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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The results after 230 initial open tension-free hernioplasties a.m. Lichtenstein for groin hernias are evaluated 24 months after operation. Of the 167 primary operations 57% were performed under local analgesia, and 68% of the patients were discharged on the day of operation after primary herniotomy. Infection occurred after 2.7% of the operations, but in no case did the mesh have to be removed. Complications occurred after 7.4% of the operations, necessitating reoperation after 4.3% of the operations. After 24 months 96% of live patients were controlled for recurrences. After 154 primary herniotomies 2.6% recurred. No indirect hernia recurred, 3.6% of direct hernias recurred. After 57 operations for secondary hernias 7.0% recurred. Thirty-eight different surgeons operated 1-19 hernias (median 4). It is concluded that recurrences after open tension-free hernia-repairs are rare, complications few, the operation is simple to perform and can be done under local analgesia in a same day regime.
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PMID:[Tension-free herniotomy using the Lichtenstein's method. Results of five years' experience]. 1086 11

This study was undertaken to assess the impact on mortality and the need for postoperative ventilation of intra- and postoperative epidural analgesia and delayed surgery in neonates with congenital diaphragmatic hernia. The study was a retrospective chart review of 35 neonates with congenital diaphragmatic hernia treated in Durban between 1988 and 1993. The mortality rate was 30%, with too few patients having delayed surgery to demonstrate a benefit from this policy. Mortality and the requirement for postoperative ventilation were reduced in the epidural group. However, the patients with the worst prognosis all received general anaesthesia. The benefit of delaying surgery for congenital diaphragmatic hernia repair could not be demonstrated because of small numbers. Epidural analgesia appears to be a useful technique to reduce the need for postoperative ventilation following repair in lower-risk patients.
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PMID:Congenital diaphragmatic hernia repair--impact of delayed surgery and epidural analgesia. 1096 92

A retrospective case review to describe current practices and outcomes of patients undergoing inguinal hernia repair was undertaken in a principal referral hospital (John Hunter Hospital, Newcastle, New South Wales). The participants were patients who had elective laparoscopic or open inguinal hernia repair between 1 June 1997 and 31 May 1998. The main outcome measures were duration of surgery, type of anaesthesia, use of antibiotics, length of stay, postoperative complications, analgesic administration, and costs. Laparoscopic repair was advantageous in terms of length of stay and use of analgesia, but at a higher in theatre financial cost. Low rates of day stay surgery and use of local anaesthesia, and a high rate of antibiotic administration were apparent. It was concluded that local surgical practice has adopted some but not all advances described in the literature. Performance of a more expensive hernia repair in some patients may mitigate against performance of any repair in others.
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PMID:An audit of open and laparoscopic inguinal hernia repair. 1105 83

The authors describe the anaesthetic procedure for a strangulated hernia repair needing resection and anastomosis of the small bowel in an adult patient. This procedure was performed with an ilio-inguinal/ilio-hypogastric nerve block according to a paediatrical simplified technique with a single puncture. For this patient who had relative contraindications for central blocks, this regional technique allowed to avoid general anaesthesia with its gastric aspiration and predictible difficult intubation risks. This block associated with a very light sedation was sufficient for all the surgical procedure, and postoperative analgesia was efficient over 3 hours. This simplified nerve block, better than the conventional approach for the clinical practice, represents a recommended alternative for hernia repair in emergency for high risk patients who could have a general anaesthesia or a central block.
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PMID:[Ilio-inguinal Ilio-hypogastic nerve block with a single puncture: an alterantive for anesthesia in emergency inguinal surgery]. 1153 Jul 53

One hundred and fifty-five patients scheduled for inguinal hernia repair (IHR) were given the choice of either general anesthesia (GA) (n = 53) or spinal anesthesia (SP) (n = 47) or nerve stimulator guided paravertebral blockade (PVB) (n = 55). The incidence of postoperative nausea and vomiting (PONV), duration of hospital stay and need for postoperative analgesia were recorded. Apart from a difference in the age of patients in the GA group who were found to be slightly younger, all groups were found similar with regard to weight, height, duration of surgery, sex, type of hernia and ASA class. The incidence of PONV (0%) v/s 19% and 21% was significantly reduced in patients treated with the PVB compared to patients receiving SA and GA respectively. The length of hospital stay was also found to be shorter in the PVB group (mean 1.2 days) v/s SA (mean 2.4 days) and GA (mean 2.9 days). The need for supplemental postoperative analgesics was also found to be higher in both SA and GA when compared to PVB patients who were managed without any analgesics during the first 24 postoperative hours. The described technique appears to be an attractive alternative method to provide adequate anesthesia for IHR.
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PMID:Paravertebral blockade vs general anesthesia or spinal anesthesia for inguinal hernia repair. 1156 33

