Effect of transversus abdominis plane block with or without buprenorphine after inguinal hernia surgery on postoperative pain.

INTRODUCTION: Transversus abdominis plane (TAP) has been mentioned as having bene-ficial effects on chronic pain after hernioplasty. This study assessed the effects of TAP block on acute and persistent postoperative pain after inguinal hernia surgery, with or without buprenorphine. MATERIAL AND METHODS: 64 patients were allocated to group R ( n = 32) and received 20 mL of 0.25% ropivacaine for TAP block; group RB ( n = 32) received 20 mL of 0.25% ropivacaine containing 300 µg of buprenorphine for TAP block. The primary outcome was the analgesic and antihyperalgesic effect of buprenorphine. The duration of analgesia, analgesic consumption, postoperative pain scores at rest and sitting up to 48 hours, and the effect on wound hyperalgesia were evaluated. Secondary outcomes included the incidence of side effects and complications. RESULTS: The median (IQR) duration of analgesia in group R was 386.5 (37.25) minutes vs. 868 (41.3) minutes in the RB group. Median pain scores on sitting were found to be significantly better in group RB than in group R at 6, 12, and 24 hours ( P < 0.001). The wound hyperalgesia index showed a significant difference between groups ( P < 0.001). The incidence of persistent postoperative pain was 6.25% in the R group, as compared to 0% in the RB group. Otherwise, the patients did not have any further complications associated with the block. CONCLUSIONS: The results demonstrated that TAP block with buprenorphine reduced acute postoperative pain severity, but we did not find a difference between groups in persistent pain.

Severe wound infection by MRCNS following bilateral inguinal herniorrhaphy.

BACKGROUND: Wound infection after inguinal hernia surgery is not uncommon in the clinical setting. The common microbial aetiology of postoperative inguinal hernia wound infection is Gram-positive bacteria. Staphylococcus aureus is a common pathogen causing wound infection while Staphylococcus epidermidis and Pseudomonas are rare. Staphylococcus epidermidis as a cause of severe wound infection is rarely described in literature. We herein present a case of a 79-year-old man with a rare wound infection after bilateral inguinal herniorrhaphy caused by MRCNS (Methicillin Resistant Coagulase Negative Staphylococcus). CASE PRESENTATION: We present a case of wound infection accompanied by fever with a temperature of 38.8 °C after bilateral inguinal herniorrhaphy in a 79-year-old man. Bilateral inguinal wounds were marked by redness and swelling, with skin necrosis. In addition, an abscess of approximately 1.5 cm × 1.5 cm was seen on the left wrist. A small amount of gas under the skin in the wound area was observed after pelvic computed tomography (CT) scans. No bacteria were cultured from the inguinal wound discharge, while blood culture detected MRCNS, and Acinetobacter lwoffi was cultured from the pus in the left wrist. We chose appropriate antibiotics based on the results of the bacterial culture and the drug susceptibility results. Vacuum assisted closure (VAC) therapy was used after debridement. The patient was discharged after the wounds improved. He was followed up for ten months and showed no signs of complications. We are sharing our experience along with literature review. CONCLUSIONS: We are presenting a rare case of MRCNS wound infection following open inguinal hernia surgery. Although a rarity, clinicians performing inguinal hernia surgery must consider this entity in an infected wound and follow up the patient for complications of MRCNS.

The risk of venous thromboembolism after minor surgical procedures: A population-based case-control study.

