Laparoscopic inguinal hernia repair.

Open hernia repair is associated with significant postoperative pain and disability resulting in delayed return to full activity. Laparoscopic hernia repair has been advocated as the procedure that combines the benefit of tension-free repair with the preservation of the basic anatomy of the inguinal area. We present our experience with 803 laparoscopic hernia repairs in 517 patients over a period of 66 months (August 92 to February 98). The effects of the learning curve and the refinement of the technique had their impact on earlier results and complications. However, with more experience we found that the laparoscopic preperitoneal approach is safe and efficacious. There was no mortality. Most patients (85%) were discharged home within 24 h of the procedure and returned to full activity within 10 days. Patient satisfaction was excellent. The complication rate decreased and operative time was reduced with experience. This procedure is clearly indicated in patients who have recurrent or bilateral hernias. It is associated with shorter convalescence and a quick return to work.

Bupivacaine local injection in anorectal surgery.

A retrospective study of 46 patients who received bupivacaine local injections after hemorrhoidectomy were compared to a matching group of 46 patients of similar age and sex distribution who underwent the same operation. Pain medications requirement on the same day of operation and on subsequent days were measured and found to be the same in both groups. The incidence of urinary retention was equal in both groups. However, the group receiving bupivacaine had a shorter hospital stay. In this respect, local injection of bupivacaine after hemorrhoidectomy may have a role in making patients more comfortable and shortening hospital stay.

Axillopopliteal & aortopopliteal bypass--two case reports.

Two cases of aortopopliteal and axillopopliteal bypass grafts done for limb salvage are reported. These extra-anatomical bypass grafts are valuable in patients who cannot otherwise undergo anatomical bypass grafts.

Pseudoaneurysm of the popliteal artery following arthroscopic meniscectomy.

A pseudoaneurysm was diagnosed by ultrasound of popliteal fossa in a 40-year-old female following arthroscopic meniscectomy. The patient was treated successfully with a reversed saphenous vein graft (SVG). This case is used to review the literature concerning the complications of arthroscopic meniscectomy.

The relation of venous ulceration with ambulatory venous pressure measurements.

Two hundred thirty-six limbs of 220 unselected patients who were admitted with venous problems (83 with ulcers) were studied with continuous-wave Doppler ultrasonography, duplex scanning, and ambulatory venous pressure measurements. Patients with evidence of deep venous disease because of reflux or obstruction in the deep veins on Doppler and duplex ultrasonic examination or with an ambulatory venous pressure greater than 45 mm Hg despite the ankle cuff had venography. One hundred fifty-three limbs had superficial venous disease (reflux in the superficial veins with competent popliteal valves), and 83 limbs had deep venous disease (popliteal reflux on duplex examination or deep venous obstruction on venography). No ulceration occurred in limbs with ambulatory venous pressure < 30 mm Hg, and there was a 100% incidence with ambulatory venous pressure > 90 mm Hg. A linear increase occurred from 14% in limbs with ambulatory venous pressure between 31 and 40 mm Hg to 100% in limbs with ambulatory venous pressure greater than 90 mm Hg (r = 0.79). In the groups studied, an increased incidence of ulceration was associated with an increase in ambulatory venous pressure irrespective of whether the venous problem was the result of superficial or deep venous disease. Ambulatory venous pressure has both diagnostic and prognostic significance in patients with venous disease.