Hernia : the journal of hernias and abdominal wall surgery
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Comparative Study
Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias.
The objective of this study is to determine the reliability and validity of ultrasonography (US) in diagnosing incisional hernias in comparison with computed tomography (CT). The CT scans were assessed by two radiologists in order to estimate the inter-observer variation and twice by one radiologist to estimate the intra-observer variation. Patients were evaluated after reconstruction for an abdominal aortic aneurysm or an aortoiliac occlusion. ⋯ US imaging has a moderate sensitivity and negative predictive value, and a very good specificity and positive predictive value. Consistency of diagnosis, as determined by calculating the inter- and intra-observer Kappa statistics, was good. The incidence of incisional hernias is high after aortic reconstructions.
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Laparoscopic ventral hernia repair (LVHR) is a well established procedure in the treatment of ventral hernias. It is our clinical experience that patients suffer intense postoperative pain, but this issue and other recovery parameters have not been studied in detail. ⋯ LVHR was associated with considerable postoperative pain and fatigue in the first postoperative month, prolonging the time of convalescence and significantly affecting patients' quality of life up to 6 months postoperatively. Mesh fixation with fibrin glue or other non-invasive/degradable products seems promising for reducing pain and it should be investigated in future randomised trials.
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Randomized Controlled Trial Comparative Study
Pre-emptive infiltration of Bupivacaine in laparoscopic total extraperitoneal hernioplasty: a randomized controlled trial.
To investigate the effectiveness of pre-emptive preperitoneal infiltration of 0.5% Bupivacaine in postoperative pain control in laparoscopic total extraperitoneal (TEP) hernioplasty. ⋯ Pre-emptive preperitoneal infiltration of 0.5% Bupivacaine significantly reduces postoperative pain in laparoscopic TEP hernioplasty.
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Inguinal hernias are classified anatomically into indirect and direct types. We illustrate two cases of an inguinal hernia where the defect was demonstrated to lie between the deep ring and the inferior epigastric vessels, therefore, not fitting the standard criteria for either direct or indirect inguinal hernias. Taking this into account, we propose that the hernia which we describe should either be considered as a completely new type of inguinal hernia or, alternatively, all of the currently accepted classifications should be changed or adapted to incorporate it.