Hernia : the journal of hernias and abdominal wall surgery
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Randomized Controlled Trial
A prospective, randomized, comparative trial of a COX-2 selective nonsteroidal anti-inflammatory drug versus placebo in inguinal herniorrhaphy patients.
The standard opioid treatment for postoperative pain can be associated with nausea, vomiting, and constipation. In addition, opioids often provide insufficient pain relief. The purpose of this study was to compare postoperative pain and functional outcomes in patients undergoing inguinal herniorrhaphy who receive a COX-2 selective nonsteroidal anti-inflammatory drug (COX-2) or placebo preoperatively and for 4 days postoperatively. ⋯ Administration of a COX-2 selective nonsteroidal anti-inflammatory drug prior to and following outpatient inguinal herniorrhaphy improves functional outcomes when compared with placebo and increases patient satisfaction. These results suggest that multimodal pain therapy with COX-2 inhibitors may have a role in outpatient inguinal hernia repair.
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To determine the complication and infection risks following extra-peritoneal onlay mesh placement in parastomal hernia repair. ⋯ Parastomal hernia repair using a prosthetic mesh is a safe and effective method, with the lowest recurrence rates and acceptably low infection rates. Prosthetic materials should not be used in cases of fecal contamination.
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Clinical Trial
Factors determining the doses of local anesthetic agents in unilateral inguinal hernia repair.
Today, local anesthesia is used in specialized hernia clinics in most cases. The technique for establishing local anesthesia for inguinal surgery may differ among surgeons. Few articles to date have mentioned the exact doses of local agents. This prospective study aimed to research the doses of local anesthetic agents needed in practice and determine the patient-related and other factors which affected those doses. ⋯ This prospective study showed, again, the feasibility of local anesthesia in elective inguinal hernia repair in all patient groups with different characteristics. The mean and maximum doses of local anesthetic agents were well within safety limits, even in recurrent and large hernias. Younger age, large hernias, recurrent hernias, omental mass in the hernia sac, high BMI, and duration of operation might be the factors affecting local anesthetic doses. The significant independent parameters in the multivariate analysis were duration of operation, sac content, and BMI for lidocaine dose, whereas the duration of operation and sac content were determinative for the sum volume of lidocaine and bupivacaine.
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Comparative Study
Laparoscopic incisional hernia repair: evaluation of effectiveness and experiences.
Incisional hernia is the most frequent postoperative complication following abdominal surgery and is a common and costly source of morbidity. Conventional mesh repair is the standard treatment today, but the use of laparoscopic incisional hernia repair (LIHR) seems to be a good alternative. We performed a retrospective analysis comparing open incisional hernia repair with the laparoscopic approach. ⋯ Our results show the tendency that LIHR is associated with less postoperative pain and comparable postoperative complications. The low recurrence rate proves the safety and the good long-term results of this procedure. Laparoscopic hernia repair is an alternative to open procedures in cases of feasibility. Further studies, especially randomized controlled trials, are required to confirm these findings and provide the basis for future treatment guidelines.