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Kulacoglu H.,Diskapi Yildirim Beyazit Teaching and Research Hospital
Acta chirurgica Iugoslavica

Inguinal hernia repair is one of the most common procedures in general surgery. All anesthetic methods can be used in inguinal hernia repairs. Local anesthesia for groin hernia repair had been introduced at the very beginning of the last century, and gained popularity following the success reports from the Shouldice Hospital, and the Lichtenstein Hernia Institute. Today, local anesthesia is routinely used in specialized hernia clinics, whereas its use is still not a common practice in general hospitals, in spite of its proven advantages and recommendations by current hernia repair guidelines. In this review, the technical options for local anaesthesia in groin hernia repairs, commonly used local anaesthetics and their doses, potential complications related to the technique are evaluated. A comparison of local, general and regional anesthesia methods is also presented. Local anaesthesia technique has a short learning curve requiring simple training. It is easy to learn and apply, and its use is in open anterior repairs a nice way for health care economics. Local anesthesia has been shown to have certain advantages over general and regional anesthesia in inguinal hernia repairs. It is more economic and requires a shorter time in the operating room and shorter stay in the institution. It causes less postoperative pain, requires less analgesic consumption; avoids nausea, vomiting, and urinary retention. Patients can mobilize and take oral liquids and solid foods much earlier. Most importantly, local anesthesia is the most suitable type of anesthesia in elder, fragile patients and patients with ASA II-IV scores. Source

Ergul Z.,Diskapi Yildirim Beyazit Teaching and Research Hospital
Chirurgia (Bucharest, Romania : 1990)

Inguinal hernia repair is one of the most common operations in a junior surgical resident's postgraduate training. Short recall courses can improve junior residents' anatomy knowledge and results in better surgical outcomes. We aimed to investigate the effect of a short course on anatomical competency during inguinal hernia repairs. During the first 25 inguinal hernia repairs, two junior residents were asked to identify iliohypogastric, ilioinguinal, and genital branch of genitofemoral nerves. Then, the residents were given a short recall course by anatomists. Afterwards, the participants were taken into an in-vivo anatomy test again. The same parameters were recorded in another 25 inguinal hernia repairs. In addition to the nerve identification records, case characteristics [body mass index (BMI < or = 25 vs. >25), hernia type (indirect vs. direct), and anesthesia used (general or regional vs. local)] were recorded. Anatomy education had a clear impact on the correct identification rates for the iliohypogastric and ilioinguinal nerves. The rates increased from 70% to 90% and above. Correct identification rate for the three nerves together significantly increased from 16 to 52% following anatomy education (P = 0.006). All three nerves were identified with significantly higher success rates after anatomy education. The increase in the success rate for identification of the genital branch of genitofemoral nerve was 4-fold. Short anatomy courses in specific subjects for junior surgical residents given by formal anatomists may be effective during postgraduate education. The benefit obtained in the present study for the inguinal region nerves may be expanded to more important anatomical structures, such as the recurrent laryngeal nerve in a thyroidectomy, or more complex subjects. Source

Kulacoglu H.,Diskapi Yildirim Beyazit Teaching and Research Hospital
Il Giornale di chirurgia

It has been reported that femoral hernias are rather common after a previous repair of inguinal hernia. We herein present a modified patch repair technique for large femoral hernias that develop after a Lichtenstein operation for ipsilateral inguinal hernia. The modified technique for femoral hernia was applied to three patients who had a Lichtenstein repair for inguinal hernia. All patients were male. Hernia sac is dissected completely and sent back into to the preperitoneal space. Special attention should be given to the prevascular component of the sac. It is dissected as deep as possible into the preperitoneal space over the femoral vein. The defect is quite wide in this particular type of femoral hernia following Lichtenstein repair. A prosthetic patch that matches the defect is prepared. The medial edge of the mesh is configured to correspond to the pubic corner and lacunar ligament. The lateral margin of the patch is cut to create several petals for inverting the mesh above and medial to the femoral vein to prevent prevascular herniation. The mesh is secured to inguinal ligament, ilioinguinal tract, lacunar ligament, and Cooper ligament. Few sutures are put on the pubic corner and lacunar ligament. One patient was discharged after two hours, other two stayed overnight. Readmission because of seroma development was recorded in two cases where standard polypropylene meshes were used. No complication was observed in the other patient who received lightweight meshes. No early recurrences were recorded after 4, 9, and 30 months. Femoral recurrence after previous inguinal hernia repair seems to be a specific entity. It has a prevascular component and the hernia defect can be much larger than that of a primary femoral hernia. A patch repair with infra-inguinal approach can be a valuable alternative with low complication rate. Source

