Analgesia-sedation for day-case inguinal hernia repair

The objective of this study was to determine whether analgesia-sedation improved patient acceptance of day-case herniorrhaphy and to evaluate the extent of patient morbidity. A total of 98 patients (mean age 34 years, range 17-75 years) were studied before and after herniorrhaphy to determine their response to the procedure. All patients were unpremedicated and underwent herniorrhaphy using a Bassini repair technique with a standard local anaesthetic block. Sedation was obtained with titrated intravenous midazolam (Hypnovel, Roche Products Ltd.) without narcotic analgesia. Patients were evaluated with a simple questionnaire after surgery. The maximum dose of midazolam used was 5 mg (median dose 3.5 mg). Monitoring of vital signs with pulse oximetry during the operative period was routine though oxygen therapy was not required. All patients were able to walk without assistance and were discharged under responsible supervision. Operative morbidity was low (5 percent). Adverse reactions to the procedure such as nausea, vomitting and headache were not seen. In conclusion, conscious sedation allows amnesia to be achieved with low morbidity in the majority of patients undergoing local anaesthetic procedures. This should result in increased patient acceptance.(AU)

Inguinal hernia in children

Two hundred and seventy one cases of inguinal hernias and hydrocoels in children treated at the University Hospital of the West Indies over a five-year period have been reviewed. The dominance of the boys and the right side is borne out. The younger infant has the highest risk of incarceration which is more common in boys and in right-sided hernias. Females with inguinal hernias were screened for testiculaar feminization and none was found. There were three girls with hydeocoels of the Canal of Nuck. The incidence of metachronous presentations of contralateral hernia occurred only in 6.6 percent of cases. When routine explorartion of the contralateral side was undertaken in 5.2 percent of cases, a hernia sac was found only in less than half of them. These findings support the present policy of not routinely exploring the opposite side in unilateral inguinal hernias. Herniotomy was adequate for 92.6 percent of cases. Herniorrhaphy was seen in only one case. One testicular atrophy occurred following incarceration. Eighty-six per cent of these children were managed as day cases. Inpatient management was required when the hernia was complicated or when there were associated other medical conditions. (AU)

The pattern of gastro-intestinal obstruction in Trinidadian children

A review is presented of 156 children admitted to hospital with gastro-intestinal obstruction. The common underlying causes were obstructed hernia (46.8 percent), intussusception (23.7 percent) and pyloric stenosis (16 percent) of cases. There was a marked male proponderance in each of these three groups, and the predominance of patients of African extraction in the hernia group reached 100 percent when the hernia was umbilical. Well-known observations in children with obstructed inguinal hernias which were confirmed were a right-sided prediliction, and a tendency for tecurrent obstruction in the absence of early repair. All of the patients with intussusception were under the age of one year, and this was associated with an unusually low incidence of discomfort or irritability as a presenting complaint, and a paucity of anatomical lead points. Fifteen bowel resections were required in 14 children, seven for gangrenous or irreducible intussusceptions. There were nine fatalities, four in the group with intussusception, and the details of these suggest that all fatalities could be eliminated with improvements in respiratory care, and pre-and intra-operative management (AU)

Results of inguinal hernia repair using a nylon darn

281 inguinal hernias were repaired by a nylon darn method and 249 examined between one and ten years after operation. There were five failures, including three reoccurrences. There were four imperfections, none of which required re-operation. Combining this series with the original one of Leacock & Rowley, a total of 729 hernias were repaired by this method. 597 were followed up, with a failure rate of 2.15 percent. (AU)

Results of nylon repairs in inguinal hernias (abstract only)

Three hundred and forty eight inguinal hernias were repaired by nylon darn technique and the patients followed for a period of 1 to 10 years. There were 7 method failures, namely 4 recurrences and 3 nylon sinuses, all requiring further operation. There were 7 imperfections namely 5 bulges and 2 indurations, none requiring further operation (AU)

An unusual content of a hernial sac

Hernial sac found with right ovary, fallopian tube and uterus inside. (AU)