The investigation survey of inguinal hernia operation techniques preferred by pediatric surgeons in Turkey

In inguinal hernia, standard procedure has been considered open repair for a long time, the number of pediatric surgeons who prefer laparoscopic techniques is increasing day by day. In this study, it was aimed to determine how pediatric surgeons in our country approach patients with inguinal hernia and manage the treatment process. Controversial issues on inguinal hernia repair were identified and a questionnaire was prepared to reveal the current situation. The questionnaire was delivered to members of Turkish Association of Pediatric Surgery on the official website of the association. The survey was directed to 420 people, 92 people returned with the answers to the questionnaire. Thirty-six of the surgeons prefer the laparoscopic method for inguinal hernia repair. The reason for choosing open surgery was questioned, the most frequent answer was to be more experienced and to have more cumulative knowledge on open repair method. According to survey, the greatest advantage of laparoscopy was stated to be the better evaluation of the contralateral inguinal canal (n=16, %44.4). Twelve of surgeons who performed laparoscopic treatment in the selection of patients stated that gender is important and prefer laparoscopic surgery for female patients. Thirty percent (n = 11) of the participants stated that they prefer laparoscopy in patients between 3 months and 13 years old, while the rest prefer laparoscopy at all ages. In conclusion thirty nine percent of surgeons in Turkey prefer laparoscopic repair. Open repair is still preferred in our country. There is still no consensus on perfect method and patient selection yet.

A COMPARATIVE STUDY OF LICHTENSTEIN MESH REPAIR VS NONMESH TISSUE REPAIR DESARDA'S TECHNIQUE FOR INGUINAL HERNIA REPAIR

Introduction: Inguinal hernia is dened as a protrusion of the contents of the abdominal cavity or preperitoneal fat through a hernia defect in the inguinal area, irrespective of whether this is preformed. The incidence and prevalence of inguinal hernia are not precisely known. The chance of a person having to undergo on inguinal hernia operation during his/her life in quite high, 27% in men and 3% in women. Aims and objectives: The Aim of Study is to nd the Effectiveness of Non Mesh Tissue Repair (Desarda) in compared with mesh repair (Lichtenstein) Materials And Methods: Over A Period 1 Year of Eight Months 40 Patients Aged Between 21 & 70 Years Treated for Inguinal Hernia were Included in this Prospective Randomized Study Result: In this study Return to normal nonsternous Activity After 7-15 days in Desarda group was 84 % while only 48% of patient in Lichtenstein repair.(p value <0.0001). Conclusion:The Lichtenstein repair and Desarda procedures of primary inguinal hernia repair do not differ in the means of procedure, complexity. The time taken for return to normal nonsternous activity is signicantly higher for Lichtenstein group compared to Desarda's repair. The patients are satised with the Lichtenstein repair and Desarda's repair with surgery outcome.

How To Prevent Inguinodynia - After Tension-Free Inguinal Hernia Repair – Our Experience

Inguinodynia is persistence of pain for more than 3 months after inguinal hernia operation. Chronic pain may be associated with hyperesthesia or hypoesthesia. This pain may be mild, moderate or severe. Inguinodynia may even effect quality of life. Pain may resolve on its own or after conservative treatment. Sometimes it persists and conservative methods fail then various other modalities of treatment are considered including re-exploration and neurectomy. We performed all 396 inguinal hernia repair by a modified Lichtenstein tension-free procedure. In our series of 396 cases inguinodynia happened only in 3 cases, a real low incidence. Some researchers have reported the incidence of inguinodynia as high as 19 percent 1 year after operation. No case required re-exploration, removal of mesh or neurectomy in our series. Keywords Chronic pain, Inguinal hernia, Inguinodynia, inguinal hernia repair

Value of Transthoracic Echocardiography in the Prediction of Post-spinal Anesthesia Hypotension

INTRODUCTION: Spinal Anesthesia (SA) can lead to hypotension due to sympathic denervation, which causes a reduction in venous return to the heart as a result of peripheral vasodilation and redistribution of intravascular blood. Transthoracic Echocardiography (TTE) is a noninvasive and easy-to-use method to visualize cardiac reserve and functions. We aimed to evaluate whether parameters attained via transthoracic echocardiography are predictive of development of post-SA hypotension. METHODS: Forty-two patients between the ages of 18 and 80, who would undergo inguinal hernia operation under SA, with ASA physical status I-II and had no clinically recognized cardiovascular disease, were included in the study. TTE was performed for each patient 30 minutes before the operation, and measurements were recorded along with the intraoperative hemodynamic parameters. RESULTS: There was a statistically significant difference between the medians of left ventricle end-diastolic diameter (LVEDD) (cm) according to the status of post-SA hypotension (p=0.003).Accordingly, median LVEDD of patients who did not develop hypotension was significantly larger compared with that of those who had hypotension. Similarly, a statistically significant difference emerged between the medians of right ventricular (RV) tricuspid annular plane systolic excursion (TAPSE) (cm) showing RV global function according to the status of post-SA hypotension (p=0.001). Accordingly, patients who did not have hypotension had a larger RV-TAPSE median compared with that of those who had hypotension. The difference between the medians of RV isovolumetric relaxation time (RV-IVRT), which is one of the indicators of RV diastolic functions was again statistically significant according to the status of post-SA hypotension (p=0.025). DISCUSSION AND CONCLUSION: TAPSE, RV-IVRT and LVEDD measured via preoperative TTE, can be significant parameters to predict the development of post-SA hypotension.

Erector Spinae Plane Block for Different Laparoscopic Abdominal Surgeries: Case Series

The ultrasound guided erector spinae plane (ESP) block is a recent block described for various surgeries for postoperative analgesia. ESP block has effect on both visceral and somatic pain; therefore, its use in laparoscopic cholecystectomy and other abdominal surgeries can be advantageous. We describe successful ESP block application in three different cases for postoperative pain. Two patient were operated on using endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy and one patient was operated on using laparoscopic cholecystectomy together with the inguinal hernia operation.

How to Surgically Remove the Permanent Mesh Ring after the Onstep Procedure for Alleviation of Chronic Pain following Inguinal Hernia Repair

A promising open inguinal hernia operation called Onstep was developed in 2005. The technique is without sutures to the surrounding tissue, causing minimal tension. A specific mesh is used with a memory recoil ring in the border, which may cause pain superficial to the lateral part of the mesh for slender patients. The aim of this study was to illustrate an easy procedure that alleviates/removes the pain. A male patient had persistent pain six months after the Onstep operation and therefore had a ring removal operation. The procedure is presented as a video and a protocol. At the eleven-month follow-up, the patient was free of pain, without a recurrence. It is advised to wait some months after the initial hernia repair before removing the ring, since the mesh needs time to become well integrated into the surrounding tissue. The operation is safe and easy to perform, which is demonstrated in a video.