BACKGROUND: Surgery is a well-known risk factor for venous thromboembolism (VTE). However, for several minor surgical procedures, thromboprophylaxis is not advised. OBJECTIVES: These "low-risk" procedures include a wide variation of interventions for which we estimated the VTE risk to verify their "low-risk" status. PATIENTS/METHODS: We used data from a large population-based case-control study (Multiple Environment and Genetic Assessment study) into causes of VTE, and linked these to the Dutch Hospital Data Registry to identify exposure to surgical procedures. Logistic regression was used to calculate odds ratios for the 90-day and 1-year relative risks of VTE following these procedures, which were adjusted for body mass index (BMI), sex, age, comorbidities, and infection/inflammation. RESULTS: We included 4247 patients with VTE and 5538 control subjects. Median age and BMI were 48.5 years and 25.5 m2/kg, respectively. Nine unique procedures or groups of procedures were analyzed. One hundred twenty-three participants-90 cases and 33 controls-had undergone a minor procedure within 90 days of the index date, resulting in a 3.5-fold (OR, 3.5; 95% CI, 2.3-5.3) overall increased VTE risk. Furthermore, venous stripping (OR, 7.2; 95% CI, 2.4-21.2), open abdominal/inguinal hernia repair (OR, 3.7; 95% CI, 1.2-11.6), and laparoscopic cholecystectomy (OR, 3.2; 95% CI, 1.0-10.6) were associated with an increased risk. Other minor procedures were less strongly or not associated with an increased risk. In the 1-year period before the index date, all odds ratios were lower. CONCLUSION: Of the "low-risk" procedures, we found that venous stripping, open abdominal/inguinal hernia repair, and laparoscopic cholecystectomy were associated with a clearly increased risk of VTE within 90 postoperative days.

The efficacy of ultrasound-guided triple nerve block (ilioinguinal, iliohypogastric, and genitofemoral) versus unilateral subarachnoid block for inguinal hernia surgery in adults: a randomized controlled trial.

INTRODUCTION: The present study was carried out to evaluate the efficacy of ultrasound-guided triple nerve block (ilioinguinal, iliohypogastric, and genitofemoral) versus unilateral subarachnoid block for adult male patients undergoing unilateral inguinal hernia surgery. MATERIAL AND METHODS: Sixty ASA I-III adult male patients > 18 years old, scheduled for unilateral inguinal hernia surgery were randomly allocated into 2 groups of 30 patients each. In Group A ( n = 30) the patients received ultrasound-guided nerve block (ilioinguinal, iliohypogastric, and genitofemoral), and in Group B ( n = 30) the patients received unilateral subarachnoid block. The primary outcome was to assess postoperative analgesic efficacy (visual analogue scale [VAS] scores at rest and during coughing/ambulation). The secondary outcomes were time to first rescue analgesia with morphine, the total dose of morphine used as rescue analgesia, urinary retention, time to first micturition, time to first unassisted walking, and time to discharge from the surgical recovery room. RESULTS: The mean pain scores at 1, 2, 4, and 6 hours during rest and during coughing/ambulation were significantly lower in Group A when compared to patients in Group B ( P < 0.001). There was no requirement for rescue analgesic opioids in Group A ( P < 0.001). Mean time to first micturition and mobilization occurred earlier in Group A, leading to early discharge from the recovery room ( P < 0.001). No major side effects were observed in any of the study groups. CONCLUSIONS: Ultrasound-guided triple nerve block technique can be used as a sole anaesthetic technique for inguinal hernia surgery because it not only provides optimal anaesthesia intra-operatively but also has a favourable analgesic and opioid-sparing efficacy in the early postoperative period with minimal adverse effects.

Preoperative treatment with botulinum toxin A: a tool for giant groin hernia repair? Case report.

<b>Introduction:</b> Giant groin hernia is an unusual disease nowadays and its management can be a challenge for surgeons. The application of botulinum toxin A as a preoperative therapy could decrease the thickness of the lateral wall muscles, increase their length and increase the volume of the abdominal cavity facilitating the surgical repair. Morbidity and mortality due to high intra-abdominal pressure would decrease, allowing a minimal tension closure after reduction of the herniated viscera. <br><b>Case report:</b> We present the repair of two cases of massive inguinal hernia with loss of domain using preoperative abdominal wall injection of botulinum toxin.

Comparison of spinal anaesthesia versus ilioinguinal-iliohypogastric nerve block applied with tumescent anaesthesia for single-sided inguinal hernia.

