[Repair of recurrent inguinal hernia. Tactics, technic and results]. / Reparation der Rezidivleistenhernie. Taktik, Technik und Ergebnisse.

Based on 301 surgical repairs of recurrent groin hernias perioperative management and recommended techniques for preparation and repair of various kinds of recurrent hernias are presented. Follow-up examinations could be performed on 175 patients, representing 88.8% of 197 patients who underwent surgery for recurrent hernias. Shouldice's technique for hernia repair proved to be the treatment of choice for recurrent groin hernias with a recurrence rate of 2.9% (5/175). Early postoperative complications occurred up to the 14th day following surgery. Frequently they could not be documented due to an average postoperative hospitalization period of 6.2 days only. The rates of postoperative complications were 8.1% prior dismission and 12.6% within two weeks after the operation respectively.

[Invagination of the vermiform appendix in mucinous cystadenoma]. / Invagination der Appendix vermiformis bei mucinösem Cystadenom.

Intussusception of the appendix vermiformis in adults is an uncommon event. The combination of a mucinous cystadenoma with an intussuscepted appendix is extremely rare. Clinical symptoms are nonspecific; in most cases the correct diagnosis is not made before surgical exploration. With the radiologic and endoscopic presentation of a polypoid lesion of the caecum, a neoplasm is often considered. Endoscopic appendectomy or disinvagination by enema have been described. Thus the definitive therapy is surgery and depends on the histological diagnosis.

[Doppler sonography of testicular circulation following reconstruction of inguinal hernia]. / Doppler-Sonographie der Hodendurchblutung nach Leistenhernienreparation.

The use of pre- and postoperative testicular Doppler ultrasound examination in groin hernia repair is evaluated in 50 patients operated by the technique of Shouldice. The etiological differentiation between ischemic orchitis and testicular necrosis is based on the monitoring of testicular perfusion. The technique is presented in detail. Preoperatively the arterial supply could be examined in 45 of 50 patients and the venous flow in 41 patients. The postoperative arterial flow was found in all and the venous flow in 47 patients. Our results revealed the Doppler sonography as a suitable technique for postoperative semiquantitative examination of testicular perfusion. It should be employed in all cases of postoperative testicular pain. A mandatory use of the Doppler technique to obtain an indication for operative revision has still to be discussed.

[Para-esophageal omental incarceration--a rare complication of para-esophageal hernia]. / Paraoesophageale Netzincarceration--Eine seltene Komplikation einer paraoesophagealen Hernie.

Herniation of large omentum is a rare complication of parahiatal hernias. This paper presents by means of a case report clinical symptoms, radiologic procedure and operative management of parahiatal greater omentum incarceration.

[Cremaster resection in Shouldice repair. A prospective controlled bicenter study]. / Cremasterresektion bei Shouldice-Reparation. Eine prospektiv kontrollierte Bicenter-Studie.

The aim of this prospective controlled trial was to determine the value of the resection of the cremaster muscle in Shouldice's hernia repair. 237 Shouldice operations with resection of the cremaster muscle of the Department of Surgery of the RWTH of Aachen were compared with 153 Shouldice repairs without resection of the cremaster muscle of the Department of Surgery of the Elisabeth Hospital in Essen. A comparable follow-up of 12 to 26 months in both groups revealed no significant differences in postoperative complications. In the group without resection of the cremaster muscle four indirect recurrent hernias were diagnosed. In the group with resection of the cremaster muscle no indirect recurrent hernia was detected, only one direct recurrent hernia was documented. The significantly elevated rate of recurrent hernias (p less than 0.05) and the occurrence of atypical indirect recurrent hernias in the group without resection of the cremaster muscle demonstrate the important influence on the technique of repair. Based on our results the resection of the cremaster muscle in an essential part of Shouldice's hernia repair.