Ömer Karahan

The effects of different hernia repair methods on postoperative pain medication and CRP levels.

Although tension-free techniques of hernia repair using synthetic meshes have yielded encouraging results, the best method of inguinal hernia repair is still unclear. The aim of this study was to compare the responses of inflammatory mediators and postoperative pain relief following laparoscopic total extraperitoneal (TEP) hernioplasty, open tension-free mesh hernioplasty (Lichtenstein), posterior preperitoneal mesh hernioplasty (Nyhus procedure), and Bassini procedure. Patients with primary inguinal hernia were randomized in the operating room to undergo one of these repair techniques. Group I comprised 24 patients treated by Lichtenstein procedure; Group II comprised 21 patients treated by Nyhus procedure; Group III comprised 19 patients treated by Bassini procedure; and Group IV comprised 20 patients treated by laparoscopic TEP mesh hernioplasty. Postoperative pain levels following hernia repair were compared by measuring the use of patient-controlled analgesia (PCA) during the 24 hours after surgery. Serum samples withdrawn before surgery and 48 hours after surgery were assayed for C-reactive protein (CRP) content. Patient characteristics, operating time, and operative and early complications were noted. Serum CRP levels rose markedly following Nyhus (184.5 ± 41.6 mg/L), Lichtenstein (138.4 ± 72.5 mg/L), and Bassini repair (137.2 ± 55.9 mg/L) compared with that of patients who underwent TEP mesh hernioplasty (55.5 ± 41.2 mg/L). There were also significant differences in the postoperative need for analgesics via PCA among patients undergoing Nyhus (382.9 ± 189.1 mg), Bassini (303.2 ± 173.7 mg), and Lichtenstein (253.9 ± 129.3) procedures compared with 196.6 ± 148.8 mg for the TEP mesh hernioplasty group. Patients in the Lichtenstein group also had significantly less need of analgesics than those in the Nyhus and Bassini groups. In conclusion, TEP mesh hernioplasty is less traumatic and yields less postoperative pain than the Nyhus, Lichtenstein, and Bassini procedures.

The management of hepatic hydatid cyst cavity by overlapping.

The obliteration of the cyst cavity after evacuation is a controversial procedure in hepatic hydatid disease. There is no ideal surgical technique which can be used in all hydatid cyst cavities. Since 1989 we have been using a new technique, which we call overlapping, in the treatment of suitable cases of hepatic hydatid cyst cavities. The technique depends on the obliteration of the cavity without drainage. After evacuating the hydatid material from the cavity, instillation of the cystic cavity is performed with scolecidal agent (silver nitrate solution, 0.5%). The cavity is opened along its long axis. The pericyst is prepared, and the upper edge is sutured to the bottom of the cavity with absorbable stitch (modified external collapse). Before doing this, if there is no possibility of operative ultrasonography, the cavity is punctured with a fine needle to evaluate any dangerous areas. Then the other edge of the pericyst is laid down beside the collapsed one and sutured to the former with the same technique. The term “overlapping” stems from this second procedure. During the operation, we decide which pericyst will collapse and which one will overlap. Before overlapping, openings between the cavity and biliary tree should be found and if there are any, they should be secured. In cases of large and multiple openings, T-tube choledochostomy is necessary. We applied overlapping to 31 of 43 hepatic hydatid cysts (ranging from 5 to 17 cm in diameter, with a mean of 12 cm) in 19 patients. Twenty-four of 31 cysts had partial pericystectomy before overlapping. Three cystic cavities were connected to the biliary tree. Because of a large connection, T-tube choledochostomy was added in one case. We have not seen any complications, either infection or biliary fistula. The results of the obliteration of cavities were excellent in 15 cysts. There were no residual cavities

Transanal electrovaporisation of rectal tumours.

OBJECTIVEnTo present our early results with endoscopic transanal electrovaporization of rectal tumours.nnnDESIGNnRetrospective study.nnnSETTINGnDepartment of Surgery, Faculty of Medicine, University of Selçuk.nnnSUBJECTSn10 patients, 4 with malignant and 6 with benign lesions.nnnINTERVENTIONSnVaporization of the tumour using a new ridged roller electrode, the VaporTrode, and a standard 24F urological resectoscope.nnnMAIN OUTCOME MEASURESnMorbidity and recurrence.nnnRESULTSnThere were no complications and all adenomas were vaporized completely. 2 patients with obstruction required a further treatment 3 and 5 months later because of recurrence. Median duration of operation was 22.5 minutes (range 10-38) and median duration of hospital stay was 3 days (range 1-4).nnnCONCLUSIONnThe VaporTrode is a safe and potentially useful tool for transanal excision of rectal tumours, the long term efficacy of which should be tested in larger series of patients.