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

sensitivity and specificity of the conventional symptoms and signs in making a diagnosis of acute appendicitis

Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality. So, surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. This study is designed to evaluate the sensitivity and specificity of clinical examination in the diagnosis of acute appendicitis. The study included 866 patients of acute appendicitis who had undergone appendicectomy with preoperative diagnosis of acute appendicitis. They were analyzed retrospectively. The parameters evaluated were age/gender, clinical presentation [signs and symptoms] and total white blood cell counts. The operative findings were recorded and the inflammation of the appendix was graded into normal, acutely inflamed and gangrenous. Clinical diagnosis was made correctly in 807 [93.2%] of the patients. White blood cells count ranged from 3.70 to 45.30 /mm[3] [mean 17.5353 /mm[3]]. It was <10.000/mm[3] in 133 [15.4%] patients. Clinical assessment is the best criterion to reach a confident diagnosis. Investigations may supplement the diagnosis but are never a substitute for it

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

Outcomes and complications of thyroid surgery among the Sudanese patients

To reveal the outcomes and complications of post-thyroidectomy, a study was carried out on 1351 patients aged between 18 and and 76 years [mean, 43.9 years] of whom 945 were female [69.95%] and 406 [30.05%] were male patients [female to male ratio was 2.3:1]. The most common Indications for total thyroidectomy were diffuse goiter and multlnodular goiter [45.7% and 36.04%of cases respectively]. Incidence of malignancy was 41 cases [2.7%]. Of those patients with malignancy, thirty cases [73.2%] underwent an associated nodal dissection along with total thyroidectomy. The Incidence of postoperative wound haematoma was 0.6% [8 cases], wound infection was 0.4% [5 cases], and mortality rate was 0.0%. The Incidence of postoperative hypocalcaemia was 8.4% [113 cases]. Younger age was statistically associated with an Increased Incidence of hypocalcaemia [P<0.002], whereas sex [P=0.31], Indication for surgery [P=0.16], and associated neck dissection [P=0.13] were not. The Incidence of hyperthyroidism was 0.148% [2 cases]. The mean duration of hospital stay was 4.2 days and was unaffected by occurrence of postoperative hypocalcaemia. The Incidence of unilateral and bilateral vocal cord paralyses was 1.1% [23 cases] and 0.22% [3 cases], respectively. The study showed that there is an Increase of the Incidence of complications when the operation performed for carcinoma. This Increase may be due to the extent of disease found at operation or the less experienced surgeons. Postoperative hypocalcaemia is the most common immediate surgical complication of total thyroidectomy. Other complications, including recurrent laryngeal nerve paralysis, hypothyroidism, hyperthyroidism, and haematoma formation