Hernia : the journal of hernias and abdominal wall surgery
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The study aims to demonstrate the presence of a fibrous or fibromuscular ring structure within the wall of the sacs of inguinal hernia in children and its importance in the development of incarceration as a direct cause of this complication. A case series study of 784 children with unilateral inguinal hernias operated on over a period of 9 years (1992-2000) in two teaching hospitals (Mosul, Iraq). All underwent herniotomy. ⋯ Incarcerations of inguinal hernia in children are usually caused by the inguinal rings. Another cause for incarceration being studied is a fibrous or fibromuscular ring structure identified within the wall of the hernial sac, causing the incarceration in 5.6% of elective (nonincarcerated) hernias and 16% of incarcerated hernia patients. Patients with these hernia sac rings are three times more liable to incarceration than others.
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Review Meta Analysis
Open mesh versus non-mesh repair of groin hernia: meta-analysis of randomised trials based on individual patient data [corrected].
The EU Hernia Trialists Collaboration was established to provide reliable evaluation of newer methods of groin hernia repair. It involved 70 investigators in 20 countries. ⋯ The review provides strong evidence that open mesh repair is associated with a reduction in the risk of recurrence of between 50% and 75%. There is also some evidence of quicker recovery and of lower rates of persisting pain following open mesh repair.
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Comparative Study
Intra-abdominal pressure: a reliable criterion for laparostomy closure?
Laparostomy is frequently performed in the surgical therapy of mechanical obstruction, peritonitis, or trauma to prevent abdominal compartment syndrome (ACS). Extended incisional hernia is inevitable when fascial closure is missed (up to 90% of cases). Intra-abdominal pressure (IAP) has not yet been evaluated as a criterion for the feasibility of fascial closure. ⋯ Fascial closure increased the IAP, which was accompanied by short-termed decrease in urine output. At these levels of IAP fascial closure appears to be harmless, but further prospective studies are needed to determine the critical level of IAP for allowing a safe repair of large fascial defects.
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Randomized Controlled Trial Clinical Trial
Do absorbable mesh sutures cause less chronic pain than nonabsorbable sutures after Lichtenstein inguinal herniorraphy?
Chronic inguinal pain occurs in 20-30% of patients after hernia surgery. A prospective randomized study of 162 patients was undertaken to determine whether absorbable sutures cause less pain than continuous polypropylene fixation of the mesh in the Lichtenstein operation. All patients were operated on under local anesthesia by the same senior surgeon. ⋯ The rate of significant wound hematomas (n = 3), infections (n = 1), and recurrences (n = 2) were low and not related to the type of sutures. In both study groups 24-26% of the patients felt some pain in follow-up, but over 90% were very satisfied with the operation. The absorbable suture material does not appear to cause less neuropathic pain after Lichtenstein operation than nonabsorbable sutures.