Outcome after Mesh or Shouldice Herniorrhaphy

BACKGROUND: Inguinal herniorrhaphy remains one of the most common general surgical operations. Mesh repair is advocated by several specialized hernia centers. The purpose of this study was to compare results of mesh and Shouldice repair for inguinal herniae. METHODS: A clinical review was made of 73 cases of inguinal herniae treated during the 3 years from January 1993 to December 1996 at the Department of Surgery, Dae Rim Saint Mary's Hospital, and at the Department of Surgery, Eum Sung Saint Mary's Hospital. We treated 38 patients with mesh repair and 35 patients with a Shouldice procedure. Among 73 cases, 72 cases were males and only one case was a female. All except 8 cases had indirect types of hernias. RESULTS: Mesh repair required less time (80 minutes) and was an easier operative technique than the Shouldice procedure (95 minutes), but postoperative pain was similar between the two procedures. Postoperative pain was relieved after one week in 60% of the patients and after four weeks in 88% of the patients. The complications following the operations were similar between the two procedures: voiding difficulties developed in two cases, wound infection in one case, and a hematoma in two cases. There were no recurrences during the 6 month to 3 year follow up. CONCLUSIONS: Inguinal herniorrhaphy using a mesh repair technique provides is simple, rapid, less painful, and effective.

Comparison of Mepivacaine and Bupivacaine as an Adjuvant of Morphine for Benign Anorectal Surgery under Caudal Anesthesia

BACKGROUND/AIMS: The caudal anesthsia is most commonly used for benign anorectal surgery, The combination of long-acting anesthetics and opiates has been used for longer duration and successful control of postoperative pain. But the side effects of peridural anesthesics and morphine have commonly occured in caudal anesthesia. This study was performed to assess the difference in clinical effects between peridural mepivacaine and bupivacaine with morphine. METHODS: We evaluated the clinical effects in 60 patients who had anal operation with Jack-Knife position under caudal anesthesia. We divided randomly these 60 patients into two groups, M and B groups (in each group, 30 patients included). Group M (n=30) was given 2% mepivacaine 20 ml with morphine 2 mg caudally, and Group B (n=30) was given 0.5% bupivacaine 20 ml with morphine 2 mg in the same manner. We measured the onset time, duration, postoperative analgesia, and side effects including urinary retention. RESULTS: The onset time for analgesia was significantly shorter in group M than in group B. The duration of postoperative pain complaints was significantly longer in group M than in group B. The postoperative analgesic effects and side effects were not significantly different between two groups. CONCLUSIONS: Caudal mepivacaine and morphine mixture is effective for control of postoperative pain without significant side effects.