scholarly journals Totally extraperitoneal inguinal hernia repair versus Lichtenstein repair: a one-year follow-up study

2021 ◽  
Author(s):  
H. O. Havrylov ◽  
O. V. Shulyarenko

The inguinal hernia has an incidence of 27 — 43 % in males. Surgical repair is the most accepted treatment to prevent the development of complications. Laparoscopic inguinal hernia repair has become popular worldwide and includes the use of a laparoscopic technique for mesh placement behind the defect. Objective — to assess whether totally extraperitoneal (TEP) inguinal hernia repair shows benefits over Lichtenstein repair in intraoperative and one‑year follow‑up postoperative outcomes for male patients with primary unilateral inguinal hernia. Materials and methods. 53 males were randomly allocated to two groups. Group 1 included 27 patients who underwent totally extraperitoneal hernia repair using self‑gripping lightweight mesh, and group 2 included 26 patients who were treated surgically with Lichtenstein repair using lightweight mesh. Results. Both groups were comparable in mean age, type of hernia, body mass index and patient’s distribution according to the European hernia society classification. TEP repair takes on average a little less time as compared to Lichtenstein repair, and this difference is not statistically significant. The mean of visual analogue scale for pain scoring in the first 24 hours after surgery as well as in the next 24 hours is statistically significantly smaller in group 1 compared to group 2. The mean time taken to return to work was 2.15 times longer in group 2 than in group 1, and the difference was statistically significant. Conclusions. Totally extraperitoneal hernia repair shows potential benefits over Lichtenstein repair for primary unilateral inguinal hernias as it causes less pain in the postoperative period and ensures early return to work.  

2021 ◽  
Vol 8 (31) ◽  
pp. 2830-2834
Author(s):  
Ranju Sebastian ◽  
Remani Kelan Kamalakshi ◽  
Jamsheena Muthira Parambath ◽  
Praseetha Vallomparambath Kuttiparambil

BACKGROUND Spinal Anaesthesia is the most commonly used form of anaesthesia for surgeries below the level of umbilicus. Bupivacaine is the drug of choice for subarachnoid block. Spinal anaesthesia with bupivacaine is associated with many side effects and complications especially in patients with multiple co-morbid conditions. In our study we compared the anaesthetic effectiveness of 3.5 ml hyperbaric bupivacaine with a mixture of 100 mg ketamine and 0.1 mg adrenaline, the solution is made hyperbaric by adding 1.4 ml of 5 % dextrose given intrathecally. The objective of our study was to compare the anaesthetic properties and clinical effectiveness of intrathecally administered ketamine with bupivacaine for inguinal hernia repair. METHODS This randomised control study was conducted on fifty American society of Anaesthesiologists (ASA) 1 and 2 patients in the age group of 25 – 60 years posted for elective inguinal hernia repair from December 2004 to December 2005. They were randomized in to two groups. Group 1 (Bupivacine group) and Group 2 (Ketamine group). Bupivacaine group (group 1) received 3.5 ml of bupivacaine heavy and ketamine group (group 2) received preservative free ketamine 100 mg with 0.1 mg adrenalin 1/1000 solution in 1.4 ml of 5 % dextrose to make it heavy. Anaesthetic properties, side effects and complications of both groups were compared intraoperatively. RESULTS The onset of action of ketamine (1.58 minutes) was faster than bupivacaine (3.31 minutes) which is statistically significant. Duration of blockade was longer in bupivacaine group (sensory 227.92 and motor 203.08) compared to ketamine group (sensory 143.40 and motor 109.46). Ketamine group showed a greater level of haemodynamic stability than bupivacaine group. CONCLUSIONS Intrathecal ketamine produces optimal anaesthetic conditions for surgeries like inguinal hernia repair. Haemodynamic stability provided by intrathecal ketamine is beneficial in patients with multiple comorbidities. KEYWORDS Hyperbaric Bupivacaine, Ketamine in Hyperbaric Solution, Intrathecal Block, Inguinal Hernia Repair


2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
René Gordon Holzheimer ◽  
Nikolai Gaschütz

Abstract Can open inguinal hernia repair (OIHR) and tailored neurectomy (TN) be effective for prophylaxis of chronic postoperative inguinal hernia repair (CPIP) (I) and treatment of CPIP (II)? Patients with symptomatic primary inguinal hernia (I group 1) and secondary hernia with CPIP (II, groups 2–5) were investigated for postoperative complications and nerve damage. About, 98% of patients with OIHR with TN reported preoperative pain (I group 1, n = 388, recurrence rate 1%). There were 73 cases (II) of CPIP after laparoscopic inguinal hernia repair (LIHR) (group 2, n = 22), OIHR (group 3, n = 37), LIHR followed by OIHR/LIHR (group 4, n = 5) and OIHR followed by LIHR/OIHR (group 5, n = 9). The results were as follows: preoperative pain: 33–100%, recurrence rate 0–11% (II, groups 2–5), nerve damage 92–100% and persistent CPIP: n = 1 after trocar perforation of inguinal nerve elsewhere. OIHR is effective to avoid CPIP with compression neuropathy. This is the largest series of histological nerve damage in CPIP.


2021 ◽  
Vol 8 (2) ◽  
pp. 606
Author(s):  
Haydar Celasin ◽  
Faraj Afandiyev

Background: We aimed to determine the incidence and predictors of testicular atrophy (TA) in patients undergoing inguinal hernia repair at our hospital.Methods: The total patient number is 578.The patients were divided Group-1 (developed testicular atrophy) and Group-2 (did not develop testicular atrophy). The testicles were evaluated with Scrotal Color Doppler Ultrasonography (SCDU) in preoperative and postoperative third month.Results: Median age in the Group - 1 and Group - 2 respectively is 64,0±12,3 (47-81) and 48,9±17,4 (18-89) (p=0.037). TA developed in 5.01% (29/578) of the patients. We determined that TA developed more often in the patients who are over the age of 40 (p=0.007), in secondary cases (p<0.001), in  open repair (p<0.001), those who do not use perioperative narcotic and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) (p<0.001), those who use perioperative antispasmodic drugs (p=0.017), those having a rheumatic disease(RD) and  diabetes mellitus(DM) (p<0.001).Results of multivariate analysis, testicular atrophy development increases when perioperative NSAID is not used ( OR:13.24; 95% CI:4.19-41.87; p<0.001) , perioperative narcotic is not applied (OR:13.91; 95% CI:4.35-44.55; p<0.001) and RD exists (OR:0.10; 95%CI:0.03-0.35; p<0.001).Conclusions: Advanced age, DM and rheumatic disease, not using perioperative NSAIDs, narcotic drugs and antispasmodic drugs increases the risk of testicular atrophy.


2018 ◽  
Vol 268 (2) ◽  
pp. 241-246 ◽  
Author(s):  
Marleen Roos ◽  
Wouter J. Bakker ◽  
Nelleke Schouten ◽  
Charlotte Voorbrood ◽  
Geert Jan Clevers ◽  
...  

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