BACKGROUND & AIMS: Primary aim of this study is to determine whether the use of local anaesthesia performed with IINB and IHNB against spinal anaesthesia in inguinal hernia repair is accepted as an alternative medicine. METHODS: 75 cases in the class of American Society of Anesthesia physical status (ASA) I-III between the ages of 18 and 75 diagnosed with single-sided inguinal hernia and hospitalized for surgery in general surgery clinic were prospectively and randomly included in this study. RESULTS: There was statistically significant difference between the groups (30.14 ± 8.2 and 35.51 ± 9.39) in terms of the duration of the surgery. The duration was shorter in Group 1 (p < 0.001). There was statistically significant difference between the groups in terms of the duration of the first mobilization. It was significantly shorter in Group 2 than in Group 1 (5.71 ± 1.7 and 2.70 ± 1.53 min) (p < 0.001). Mean duration of length of hospital stay criteria was significantly shorter in Group 2 than in Group 1 (26.00 ± 6.43 and 14.23 ± 5.40 h) (p < 0.001). Throughout the follow-up period in postoperative 24 h, the number of patients who needed analgesia was significantly higher in Group 1 than in Group 2 (91.4% and 45.7%) There was statistically significant difference between the groups in terms of patient satisfaction and urinary retention development (p < 0.005). Hematoma development or postoperative bleeding was not observed in either group. The time of sensory block onset was significantly higher in Group 2 than in Group 1 (9.66 ± 1.41 and 9.03 ± 0.98 min) (p < 0.005) CONCLUSION: The results of our study show that IINB and IHNB applied with local anaesthesia are superior to spinal anaesthesia in unilateral inguinal hernia repairs.

The transversus abdominis plane block reduces the cumulative need of analgesic medication following inguinal hernia repair in TAPP technique: a retrospective single center analysis among 838 patients.

PURPOSE: Laparoscopic inguinal hernia repair (IHR) may lead to early postoperative pain. Therefore, opioid and non-opioid analgesic agents are often administered in the post-anesthesia care unit (PACU). To reduce the postoperative cumulative need of analgesic medication, as well as to accelerate the physical recovery time, the transversus abdominis plane (TAP) block has recently been studied. The TAP block is a regional anesthesia technique. Even though there is evidence about the efficacy of the block used in procedure such as an open inguinal hernia repair, the evidence regarding its use for the TAPP (transabdominal preperitoneal) technique remains low. We aim to provide more sufficient evidence regarding this topic. METHODS: A monocentric retrospective observational study investigating the effect of the TAP block prior to primary IHR in TAPP technique was conducted. The data of 838 patients who were operated on using this technique from June 2007 to February 2019 were observed. 72 patients were excluded because of insufficient information regarding their analgesic medication protocol. The patients' data were taken from their files. RESULTS: The patients in the TAP block group (n = 364) did not differ statistically significantly compared to the control group (n = 402) in terms of gender, BMI and age. Individuals of the TAP block group experienced less postoperative pain in the PACU (p < 0.001) and received less analgesic medication (morphine, oxycodone, piritramide, acetaminophen; p < 0.001). CONCLUSION: We assume that the TAP block is a sufficient approach to reduce postoperative pain and analgesic medication administration for IHR in TAPP technique.

Well-Defined Gold Nanorod/Polymer Hybrid Coating with Inherent Antifouling and Photothermal Bactericidal Properties for Treating an Infected Hernia.

Biomedical device-associated infection (BAI) is a great challenge in modern clinical medicine. Therefore, developing efficient antibacterial materials is significantly important and meaningful for the improvement of medical treatment and people's health. In the present work, we developed a strategy of surface functionalization for multifunctional antibacterial applications. A functionalized polyurethane (PU, a widely used biomedical material for hernia repairing) surface (PU-Au-PEG) with inherent antifouling and photothermal bactericidal properties was readily prepared based on a near-infrared (NIR)-responsive organic/inorganic hybrid coating which consists of gold nanorods (Au NRs) and polyethylene glycol (PEG). The PU-Au-PEG showed a high efficiency to resist adhesion of bacteria and exhibited effective photothermal bactericidal properties under 808 nm NIR irradiation, especially against multidrug-resistant bacteria. Furthermore, the PU-Au-PEG could inhibit biofilm formation long term. The biocompatibility of PU-Au-PEG was also proved by cytotoxicity and hemolysis tests. The in vivo photothermal antibacterial properties were first verified by a subcutaneous implantation animal model. Then, the anti-infection performance in a clinical scenario was studied with an infected hernia model. The results of animal experiment studies demonstrated excellent in vivo anti-infection performances of PU-Au-PEG. The present work provides a facile and promising approach to develop multifunctional biomedical devices.

