Indications for incisional hernia repair: an international questionnaire among hernia surgeons.

BACKGROUND: Incisional hernia repair can be a significant challenge for both surgeon and patient. Despite the growing amount of literature describing various methods of surgical techniques, little has been published regarding the natural course of incisional hernia and the opinions about indications for incisional hernia repair. METHODS: A questionnaire was sent to a group of surgeons internationally renowned in incisional hernia surgery and research. RESULTS: Pain and limitations of daily activities were considered the most important indications for repair. Cosmetic complaints were seen as least important. About 23% of patients were asymptomatic. More than 20% did not receive surgical treatment. CONCLUSIONS: A large proportion of patients with incisional hernia is not operated. Despite this large group of patients, valid data describing the natural course are absent. A prospective trial monitoring incisional untreated hernias as well as comparing conservative treatment with repair should be performed.

Natural course of incisional hernia and indications for repair.

BACKGROUND: Incisional hernias and incisional hernia repair can be a significant challenge for both surgeon and patient. Despite the growing amount of literature describing various methods of surgical techniques, little has been published the natural course of an incisional hernia and regarding indications for incisional hernia repair. METHODS: An internet database search was performed to identify articles describing symptoms presented by patients and indications for incisional hernia repair. RESULTS: Various symptoms and indications regarding incisional hernia repair and the natural course of an incisional hernia are mentioned in the literature. Nevertheless, published data accurately describing these symptoms and indications are rare. CONCLUSION: A prospective trial monitoring incisional hernias as well as comparing conservative treatment with repair should be performed.

Pain-related behaviour in children: a randomised study during two sequential dental visits.

AIM: To determine the difference in pain- and distress-related behaviour in children between two consecutive dental treatment sessions using a computer-controlled local anaesthetic delivery system, with dental anxiety as co-variable. METHODS: A randomised prospective study over two sequential visits in three paediatric dental practices. For both visits 112 young, healthy children needing dental treatment were randomly assigned to either the use of the Wand(®) or the Sleeper One(®). All statistical analyses were performed using SPSS 17. A significance level of p < 0.01 was used, correcting for conducting a high number of tests. RESULTS: Children showed significantly more muscle tension, more verbal protest, and more crying or screaming during the second treatment. CONCLUSIONS: Sequential dental treatments seem to have a conditioning effect. It is important to know the level of dental anxiety to adjust the treatment sequence to the needs of the child.

Comparison of two computerised anaesthesia delivery systems: pain and pain-related behaviour in children during a dental injection.

AIM: The purpose of this study was to investigate whether there is a difference in pain and distress response of the child when using two different computer-controlled local analgesic delivery systems, the Sleeper One(®) and the WAND(®), and whether this was influenced by the anxiety level of the child. METHODS: This randomised controlled trial was conducted among 112 children (56 girls) aged 4-6 years (mean age 66 months, SD 9 months). All children needing at least one dental visit using local analgesia were randomly assigned to either the Sleeper One(®) or the WAND(®). RESULTS: During the injection phase, children expressed the same amount of disruptive behaviour using the Sleeper One(®) or the WAND(®) (Mann-Whitney U test, p > 0.05). The average injection time of the Sleeper One(®) (mean 2.49 min, SD 0.56) was significantly shorter than that of the WAND(®) (mean 3.20 min, SD 0.61; Mann-Whitney U test, p < 0.001). CONCLUSION: No significant difference was found in pain and distress reaction of the child between the WAND(®) and the Sleeper One(®). The average delivery time of the Sleeper One(®) was shorter.

The use of mesh in acute hernia: frequency and outcome in 99 cases.

BACKGROUND: Incarceration of inguinal, umbilical and cicatricial hernias is a frequent problem. However, little is known about the relationship between the use of mesh and outcome after surgery. The goal of this study was to describe the relationship between the use of mesh in incarcerated hernia and the clinical outcome. PATIENTS AND METHODS: Correspondence, operation reports and patient files between January 1995 and December 2005 of patients presented at one academic and one teaching hospital in Rotterdam were searched for the following keywords: incarceration, strangulation and hernia. The patient characteristics, clinical presentation, pre-operative findings and clinical course were scored and analysed. RESULTS: A total of 203 patients could be identified: 76 inguinal, 52 umbilical, 39 incisional, 14 epigastric, 14 femoral, five trocar and three spigelian hernias. In the statistical analysis, epigastric, femoral, trocar and spigelian hernias were pooled, due to their small group sizes. One patient was excluded from the analysis because the hernia was not corrected during operation. In total, 99 hernias were repaired using mesh versus 103 primary suture repairs. Twenty-five wound infections were registered (12.3%). One mesh was removed during a reintervention for anastomotic leakage, although no signs of wound infection were present. Nine patients died, none of them due to wound-related problems [one cardiovascular, one ruptured aneurysm, two anastomotic leakage, two sepsis e causa incognita (e.c.i.), three pulmonary complications]. Univariate analysis showed that female patients (P = 0.007), adipose patients (P = 0.016), patients with an umbilical hernia (P = 0.01) and patients who underwent a bowel resection (P = 0.015) had a significantly higher rate of wound infections. The type of repair (e.g. primary suture or mesh), use of antibiotic prophylaxis, gender, ASA class and age showed no significant relation with post-operative wound infection. After logistic regression analysis, only bowel resection (P = 0.020) showed a significant relation with post-operative wound infection. CONCLUSIONS: Wound infection rates are high after the correction of acute hernia, but clinical consequences are relatively low. Mesh correction of an acute hernia seems to be safe and should be considered in every incarcerated hernia.