Bursting strength evaluation in an experimental model of incisional hernia.

Incisional hernias occur in up to 11 per cent of patients undergoing abdominal surgery. Up to 50 per cent of these patients with hernias will require repeat operative procedures. Management of these hernias have focused primarily on tensile strength of the mesh material, have not addressed currently used materials, and have not compared the strength of these repairs with each other. Forty-nine adult Sprague-Dawley rats had an incisional hernia created by removing a portion of their abdominal wall that was then repaired primarily, using either a composite mesh, Dual mesh (Gore-Tex), or polypropylene mesh. Six weeks after the repair, the rats were euthanized. Hydrostatic distension of the abdominal cavity was performed to compare bursting strength of each repair. Wound tensile strength was assessed and compared. Tissue samples were also taken to compare repair types for incorporation of prosthetic materials. The gross weight of the animals subjected to hydrostatic distention was equivalent between groups, as was the volume required prior to failure of the repair. There was a trend toward improved tensile strength of the Prolene mesh repair, which had a lower average inflammatory and fibrosis score on histology. Overall, the type of mesh used for repair does not seem to impact significantly the strength of the repair when assessed 6 weeks postoperatively. Choice of prosthetic material to repair the hernia should be made based on economics and handling characteristics alone. Prolene mesh has satisfactory strength with the least amount of inflammation and fibrosis.

Reduction of conscious sedation requirements by olfactory stimulation: a prospective randomized single-blinded trial.

OBJECTIVES: This study investigated the possibility that olfactory stimulation would decrease sedation needed for colonoscopy and therefore decrease the recovery time needed after conscious sedation. MATERIALS AND METHODS: Patients were randomized to receive a cherry-flavoredscent in oxygen flowing at a 4 L per minute rate via nasal cannula or oxygen alone. The scent was provided in a cherry-flavored oil. A Bispectral Index (BIS) monitor (Aspect Medical Systems, Newton, MA) was placed and scores were recorded every 5 minutes during the procedure to control for different sedation patterns between different endoscopists. The recovery area nurse was unaware of whether a given patient was in the aroma or plain oxygen group, and based each patient's discharge on preexisting standardized criteria. RESULTS: Two hundred and eighty-four (284) patients completed the study. Both the procedure times and the recovery times were not statistically significant between the two groups. The doses of sedatives used, BIS scores at 5 minute intervals, and rate of change in BIS scores were also not statistically significant between the two groups. CONCLUSIONS: Overall, there is no difference between olfactory stimulation and inhaled oxygen with regard to amount of sedation used and recovery times for colonoscopy. An inhaled cherry- scent may not have as great a calming effect as other scents that have been studied.