Vasitis: a rare diagnosis mimicking inguinal hernia: a case report.

BACKGROUND: Vasitis or inflammation of the vas deferens is a rare condition, and few case reports with computed tomography images have been published since 1980. CASE PRESENTATION: A 50-year-old man presented with severe right inguinal and lower abdominal pain. Initial diagnosis at the emergency department was incarcerated or strangulated inguinal hernia. The computed tomography scan revealed diffuse edematous changes of right spermatic cord and vas deferens with peripheral fat stranding. Correlating with his clinical symptoms, signs, and imaging findings, the diagnosis of vasitis was made. We report a case of acute vasitis about the cause, symptom, pathogen, differential diagnoses, image findings, and treatment. CONCLUSION: Although very rare, vasitis should be listed as one of the differential diagnosis for inguinal mass lesions. Cross-sectional imaging may be necessary to confirm the diagnosis and exclude differentials such as an inguinal hernia. Recognition of the characteristic image findings can help to make the correct diagnosis and avoid unnecessary surgery.

Perioperative Gabapentin Improves Patient-Centered Outcomes After Inguinal Hernia Repair.

INTRODUCTION: Over 5,300 inguinal hernia repairs (IHR) were performed in the Military Health System in 2015. Chronic pain can be a debilitating complication, occurring in up to 34% of patients after IHR and impacts mission readiness. Gabapentin has been shown to be effective for postoperative analgesia in a variety of operations. We evaluated the effect of a short course of perioperative gabapentin on chronic pain after IHR. METHODS: This was a double-blinded, randomized study involving male patients ≥18 years old with an initial inguinal hernia and no history of chronic pain or psychiatric disorder. Patients chose laparoscopic or open surgery and were then randomized to receive gabapentin 300 mg before surgery, then three times daily for 6 doses or placebo. There were 50 patients randomized to both the gabapentin and placebo groups for a total of 100 patients. Main outcomes were pain and health status, assessed with a visual analogue scale (VAS) and the Short Form-12v2 (SF-12v2). Assessments were performed preoperatively and 1, 6, 12, and 24 months postoperatively. Analysis of variance was used to compare groups. RESULTS: From the initial 100 patients, 19 withdrew or were excluded. Thus, 81 patients remained, 40 receiving gabapentin and 41 placebo. Throughout the 24-month follow-up, there was no difference in VAS pain scores between the gabapentin and placebo groups (p = 0.867). Beyond 1 month of follow-up, SF-12v2 physical component score (PCS) scores were improved in the gabapentin group (p = 0.039). When comparing open to laparoscopic groups, SF-12v2 PCS scores were improved in the laparoscopic group (p = 0.046) and SF-12v2 mental component summary scores were improved in the open group (p = 0.041). CONCLUSIONS: Perioperative gabapentin was not effective in decreasing chronic pain after IHR; however, patient perception of physical health, as measured by SF-12v2, did improve.

