hernia Repair

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Mushonga
Keyword(s):  
Inguinal Hernia ◽  
Local Anaesthetic ◽  
Inguinal Canal ◽  
Operating Time ◽  
Optimal Choice ◽  
General Anaesthetic ◽  
Significant Difference ◽  
Surgeon Experience ◽  
Randomised Control Trials ◽  
Post Operative Nausea

Abstract Aim Inguinal hernias occur when visceral tissue protrudes through the inguinal canal [1]. Around 20 million inguinal hernia repairs (IHR) are done annually worldwide and involve re-enforcement of the compromised wall of the inguinal canal using polypropylene mesh via open anterior approach or minimally invasive laparoscopy [2,3]. Despite gold standards in surgical approach, there’s no distinctively superior practice between local anaesthetic (LA) and general anaesthetic (GA). Therefore, the objective was to review IHR under both LA and GA and investigate which method is conductive to optimal patient outcomes. Method Systematically reviewed randomised control trials (RCTs) evaluating the benefits of LA over GA in IHR, by comparing factors such as post-operative nausea, urinary retention (UR), haematoma, wound infection (WI), pain, and operating time. PubMed was utilised for finding suitable studies, and data was obtained and summarised appropriately. Results Data assembled from RCTs evaluating benefits of LA over GA in IHR indicated no significant difference between groups when comparing nausea, UR, haematoma, WI and pain [4]. Supporting studies reviewing RCTs juxtaposing GA and LA in IHR elucidated no significant variance in operating time, haematoma and WI [5]. Patients did show less rates of UR, reduced pain scores and greater patient satisfaction under LA [5]. Conclusions LA is used in specialised hernia clinics due to less cardiovascular risk however development of short-acting GA’s allows for suitability for day-case surgery. Future investigation is required taking into account factors like surgeon experience, patient anatomy and economic viability for a definitive gold standard.

scholarly journals The results of preperitoneal inguinal hernioplasty without fixation of the mesh endoprosthesis in the experiment.

2019 ◽  
Vol 12 (2) ◽  
pp. 97-101
Author(s):  
Anna Viktorovna Mokrova ◽  
Oleg Vladimirovich Zaitsev ◽  
Dmitry Anatolyevich Khubezov ◽  
Vladimir Alexandrovich Yudin ◽  
Sergey Vasilevich Tarasenko ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Inguinal Canal ◽  
Abdominal Cavity ◽  
Preperitoneal Space ◽  
Indirect Inguinal Hernia ◽  
Inguinal Hernioplasty ◽  
Experimental Development ◽  
Direct Inguinal Hernia ◽  
Significant Difference ◽  
Mesh Endoprosthesis

The purpose of the study is experimental development of preperitoneal inguinal hernioplasty with synthetic mesh, according assessment of the need of its fixation to the tissues. Materials and methods. An inguinal hernia was simulated on human cadaveric material. The study used 27 male corpses. Two inguinal hernias were modeled on one corpse: on one side - indirect, on the other - direct. A polypropylene mesh (standard density, 15 x 15 cm) was placed in the preperitoneal space. The endoprosthesis was impacted from the side of the abdominal cavity by a special designed device. The effect of a peak intra-abdominal pressure of 200 mm Hg was simulated. The degree of displacement of the reticular endoprosthesis into the inguinal canal was estimated at the moment of peak pressure on it from inside the abdominal cavity. For a simulated indirect inguinal hernia, two variants of the technique were considered: with fixation of the endoprosthesis to the underlying tissues and without fixation. For the modulated direct inguinal hernia, the following options were considered: non-fixative, with fixation at one point to the pubis and with plasty of the transverse fascia. Results. When modeling preperitoneal plasty of a direct inguinal hernia, there is a pronounced displacement of the endoprosthesis into the inguinal canal with a non-fixing plasty, unlike the method with transverse fascia plasty or fixation to the pubis. In indirect inguinal hernia, there was no significant displacement of the endoprosthesis in both considered variants. Conclusions. According to the obtained results, conclusions were drawn on the need for additional plasty of the transverse fascia or fixation of the endoprosthesis at a single point in a direct inguinal hernia. With indirect inguinal hernia in the experiment, no significant difference in the displacement of the mesh endoprosthesis into the inguinal canal was obtained with and without fixation.

scholarly journals Comparison of Totally Extraperitoneal versus Transabdominal Preperitoneal repair of inguinal hernias

