Magnetic resonance imaging has no role in diagnosing the origin of pain in patients with overwhelmingly painful inguinal hernia.

PURPOSE: Clinical tools for predicting postoperative pain should be developed to provide better care for patients. The aims of this study were to evaluate preoperative magnetic resonance imaging (MRI) findings to reveal reasons for overwhelming pain in patients with inguinal hernia and to detect changes in quality-of-life (QoL) and pain scores preoperatively and following laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia. METHODS: Twenty-two patients aged 18-50 years presenting with extremely painful inguinal hernias (highest pain scores >50, scale 0-100) were examined with MRI prior to operative treatment with TEP repair. Postoperative follow-up lasted 6 months and consisted of questionnaires regarding functional status, pain, QoL and possible complications. Postoperative MRI scans were performed only in cases of preoperative findings on the MRI or prolonged inguinal pain persisting over 6 months. RESULTS: Prolonged postoperative pain could not be predicted from preoperative MRI scans, because no signs of the pain's origin such as pubic periostal irritation, bone marrow edema, pelvic bone or hip joint abnormalities, or lower abdominal muscle hemorrhage were detected in MRI. TEP repair of inguinal hernia significantly improved the patients' quality of life and relieved pain symptoms. High preoperative pain scores were major predictors of prolonged postoperative pain. CONCLUSIONS: Carefully evaluated preoperative pelvic MRI was usually normal in patients with high pain scores prior to operation. Preoperative pain scores may serve as indicators of development of prolonged inguinal pain.

Long-term follow-up of a randomized clinical trial of open versus laparoscopic appendicectomy.

BACKGROUND: The aim of this study was to assess long-term outcome following open versus laparoscopic appendicectomy. METHODS: A total of 105 patients with suspected acute appendicitis were randomized to LA (51) or OA (54) between 1997 and 1999 at one hospital. Perioperative factors and follow-up data from the outpatient clinic were recorded. Information about symptoms and overall satisfaction was obtained by telephone interview. In addition, appendicectomy data for 2008 were analysed retrospectively for comparison in a contemporary setting. RESULTS: Data from 52 patients who had OA and 47 who had LA were analysed. OA was performed mostly by trainees, but LA was more likely to be undertaken by a consultant. The open procedure was quicker than the laparoscopic operation in the trial period (median 38 versus 65 min respectively; P < 0.001), but the difference was only 10 min in 2008. The OA group returned to work later than the LA group (median 13 versus 8 days; P = 0.013) and had more complications (22 versus 6; P = 0.014). Only one patient (OA) had a reoperation, owing to abdominal adhesions. Among 76 patients available for telephone interview, satisfaction scores were marginally higher for LA than OA. CONCLUSION: LA has some advantages compared with an open approach. REGISTRATION NUMBER: NCT00908804 (http://www.clinicaltrials.gov).