Experience of Open Herniorrhaphy Using the PerFix(R) Plug for Patients with Recurrent Groin Hernias

PURPOSE: The recurrence of a groin hernia presents few surgical options for repair. We investigated the safety and efficacy of herniorrhaphy using PerFix(R) plug for patients with recurrent groin hernias. METHODS: Between October 2000 and December 2004, 30 herniorrhaphies for recurrent groin hernia were performed and followed-up. The operation time, length of hospital stay, time of analgesic use, complication rates, and recurrence were investigated. RESULTS: Surgery had been initially performed in 26 patients with the non-mesh method, and with mesh in 4 patients; 12 patients had a direct recurrence at the medial side of the inguinal area near the pubic tubercle, 7 patients had a direct recurrence at other sites, and 11 patients had an indirect recurrence. Eight patients had urinary retention and 2 patients had minor wound complications. Hospital stays and analgesic use were comparable to non-recurrent groin hernia operations, although operation time was significantly longer in recurrent group, and there were no recurrences during the 70 months of followup. CONCLUSION: Comparing open or laparoscopic preperitoneal approach, the PerFix(R) plug method is simple and effective for recurrent groin hernia repair.

Clinical Analysis of Recurrent Gastrointestinal Stromal Tumor (GIST) Patients

PURPOSE: Gastrointestinal stromal tumors (GISTs) are of a mesenchymal origin, and they arise predominantly from the gastrointestinal tract. This study aims to aid the post operative management of GIST patients by analyzing the clinical and immunopathological features of recurrent GISTs. METHODS: We enrolled 98 GIST patients who had been operated on for their primary tumor from 1987 to 2001 at the Catholic Medical Center. Among them, 28 patients had clinical and radiological features that were proved to be recurrence, and the patients' survival rates were compared according to the treatment modalities. RESULTS: When the maximum length of tumor was shorter and the mitotic index lower, then these patients had higher disease free survival rates and lower recurrence rates. The Ki-67 negative group had lower recurrence rates than their Ki-67 positive counterparts. Recurrence was mostly observed as liver metastasis. The mean length of time to recur was 22.96 months. Fifteen patients received additional treatments such as surgery, chemotherapy and radiation therapy, but there was no significant difference in survival rates when they were compared to the 13 patients who did not receive further treatments. CONCLUSION: Of the patients diagnosed with GIST after surgery, those with worse prognostic factors, i.e. a bigger tumor size and higher mitotic index, require more meticulous surveillance for tumor recurrence, and especially for liver recurrence, which was the most common recurrence site, during the follow up exams. In addition, although there have not been any remarkably effective treatments for the recurrent GIST patients, further researches for new therapy such as STI-571 is mandated.