[Inguinal hernia - review].

Inguinal hernia is the most frequently diagnosed hernia and during their lifetime one third of males are diagnosed with an inguinal hernia. The age distribution is bimodal with the highest incidence in childhood and after 50 years of age. Diagnosis is usually reached through clinical examination of a lump in the inguinal region although some patients can present with intestinal obstruction. Inguinal hernia repair is the only definitive treatment and is one of the most common surgical procedures performed. It is usually performed as an elective procedure in local, spinal or general anasthesia. The repair constitutes of reinforcing the posterior wall of the inguinal canal, often using a polypropylene mesh; either via an open anterior approach or posteriorly from within the abdomen with laparoscopy. The most common complications following a hernia repair are recurrent hernia and chronic -discomfort but recurrence rates have improved with the use of mesh and laparoscopic techniques. This evidence based review describes the -epidemiology and etiology of inguinal hernia together with the most common surgical procedures; focusing on recent innovations.

Is a Technically Challenging Procedure More Likely to Fail? A Prospective Single-Center Study on the Short- and Long-Term Outcomes of Inguinal Hernia Repair.

BACKGROUND AND AIMS: The aim of this prospective single-center study was to evaluate the outcome of inguinal hernia repair. MATERIALS AND METHODS: A total of 485 inguinal hernias (452 patients and 33 patients with bilateral hernias) were operated between January 2004 and December 2010. Mean age was 56 years, and 93% were male. Patient demographics and operative data were collected, and the operating surgeon assessed the technical difficulty of the operation. Five years after surgery, a questionnaire evaluated recurrence and chronic discomfort according to the Cunningham scale. 372 responded (82%), and mean follow-up was 5.5 years. RESULTS: There were 390 repairs for a primary and 62 for a recurrent hernia. Totally extraperitoneal (TEP) operation was most frequently performed (56%), transabdominal preperitoneal (TAPP) operation in 31%, and Lichtenstein and Shouldice in 12% and 2%, respectively. At 5-year follow-up, the primary outcome of chronic discomfort was 19.5%. The independent positive predictors were young age and operation for a recurrent hernia (OR: 3.7), with TEP operation reducing the risk of chronic discomfort (OR: 0.5). The secondary outcome was the recurrence rate of 2.5%. Risk factors were strenuous work (OR: 13.7), technically difficult repairs (OR: 7.2), and chronic discomfort (OR: 6.7). CONCLUSIONS: Every fifth patient had chronic discomfort in long-term follow-up. The recurrence rate was 2.5%, and a technically difficult procedure was a risk factor.

[Incidence, cause and treatment of colonic perforations in Iceland 1998-2007: A nationwide study].

INTRODUCTION: Colon perforation is a serious illness with mortality reported from 0-39%. Surgery used to be the gold standard but treatment has changed as studies have indicated comparable results with less invasive treatment. The aim of this study was to evaluate the incidence of acute colon perforations in Iceland, causes and treatment. MATERIAL AND METHODS: A retrospective, nationwide, multicenter analysis was performed based on ICD-10 codes from databases of the main hospitals in Iceland. Age, gender, year of perforation, cause, means of diagnosis, treatment and outcome were registered. Patients under 18 years and post mortem diagnosis were excluded. RESULTS: 225 patients met criteria, 131 women (58%) and 94 men (42%), median age 70 years (range 30-95). The most common causes were diverticulitis (67%), colonoscopy (12%) and complications during operations (5%). During the first five study years, 27% received conservative treatment while 71% underwent surgery. By the end of the study era this ratio was 45% and 54% respectively. The rate of permanent stoma was 10%. CONCLUSIONS: Diverticulitis was the most common cause of colon perforation in Iceland during the study period. Many patients still undergo surgery but there has been a dramatic change toward more conservative treatment. The rate of stoma closure is comparable to studies elsewhere. 1University Hospital of Iceland, Dept. General Surgery, 2University of Iceland, Faculty of Medicine, 3Akureyri Teaching Hospital, 4Akranes Hospital and Health Care Center, Iceland. Key words: Colon perforation, diverticulitis, Hartmann's reversal. Correspondence: Elsa B. Valsdottir, elsava@landspitali.is.

[Results of cholecystectomies 2003-2010 in a small hospital in Iceland].

AIM: Cholecystectomy is a common procedure in general surgery. The aim of this study was to retrospectivly assess the results of cholecystectomies performed in Akranes Hospital (AH), a small hospital in Iceland. MATERIAL AND METHODS: This retrospective study included all patients that underwent a cholecystectomy in AH from 1 January 2003 to 31 December 2010. Patient records were reviewed from AH, as well as from Landspitali University Hospital and Domus Medica. RESULTS: 378 operations were performed. 74% of the patients were women and the mean age was 49.6 years. The majority of operations were elective (87%) and the median operative time was 46 minutes (range: 17-240). The median length of stay was 2 days (range: 1-31). Intra-operative cholangiography (IOC) was performed in 93 of 378 patients (25%). Endoscopic retrograde cholangiopancreatography, ERCP, was performed consecutively in 22 of those 93 patients (23%). The conversion rate to open surgery was 0.5%. The rate of serious complications was 2.4% of which four (1.1%) patients had a deep infection and 5 (1.3%) had a bile leakage postoperatively. Patients with cholecystitis had an increased risk of serious complications (p=0.007). Reoperation was performed on three patients who had bile leakage. No patient had a serious bile duct injury and mortality was 0%. 254 (67%) patients had 4 week control postoperatively where 13 patients (5%) had mild gastrointestinal symptoms. CONCLUSION: The results of cholecystectomies in AH are very good and comparable to the results of national and international studies. Key words: laparoscopic cholecystectomy, intra-operative cholangiography, choledocholithiasis, endoscopic retrograde cholangiopancreatography, complications. Correspondence: Marta Ros Berndsen, mrberndsen3@gmail.com.

Discomfort five years after laparoscopic and Shouldice inguinal hernia repair: a randomised trial with 867 patients. A report from the SMIL study group.

BACKGROUND: In recent years long-term discomfort after inguinal hernia surgery has become an issue of great concern to hernia surgeons. Long-term results on discomfort from large randomised studies are sparse. METHODS: One-thousand one-hundred and eighty-three patients were randomised in a multicentre trial with the primary aim of comparing recurrence rates after laparoscopic TAPP and Shouldice repair. Evaluating late discomfort and its possible risk factors were secondary objectives, and are reported here. The patients were clinically examined after 1 and 5 years, and answered questionnaires 2 and 3 years postoperation. RESULTS: Of 1,068 operated patients, 867 were eligible for analysis after 5 years (81.2%). The percentage of patients experiencing discomfort of any kind were 8.5% in the TAPP group and 11.4% (p = 0.156) in the Shouldice group. Although discomfort was usually mild it was severe for 0.2 and 0.7%, respectively. Severe pain the first postoperative week was a risk factor for late discomfort in the Shouldice group (OR 2.25, P = 0.022) but not in the TAPP group. No other risk factor for late discomfort was found. CONCLUSION: There was no difference between late discomfort at five-year follow-up after laparoscopic TAPP and Shouldice repair. Discomfort was mostly mild and pain during the first postoperative week was a prognostic variable for late discomfort in Shouldice patients.