The purpose of this study was to compare a recent contemporaneous experience between laparoscopic (LS) and open (OS) splenectomy in children. All splenectomy cases between 1994 and 1999 at our institution were reviewed. The study included open and laparoscopic cases performed according to surgeon preference. Emergency splenectomies for trauma were excluded. The patient record was reviewed for the diagnosis, indications, postoperative length of stay, operative technique, postoperative complications, blood loss/blood transfusion, total amount of parenteral narcotics, and time to resumption of oral intake. Chi-square and t tests were used to compare measured differences for statistical significance. Between May 1994 and December 1999, 52 splenectomies were performed at Vanderbilt Children's Hospital. Of these, 45 were elective operations with 29 open and 16 laparoscopic procedures. During four OS and five LS operations a concomitant cholecystectomy was performed. The median patient age was 9.2 years (range 0.5 to 17.3). There was no statistical difference between the two groups in terms of age, weight, American Society of Anesthesiologists class, or estimated blood loss. There were no immediate postoperative complications in either group. There were no conversions from LS to OS. The mean duration of surgery was 264 minutes (LS) versus 169 minutes (OS) (P < 0.05). The average time to first oral intake was shorter in patients undergoing LS (1.1 vs 1.6 days, P < 0.05) and the mean postoperative length of stay was also shorter in the LS group (1.3 vs 3.1 days, P < 0.05). The use of postoperative intravenous narcotics (in morphine-equivalent doses) was significantly less in LS patients than in OS patients (7.5 mg or 0.15 mg/kg vs 46.9 mg or 1.5 mg/kg, P < 0.001), as was the need for PCA pump analgesia (90% in the OS group vs 25% in LS group, P < 0.01). Overall the average hospital charge (anesthesia fee, narcotics charge, and hospital room charge) was $5400 (range $4240-6250) in the OS group and $4950 (range $4450-6240) in the LS group (P < 0.05). Among the nine patients undergoing splenectomy with cholecystectomy, findings between the OS and LS groups were similar except for one late complication consisting of a diaphragmatic hernia in an LS patient. Both LS and OS with or without a concomitant procedure can be accomplished safely in children. LS appears to result in longer operative times but shorter lengths of stay, earlier first oral intake, and significantly fewer requirements for intravenous narcotics; all of these contribute to a reduction in hospital charges compared with the open operation.
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PMID:Laparoscopic versus open splenectomy in the pediatric population: a contemporary single-center experience. 1156 64

Technological progress contributed to progress in surgery on the newborns. However, despite the progress in surgery and intensive care of the newborns, the results of treatment of patients with congenital defects are sometimes disappointing. The priority problems for today are the respiratory distress syndrome, hemodynamic disorders, and renal dysfunction, which can be united into the syndrome of general dysadaptation of the newborns. Based on experience gained in the treatment of newborns in pediatric surgical hospital, protocols of treating newborns with developmental defects (congenital diaphragmatic hernia, esophageal atresia, and gastroschisis) have been developed. These protocols are a stage and a prerequisite for development of more effective methods for treating such patients. Common intensive care should be supplemented by such important measures as maintenance of adequate temperature regimen at all stages of medical transportation and therapy of a newborn, obligatory preoperative preparation for stabilization of vital functions, multicomponent endotracheal anesthesia, use of inotropic agents (dopamine and dobutrex), synchronic prolonged artificial ventilation of the lungs and prolonged analgesia, limitation of indications to the use of blood preparations and wide use of hydroxyethylated starch solutions in infusion therapy, rational antibiotic therapy with constant monitoring of the microecological status, and early detection and correction of concomitant diseases. Solution of these problems will essentially decrease the postoperative mortality of newborns with developmental defects.
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PMID:[Ways to reduce mortality of newborns with developmental defects]. 1199 91

