Inguinal hernia repair: are the results from a general hospital comparable to those from dedicated hernia centres?

<p><b>INTRODUCTION</b>We aimed to report the outcomes of inguinal hernia repair performed at Tan Tock Seng Hospital and compare them with those performed at dedicated hernia centres.</p><p><b>METHODS</b>We retrospectively analysed the medical records and telephone interviews of 520 patients who underwent inguinal hernia repair in 2010.</p><p><b>RESULTS</b>The majority of the patients were male (498 [95.8%] men vs. 22 [4.2%] women). The mean age was 59.9 ± 15.7 years. Most patients (n = 445, 85.6%) had unilateral hernias (25.8% direct, 64.3% indirect, 9.9% pantaloon). The overall recurrence rate was 3.8%, with a mean time to recurrence of 12.0 ± 8.6 months. Risk factors for recurrence included contaminated wounds (odds ratio [OR] 50.325; p = 0.004), female gender (OR 8.757; p = 0.003) and pantaloon hernias (OR 5.059; p = 0.013). Complication rates were as follows: chronic pain syndrome (1.2%), hypoaesthesia (5.2%), wound dehiscence (0.4%), infection (0.6%), haematoma/seroma (4.8%), urinary retention (1.3%) and intraoperative visceral injury (0.6%). Most procedures were open repairs (67.7%), and laparoscopic repair constituted 32.3% of all the inguinal hernia repairs. Open repairs resulted in longer operating times than laparoscopic repairs (86.6 mins vs. 71.6 mins; p < 0.001), longer hospital stays (2.7 days vs. 0.7 days; p = 0.020) and a higher incidence of post-repair hypoaesthesia (6.8% vs. 1.8%; p = 0.018). However, there were no significant differences in recurrence or other complications between open and laparoscopic repair.</p><p><b>CONCLUSION</b>A general hospital with strict protocols and teaching methodologies can achieve inguinal hernia repair outcomes comparable to those of dedicated hernia centres.</p>

A 10-Year Profile of Trauma Admissions Caused by Interpersonal Violence: A Major Trauma Centre's Experience

<p><b>INTRODUCTION</b>This study aimed to characterise interpersonal violence victims admitted to a major trauma centre.</p><p><b>MATERIALS AND METHODS</b>A retrospective cohort study of interpersonal violence victims who were admitted to our centre from 1 January 2001 to 31 December 2010 was conducted. Data were obtained from our trauma registry.</p><p><b>RESULTS</b>Interpersonal violence victims constituted 444 (90.1% males and 9.9% females) out of a total of 8561 trauma admissions in the same time period. The average age was 36.6 years (range, 14 to 83 years). Majority were Chinese (53.4%) and Singaporeans (77.3%). The number of cases increased from 10 per year to 96 per year in the first 8 years, then decreased in the last 2 years (55 in year 2010). Time of injury was predominantly 0000 to 0559 hours (72.3%). Interpersonal violence mostly occurred in public spaces for both genders (88.7%). However, the number of females who were injured at home was significantly higher than males (P = 0.000). Blunt trauma (58.3%) was more common than penetrating trauma (41.7%). The average injury severity score (ISS) was 13.5 (range, 1 to 75); 34.9% of patients had major trauma (ISS >15). The average Glasgow coma scale (GCS) score was 13.5 (range, 3 to 15); 16.4% of patients had moderate-to-severe brain injury (GCS 3-8). Blunt trauma was significantly more likely to cause major trauma than penetrating trauma (P = 0.003). The sole case of firearm assault caused most morbi-mortality. Overall mortality was 4.5%. Major trauma (OR: 25.856; P = 0.002) and moderate-to-severe brain injury (OR: 7.495; P = 0.000) were independent risk factors of mortality.</p><p><b>CONCLUSION</b>There has been no prior published data on interpersonal violence locally. This study is thus useful as preliminary data for future population-based studies. It also provides data for authorities to formulate preventive and intervention strategies.</p>

Arteriovenous fistula aneurysm--plicate, not ligate

<p><b>INTRODUCTION</b>Arteriovenous fistula (AVF) created for haemodialysis can be complicated by aneurysm formation.</p><p><b>CLINICAL PICTURE</b>Ligation of the fistula is often required to prevent aneurysmal rupture and the life-threatening haemorrhage that ensues. Other methods of treatment involve using foreign bodies like mesh and grafts.</p><p><b>TREATMENT</b>We describe a new method in the treatment of this condition--plication. It involves plicating the excess free wall of the aneurysm with sutures and does not require resection or anastomosis.</p><p><b>OUTCOME</b>Early results show that this method shrinks the aneurysm size and reduces the risk of haemorrhage.</p><p><b>CONCLUSION</b>The AVF can continue to be used and the patient is spared the agony of having to go through the entire cycle of creating a new vascular access site.</p>