Bloqueo de la fascia transversalis versus bloqueo plano transverso del abdomen anterior ecoguiados en cirugía ambulatoria de hernia inguinal / Ultrasound-guided transversalis fascia plane block versus anterior transversus abdominis plane block in outpatient inguinal hernia repair

Introducción. El objetivo del estudio fue valorar la eficacia del bloqueo de la fascia transversalis (TFP) guiado por ultrasonografía en comparación con el bloqueo del plano transverso del abdomen (TAP anterior) para analgesia postoperatoria en pacientes programados para cirugía ambulatoria unilateral de hernia inguinal. Material y métodos. Estudio observacional de naturaleza retrospectiva en pacientes ASA I-II. Se establecieron 2 grupos (TAP-A y TFP), a los que se les administró 30ml de levobupivacaína 0,25% previamente a la incisión quirúrgica. La variable principal evaluada fue el dolor postoperatorio mediante la escala verbal numérica (EVN), en reposo y movimiento, a los 10, 30, 60, 90 min coincidiendo con la deambulación y a las 24 h mediante llamada telefónica. También se evaluó el nivel sensitivo de bloqueo alcanzado previamente a la cirugía, las necesidades de analgesia adicional requeridas, los efectos secundarios, la facilidad de realización de la técnica y el grado de satisfación de los pacientes con la técnica anestésica-analgésica. Resultados. Se incluyó a 61 pacientes: 30 pacientes en el grupo TAP-A y 31 en el grupo TFP. La eficacia analgésica obtenida en ambos grupos fue similar, aunque encontramos unos valores más altos de EVN en movimiento en el grupo TAP-A, que alcanzó la diferencia estadística a los 10 min (p=0,014) y 30 min (p=0,013) del postoperatorio. En el grupo TFP se alcanzó un nivel de bloqueo sensitivo más alto que en el grupo TAP-A (p<0,01). No hubo diferencias significativas en los requerimientos de analgesia adicional; la dosis acumulada de cloruro mórfico fue similar en ambos grupos en el periodo postoperatorio. Tampoco hubo diferencias en efectos secundarios ni en complicaciones. La facilidad técnica de realización del bloqueo fue similar en ambos grupos y el grado de satisfación de los pacientes, muy elevado. Conclusiones. Ambos bloqueos dentro de una estrategia multimodal proporcionan buena analgesia postoperatoria para cirugía de hernia inguinal, son fáciles de realizar y presentan escasas complicaciones. El TFP alcanza un nivel sensitivo más alto, pero no existen diferencias en los requerimientos de analgesia adicional (AU)

Introduction. The aim of the study was to assess the effectiveness of ultrasound-guided transversalis fascia plane block (TFP) compared to anterior transversus abdominis plane block (TAP-A) for post-operative analgesia in outpatient unilateral inguinal hernia repair. Materials and methods. Retrospective observational study conducted on ASA I-II patients. Two groups (TAP-A and TFP), which were given 30ml of 0.25% levobupivacaine prior to surgical incision. The primary endpoint was the post-operative pain evaluated by verbal numerical scale (VRN at rest and movement) at 10, 30, 60, 90min, coinciding with ambulation, and 24hours by telephone. An evaluation was also made of the sensory block level reached prior to surgery, the need for additional analgesia, side effects, ease of performing the technique, and the level of satisfaction of patients with the anaesthetic-analgesic technique. Results. A total of 61 patients were included, 30 patients in the TAP-A group and 31 in the TFP group. The analgesic efficacy obtained in both groups was similar, although some higher values were found in the VNR on moving in the TAP-A group, reaching statistical difference at 10minutes (P=.014) and 30minutes (P=.013) post-operatively. A higher level of sensory block was achieved in the TFP group than in the TAP-A group (P<.01). There were no significant differences in additional analgesia requirements, and the cumulative dose of morphine was similar in both groups in the post-operative period. There were no differences in side effects or complications. The technical ease of the block was similar in both groups and the level of satisfaction of patients very high. Conclusions. Both blocks with a multimodal approach achieve good post-operative analgesia of inguinal hernia repair, are easy to perform and have few complications. TFP achieves the highest sensory level, but there are no differences in the requirements for additional analgesia (AU)

Characterization of the Affective Component of Acute Postoperative Pain Associated with a Novel Rat Model of Inguinal Hernia Repair Pain.

