Dragan Krnic

Preperitoneal approach for femoral hernia repair.

BACKGROUND/AIMS Although Lichtensteins procedure is the standard procedure in surgical hernia treatment, and the role of laparoscopic hernia repair is constantly increasing, preperitoneal approach for femoral hernia repair should be equally considered. METHODOLOGY After the horizontal incision of transversal fascia, preperitoneal space is visualized. The hernial sac is opened and its content is placed in the abdominal cavity, or if there is a need, resection is performed. Once the peritoneum is sutured, the iliopubic tract and Coopers ligament are bridged with two or three sutures in the medial portion of the femoral ring. RESULTS From 1998 to 2008, 94 patients were treated for femoral hernia using the preperitoneal approach. Out of 94 participants, 86 were female. Intestinal obstruction was present in 48 cases. Resection of the small intestine or omentum was performed in 40 patients. There was no perioperative mortality. We observed early postoperative complications in 4 patients. Following the procedure, there was no recurrence of the femoral hernia. CONCLUSIONS We found that preperitoneal repair is the method of choice in surgical treatment of femoral hernia. The surgical technique is simple and feasible, while fully acknowledging the functional anatomy of the inguinofemoral region and the etiology of the condition.

Incarcerated Inguinal Hernia Mesh Repair: Effect on Testicular Blood Flow and Sperm Autoimmunity

Background The aim of our study was to determine an influence of incarcerated inguinal hernia mesh repair on testicular circulation and to investigate consequent sperm autoimmunity as a possible reason for infertility. Material/Methods This prospective study was performed over a 3-year period, and 50 male patients were included; 25 of these patients underwent elective open mesh hernia repair (Group I). Group II consisted of 25 patients who had surgery for incarcerated inguinal hernia. Doppler ultrasound evaluation of the testicular blood flow and blood samplings for antisperm antibodies (ASA) was performed in all patients before the surgery, on the second day, and 5 months after. Main outcome ultrasound measures were resistive index (RI) and pulsative index (PI), as their values are inversely proportional to testicular blood flow. Results In Group I, RI, and PI temporarily increased after surgery and then returned to basal values in the late postoperative period. Friedman analysis showed a significant difference in RI and PI for all measurements in Group II (p<0.05), with a significant decrease between the preoperative, early, and late postoperative periods. All final values were within reference range, including ASA, despite significant increase of ASA in the late postoperative period. Conclusions Although statistically significant differences in values of testicular flow parameters and immunologic sensitization in observed time, final values remained within the reference ranges in all patients. Our results suggest that the polypropylene mesh probably does not cause any clinically significant effect on testicular flow and immunologic response in both groups of patients.

P2. VATS sentinel node biopsy reduces the need for systematic mediastinal lymphadenectomy in early stage NSCLC

Objective Systematic mediastinal lymphadenectomy is still essential for an adequate postoperative staging of non-small cell lung cancer (NSCLC). We tried to investigate the controversial role of sentinel node biopsy (SNB) in early stage NSCLC surgery using videothoracoscopic approach (VATS).