2020 ◽  
Vol 23 (2) ◽  
pp. 47-51
Author(s):  
Rohit Prasad Yadav ◽  
Manish Gautam ◽  
Ashok Koirala ◽  
Sameer Bhattarai ◽  
Sachhidanand Shah ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Operating Time ◽  
Total Duration ◽  
Recurrent Inguinal Hernia ◽  
Transabdominal Preperitoneal ◽  
Significant Difference ◽  
Scrotal Hematoma ◽  
Duration Of Operation

Introduction: Laparoscopic inguinal hernia repair is a tension-free mesh repair that is based on pre-peritoneal approach of repair. It provides mechanical advantage to the surgeon, by being able to place a large piece of mesh and by using the natural force of the abdominal wall to disperse the intra-abdominal pressure over a large area to support the mesh. This retrospective study is aimed to study the demography of inguinal hernia and to compare operating time, complications and postoperative pain between patients undergoing Total Extrapritoneal (TEP) or Transabdominal Preperitoneal (TAPP) repair.Methods: A retrospective comparative study was conducted in patients with inguinal hernia who underwent laparoscopic repair by either TEP or TAPP, between April 2019 to July 2020 at Nobel Medical Collage Teaching Hospital, Biratnagar, Morang. Age, sex, type of hernia, duration of operation, post-operative complications, severity of pain and duration hospital stay were analyzed between two groups of patients undergoingsurgery by either TEP or TAPP.Results: One hundred and five patients underwent either TEP or TAPP during study period. There were 96 males and 9 females. There were 50 patients with right, 40 with left and 6 patients with bilateral inguinal hernia. Four patients had left sided irreducible inguinal hernia, 2 patients had bilateral recurrent inguinal hernia, 2 patients had right sided recurrent inguinal hernia and 1 patient had left sided recurrent inguinal hernia.There was significant difference in duration of operation (TEP 64.43min) / (TAPP 84.46min), p<0. 001. Total duration of hospital stay and postoperative pain were not significant between patients operated with TEPor TAPP. Accidental pneumoperitoneum was noticed in 8 cases, 10 cases of subcutaneous emphysema, 5 cases of seroma and 1 case of scrotal hematoma in TEP group. In TAPP group scrotal hematoma occurred in 4 cases and seroma in 5 cases which was not significantly different from TEP group.Conclusion: TAPP had significantly longer operating time as compared to TEP. However, there was no significant difference in post-operative pain and hospital stay in both group.

scholarly journals A comparative study of inguinal hernia repair: Shouldice versus Lichtenstein repair

2018 ◽  
Vol 5 (6) ◽  
pp. 2238
Author(s):  
Ram Sagar Shah ◽  
Ajay Kumar
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Wound Infection ◽  
Operating Time ◽  
Cost Effective ◽  
Lichtenstein Repair ◽  
Shouldice Repair ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Inguinal hernia is a common problem and its repair is one of the most frequently performed operation in general surgical practice. There are appreciable advantages of Lichtenstein over Shouldice repair in terms of simplicity, less time consuming and postoperative pain; there in the context of less developed countries with limited economic resources, however Shouldice repair is more cost effective and there are no differences in recurrences and other complications which would be a better proposition. The present study aims at comparing the results of Shouldice versus Lichtenstein’s repair in inguinal hernia in adult male (≥18 years).Methods: Total of fifty cases was included in this study, were equally divided into 2 groups; Group A and Group B and subjected for Shouldice and Lichtenstein mesh repair respectively. Operating time, postoperative complications as Wound infection, Seroma, Hematoma, Postoperative pain, and days of hospital stay, total costs and time to return to usual activity was noted.Results: Out of 50 patients, 36 (72%) were had indirect hernia and most of them were in between 18-29.9 years of age. There were no difference between two groups with respect to postoperative pain, Wound infection 12% and 8%, Seroma  8% and 4% and Hematoma 4% and 4% in Group A and Group B respectively. However, there is significant difference noted in operating time period in which Shouldice repair took more time (Mean time in Shouldice 84.16 min and Lichtenstein 58.80 min). There were no recurrences in either group.Conclusions: So, comparing our results of both groups, Lichtenstein repair were found to be better as it is simple procedure and is less time consuming than Shouldice repair.  However, Shouldice repair was found to be cost effective which could be an important consideration in developing countries.