AIMS: Acute postoperative pain remains a significant healthcare issue. Historically, the assessment of postoperative pain in rodents has relied on evoked withdrawal or reflexive measures. Using a recently developed, anatomically relevant rat model of acute postoperative pain (J Pain, 16, 2015, 421), the present experiments sought to investigate the affective component of acute postoperative pain associated with inguinal hernia repair. METHODS: Male Lister hooded rats underwent surgery to model Lichtenstein inguinal hernia repair (without hernia induction), or a sham procedure. Postsurgical characterization involved a modified place escape/avoidance paradigm (mPEAP), as well as home cage and open field locomotor activity monitoring. In pharmacological validation studies, rats received either morphine or carprofen prior to mPEAP testing. RESULTS: Surgery was associated with a significantly increased proportion of the trial duration in the light compartment of the mPEAP arena, in avoidance of the noxious stimulus, compared with sham animals. When retested in the mPEAP at day 7 postsurgery, there was no difference between sham and surgery animals for time spent in either compartment, but surgery animals displayed a persistent increase in the percentage response to noxious stimulation. Morphine and carprofen treatment in surgery animals reduced escape/avoidance behavior at discrete time points over the trial. Surgery-induced reductions in home cage and open field locomotor activity were also observed. CONCLUSION: The present studies report for the first time the characterization of the affective component of acute postoperative pain using the mPEAP in a rodent model, which may facilitate development of improved understanding and treatment of postoperative pain.

Anestesia subaracnoidea y anestesia general en el tratamiento quirúrgico de la hernia inguinal en pacientes ambulatorios. Análisis comparativo de coste-efectividad / Spinal anesthesia versus general anesthesia in the surgical treatment of inguinal hernia. Cost-effectiveness analysis

Objetivo. Comparar los costes variables en relación con la efectividad clínica de la utilización de anestesia general frente a anestesia subaracnoidea en la cirugía ambulatoria de la hernia inguinal. Material y métodos. Estudio observacional, de cohortes, retrospectivo, con medición y análisis del coste-efectividad, realizado en una unidad de cirugía ambulatoria de un hospital general entre enero de 2010 y diciembre de 2011. Se incluyeron pacientes mayores de 18 años con tratamiento quirúrgico de la hernia inguinal primaria unilateral. Los tiempos de inducción anestésica y permanencia en quirófano y en unidad de recuperación postanestésica, la efectividad anestésica (incidencia de efectos adversos y el grado de bienestar del paciente) y los costes variables asociados al consumo de fármacos y utilización de recursos humanos fueron comparados. Resultados. Se incluyeron 218 pacientes, el 87,2% hombres, con una edad media de 53 años (rango 18 a 85 años). Ciento treinta y nueve (63,76%) pacientes recibieron anestesia subaracnoidea, y 79 (36,2%), anestesia general. La permanencia en recuperación postanestésica fue de 337,6 ± 160,2 min en el grupo de anestesia subaracnoidea y de 210,0 ± 97,5 min para el grupo de anestesia general (p < 0,001). Los costes de los fármacos para anestesia general fueron mayores que para subaracnoidea (86,2 ± 8,3 frente a 18,7 ± 7,2). La diferencia del coste total entre ambas técnicas fue de 115,8 Euros, mayor para el grupo de anestesia subaracnoidea (p < 0,001). Conclusiones. La anestesia subaracnoidea y la general muestran una efectividad similar, pero los costes globales para la primera son mayores que para la segunda. La relación coste-efectividad es más favorable para la anestesia general que para la subaracnoidea en hernioplastia ambulatoria (AU)

