Painful incarcerated hernia following a rugby union lineout.
Discussion related to hernias in sport usually involves the diagnosis and treatment of chronic musculotendinous groin disruption. A case of acute trauma in an incarcerated inguinal hernia, occurring in a rugby union player during a lineout, is presented. The injury arose as a result of a change in the laws of the game. (+info)
Value of scintigraphy in chronic peritoneal dialysis patients.
BACKGROUND: A variety of factors can adversely impact chronic peritoneal dialysis (CPD) as an effective renal replacement therapy for patients with end-stage renal disease. These factors include peritonitis, poor clearances, loss of ultrafiltration, and a variety of anatomic problems, such as hernias, peritoneal fluid leaks, loculations, and catheter-related problems caused by omental blockage. This study reviews our experience with peritoneal scintigraphy for the evaluation of some of these difficulties. METHODS: From 1991 to 1996, 50 peritoneal scintigraphy scans were obtained in 48 CPD patients. Indications for scintigraphy were evaluated, and the patients were placed into four groups: group I, abdominal wall swelling; group II, inguinal or genital swelling; group III, pleural fluid; and group IV, poor drainage and/or poor ultrafiltration. A peritoneal scintigraphy protocol was established and the radiotracer isotope that was used was 2.0 mCi of 99mtechnetium sulfur colloid placed in two liters of 2.5% dextrose peritoneal dialysis solution. RESULTS: Ten scans were obtained to study abdominal wall swelling, with seven scans demonstrating leaks; six of these episodes improved with low-volume exchanges. Twenty scans were obtained to evaluate inguinal or genital swelling, and 10 of these had scintigraphic evidence for an inguinal hernia leak (9 of these were surgically corrected). One of four scans obtained to evaluate a pleural fluid collection demonstrated a peritoneal-pleural leak that corrected with a temporary discontinuation of CPD. Sixteen scans were obtained to assess poor drainage and/or ultrafiltration. Five of these scans demonstrated peritoneal location, and all of these patients required transfer to hemodialysis. The other 11 scans were normal; four patients underwent omentectomies, allowing three patients to continue with CPD. CONCLUSION: Peritoneal scintigraphy is useful in the evaluation and assessment of CPD patients who develop anatomical problems (such as anterior abdominal, pleural-peritoneal, inguinal, and genital leaks) and problems with ultrafiltration and/or drainage. (+info)
Surgical options in the management of groin hernias.
Inguinal and femoral hernias are the most common conditions for which primary care physicians refer patients for surgical management. Hernias usually present as swelling accompanied by pain or a dragging sensation in the groin. Most hernias can be diagnosed based on the history and clinical examination, but ultrasonography may be useful in differentiating a hernia from other causes of groin swelling. Surgical repair is usually advised because of the danger of incarceration and strangulation, particularly with femoral hernias. Three major types of open repair are currently used, and laparoscopic techniques are also employed. The choice of technique depends on several factors, including the type of hernia, anesthetic considerations, cost, period of postoperative disability and the surgeon's expertise. Following initial herniorrhaphy, complication and recurrence rates are generally low. Laparoscopic techniques make it possible for patients to return to normal activities more quickly, but they are more costly than open procedures. In addition, they require general anesthesia, and the long-term hernia recurrence rate with these procedures is unknown. (+info)
Management of inguinal herniae in patients on continuous ambulatory peritoneal dialysis: an audit of current UK practice.
Patients receiving continuous ambulatory peritoneal dialysis are at increased risk for the development of inguinal herniae, with a reported prevalence of 14%. Elective hernia repair is indicated for these patients as strangulation is associated with a high mortality in this population. There are currently no national guidelines relating to the optimal peri-operative management of these patients, in particular the appropriate pre- and post-operative dialysis regimen. The aim of the current study was to evaluate current practice in the UK by means of a postal questionnaire sent to all centres undertaking renal transplantation. Replies were received from 34/37 centres. The principal study finding was the wide variation in surgical practice between different centres with regard to pre- and post-operative dialysis regimes. Only 44% of centres had an established protocol. Based upon the study findings we have devised a protocol that we hope to see implemented into UK practice. Following its introduction, a re-assessment will be performed and the audit cycle completed. (+info)
Inguinal hernia repair: a survey of Canadian practice patterns.
