Hernia : the journal of hernias and abdominal wall surgery
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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.
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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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Randomized Controlled Trial Comparative Study
Postoperative pain management after inguinal hernia repair: lornoxicam versus tramadol.
In this randomized and prospective study, we compared the analgesic effects of lornoxicam and tramadol in patients after inguinal hernia repair. ⋯ Lornoxicam 8 mg i.v. and b.i.d., tramadol 1 mg/kg at the end of the surgery and every 6 h up to 24 h after inguinal hernia repair provided rapid and effective analgesia and was well tolerated.
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Editorial Practice Guideline
European Hernia Society guidelines on the treatment of inguinal hernia in adult patients.
The European Hernia Society (EHS) is proud to present the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. They have been developed by a Working Group consisting of expert surgeons with representatives of 14 country members of the EHS. ⋯ Working together on this project was a great learning experience, and it was worthwhile and fun. Cultural differences between members were easily overcome by educating each other, respecting different views and always coming back to the principles of evidence-based medicine. The members of the Working Group would like to thank the EHS board for their support and especially Ethicon for sponsoring the many meetings that were needed to finalise such an ambitious project.
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Comparative Study
Low recurrence rate of a two-layered closure repair for primary and recurrent midline incisional hernia without mesh.
Incisional hernia is a serious complication after abdominal surgery and occurs in 11-23% of laparotomies. Repair can be done, for instance, with a direct suture technique, but recurrence rates are high. Recent literature advises the use of mesh repair. In contrast to this development, we studied the use of a direct suture repair in a separate layer technique. The objective of this retrospective observational study is to assess the outcomes (recurrences and complications) of a two-layered open closure repair for primary and recurrent midline incisional hernia without the use of mesh. ⋯ A two-layered suture repair for primary and recurrent incisional hernia repair without mesh with extensive adhesiolysis was associated with a recurrence rate comparable to mesh repair and had an acceptable complication rate.