No abstract

EDA may be a risk factor for postoperative AKI after major hepatectomy.

The survey confirms the use of prosthetic material as the standard, and the Lichtenstein repair as the first choice for primary inguinal hernia repair. The popularity of laparoscopic hernia surgery is increasing at the price of less teaching operations available for young residents.

Introduction Primary venous aneurysm is a rare, but essential consideration in the diVerential diagnosis of an inguinal and femoral hernia. Methods We report a case of a 43-year-old man who was referred for evaluation and treatment of a femoral hernia. Results The patient presented with a 3-month history of an asymptomatic tumor on his right upper inner thigh. Physical examination noted a non-tender, non-indurated tumor. Conclusion Surgical exploration demonstrated a primary venous aneurysm of the proximal saphenous vein.

Aims: Epidural analgesia (EDA) is a common analgesia regime used in hepatectomy and is accompanied by sympatholysis, consecutive peripheral vasodilatation and hypotension in the context of deliberate intra-operative low central venous pressure. This associated fall in mean arterial pressure may also compromise renal blood pressure auto-regulation and lead to acute kidney injury (AKI). This study investigates whether EDA is a risk factor for postoperative AKI after liver surgery. Methods: The incidence of AKI was retrospectively investigated in patients who underwent liver resection with or without EDA from 2002 to 2012. Uni-and multivariate analyses were performed including recognized preoperative and intraoperative predictors of post-hepatectomy renal failure.Results: A series of 1153 patients was investigated. AKI occurred in 8% of the patients and was associated with a significantly increased morbidity (71% vs. 47%, p < 0.001) and mortality (21% vs. 0.3%, p < 0.001). Incidence of AKI was significantly higher in the EDA group (10% vs. 4%, p = 0.012) overall. While no significant difference in the incidence of AKI was observed between patients undergoing minor hepatectomy (5% vs. 3%, p = 0.421), a highly significant difference in AKI rates occurred in patients undergoing major hepatectomy (14% vs. 5%, p = 0.02). On multivariate analysis, EDA remained an independent risk factor for AKI after major hepatectomy (p = 0.03). Conclusions: While the use of EDA does not impact on renal function in minor hepatectomy, EDA is suggested to be an independent risk factor for postoperative AKI after major hepatectomy.