Objective. To compare the costs related to the clinical effectiveness of general anesthesia versus spinal anesthesia in inguinal hernioplasty ambulatory surgery. Material and methods. An observational, retrospective cohort study measurement and analysis of cost-effectiveness, in the ambulatory surgery unit of a general hospital. All patients over 18 years of age diagnosed with primary inguinal hernia and scheduled for unilateral hernioplasty between January 2010 and December 2011 were included. Duration of anesthetic induction, length of stay in both the operating room, and in the post-anesthesia care unit, the anesthetic effectiveness (the incidence of adverse effects and the patient's comfort level), and variable economic costs associated with the use of drugs, as well as the use of human resources, were compared. Results. The final analysis included 218 patients, 87.2% male, with a mean age of 53 years (range: 18-85 years). Of these, 139 (63.76%) received subarachnoid anesthesia and 79,(36.2%) general anesthesia. The length of time a patient remained in the post-anesthesia care unit was 337.6 ± 160.2 min in the subarachnoid anesthesia group, and 210.0 ± 97.5 min for the general anesthesia group (P < .001). Costs of drugs for general anesthesia were higher than that for subarachnoid anesthesia (86.2 ± 8.3 vs. 18.7 ± 7.2). The total cost difference between the 2 techniques was Euros 115.8 more for subarachnoid anesthesia (P < .001). Conclusions. Both techniques showed similar effectiveness. The overall costs for subarachnoid anesthesia were greater than for the general. The cost-effectiveness of general anesthesia is better for outpatient inguinal hernia repair surgery (AU)

Estudio epidemiológico multicéntrico de las técnicas anestésicas en la cirugía de la hernia inguinal en España / Multicentre epidemiological study of anaesthetic techniques in inguinal hernia surgery in Spain

Objetivo: Recientemente se ha producido renovado interés sobre la técnica anestésica en la cirugía de la hernia inguinal y las ventajas y los inconvenientes derivados de las diferentes técnicas anestésicas. En nuestro país no hay información acerca de la la técnica anestésica en la hernioplastia. Nuestro objetivo es realizar un estudio epidemiológico sobre las técnicas anestésicas en la cirugía de la hernia inguinal. Pacientes y métodos: Estudio epidemiológico transversal, descriptivo y multicéntrico en 20 hospitales de España. Cada centro incluyó a 12 pacientes sometidos a herniorrafia y registró datos sociodemográficos, antecedentes patológicos, técnica realizada, parámetros de recuperación y complicaciones. Resultados: Se incluyó a 238 pacientes (el 91% ASA I-II), con una media de edad de 57 (25-84) años, 213 varones y 25 mujeres. El régimen de hospitalización fue: cirugía ambulatoria un 47%, corta estancia un 26% y el resto con ingreso. Se realizó anestesia subaracnoidea en un 60%, anestesia general en un 27% y anestesia local con sedación, habitualmente benzodiacepinas, en un 13% de los casos. El alta de los pacientes intervenidos en régimen de cirugía ambulatoria fue entre 1 y 6 h en el 94 y el 100% de los casos de anestesia general y anestesia local respectivamente, frente a un 68% para la anestesia subaracnoidea. No hubo diferencias en las características del dolor, náuseas y vómitos entre las técnicas anestésicas; sin embargo, hubo 10 episodios de retención urinaria, todos ellos en el grupo de anestesia subaracnoidea, en pacientes varones y con una edad media de 68 años. Conclusiones: La anestesia subaracnoidea es la más utilizada en España para la herniorrafia, y se asocia con una elevada incidencia de retención urinaria y retraso en el alta hospitalaria (> 6 h en un 32% de los casos) en comparación con la anestesia local. Esta debería ser promovida activamente en nuestro país(AU)

No disponible

Cefalea postpunción dural tras herniotomía inguinal pediátrica / No disponible

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Fibrin sealant in inguinal hernioplasty: an observational multicentre study in 1,201 patients.

PURPOSE: A prospective, multicentre, observational study was undertaken to assess Tisseel fibrin sealant for atraumatic mesh fixation in inguinal hernia repair throughout France. METHODS: Surgeons recorded data on patients undergoing tension-free inguinal hernioplasty with mesh fixation with Tisseel, regardless of the hernioplasty technique used. Assessments were made at 2 days and 1 month after surgery. Data on local complications, operation times and ease of product use were collected. RESULTS: In total, 1,201 patients were recruited (90% men, mean age 57 years), among which 526 procedures were performed using open techniques and 675 using laparoscopic repairs. Local complications occurred in 4.7% of patients: 3.0% haematoma, 1.4% seroma, 0.3% recurrence. The mean visual analogue scale (VAS)-rated pain scores were 3.2 pre-operatively, 2.3 immediately after surgery and 1.8 at 1 month. Surgeons rated the product as very easy to use. CONCLUSIONS: Tisseel fibrin sealant appears to be a well-tolerated and easy-to-use alternative to traditional, tissue-penetrating devices for mesh fixation in hernia repair techniques.

