The most significant predictive variables of complications in Lichtenstein hernioplasty are the type of closure, antibiotic prophylaxis, ASA risk and the presence of previous recurrence.

A new technique for ligating vessels and similar structures that offers more security is described. The aim of the study was to test whether this hypothesis was correct. Six different types of knots, including the one described in this article were compared by a strength-testing study. The knots were tied on a silicon tube through which a constant air flow of 795.10 mmHg of pressure circulated. Tension of 2 kg was then applied to both loose ends of the suture filament (polyglyconate n degrees 1 gauge) for 25 seconds. Then, 15 seconds after the tension was released an overpressure of 2250.31 mmHg was applied to the system. Two computerized pressure sensors were applied to both ends of the tube. The newly described knot reached the highest strangulating force (997.63 mmHg) and had the highest resistance to slippage. From these results, we conclude that the new knot is far more secure for vessel and duct ligature and that it represents a new and useful tool for surgeons in both open and laparoscopic surgery.

The most frequent complication of colostomy is para-stoma1 hernia. Such a hernia may be caused by poor surgical technique, infection, incorrect location or too large a hole (early hernia), or by high intra-abdominal pressure due to obesity, constipation, prostatism or chronic cough (late hernia)'. According to Rubin et al. 2, the risk of recurrence after parastomal hernia repair is considerable and is higher for fascial repair (76 per cent) than for stoma relocation (33 per cent). However, complications are more common after stoma relocation (88 per cent) than following fascial repair (50 per cent). This high rate reflects incisional hernia, which develops in 52 per cent of patients. In the study of Rubin et aL2, stoma relocation involved laparotomy in all cases. In 1967, Turnbull developed a method wherein the ileal stoma could be relocated without the need for a formal laparotomy. In 1978, Taylor, Rombeau and Turnbul13 reported experience with transperitoneal ileal stoma relocation without formal laparotomy in 19 patients. Kaufman4 in 1983 described a similar technique of translocation of an ileal stoma to the opposite side of the abdomen. Surgical techniqueOn the basis of Turnbull's method, the senior author (J.M.L.) has developed a new technique for relocation of a colonic stoma with parastomal hernia without formal laparotomy. For anatomical reasons the translocation has to be made on the same side of the abdomen. A circumstomal fusiform incision is made in the skin. The original primary stoma is closed with silk stitches, the first and the last of which are not cut so that the threads remain long; the stoma is then dissected and reintroduced inside the peritoneal cavity. A disc of skin is dissected 6cm above or below the original primary colostomy. The fascia of the original primary colostomy is then closed with a no.1 polypropylene suture, but the stitches are not tied. The threads are secured with a Kocher or similar clamp. These threads are then pulled firmly, so that the fascia moves from the Paper accepted 18 October 1995 +6cm Fig. 1 As the closing stitches of the original colostomy are pulled, the fascia of the new colostomy location is incised new site to the primary colostomy site. Next the fascia is incised where the new colostomy is to be placed (Fig. I ) . This method ensures a large separation between both fascial sheath incisions. This allows safe closure of the original colostomy fascia, without any tension, after the terminal portion of the colon has been brought through the newly created stoma site using the two long threads. No more than 1 cm of the terminal portion of the colon should be excised; otherwise the mesocolon would have to be trimmed, which could lead to difficulty with irrigation.Between November 1992 and June 1995, 11 repairs of parastomal hernia by translocation of the colostomy without formal laparotomy were performed in 11 patients. The patients were eight women and three men aged 42-86 (mean 63)years. Follow-up ranged from 2 to 36 months; no wound infection or other compli...

The objectives of this study were to (1) determine the number of punctures surgeons and assistants suffer during operations involving a laparotomy during the intraabdominal and closure phases; and (2) determine if the number of puncture injuries during wound closure can be reduced using a new surgical instrument (PdB) that protects the surgeon's hands and the patient's viscera against needlesticks. For the first objective, all laparotomies performed during 1 month (n = 52) were controlled, collecting the gloves used and determining the number of perforations. For the second objective, a randomized prospective controlled study, involving two series of 100 medial laparotomies, was carried out. The incidence of perforations was 29% during the intraabdominal phase and 16% during the wound closure phase. The glove perforation rate while closing medial laparotomies was 31.5% if the PdB was not used and 3% if the PdB was used (p < 0.0001). The glove perforation rate during laparotomy is significant, but with the use of the PdB this incidence can be significantly reduced.