Heybeli T.,Diskapi Yildirim Beyazit Teaching and Research Hospital
Chirurgia (Bucharest, Romania : 1990)

Incisional hernia following laparotomy and recurrent herniation after its repair are still common problems in spite of mesh augmentation. The underlying biological mechanism may be related to collagen metabolism. Recently, some members of growth factors family have been tested in the prevention of wound failure and incisonal hernia formation. Growth factors may promote fibroblast proliferation and collagen deposition. In the present study, we searched the effects of basic fibroblast growth factor (bFGF) loaded polypropylene meshes in an incisional hernia model in rats. A total of 80 Wistar albino rats were randomly divided into five groups. A uniform surgical procedure was employed in all groups: a 5 cm skin incision was made at the midline and a full segment of the abdominal wall sized 3 x 2 cm was excised. Abdominal wall was closed with rapidly absorbable 3/0 catgut. Following this standard surgery, five different procedures were applied to the groups before closing the skin with 4/0 monofilament polypropylene sutures. Control subjects (Group 1) received no extra procedure after abdominal wall suturing. Polypropylene meshes were used in onlay position by fixing 4/0 monofimalent polypropylene interrupted sutures in other four groups. A standard mesh with no chemical treatment was used in Group 2. Gelatin coated meshes were used in Group 3, while Group 4 and 5 received bFGF loaded meshes with 1 microgram (microg) and 5 microg doses respectively. All the groups then divided into 1st month (early: E) and 2nd month (late: L) subgroups (n=8 each) according to sacrification dates. Tensiometric and histopathological evaluations were done. The specimens for histopathology were obtained from the interface area of the meshes and stained with hematoxylin and eosin, and also Masson trichrome. The variables were examined and evaluated by a single blinded pathologist under light microscopy in respect of inflammation, vascularization, fibroblast activity, collagen fibers and connective tissue organization. The avidin-biotin-peroxidase method was performed using the primary monooclonal antibodies against collagen type I and collagen Type III. bFGF loaded meshes showed higher tensile strength values in comparison with a standard polypropylene mesh after 2 months. Histopathological and immunohistochemistry studies also revealed somewhat better scores in favor of bFGF loaded mesh over a standard polypropylene mesh. These limited effects of bFGF did not seem to be dose dependent. The use of bFGF loaded polypropylene mesh in the abdominal wall healing may cause somewhat higher tensile strength values in comparison with a standard polypropylene. However, histopathological and immunohistochemistry studies revealed only a slightly better healing in favor of bFGF loaded mesh over a standard polypropylene mesh. Source

Kulacoglu H.,Diskapi Yildirim Beyazit Teaching and Research Hospital | Oztuna D.,Ankara University

Purpose: The aim of this systematic review was to determine the exact volume and growth pattern of articles on abdominal wall hernias, in particular the effect of the journal Hernia on publications about hernias. Methods: A PubMed search was performed for every year between 1965 and 2010, using the title words "inguinal hernia," "incisional hernia," and "umbilical hernia." Then, two consecutive 10-year periods were chosen for a systematic PubMed search, before and after 2001-the year in which Hernia began to be indexed in PubMed. The main keywords used were as follows: "inguinal hernia" "incisional hernia" "umbilical hernia" "mesh" "laparoscopic" and "experimental. " Results: The number of all articles indexed in PubMed increased 1.6-fold between the periods 1991-2000 and 2001-2010. The number of articles with the title word "inguinal hernia" increased 1.7-fold, whereas the rises for incisional and umbilical hernias were more prominent: 3.9- and 2.6-fold. Article titles with the combined keywords "hernia and mesh" and "hernia and laparoscopic" increased 2.8- and 2.4-fold. The most striking combined search was for "umbilical hernia and mesh" with a 20.5-fold rise. The percentage of articles published in the journal Hernia among all articles in all 25 selected journals, including Hernia was 30% on average. Hernia, Surgical Endoscopy and the British Journal of Surgery were the leading journals for publications for inguinal hernia in the last decade. Conclusions: Growth in hernia papers is greater than the overall growth in PubMed. Articles on incisional hernia increased faster than did those on inguinal and umbilical hernias. The establishment and indexing of Hernia decreased the proportion of hernia publications in other journals. The core journals for herniology are Hernia, Surgical Endoscopy, and the British Journal of Surgery. © 2011 Springer-Verlag. Source

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