scholarly journals A randomized controlled study comparing the outcome of laparoscopic totally extra peritoneal repair versus Desarda repair in the management of inguinal hernia

2019 ◽  
Vol 6 (10) ◽  
pp. 3667
Author(s):  
Deepika Sinha ◽  
Chandra Bhushan Singh
Keyword(s):  
Inguinal Hernia ◽  
Operating Time ◽  
Randomized Controlled Study ◽  
Routine Activity ◽  
Controlled Study ◽  
Daily Routine ◽  
Analgesic Requirement ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Desarda repair is a technique of a tissue based tension free mesh free inguinal hernia repair, shown to be comparable to the standard Lichtenstein repair. Till date, no study has been done comparing Desarda repair with laparoscopic total extra peritoneal repair (TEP), hence this study was planned.Methods: The prospective randomized controlled study was done over a period of 18 months, and included a total of 50 patients, randomly allocated into 2 groups: TEP (group 1) and Desarda repair (group 2), 25 in each group, and followed up for a period of 1 year.Results: Chronic inguinodynia, including groin stiffness showed a statistically significant difference between the 2 groups (p=0.02). Foreign body sensation (16% in TEP group and none in Desarda group) and recurrence rate (12% in TEP group and none in Desarda group) did not show a significant difference. The operating time in the Desarda group (66.8±20.35 minutes) was significantly less than TEP group (78.6±11.86 minutes), with p<0.01. There was no significant difference in terms of post-operative pain scores (VAS scores) at five time points, post-operative analgesic requirement, hospital stay and return to normal daily routine activity or work and post-operative complications. Desarda repair was also found to be much more economical.Conclusions: The present study establishes the potential benefits of Desarda repair over TEP in terms of shorter duration of surgery, lesser incidence of chronic inguinodynia and lesser cost of the procedure, along with the avoidance of mesh related complications. 

scholarly journals A comparative prospective randomised controlled study for mesh fixation by cyanoacrylate glue versus prolene sutures in patients undergoing Lichtenstein hernioplasty

2019 ◽  
Vol 7 (1) ◽  
pp. 83
Author(s):  
Dheer S. Kalwaniya ◽  
Satya V. Arya ◽  
Sumedha Gupta ◽  
Manigandan Kuppuswamy ◽  
Jaspreet S. Bajwa ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Mesh Fixation ◽  
Operating Time ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Cyanoacrylate Glue ◽  
Post Operative Pain ◽  
Significant Difference

Background: Inguinal hernia repair is one of the most commonly performed procedures by general surgeons. Cyanoacrylate is the generic name for a family of fast acting adhesives. The aim of the present study done in Department of General Surgery, Safdarjung Hospital, New Delhi was to compare the newer emerging technique of mesh fixation.Methods: A total of sixty patients were included in the present study and were allotted in case and control group randomly by sealed envelope technique. In case (study) group, all the patients underwent mesh fixation by cyanoacrylate glue and in control group, by prolene 3-0 sutures.Results: Most frequency in age group 31-40 yrs, males:females ratio >1 and right sided inguinal hernia was more common. Bi-lateral hernia was common in elderly. Indirect: direct ratio 4.5:1. Operating time period for the patients of the case (study) group is less than control group. P value of post-operative pain in immediate post-operative period (day 1 and 2) and POD 30, 60 and 90 was not of clinical significance whereas the p-value on 6,120,150 and 180 post op day was of clinical significance. In our study, there was a case of incidental observation: a) reaction due to use of cyanoacrylate glue, b) rejection of mesh for which mesh had to be removed.Conclusions: There is no statistically significant difference between mesh fixation with cyanoacrylate glue and mesh fixation by prolene suture techniques in immediate post-operative pain. Statistically significant difference favoring mesh fixation by cyanoacrylate glue technique was seen with respect to operating time and post-operative groin pain with increasing post-operative duration.

