Comparative study of the immediate postoperative pain for the classical versus laparoscopic types of surgery within the treatement of inguinal hernias.

BACKGROUND: The inguinal hernia is the protrusion of intra-abdominal contents through a defect of the abdominal wall. This content can be represented by omentum, most frequently intestine. Theoretically, any intraperitoneal organ can be located in the hernia sac.The inguinal hernia is distinguished by several features: it is the most common form of hernia, it can occur in any age category, the only treatment is the surgical treatment, in the absence of the treatment, severe complications can endanger the patient's life.The treatment of hernias consists either in the use of a classical ("open") surgical procedure or of a laparoscopic procedure. The objective of both procedures is to remove and treat the hernia sac and repair the defect that appeared in the posterior wall of the groin canal. OBJECTIVES: The purpose of this study is to compare the effectiveness of the two surgery types, considering the immediate postoperative pain. METHODS: This paper is a prospective study conducted between September 2019 and February 2020, including a number of 80 patients admitted in the Department of General Surgery I and II, Emergency Clinical County Hospital of Târgu Mureș. In the study were included patients with uncomplicated inguinal hernia for which a classical or laparoscopic procedure was performed. Patients with complicated inguinal hernia (strangulation, incarceration) and patients with associated comorbidities (neoplasms, autoimmune diseases, neurological disorders) were excluded. For the study group were taken into consideration: demographic data (age, gender), type of surgery and the pain assessment using the VAS scale. RESULTS: Following the study, it was statistically confirmed the prevalence of elderly patients to the detriment of young patients in both classical and laparoscopic study group. As we age, the pain sensitivity decreases, an aspect highlighted in the classical study group, the statistics showing the presence of less pain in elderly patients on the second postoperative day compared to young patients. Regarding the pain in both postoperative days, it was statistically proved that the pain tends to decrease in intensity on the second postoperative day compared to the first postoperative day. CONCLUSIONS: As seen from this paper, taking into consideration the pain aspect, the two surgeries are very similar. Regardless of the chosen type of procedure, a preponderance of elderly patients was observed. The "Open Tension Free" procedure is a modern and efficient technique due to the absence of the local tension that can generate recurrence. The laparoscopic procedure has the advantage of reducing surgical trauma and minimizing recurrences. In the end, the type of treatment should be chosen by the surgeon after taking into consideration the type of hernia, the age and the patient's comorbidities and the economic considerations. KEY WORDS: Classical procedure, Inguinal hernia, Laparoscopic procedure.

Predicting the Early Response to Neoadjuvant Therapy with Breast MR Morphological, Functional and Relaxometry Features-A Pilot Study.

Aim: To evaluate the role of MR relaxometry and derived proton density analysis in the prediction of early treatment response after two cycles of neoadjuvant therapy (NAT), in patients with breast cancer. Methods: This was a prospective study that included 59 patients with breast cancer, who underwent breast MRI prior (MRI1) and after two cycles of NAT (MRI2). The MRI1 included a sequential acquisition with five different TE's (50, 100, 150, 200 and 250 ms) and a TR of 5000 ms. Post-processing was used to obtain the T2 relaxometry map from the MR acquisition. The tumor was delineated and seven relaxometry and proton density parameters were extracted. Additional histopathology data, T2 features and ADC were included. The response to NAT was reported based on the MRI2 as responders: partial response (>30% decreased size) and complete response (no visible tumor stable disease (SD); and non-responders: stable disease or progression (>20% increased size). Statistics was done using Medcalc software. Results: There were 50 (79.3%) patients with response and 13 (20.7%) non-responders to NAT. Age, histologic type, "in situ" component, tumor grade, estrogen and progesterone receptors, ki67% proliferation index and HER2 status were not associated with NAT response (all p > 0.05). The nodal status (N) 0 was associated with early response, while N2 was associated with non-response (p = 0.005). The tumor (T) and metastatic (M) stage were not statistically significant associated with response (p > 0.05). The margins, size and ADC values were not associated with NAT response (p-value > 0.05). The T2 min relaxometry value was associated with response (p = 0.017); a cut-off value of 53.58 obtained 86% sensitivity (95% CI 73.3−94.2), 69.23 specificity (95% CI 38.6−90.9), with an AUC = 0.715 (p = 0.038). The combined model (T2 min and N stage) achieved an AUC of 0.826 [95% CI: 0.66−0.90, p-value < 0.001]. Conclusions: MR relaxometry may be a useful tool in predicting early treatment response to NAT in breast cancer patients.