Chronic pain after inguinal hernia repair

Hernia repair is one of the most common surgical procedures, and some patients suffer from chronic pain after hernia surgery. Chronic pain was believed to be a recognized but infrequent complication after inguinal hernia repair. Although it is usually mild, its exact cause and lack of evidence-based treatment path present problems in the effective management of this surgical complication. It has significant variable degrees of effects on work and social activities. The aim of the present study was to evaluate chronic post-herniorrhaphy pain in patients who underwent Darn or modified Bassinis' repair. We evaluated the patients over the subsequent 3 months, using a telephone filled questionnaire. The questionnaire included the chronic pain grading scale [CPG] questionnaire to focus on chronic pain and its limitations to their quality of life. The results show that the majority of patients were successfully treated by therapeutic injection into the point of maximal tenderness. It was concluded that chronic pain following open inguinal hernia repair can be disabling, sometimes seriously affecting quality of life. It is, therefore, very important to discuss the possibility of resulting chronic severe pain when obtaining preoperative informed consent. This paper highlights the importance of education of junior trainees about the appropriate issues and skills needed to get informed consent. We believe that each patient must be informed about the possibility of chronic, severe pain and its impact on their quality of life should it occur. The present findings indicate that identification and preservation of nerves during open inguinal hernia repair reduce chronic incapacitating groin pain and that, in the majority of patients with chronic pain at 6 months, the pain at 1 year is resolved only with conservative or medical treatment

Life style and outcome following open cholecystectomy

Gallstone disease remains one of the most common medical problems leading to surgical intervention. The Increasing number of cholecystectomy has increased the need to assess the effects of the surgery on presenting symptoms. Cholecystectomy is intended to relieve symptoms of gallstones, but unfortunately some patients will experience post-cholecystectomy symptoms, including pain. There is limited information in the literature on gallstone-related pain and its influence on quality of life. The aim of this study is to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy. This study examined symptomatology and quality of life following elective cholecystectomy for symptomatic gallstone disease with defined indications for surgery. Eighty three patients had open cholecystectomy in charity teaching hospital during the period between March 2007 and March 2008. Preoperative data on pain, symptoms, and history was recorded, and the questionnaire on pain and symptoms was filled 1 year postoperatively. Preoperative sonography evaluated gallbladder motility, gallstones, and gallbladder volume. Preoperative variables in patients with or without post-cholecystectomy pain were compared statistically, and significant variables were combined in a logistic regression model to predict the postoperative outcome. The results show that sixty eight patients completed all questionnaires. 54 of patients [80%] had documented gallstones preoperatively, 44 [64.7%] had biliary pain and 49 [72%] had both biliary pain and documented gallstones prior to surgery. Twenty three patients had some pain postoperatively. Of these thirteen patients continued to have abdominal pain after the operation. Patients with pain 1 year after cholecystectomy were characterized by the preoperative presence of a high dyspepsia score, 'irritating' abdominal pain, and an Introverted personality and by the absence of 'agonizing' pain and of symptoms coinciding with pain [P < 0.003]. In a constructed logistic regression model 8 of 11 predicted patients had postoperative pain [PV pos = 0.73]. Of 57 patients predicted as having no pain postoperatively, 52 were pain-free [PV neg = 0.91]. The cure rate for biliary colic was 85% if stones were documented preoperatively, and 49% when they were not [P< 0.05]. It was concluded that most patients [81%] with biliary colic and gallstones have complete relief of upper abdominal pain after cholecystectomy. Pain relief in patients felt to have acalculus cholecystitis was only 52%. Non-pain symptoms were common preoperatively [82%] and were relieved in 44% of patients

reliability of modified Alvarado score as a tool for diagnosis of acute appendicitis in Sudanese adults

Decision making in cases of acute appendicitis may be difficult especially for junior surgeons as diagnosis of that condition is sometimes difficult. In conditions like acute appendicitis, it is not possible to have definitive diagnosis by gold standard test [histopathology] before surgery, so various diagnostic modalities are introduced to establish accurate diagnosis. Modified Alvarado score [MAS] system is one of the examples. This work was carried out to evaluate the reliability and sensitivity of modified Alvarado scoring system in Sudanese adult patients with suspected diagnosis of acute appendicitis This prospective study included 866 [452 males and 414 females] who underwent appendicectomy in different centers in Khartoum, Sudan in the period from January 2006 to August 2007. It included all adult patients above 16 years with clinical diagnosis of acute appendicitis. Modified Alvarado score system was calculated for all patients; however decision to operate was clinical.The results showed that the overall sensitivity, specificity and accuracy were 87.78%, 24.78% and 79e.56% respectively. Our data suggested that the modified Alvarado scoring system had little applicability to the local adult population. Its sensitivity was high but the specificity was too low. So, we conclude that the modified Alvarado scoring system is not accurate in the diagnosis of suspected cases of acute appendicitis in Sudanese adult patients