Laparoscopic inguinal hernia repair in children via PIRS (percutaneous internal ring suturing)

2020 ◽  
Vol 99 (6) ◽  
pp. 277-281
Keyword(s):  
Inguinal Hernia ◽  
Pediatric Surgery ◽  
Inguinal Canal ◽  
Operating Time ◽  
Initial Study ◽  
University Hospital ◽  
Internal Ring ◽  
Hernia Surgery ◽  
Safe Alternative ◽  
Inguinal Hernia Surgery

Introduction: The miniinvasive approach is a trend in pediatric surgery nowadays. The new surgical technique called percutaneous internal ring suturing (PIRS) is a promising method bringing all the benefits of miniinvasive surgery. Methods: Prospective study of patients operated on using the PIRS technique from 01 January 2018 to 01 January 2020 at the Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University, University Hospital Motol. Results: 73 patients (25 boys and 48 girls) were operated on using PIRS. The median age was 68 months. 90 % of operations were performed by the same team of surgeons. During the procedure there were found 53 right-sided and 38 left-sided inguinal hernias. In 18 cases the hernia was bilateral, but only in 13 cases was this diagnosis made before the operation. A non-absorbable stitch was used in 57 cases to close the internal ring of the inguinal canal, and a non-absorbable monofilament in 16. The median operating time was 34 minutes. There were 3 recurrences (3.3 %) in our study. Conclusion: In our initial study, the PIRS technique proved to be a safe alternative method to the open inguinal hernia surgery. This method provides the benefit of allowing to revise the contralateral inguinal canal as a prevention of a metachronous inguinal hernia. The cosmetic results were excellent.

scholarly journals A comparison of outcomes of four ports versus three ports laparoscopic cholecystectomy

2018 ◽  
Vol 4 (1) ◽  
pp. 66-71
Author(s):  
K. Koirala ◽  
G. Simkhada ◽  
N. Adhikari ◽  
R. Mukhia ◽  
S. Shakya
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Teaching Hospital ◽  
Operating Time ◽  
Acute Calculous Cholecystitis ◽  
Significant Difference ◽  
Surgeon Experience ◽  
Operative Complications ◽  
Calculous Cholecystitis ◽  
Post Operative Complications

Background: Conventional laparoscopic cholecystectomy is performed using four ports. With increasing surgeon experience, there is a trend towards performing it using three ports. The aim of this study was to compare the three-port laparoscopic cholecystectomy with the conventional four-port technique in terms of safety, benefits and feasibility in a teaching hospital and private hospital setups.Materials & Methods: A retrospective review of medical records was performed on patients who underwent laparoscopic cholecystectomy at KIST Medical College and Teaching Hospital and Om Hospital & Research Center P. Ltd by a single laparoscopic surgeon. The review included demographics, operating time, analgesics requirement, post- operative hospital stay and intra-operative and post-operative complications. The data were tabulated in MS-Excel and statistically analyzed using SPSS statistics software, version 21.Results: There were 150 patients included in this study with 75 patients in each three and four-port groups. The demographics were comparable in both groups. 7.3% were diagnosed with acute calculous cholecystitis, 76.7% with chronic calculous cholecystitis and 3.3 % were gall bladder polyps. Four-port technique was generally required for the acute calculous cholecystitis which was statistically significant. The three-port group had a shorter mean operative time than the four-port group. There was no statistically significant difference in the doses of analgesics requirement and mean post-operative hospital stay in both groups. There were no major intra and post-operative complications in both groups. Four-port technique was commonly done in teaching hospital and the three-port in private hospital.Conclusions: There is significant number of laparoscopic cases being performed using three ports and we concluded that the three-port laparoscopic cholecystectomy is safe and feasible in experienced hand although there is no significant benefit. The study also showed an increasing use of four-port technique in the teaching institution which is better to clearly visualize the anatomy of the Calot’s triangle. So we recommend using the four-port technique for teaching the beginners and as the experience is gained, we can gradually shift to three-port technique and at the same time we shouldn’t hesitate to convert to four-port in difficult cases.JMMIHS.2018;4(1):66-71

scholarly journals Complication rates of external ventricular drain insertion by surgeons of different experience

2018 ◽  
Vol 100 (3) ◽  
pp. 221-225 ◽  
Author(s):  
J Yuen ◽  
W Selbi ◽  
S Muquit ◽  
T Berei
Keyword(s):  
Risk Factors ◽  
Antibiotic Prophylaxis ◽  
Infection Rate ◽  
External Ventricular Drain ◽  
Operating Time ◽  
Complication Rates ◽  
Increased Risk ◽  
Significant Difference ◽  
Surgeon Experience ◽  
Duration Of Surgery

