Résumé
Introduction: Postoperative inguinal pain is one of the most significant complications following inguinal hernia repair. Routine ilioinguinal nerve excision has been proposed as a means to avoid this complication
Objectives: To compare the postoperative pain after preservation and elective division of ilioinguinal nerve during inguinal hernioplasty
Methods: This was a Randomized Controlled Trial conducted at the department of general surgery at KVSS Site Hospital for a period of 6 months from Jun 2011 to Nov 2011. 84 patients who underwent mesh hernioplasty for unilateral inguinal hernia, were randomly assigned into two groups [A and B], 42 in each group. Ilioinguinal nerve was preserved in group A patients, whereas elective division was carried out in patients of group B. Mean postoperative pain scores were recorded using numerical analogue scale on first and third postoperative day, and one month after surgery. The SPSS version 16 was applied to the data
Results: Mean+/-SD age was 38.46+/-14.36 years. Seventy four [88.1%] patients were male whereas ten [11.9%] were female, with male to female ratio being 7:1. Using the numerical analogue scale to detect pain severity on postsurgical day 1 and 3, mean scores+/-SD in the nerve-preservation and nerve-excision groups were 2.88+/-0.43 versus 2.04+/-0.39, and 1.95+/-0.39 versus 1.43+/-0.44, respectively [p <0.05]. At 1 month after surgery, these scores were 1.73+/-0.62 versus 0.98+/-0.25, respectively [p <0.05]
Conclusions: Postoperative pain after inguinal hernioplasty significantly decreases in elective division of ilioinguinal nerve as compared to nerve preservation
Résumé
Objective: To assess the diagnostic accuracy of the Alvarado score in acute appendicitis
Study design: A cross sectional study
Place and duration: The study was conducted at the Accident and Emergency Department of KVSS Site Hospital during a period of 12 months from 1 Jan 2012 to 31 Dec 2012
Methodology: Hundred and ten consecutive patients who attended emergency department of KVSS Site Hospital with provisional diagnosis of acute appendicitis were included in this study after informed consent. Alvarado score was recorded and according to the aggregate score, patients were divided into two groups with scores of <5 and >/=5. The clinical diagnoses and operative findings of patients who were subjected to surgery for Alvarado score>/= 5 were compared with their histopathology reports. A self designed questionnaire was used to record relevant data including patients' age, gender, weight, Alvarado score and histopathology
Result: Out of total 110 cases [79 males, 31females], 28.2% [n=31] belonged to Group-A and 71.81% [n=79] belonged to Group-B. Surgical procedures were performed in 98.2% of cases, along with conservative treatment. Final diagnosis by histopathology was confirmed in 71.3% [n=77] cases. The overall negative appendectomy rate was 28.7% [males: 28.2%, females: 30%]. Sensitivity and specificity of Alvarado scoring system was found to be 93.5% and 80.6% respectively. Positive and negative predictive values were 92.3% and 83.3% respectively and accuracy was 89.8%
Conclusion: The Alvarado score is highly effective and non-invasive in the diagnosis of acute appendicitis