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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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.
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PMID:Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair. 1215 42

A study was carried out to compare the use of two different tension-free surgical techniques, for the repair of primary inguinal hernia in cases without complications. The study was carried out on 91 consecutive patients who presented with primary and uncomplicated inguinal hernia. The patients were randomly divided into two groups. Group I consisted of 42 patients whose inguinal hernia was repaired by means of the application of a triangular flap rotated from the anterior sheath of the abdominal rectus muscle and then sutured to the inguinal ligament with non-continuous and nonabsorbable suture 00. Group II consisted of 49 patients whose inguinal hernia was repaired by tension-free hernioplasty, placing a mesh umbrella plug in the deep inguinal orifice and, if necessary, mesh reinforcement to the floor of the inguinal canal (the Gilbert technique). There were no statistically significant differences with regard to age, sex, hernia evolution time, trans- or postoperative complications, or hernia recurrence during an average follow-up time of 3 years. Patients in the flap group required significantly more surgery time and postoperative analgesics. Cost analysis showed that patients receiving a muscle sheath flap spent less money on the actual surgical procedure, given the saving on the purchase of a prosthetic mesh. However, when taking into account the greater need for analgesia and the longer time in the operating theater, there was no difference in overall cost between the two procedures. Inguinal hernia repair using a triangular flap from the anterior sheath of the abdominal rectus muscle is an additional surgical procedure that can be utilized in cases where prosthetic mesh repair is not feasible.
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PMID:Mesh prosthesis versus triangular flap from the anterior sheath of the abdominal rectus muscle in primary inguinal hernia repair. 1255 39