Multicentric observational study of pain after the use of a self-gripping lightweight mesh.

INTRODUCTION: Investigation in the field of inguinal hernia surgery is now focused on postoperative pain. The extended use of lightweight meshes and alternative methods of fixation may play a relevant role in the reduction of pain. In this study, a new self-gripping lightweight polypropylene mesh is tested. METHODS: A multicentric, observational study was scheduled to prospectively evaluate this new mesh. Ten centers agreed to participate. Only primary, type 1 or 2 uncomplicated hernias in adults were included. The mesh was placed as a Lichtenstein procedure without any fixation. A complete pain questionnaire was followed at 1 week, and at 1, 3 and 6 months postoperatively. The principal goal of the study was to evaluate maximum pain score at 6 months. Pain was assessed by a visual analog scale. A total of 256 patients were operated. Mean operative time was 35.6 min; 76.2% of patients were operated in an ambulatory setting. RESULTS: There were a few postoperative complications: 2 wound infections, 17 seromas, 21 hematomas, 6 orchitis. The incidence of acute pain was 27.3% at week 1 and 7.5% at month 1. The incidence of chronic pain was 3.6% at month 3 and 2.8% at month 6. No recurrences or long-term complications were observed. CONCLUSION: This self-gripping mesh can be used safely in type 1 and 2 primary, uncomplicated inguinal hernia with minimal morbidity and most patients under ambulatory setting. The registered incidence of chronic pain is lower than 3%.

Bilateral inguinal hernia repair: laparoscopic or open approach?

BACKGROUND: The aim of this study was to investigate outcomes in the treatment of bilateral inguinal hernia, comparing the laparoscopic totally extraperitoneal (TEP) and open tension-free mesh repair (LICHT) approaches. METHODS: We performed a prospective controlled non randomized clinical study in 128 patients with bilateral inguinal hernia over a period of 3 years. LICHT was used in 106 cases (53 patients) while TEP was employed in 150 cases (75 patients). The main outcome measurements were: recurrence rate, operating time, hospital stay and postoperative complications. RESULTS: There were three recurrences (2.3%): two in the LICHT group (3.8%) and one (1.3%) in the TEP group P = NS. The TEP procedure was faster than LICHT repair (48.8 ± 10.8 vs. 70.4 ± 11.2 min) P < 0.01. Postoperative complications were more frequent in LICHT group (16%) than TEP group (5.3%) P < 0.01. Hospital stay was significantly shorter in the TEP group (0.6 ± 0.8 vs. 1.3 ± 1.2 days) P < 0.001. CONCLUSIONS: The TEP approach is an effective option for the treatment of bilateral inguinal hernia when performed by experienced surgeons.

Tratamiento laparoscópico del cáncer gástrico / Laparoscopic management of gastric cancer

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Preperitoneal repair for recurrent inguinal hernia: laparoscopic and open approach.

BACKGROUND: The aim of this study was to investigate the outcome of preperitoneal repair using laparoscopic (TEP) and open (OPM) approach in recurrent inguinal hernia. METHODS: We performed a prospective controlled nonrandomized clinical study in 188 patients with 207 recurrent inguinal hernias over a period of 5 years. TEP repair was employed for 86 repairs, and OPM was used in 121 procedures. The main outcome measurements were: recurrence rate, operating time, hospital stay, and postoperative complications. RESULTS: There were three recurrences (1.7%). Two in the OPM group (1.8%) and one (1.3%) in the TEP group [ P=NS (not significant)]. The TEP procedure was faster than OPM for unilateral repair (40.8 vs 46.3 min) (P<0.001). Postoperative complications were more frequent in the OPM group (23.9%) than the TEP group (13.9%) ( P=NS). Hospital stay was significantly shorter in the TEP group (1.2 vs 3.9 days) (P<0.001). CONCLUSIONS: Preperitoneal approach (open or laparoscopic) seems to be a good option in recurrent inguinal hernia when these procedures are done by experienced surgeons.

Laparoscopic repair of recurrent hernias.

