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  • 1
    ISSN: 1248-9204
    Keywords: Inguinal hernia ; Plug ; Mesh ; Groin pain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Background The 14 day results of this study reported elsewhere demonstrated that the Perfix® plug-and-patch was as effective as the Lichtenstein patch but not as cost-effective. The present analysis looks at the results at one year to measure quality of life between the two groups. Patients and Methods 141 patients were randomly allocated in a doubleblind manner to receive either a Lichtenstein patch (patch) or a Perfix® plug- and-patch (plug-and-patch) for primary inguinal hernia. Quality of life at 6 months and one year was assessed by the short-form 36 (SF36). On a 3 point scale patients were asked at one year to rate groin, wound and testicular discomfort. Results Physical function by SF36 was similar in the 2 groups at 6 months, but at one year in the patch group (95.11 +/-20.07) was significantly better (p 〈 0.05) than physical function in the plug-and-patch group (82.5 ± 20.98). At one year the number of patients with wound discomfort limiting work or social activities was significantly greater in patients receiving the plug-and-patch (n = 12) compared with patients receiving the patch (n = 4), p 〈 0.031. At one year, 4 of 70 patients receiving the plug-and-patch had required reoperation to remove the preformed plug-and-patch device and replace it with a flat Lichtenstein patch, because of wound pain which was limiting activity. Conclusion A significant proportion of patients suffer chronic pain after placement of a Perfix® plug-and-patch for primary inguinal hernia repair. Removal of the Perfix® device is required in approximately i in 20 patients (5.6% in this series).
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Hernia 3 (1999), S. 109-111 
    ISSN: 1248-9204
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Hernia 4 (2000), S. 1-5 
    ISSN: 1248-9204
    Keywords: Inguinal hernia ; Daycase ; Ambulatory ; Cost-savings
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A Hernia Service (HS) was commenced in Derriford Hospital, Plymouth, UK in May 1996 to improve patient outcome following a poor star rating for overall hospital performance in daycase hernia surgery. Between 1996 and December 1998, 576 patients, median age 65 years (range 24–88) with unilateral or bilateral inguinal hernias underwent surgical repair on the HS. During the same time period on the General Surgical Service (GSS) 1722 patients underwent surgical repair. On the HS, patients operated under local anaesthesia (LA) increased from 78.0 to 90.5%, and on the GSS use of LA increased from 7.6 to 22.4%. The percentage of daycases on the HS increased from 53.0 to 81.4% and on the GSS from 2.9 to 28.0%. The actual number of inpatient hospital days saved by the HS was 236 days in 1997 and 284 days in 1998. The potential saving was greater: in 1998 if the GSS daycase rate (28.0%) had been the same as the HS daycase rate (81.4%) 605 inpatient days would have been saved. A hernia satisfaction questionnaire was sent to a ran dom sample of 50 patients who had had their hernia repaired by the HS and 50 patients who had been treated by the GSS. HS patients experienced a mean pain score of 4,7 (range 1–10) compared to 5.7 (range 0–10) (p=0.07) for the GSS. Similarly, HS patients required less post-operative analgesia (mean 2.8 days compared to 5.9 days for the GSS group, p〈0.01) and resumed normal activity at an earlier stage (mean 10.8 days compared to 17.6 days for the GSS patients, p〈0.01). Instigation of a dedicated HS has improved patient outcome and substantially increased the use of local anaesthesia and the number of daycase hernia repairs on both the HS and the GSS, with substantial cost savings.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Hernia 4 (2000), S. 195-196 
    ISSN: 1248-9204
    Keywords: Umbilical hernia ; Mayo repair ; Mesh ; Recurrence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Unlike inguinal herniorraphy, the results of surgery for umbilical hernia have been poorly audited. The extent to which the popular sutured repair of Mayo has given way to mesh-based repairs in recent years is also unknown. To investigate these deficiencies, a review was undertaken of 651 umbilical hernia repairs performed between April 1994 and March 1999 at a single institution by 10 general surgeons. Excluding children and umbilical hernias repaired at laparotomy, a total of 473 primary adult hernias and 18 recurrent hernias were repaired. The proportion repaired for recurrence was 3.8%. Follow up ranges between 12 and 60 months (mean 27 months, median 25 months). Of the 18 recurrences, there were 16 sutured repairs and 11 of the patients had predisposing factors for recurrence such as wound infection, obesity, chronic renal failure or ascites. Sutured repair of primary umbilical hernias in this large series was successful in 96% of cases; in the remainder underlying co-morbidity was an important predisposing factor for recurrence. This study does not support the routine use of mesh in primary adult umbilical hernia repair.
    Type of Medium: Electronic Resource
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