There was no difference in time to full recovery after LA and OA in patients with laparoscopically confirmed appendicitis. A trend towards better physical activity was noted after the laparoscopic procedure.
There was no difference between late discomfort at five-year follow-up after laparoscopic TAPP and Shouldice repair. Discomfort was mostly mild and pain during the first postoperative week was a prognostic variable for late discomfort in Shouldice patients.
Interest in inguinal hernia surgery has increased significantly with the introduction of new operating techniques during the past decade. This multicenter study compared short-term results in patients treated by the laparoscopic transabdominal preperitoneal patch technique (TAPP; n = 518) and the Shouldice technique (n = 524). We evaluated demographics, operative data, complications, hospital stay, postoperative pain, use of cs, functional status, sick leave, and complaints up to 3 months postoperatively. The median operating time was shorter in the Shouldice group (55 vs. 65 min), but there were no significant differences in complication rates, and major complications were rare. The hospital stay was 1 day or less in over 98% of cases in both groups, but more operations were performed on outpatient basis in the Shouldice group. In the TAPP group postoperative pain and analgesic consumption were less, postoperative functional status was better, and sick leave was shorter (10 vs. 14 days). These results show that the two methods are equally safe and have few major complications. The TAPP operation is associated with less postoperative pain, better postoperative functional status, and shorter sick leave, but at the price of a longer operating time.
Nárahaular (groin hernia) eru algengust kviðslita og valda útbungun á nárasvaeði en geta auk þess valdið verkjum og jafnvel garnastíflu. 1,2 Aðgerðir á nárahaulum eru á meðal algengustu aðgerða í almennum skurðlaekningum 3 , en víða á Vesturlöndum eru framkvaemdar um 130-160 aðgerðir á 100.000 íbúa árlega. 4,5 Algengast er að aðgerð sé gerð vegna einkenna en einnig til að fyrirbyggja fylgikvilla, til daemis garnastíflu. Þetta er örugg aðgerð en helstu vandamálin eru endurtekin kviðslit og langvinnir verkir. 8-12 Þessi grein fjallar aðallega um greiningu og meðferð nárakviðslita, en einnig er fjallað um líffaerafraeði nárans, meingerð nárakviðslita og klíníska birtingamynd þeirra. Greinin byggir á nýjustu heimildum, þar á meðal nýlegum íslenskum rannsóknum. Flokkun, faraldsfraeði og líffaerafraeði Kviðslit er útbungun á lífhimnu, lífhimnufitu eða kviðarholslíffaeri í gegnum meðfaedd eða áunnin göt á kviðveggnum. Algengustu kviðslitin eru nárahaular, naflakviðslit og kviðslit í öri. Nárahaular skiptast í tvennt; eiginleg nárakviðslit og laeriskviðslit en þau síðarnefndu eru aðeins 4% nárahaula og hlutfallslega miklu algengari hjá konum. 3 Nárakviðslitum er síðan skipt í tvennt: miðlaeg og hliðlaeg kviðslit sem hafa mismunandi meingerð og líffaerafraeðilega afstöðu (sjá Box 2). Hjá körlum eru hliðlaeg kviðslit tvisvar sinnum algengari en miðlaeg (60% miðað við 30%), 1
Background and Aims The aim of this prospective single-center study was to evaluate the outcome of inguinal hernia repair. Materials and Methods A total of 485 inguinal hernias (452 patients and 33 patients with bilateral hernias) were operated between January 2004 and December 2010. Mean age was 56 years, and 93% were male. Patient demographics and operative data were collected, and the operating surgeon assessed the technical difficulty of the operation. Five years after surgery, a questionnaire evaluated recurrence and chronic discomfort according to the Cunningham scale. 372 responded (82%), and mean follow-up was 5.5 years. Results There were 390 repairs for a primary and 62 for a recurrent hernia. Totally extraperitoneal (TEP) operation was most frequently performed (56%), transabdominal preperitoneal (TAPP) operation in 31%, and Lichtenstein and Shouldice in 12% and 2%, respectively. At 5-year follow-up, the primary outcome of chronic discomfort was 19.5%. The independent positive predictors were young age and operation for a recurrent hernia (OR: 3.7), with TEP operation reducing the risk of chronic discomfort (OR: 0.5). The secondary outcome was the recurrence rate of 2.5%. Risk factors were strenuous work (OR: 13.7), technically difficult repairs (OR: 7.2), and chronic discomfort (OR: 6.7). Conclusions Every fifth patient had chronic discomfort in long-term follow-up. The recurrence rate was 2.5%, and a technically difficult procedure was a risk factor.
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