The authors analyse the current state of the art of the prosthetic repair of incisional hernia and the problems involved in positioning the prosthesis, comparing their own experience with the most recent literature. From January 1994 to June 2001, 50 patients were operated on for incisional hernia (28 males and 22 females); 12% had recurrent or re-recurrent incisional hernias. Defects smaller than 3 cm were repaired with a polypropylene plug; a double-layer polypropylene mesh placed in a preperitoneal position was used for defects measuring from 3 to 5 cm; in defects greater than 5 cm a double-layer mesh was placed behind the muscle layer. Fifteen patients were operated on under local anaesthesia. Only 22% required postoperative analgesia. The mean hospital stay was 3.95 days. Only 3 recurrences (6%) were recorded. On the basis of our experience it seems appropriate to repair incisional hernias when of small size, preferably under local anaesthesia, avoiding opening the hernia sac, using an extraperitoneal approach with an overlap technique that employs polypropylene.
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PMID:[Extraperitoneal prosthesis repair in the surgical treatment of inguinal hernias]. 1203 14

Surgeons who favor the laparoscopic repair of groin hernias must limit the additional costs associated with this technique, which is not universally acknowledged to be superior to other less expensive open tension-free repairs. This retrospective study compared outcome and costs between laparoscopic and open tension-free hernia repair in 320 patients with inguinal hernias. Patients underwent either (a) transabdominal preperitoneal procedure (TAPP; 60 patients, 72 procedures), (b) totally extraperitoneal procedure (TEP; 174 patients, 202 procedures), or (c) open tension-free procedure (86 patients, 105 procedures). Regarding important postoperative complications there were two (3.3%) recurrences in the TAPP group and one (0.6%) in the TEP group, and six (9.9%) transient neuralgias in the TAPP group and one (1.2%) in the tension-free group. There were no deaths, no testicular atrophies, and no wound or mesh infections. The mean hospital postoperative stay was the same in the three groups (1 day). Mean operating time was shorter in the tension-free group concerning the unilateral cases and shorter in the TEP group concerning the bilateral cases. Fewer patients required analgesia during the first 6 h after the operative procedure in the TEP group than in the other two groups. The mean total costs were 483.90 euros in the open tension-free repair, 763.20 euros in the TAPP repair, and 572.50 euros in the TEP repair. The open procedure was the cheaper for the hospital. Laparoscopic hernia repair and tension-free repair as described by Gilbert are comparable in postoperative complications. TEP hernia repair is associated with less postoperative pain and earlier return to normal activities, but it is more expensive and continues to be a difficult procedure. Open tension-free repair is the least expensive method and is easier to learn than the other two procedures.
Hernia 2002 Jul
PMID:Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair. 1215 42

Although tension-free techniques of hernia repair using synthetic meshes have yielded encouraging results, the best method of inguinal hernia repair is still unclear. The aim of this study was to compare the responses of inflammatory mediators and postoperative pain relief following laparoscopic total extraperitoneal (TEP) hernioplasty, open tension-free mesh hernioplasty (Lichtenstein), posterior preperitoneal mesh hernioplasty (Nyhus procedure), and Bassini procedure. Patients with primary inguinal hernia were randomized in the operating room to undergo one of these repair techniques. Group I comprised 24 patients treated by Lichtenstein procedure; Group II comprised 21 patients treated by Nyhus procedure; Group III comprised 19 patients treated by Bassini procedure; and Group IV comprised 20 patients treated by laparoscopic TEP mesh hernioplasty. Postoperative pain levels following hernia repair were compared by measuring the use of patient-controlled analgesia (PCA) during the 24 hours after surgery. Serum samples withdrawn before surgery and 48 hours after surgery were assayed for C-reactive protein (CRP) content. Patient characteristics, operating time, and operative and early complications were noted. Serum CRP levels rose markedly following Nyhus (184.5 +/- 41.6 mg/L), Lichtenstein (138.4 +/- 72.5 mg/L), and Bassini repair (137.2 +/- 55.9 mg/L) compared with that of patients who underwent TEP mesh hernioplasty (55.5 +/- 41.2 mg/L). There were also significant differences in the postoperative need for analgesics via PCA among patients undergoing Nyhus (382.9 +/- 189.1 mg), Bassini (303.2 +/- 173.7 mg), and Lichtenstein (253.9 +/- 129.3) procedures compared with 196.6 +/- 148.8 mg for the TEP mesh hernioplasty group. Patients in the Lichtenstein group also had significantly less need of analgesics than those in the Nyhus and Bassini groups. In conclusion, TEP mesh hernioplasty is less traumatic and yields less postoperative pain than the Nyhus, Lichtenstein, and Bassini procedures.
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PMID:The effects of different hernia repair methods on postoperative pain medication and CRP levels. 1219 18


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