[A case of ascending colon carcinoma metastasized to an inguinal hernia sac].

While inguinal hernia is one of the most common diseases, metastatic cancer of an inguinal hernia sac is rare. We report a case of ascending colon cancer metastasized to an inguinal hernia sac. A 60-year-old man, who was undergone a right hemicolectomy for an ascending colon cancer, was pointed out a palpable inguinal mass at one year and eight months after the operation. He was diagnosed as inguinal hernia, and herniorrhaphy was performed. In the operation, a tumor of the inguinal hernia sac, which invaded to spermatic cord, could be found and was removed with right testis. Bassini's method was performed after the resection of the inguinal tumor. Histological examination revealed that the tumor was metastasis of colon carcinoma. Examination of the entire body showed no other metastasis. As for the advanced colon cancer, we need to mention the possibility of metastatic saccular tumor.

Paravertebral blocks provide superior same-day recovery over general anesthesia for patients undergoing inguinal hernia repair.

Inguinal herniorrhaphy is commonly performed on an outpatient basis under nerve blocks or local or general anesthesia (GA). Our hypothesis is that use of paravertebral blocks (PVB) as the sole anesthetic technique will result in shorter time to achieve home readiness and improved same-day recovery over a 'fast-track' GA. Fifty patients were randomly assigned to receive either PVB or GA under standardized protocols (PVB = 0.75% ropivacaine, followed by propofol sedation; GA = dolasetron 12.5 mg, propofol induction, rocuronium, endotracheal intubation; desflurane; bupivacaine 0.25% for field block). Eligibility for postanesthetic care unit (PACU) bypass and data on time-to-postoperative pain, ambulation, home readiness, and incidence of adverse events were collected. More patients in the PVB group (71%) met the criteria to bypass the postanesthetic care unit compared with patients in the GA group (8%; P < 0.001). Only 3 (13%) of patients in the PVB group requested treatment for pain while in the hospital, compared with 12 (50%) patients in the GA group, despite infiltration with local anesthetic (P = 0.005). Patients in the PVB group were able to ambulate earlier (102 +/- 55 minutes) than those in the GA group (213 +/- 108 minutes; P < 0.001). Time-to-home readiness and discharge times were shorter for patients in the PVB group (156 +/- 60 and 253 +/- 37 minutes) compared with those in the GA group (203 +/- 91 and 218 +/- 93 minutes) (P < 0.001). Adverse events (e.g., nausea, vomiting, sore throat) and pain requiring treatment in the first 24 hours occurred less frequently in patients who had received PVB than in those who had received GA. In outpatients undergoing inguinal herniorrhaphy, PVB resulted in faster time to home readiness and was associated with fewer adverse events and better analgesia before discharge than GA.

Could inguinal hernia be treated medically?

Inguinal hernia is the most common congenital anomaly requiring surgical correction. The cause of the hernia is, most commonly, persistence of the processus vaginalis. Study of testicular descent in rodents has revealed a role for the genitofemoral nerve and calcitonin gene-related peptide (CGRP). Since the testis cannot descend without the processus vaginalis, we wondered whether both descent and hernia closure might be regulated by the same mechanism. Therefore, we tested the idea that CGRP might be active in closure of the inguinal hernia. Using hernial sacs removed at herniotomy operation, fusion of the hernial surfaces was induced by CGRP, but not by CGRP 8-37, CGRP 27-37 or dihydrotestosterone. Hepatocyte growth factor also caused peritoneal obliteration in vitro. We propose that obliteration of the processus vaginalis is under the control of molecules released from the genitofemoral nerve, and that a chemical treatment of inguinal hernia is at least theoretically possible.