Lichtenstein versus laparoscopic total extraperitoneal repair of inguinal hernia: a propective randomized controlled study

Hernia repair is one of the most commonly performed general surgical procedures. Several methods have been developed over years to improve the traditional methods of hernia repair. The most important recent innovations being the Lichtenstein mesh repair and the laparoscopic mesh repair. To compare Lichtenstein hernia repair with Laparoscopic totally extra-peritoneal hernia repair [TEP]. A prospective randomized controlled study including a total of 96 male patients with 110 inguinal hernias. They were randomized into 2 groups, group I underwent laparoscopic [TEP repair [n = 56] 50.9% and group 2 underwent Lichtenstein repair [n = 54] 49.1% for inguinal hernia. Statistical analysis was performed using SPSS 10.0 where student 1-tests and chi-square tests, were applied. The two groups of patients were comparable in age and type of hernia. The mean age in the first group was 44.4 +/- 14.6 years [range from 19-65 years], in the second group was 46.8 +/- 14.7 years [range from 20-70 years] and P value was > 0.05. In unilateral hernias the operative time was comparable in both groups. [49 +/- 5.5 min. in group 1 and 50.2 +/- 9.3 min. in group 2] and P > 0.05. On the other hand, in bilateral and recurrent cases the operative lime was 65 +/- 9.1 min. and 48.3 +/- 2.9 min in-group 1 [TEP], while in-group 2 [open], it was 81.7 +/- 7.6 min. and 66.3 +/- 7.5 min. respectively. This was significantly positive [P < 0.05]. Hospital stay was shorter in laparoscopic group [1.6 +/- 0.6 nights] than in open group [2.1 +/- 0.8 nights], but this was not statistically significant [P > 0.05]. On average, analgesia was taken for 5 +/- 1.1 days after Lichtenstein repair compared with 3.1 +/- 1 days after laparoscopic repair [p < 0.05]. Post-operatively, a seroma or a wound haemnatomna developed in five [9.3%] patients after Lichtenstein repair and in one [1.8%] patient after laparoscopic repair [p < 0.05]. Other complications like urinary retention and surgical emphysema were minimal and comparable in both groups. There was no recurrence in either group of patients all over the period of follow up ranged from 3-24 months [mean 15 +/- 7.3 months]. This study confirms that, in short term evaluation, laparoscopic total extraperitoneal hernia repair is superior to Lichtenstein repair in term of hospital stay, post operative pain, complications and operative time particularly in bilateral and recurrent cases

impact of sonography and Alvarado score on the clinical management of patients with acute appendicitis

Purpose: To determine whether diagnosis by graded compression ultrasonography improves clinical outcome for patients with suspected acute appendicitis. Material and A total of 180 patients suspected to have acute appendicitis were included in the study. 90 patients were randomized to the intervention group and were subjected to a diagnostic protocol incorporating ultrasonography and the Alvarado score. A control group included 90 patients in whom the standard clinical management was applied. The appendix was visualized at US in 69 of 83 patients [83%]. Sensitivity, specificity and accuracy of ultrasound in the diagnosis of acute appendicitis were measured at 92%, 90% and 91% respectively. Patients in the intervention group had a statistically significant lower number of both non-therapeutic operations and perforated appendix. There was no statistically significant difference in between groups in the total number of operations performed. Graded compression sonography is a powerful imaging tool that substantially improves diagnostic accuracy in patients with clinically equivocal appendicitis