Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis.

The aim of this study was to analyze and evaluate the long-term recurrence rate and risk factors for inguinal hernia recurrence in patients treated by the Shouldice suture repair. A total of 293 hernias treated by Shouldice suture technique in 1992 were studied retrospectively. After a 10-year follow-up, 15 potential risk factors for recurrence were assessed in 142 patients undergoing 171 Shouldice repairs. Recurrent hernias showed a significantly higher (22.0%) recurrence rate than primary inguinal hernias (7.7%). Furthermore, an age of more than 50 years, smoking, and the presence of two or more similarly affected relatives were found to be independent risk factors for recurrence. The present study underlines the importance of patient-related risk factors for the development of a recurrent inguinal hernia. Patients at risk should preoperatively be identified in order to improve treatment by, for example, the application of mesh techniques.

[Ileocecal invagination due to a benign small intestine tumor. A case report]. / Ileozökale Invagination aufgrund eines benignen Dünndarmtumors. Ein Fallbericht.

We report a case of postoperative ileocecal invagination in a 63-year-old male. Forty-six days after esophageal resection and gastric tube reconstruction with cervical anastomosis for an esophageal carcinoma, the patient suffered from colicky pain in the right abdomen. The diagnostics showed an ileocecal invagination up to the right flexure of the colon. The invagination was based on a leiomyoma of the terminal ileum. Because of necrosis of the mucous membrane, an ileocecal resection with ileoascendostomy could not be avoided. We discuss this case on the basis of the existing literature.

[Meshes in inguinal hernia repair]. / Netze in der Leistenhernienchirurgie.

Repair of a groin hernia is strongly influenced by prosthetic mesh implantation carried out in nearly 50 % of all operations. Recurrency rates, however, did not decrease by this policy. Many different materials are available. Due to bioinstability on the long-term and elevated infection rates PTFE is not suitable for inguinal hernia repair. Polyester also provides no long-term stability and induces a chronic foreign body reaction. Polypropylene initially leads to an acute inflammatory reaction and often ends in fibrosis. Both reactions are related to the weight of the used mesh. All materials may lead to specific complications. These include seroma formation, infection, migration of the prosthesis with arrosion of organs, damage of the vas deferens, development of recurrency by shrinkage of the fibers around the mesh, formation of adhesions in the preperitoneal position, and chronic inguinal pain. Therefore, meshes should be used only after individual estimation of risks and benefit. This includes the hernia classification, the number of previous operations and the possibility of a defect in collagen metabolism. The unknown long-term risks for the patient may be taken only in strong indications.

Caecal-diverticulitis: a rare differential diagnosis for right-sided lower abdominal pain.

OBJECTIVE: There are several differential diagnoses for acute abdominal discomfort with pain referred to the right lower quadrant region. The objective of this report is to outline our experience with diverticulitis of the caecum, which is a rare condition that is particularly difficult to diagnose correctly pre-operatively. METHODS: A retrospective analysis of acute diverticulitis of the caecum was performed over the period from January 1992 to December 2000 within the Surgical Department of the RWTH Aachen, Germany. The progress of each patient was assessed by interviewing the patient and by telephone contact with the patient's general practitioner. RESULTS: Seven patients with isolated infective diverticulitis of the caecum were encountered in the course of this study. In five of these cases, the pre-operative diagnosis was either unclear or incorrect. Four patients underwent surgery for suspected appendicitis. In one patient, the diverticulitis was diagnosed during laparoscopic surgery undertaken for presumed adnexal disease. Intestinal continuity was restored in all cases. The postoperative course was uneventful. CONCLUSIONS: Right-sided caecal diverticulitis is rare in comparison to diverticulitis of the sigmoid or descending colon. Nevertheless, it should be actively considered in the differential diagnosis of patients with acute tenderness in the right lower abdominal region.