OBJECTIVE: To describe the preferences of general surgeons across Canada with respect to hernia repair technique. DESIGN: A survey by mailed questionnaire. PARTICIPANTS: All 1452 fellows of the Royal College of Physicians and Surgeons of Canada currently holding a certificate in general surgery. INTERVENTION: Two mailings of the survey: the first in December 1996, the second to nonrespondents in February 1997. MAIN OUTCOME MEASURES: Surgeons' preference of hernia repair technique for specified indications. This was analysed according to practice setting and geographic location. MAIN RESULTS: Based on 706 completed questionnaires, the preferred techniques for repair of primary inguinal hernias were as follows: 23% Bassini, 20% mesh plug, 16% Lichtenstein, 15% laparoscopic, 11% Shouldice and 11% McVay. Preference for laparoscopic repair increased to 34% for recurrent hernias and 35% for bilateral hernias. The Atlantic provinces had the lowest preference rates for laparoscopic repair and the highest rates for the mesh plug technique. CONCLUSIONS: Most surgeons select the type of repair on the basis of the clinical scenario. Large variations in practice exist between provinces. (+info)
Do postal questionnaires change GPs' workload and referral patterns?
OBJECTIVE: We aimed to determine changes in workload in general practice associated with the postal administration of a health needs questionnaire. METHOD: We carried out controlled before-and-after intervention study of the effects of delivering a postal questionnaire to assess needs for care for patients with arthropathies of the hip and knee, groin hernia and varicose veins, and to assess health service utilization, general health status and risk factors for cardiovascular disease. The setting was a seven-partner, fundholding, group practice in Avon. The subjects were patients registered with an NHS group practice situated in Backwell and Nailsea, Avon. The outcome measures were the frequency of consultation, home visits and night visits, reasons for consultation, referral to specialist agencies and patterns of prescribing. RESULTS: There was no significant difference between the study and control group in the year before and the year after the postal administration of the questionnaire with respect to changes in overall frequency of consultation, frequency of referral (including type of referral) and frequency of prescribing of non-steroidal anti-inflammatory drugs. In the study group there was a significant (P<0.05) reduction in the number of daytime home visits and prescriptions written for analgesics. Analysis of the records of those who had received a medical examination, in addition to a postal questionnaire, showed that there was no significant difference between the study and control group with respect to frequency of consultation, referral to outside agencies or items prescribed. CONCLUSION: Administration of a health needs questionnaire to patients registered with this general practice was not associated with an increase in consultation frequency or referral, or a change in prescribing patterns. No plausible explanation could be identified for the significant reduction in the number of home visits and prescriptions written for analgesics. It was concluded that these results were a statistical artefact. On the basis of the evidence from this study, GPs can be reassured that the administration of health needs questionnaires of the type used in this study will not result in any increase in workload or costs of care incurred by increased referrals to outside agencies or increased prescribing. (+info)
Comparison of laparoscopic vs open modified Shouldice technique in inguinal hernia repair.
Inguinal hernia repair has been a common procedure performed by general surgeons. Recently, a newly developed approach has been introduced using the pre-peritoneal laparoscopic repair. The laparoscopic approach allows patients to recover faster, with less pain, however, a disadvantage is the higher cost. We conducted a retrospective study of inguinal hernia repairs performed by one surgeon at the same institution, comparing the laparoscopic technique to the modified Shouldice procedure with regard to surgical time, postoperative recovery time, charge, and time to return to work and to activities. Patients undergoing laparoscopic hernia repairs were able to return to work and to activities sooner than patients undergoing the modified Shouldice procedure. The results obtained in this study showed a higher charge for the laparoscopic procedure, with longer surgical and recovery room time. The more rapid return to work and activities may outweigh the higher charge and longer surgical and recovery room time. (+info)
Primary inguinal hernia repair: how audit changed a surgeon's practice.
Over 10 years one senior consultant surgeon performed 114 standard plication darn herniorraphies on 92 patients with primary inguinal hernias. These patients were contacted and were reviewed if there was any suspicion of recurrence. Four recurrences were detected, giving an overall recurrence rate of about 3.5%. According to actuarial life-table analysis the risks of recurrence at 1 year, 5 years and 10 years were 0.94%, 3.02% and 9%. This level of recurrence is unacceptable in modern practice and, as a result of the audit, the surgeon changed his technique of primary inguinal hernia repair. (+info)