Gs12
hartmann's vs. Stent and Washout, a Review of 112 Cases

Abstract

titles marked with an asterisk were judged for the RACS Prize for the best paper from a Trainee. Titles marked with a double asterisk were judged for the Bard Australia Prize for the best paper from a Trainee in hernia management. GS01HERNIA REPAIR: ARE WE THERE YET? M. Mccallum Newcastle, New South WalesHerniae have been documented since ancient times, but the era of modern hernia treatment is accepted as starting with the surgery of Bassini. Suture repairs of various types then dominated the treatment of hernia until the era of mesh repair championed by Stoppa and Lichtenstein.Surgeons feel that mesh repairs have revolutionized hernia surgery. Have the mesh repairs really made such a difference? There is evidence that all is not as it seems! Published recurrence figures don't seem to withstand close scrutiny.One of the trendy terms in herniology is the "myo-pectineal orifice", while many hernia specialists pay lip service to this concept, very few available hernia operations address this problem.The latest area of interest in the world of hernia surgery is the area of posthernia groin pain, either neuralgic or non-neuralgic. There are studies showing an incidence of chronic groin pain following anterior repairs of 30% or more, and yet these operations are the most common hernia operations in the world! Keith in 1924 first postulated the concept of herniosis and was criticized. However there is a large volume of convincing evidence that herniae are manifestations of a metabolic disorder. They are associated with abdominal aortic aneurysm and possibly with such diverse conditions as diverticular disease, cholelithiasis, and perhaps haemorrhoidal disease.Are we there yet? The answer is certainly no. However research into the metabolic problem of hernia development means that we are surely closer than we have ever been before.Purpose: Inguinal hernia repair is a common operation with much focus in recent times on improving morbidity. The use of mesh repair has greatly decreased reoccurrence rates and focus turns towards improving postoperative groin pain. This review examines the use of UHS in inguinal hernia repair and relation with postoperative groin pain. Methods: A retrospective audit of consecutive cases over one year (telephone and mailed questionnaires) was conducted. The recently validated IPQ (inguinal pain score) was used. A review of files and operative reports was also undertaken. Cases undergoing bilateral repair, or other operations simultaneously were excluded. Results: 59 patients (61%) participated in the audit, with a mean follow up of 11 months (range 5-16). 4 minor wound complications occurred. Higher pain scores appeared to correlate preoperatively with age and workers compensation status. Postoperative pain scores and limitation to functional status were low, and trended towards lower values in the UHS (ultrapro hernia system) repair group compared to the group who underwent repair with PHS (preceding week pain scores respectively -UHS repair, mean 1.22, (95%CI 1.07-1.38); PHS 1.76, (95%CI 1....