BACKGROUND: Recurrence after primary conventional inguinal herniorrhaphy occurs in approximately 10% of patients depending on the type of repair and expertise of the surgeon. The repair of the resulting recurrent hernia is a daunting task because of already weakened tissues and obscured and distorted anatomy. The failure rate of these repairs using an open anterior approach may reach as high as 36%. Because of such a high failure rate, a number of investigators have focused on repairing these difficult recurrent hernias laparoscopically using a tension-free approach. Some of the earlier reports suggested a low recurrence rate of 0.5% to 5% when a laparoscopic approach was used to repair these hernias. The purpose of this study was to evaluate the efficacy of laparoscopic treatment for recurrent hernias in our institutions. METHODS: Between February 1991 and February 1995, 96 recurrent hernias were repaired in 85 patients (78 men and 7 women). There were 48 right, 26 left, and 11 bilateral hernias. The mean age of the patients was 59 years (range, 18-86 years); the mean height was 69 in. (range, 54-77 in.); and the mean weight was 176 pounds (range, 109-280 pounds). A total of 68 herniorrhaphies were performed using the transabdominal preperitoneal (TAPP) method: 19 using intraperitoneal on-lay mesh (IPOM) repair and 8 using the total extraperitoneal (TEP) method. The method of repair in one patient was not recorded. The mean operating time was 76 min (range, 47-172 min). Thirteen patients underwent additional procedures. RESULTS: Long-term follow-up was performed by questionnaire, examination, or both in 76 patients (85 hernias). Median follow-up time was 27 months (range, 2-56 months). There were four recurrences (2 in IPOM and 2 in TAPP). Three of these were repaired laparoscopically and one conventionally. There were 20 minor and 14 major complications and no mortality. One conversion occurred in the TAPP group. Mean postoperative stay was 1.4 days (range, 0-4 days). It was felt by 92% of the patients that their symptoms were completely relieved, whereas 4% of the patients continued to exhibit symptoms for which their hernia was repaired, and 3.6% failed to answer. As reported, 86% of the patients preferred their laparoscopic repair; 1% preferred the conventional repair; and 13% failed to reply. Afterward, 77% of the patients returned to normal activity, and 35% returned to vigorous activity within 4 weeks of surgery. Satisfaction with laparoscopic repair was expressed by 92% of the patients, whereas 8% either were dissatisfied or did not answer. In the end, 95% of the patients stated that they would recommend laparoscopic hernia surgery to their family and friends. CONCLUSIONS: These preliminary data show that laparoscopic repair of recurrent inguinal hernia is a safe alternative procedure with acceptable rates of recurrence and complications.

The value of total IgE determination in mite allergy.

Our aim was to study the behaviour of patients with perennial respiratory allergy in relation to total IgE production. We chose patients allergic to house dust mite Dermatophagoides pteronyssinus, because this is the most representative perennial antigen. The total IgE in a wide group of patients was evaluated in relation to diagnosis, clinical activity, and seasonal changes. We also studied the possible changes in relation to immunotherapy. The total IgE was measured through enzyme immunoassay (Kallestad). To compare the results, a Student's test for independent data was performed and a statistically significant difference (p less than 0.001) in the IgE levels was found between the rhinitis and asthma groups with or without associated rhinitis. We did not obtain any differences between the groups in relation to clinical activity or seasonal changes. In relation to the possible changes in IgE levels according to the duration of immunotherapy, we observed a mild elevation before 7 months and between 13 and 24 months of treatment, without any significant differences with respect to basal levels. The determination of total IgE seems to us a valid and necessary test to complete the diagnosis of the existence of a cytotropic hypersensitivity mechanism in respiratory pathology. However, it seems to be less sensitive because it does not detect changes with respect to clinical activity, seasonal changes or duration of immunotherapy when dealing with perennial antigens.

Basophil degranulation test in house dust mite allergy: diagnostic value.

After reviewing the experience of various authors we applied the Basophil Degranulation Test (BDT) in the study of sensitization to Dermatophagoides pteronyssinus, so as to evaluate its diagnostic use. Fifty-five patients with asthma and/or rhinitis and a positive skin test to the mentioned antigen, as well as 20 control subjects were studied. The results demonstrated a sensitivity of 65.5% and a specificity of 80% with an efficiency index of 69.5%. We did not find any significant correlation with the histamine release test (r = 0.236). The data obtained and the proper limitations of the technique led us to consider the BDT to have a limited application in routine allergy diagnosis.

A rare case of food allergy: monosensitivity to kiwi (Actinidia chinensis).

We present a case of hypersensitivity to kiwi in a 26 year-old patient with no previous atopic history. The first reaction episode occurred a few minutes after kiwi ingestion, presenting with a localized pruritic reaction. This symptomatology repeated itself a few months later, again immediately after eating kiwi and was accompanied by dysphagia, vomiting and urticaria. In the complementary laboratory analyses a total IgE of 187 IU/ml was appreciated. The skin test to inhalant and food antigens were negative, while the kiwi extract produced a + + + + reaction. The histamine release test was positive (20%). Specific IgE levels (Kallestad) demonstrated results of 0.35 AEU/ml (class I). Specific IgG4 levels were normal and the hemagglutination test was negative. With the above results, we concluded that we were dealing with a case of monosensitivity to kiwi which was probably IgE mediated.