A prospective audit of Lichtenstein's tension-free herniorrhaphy in Taranaki, New Zealand

Tension-free hernioplasty versus conventional hernioplasty for inguinal hernia repair

PURPOSE

To show the effectiveness of tension-free hernioplasty for inguinal hernia repair.

METHODS

We studied 106 patients who underwent inguinal hernia repair, as conventional hernioplasty in 52 and as tension-free hernioplasty in 54. We analyzed the operation time, postoperative complications, pain, time to resume daily activities, and frequency of recurrence in the short and long term.

RESULTS

The average age of the patients was 46.2 years. The operation time was significantly shorter in the tension-free group than in the conventional group, at 33 +/- 11.1 versus 49 +/- 8.8 min, respectively (P < 0.05). The overall complication rate was 10%, being 1.5% in the tension-free group and 13% in the conventional group (P = 0.4). The visual-analogue pain scores after surgery were lower in the tension-free group than in the conventional group (P = 0.01). Patients in the tension-free group returned to their normal activities sooner than those in the conventional group (P < 0.05).

CONCLUSIONS

Tension-free hernioplasty resulted in less pain and allowed patients to return to their daily activities sooner than conventional hernioplasty.

Informed consent and the JHO in Scotland

AIM

To define the views of junior house-officers (JHOs) concerning consent for general surgical conditions.

METHODS

Questionnaire-based descriptive study on two cohorts of JHOs, separated by 3 years of major national and local directives.

RESULTS

From the JHO perspective: (i) there has been a shift away from the JHO being the main signatory, (ii) many JHOs (58% in 2000; 47% in 2003) feel unsupported with respect to obtaining consent, (iii) knowledge concerning any consultant/unit's complication rates was poor (<30%), (iv) knowledge concerning complication rates for several paradigm procedures was also poor, though it improved from 2000 to 2003, (v) there is no formal training in consent.

CONCLUSIONS

Despite the JHO group of 2003 outperforming that of 2000, there is major scope for improvement from patient, legal, educational and risk-management perspectives.

Is there a difference in early perioperative morbidity in transurethral resection of prostate (TURP) versus TURP with cystolitholapaxy and TURP with inguinal herniorrhaphy?

Objective of this study is to determine the difference in early peri-operative morbidity of transurethral resection of prostate (TURP) and if it is combined with inguinal hernia repair and mechanical and/or pneumatic fragmentation of bladder calculus. All patients undergoing TURP, cystolitholapaxy (CLL), inguinal hernia repair (IHR) or any combination between January 1997 and December 1999 were identified using ICD 9CM coding and indexing system. Overall 1273 patients were identified, charts were reviewed for demographics, pre-operative parameter, intra-operative data and early peri-operative morbidity. In the three year period, 19 patients had TURP and inguinal herniorrhapy (IHR), 17 patients had TURP and cystolitholapaxy (CLL), 2 patients had TURP+IHR+CLL performed simultaneously; in the same period 346, 815, 74 patients had TURP, IHR, and CLL alone respectively. All the groups were matched for age, presentation and Co-morbidities. There was significant difference in the operating time between the different groups. Complications were not significantly different in the TURP, IHR, CLL, TURP+IHR, and TURP+CLL. In conclusion, mean operative time for TURP+IHR is increased by a fraction of 168.3 for TURP+CLL by 109.8 and TURP+IHR+CLL is 202.1 over TURP alone, with no significant difference in morbidity between TURP and TURP+IHR and TURP+CLL.