Introduction Insertion of external ventricular drain (EVD) is a widely accepted, routinely performed procedure for treatment of hydrocephalus and raised intracranial pressure. The purpose of this study was to investigate whether a surgeon’s experience affects the associated complication rate. Methods This retrospective study included all adult patients undergoing EVD insertion at a single centre between July 2013 and June 2015. Medical records were retrieved to obtain details on patient demographics, surgical indication, risk factors for infection and use of anticoagulants or antiplatelets. Surgeon experience, operative time, intraoperative antibiotic prophylaxis, need for revision surgery and EVD associated infection were examined. Information on catheter tip position and radiological evidence of intracranial haemorrhage was obtained from postoperative imaging. Results A total of 89 patients were included in the study. The overall infection, haemorrhage and revision rates were 4.8%, 7.8% and 13.0% respectively, with no significant difference among surgeons of different experience. The mean operating time for patients who developed an infection was 22 minutes while for those without an infection, it was 33 minutes (p=0.474). Anticoagulation/antiplatelet use did not appear to increase the rate of haemorrhage. The infection rate did not correlate with known risk factors (eg diabetes and steroids), operation start time (daytime vs out of hours) or duration of surgery although intraoperative (single dose) antibiotic prophylaxis seemed to reduce the infection rate. There was also a correlation between longer duration of catheterisation and increased risk of infection. Conclusions This is the first study demonstrating there is no significant difference in complication rates between surgeons of different experience. EVD insertion is a core neurosurgical skill and junior trainees should be trained to perform it.

scholarly journals How surgical training in Switzerland affects outcomes and new predictors for teaching

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
B Moeckli ◽  
S A Käser ◽  
A Andres ◽  
C Toso
Keyword(s):  
Inguinal Hernia ◽  
Surgical Training ◽  
Surgical Procedures ◽  
Operating Time ◽  
Teaching Hospitals ◽  
National Database ◽  
Hospital Size ◽  
Significant Difference ◽  
National Cohort ◽  
Surgical Teaching

Abstract Objective Teaching in the operating room represents the cornerstone of surgical education. Residents need to perform a sufficient number of basic procedures in order to gain independence. However, it is still debated what impact surgical teaching has on outcomes. With this study, we provide recent data of a large national cohort and identify new factors that are associated with increased teaching. Methods We studied common procedures that are essential for surgical training: Laparoscopic Appendectomy (LA), Laparoscopic Cholecystectomy (LC), ostomy closure (OC), laparoscopic (LH) and Open Inguinal Hernia Repair (OH). The national database of the Swiss association for quality management in surgery was screened, and 72072 patients were identified from 2009 to 2019. Teaching was defined as a procedure mainly performed by a surgeon in training under supervision. Results A minority of basic surgical procedures were used for teaching (LA 28.1%, LC 22.3%, OC 21.5%, OH 31.8%, LH 6.3%), even in teaching hospitals of &gt; 200 beds (LA 33.0%, LC 32.9%, OC 27%, OH 51.5%, LH 6.5%). During the study period, there was also generally a trend towards less teaching, exemplified by the two most frequent procedures: LA 35.6 to 26.7% (-25.0%, p = &lt;0.001), LC 27.6 to 18.9% (-31.5%, p = &lt;0.001). Operating time was significantly longer for procedures that were used for teaching with a more pronounced effect for inguinal hernia repairs: LA 63.4 vs 57.5min (+10.3%, p = &lt;0.001), LC 84.0 vs 74.9min (+12.1%, p = &lt;0.001), OC 88.6 vs 81.6min (+8.6%, p = &lt;0.001), OH 81.5 vs 68.3min (+19.3%, p = &lt;0.001), LH 97.9 vs 73.8min (+32.7%, p = &lt;0.001). The overall complication rate for LA (2.6 vs 1.8%, p = &lt;0.001) and LC (3.6 vs 2.8%, p = &lt;0.001) were slightly higher in the no-teaching group and without a significant difference between the groups for OC, LH and OH. We identified the following parameters associated with increased teaching: A hospital size above 200 beds (OR = 2.48, p = &lt;0.001), an operation during office hours (OR = 1.27, p = &lt;0.001), the summer months (OR = 1.11, p = &lt;0.001) and weekdays (OR = 1.10, p = 0.003). Conclusion The teaching of basic surgical procedures appears safe. Even if associated with longer operating times, it should be promoted as teaching is currently only performed in a minority of procedures (10-33%).

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