The transversus abdominis plane block may reduce chronic postoperative pain one year after TAPP ingunial hernia repair.

INTRODUCTION: Chronic postoperative inguinal pain (CPIP) is defined as pain impacting daily activities lasting at least 3 months. With an incidence of 0.5-6.0%, chronic pain affects many patients who underwent inguinal hernia repair (IHR). Early severe postoperative pain has been described as a risk factor for CPIP. Thus, we aim to investigate the impact of the transversus abdominis plane (TAP) block on CPIP. METHODS: From 2013 to 2019 we collected data from individuals who were operated on electively in TAPP technique and who received a preoperative TAP block. RESULTS: Data from 289 patients were selected. 259 patients were male. The mean age was 59.93 years and the mean BMI was 25.72 kg/m2. 252 patients suffered from a primary inguinal hernia. No mesh fixation was conducted. 21 patients reported pain at rest, 26 pain under physical exertion and 13 patients required treatment of their pain. In 6.25% of cases patients reported CPIP. We compared our findings with data from the German Herniamed Registry (unilateral, primary IH, men, no mesh fixation; n = 8.799), because we assume that the majority of these patients did not receive a TAP block. The rate of pain under physical exertion (9.2% vs. 10.05%) and pain requiring treatment (2.45% vs. 2.95%) one year after surgery slightly differs without a statistical significance. CONCLUSIONS: We assume that the TAP block may reduce CPIP, postoperative pain during physical exertion and pain requiring treatment following IHR in TAPP technique. Additional randomized clinical trials are mandatory to evaluate the hypothesis.

Comparison of different durations of physical activity restrictions following incisional hernia repair in sublay technique, the 3N6 trial: A prospective clinical trial.

BACKGROUND: Incisional hernias (IH) occur in 4 to 20% of cases following abdominal surgeries, often after laparotomies. In the US, there are 4 to 5 million laparotomies performed per year, which could lead to 400.000 to 1.000.000 IHs. Therefore, this disease accounts as an important social-economic factor. Furthermore, these hernias can lead to bowel incarcerations, chronic pain, and a decrease in quality of life. To guarantee sufficient wound healing and decrease the recurrence rate, physical activity restrictions (PAR) are recommended. The standard recommendations for PAR seem to vary from 0 to 12 weeks, but the evidence remains low due to a lack of clinical trials. Conducting the study at hand, we aim to provide more evidence on this topic. METHODS: The 3N6 trial will be conducted as a national multicenter prospective trial with two study groups (n = 90), where the goal is to find matched pairs within the two groups. Patients who underwent open incisional hernia repair (IHR) in sublay technique will be enrolled. A patient in the 3-week PAR group will be matched to a patient in the 6-week PAR group based on heavy lifting, male gender, BMI > 30, and large hernia >7 cm. The primary endpoint is the duration of sick leave that patients require to return to work, by comparing PAR of 6 weeks with PAR of 3 weeks. The secondary endpoints are the recurrence rate, seroma formation, and chronic pain one year after surgery and postoperative complications within 30 days using Clavien-Dindo-classification. DISSEMINATION: The findings will be published in a peer-reviewed journal. We may also present the findings at local and/or national conferences.

Adenocarcinoma of an ileal conduit developing 8 years after cystoprostatectomy for locally advanced prostate carcinoma.

A 70-year-old patient was treated in September 2017 for a malignancy in an ileal conduit (IC) which he received in 2009 for the treatment of prostate cancer. The tumour was found incidentally during a routine sonography. A CT scan revealed a mass near the IC. An endoscopy with biopsies showed an intraepithelial neoplasia of the ileal mucosa in the IC. We performed a segmental ileal resection. Histological findings revealed an ileal adenocarcinoma. The postoperative course was uneventful. The patient has remained alive without tumour recurrence up to the most recent negative CT screening in April 2019. Secondary malignancies after urinary diversions are a well-known complication, including procedures using small bowel parts for the urinary diversion. Adenocarcinomas arising in an IC are rarely described in literature. Concerning said tumour entity, surgical removal is often recommended. There is no evidence for the success of chemotherapy or radiation due to insufficient clinical trials. When diagnosing a mass in an IC, a secondary malignancy should be taken under consideration.

Laparoscopic Treatment of an Incarcerated Meckel's Diverticulum in a Femoral Hernia.

Meckel's diverticulum (MD) is the persistence of the omphalomesenteric duct. It is usually asymptomatic but may present with bleeding, infections, and intestinal obstruction. It also may be a content of a hernia sac, a so-called Littre hernia. Herein, we will present the case of a 75-year-old female, who suffered from a painful swelling of the right inguinal region. Ultrasound imaging detected an inguinal hernia with incarcerated blind ending small bowel. Immediately, a laparoscopy was conducted. We diagnosed a right femoral hernia with an incarcerated MD. A TAPP (transabdominal preperitoneal) procedure was performed and the MD tangential stapled. Due to an uneventful postoperative course, the patient left the hospital after two days. An incarceration of a MD in a femoral hernia is rare. Tangential resection of the MD with simultaneous hernia repair in a TAPP technique seems to be a sufficient approach, when it is conducted by an experienced surgeon.

Patient reported outcome following incisional hernia repair: A survey on 163 patients at two maximum care hospitals.

INTRODUCTION: Incisional hernias of the abdominal wall are frequent complications after laparotomy (9-20%) and often need incisional hernia repair (IHR). In order to ensure wound healing and to therefore prevent postoperative short and long term morbidity carrying an abdominal binder (AB) and physical rest is frequently advised. However, there is a lack of evidence concerning clinical effects regarding these recommendations. Hence, we conducted a survey to analyze the patient reported outcome following IHR. METHODS: From December 2017 to May 2018, we conducted a survey among 270 patients who underwent open and laparoscopic IHR at two maximum care hospitals. They were interviewed about their type of operation, postoperative treatment, recommendations, and outcome. RESULTS: 163 patients replied to the questionnaire. The average age was 63.2 ±â€¯12 years. 74 patients were female and 89 were male. 32.6% of the patients reported an AB-induced immobility and 71.2% reported that the AB reduced pain after IHR. A prolonged period of physical rest and the use of an AB had no statistical significance on postoperative morbidity. CONCLUSIONS: Due to our findings we assume that the AB may induce immobility and reduce postoperative pain. A prolonged period of physical rest and wearing an AB does not seem to have an impact on the postoperative outcome following IHR. Therefore, a shortened duration of physical rest and wearing an AB following IHR should be taken under consideration. To reveal more evidence on this topic further clinical trials are essential.

Mesenchymal chondrosarcoma metastasising to the pancreas.

The mesenchymal chondrosarcoma (MC) is a rare malignant tumour and accounts for less than 3% of primary chondrosarcomas. Mostly MC arises from the craniofacial bones, the ribs, the ilium, the femur and the vertebrae. A 54-year-old man was treated due to an icterus of unknown origin. The medical history of the patient consists of a multimodal treated MC of the thoracic vertebrae. A CT imaging identified a 2×4 cm sized mass of the pancreatic head. Suspecting a pancreatic head carcinoma surgical removal was performed. Histopathological a metastasis of MC was diagnosed. Our patient left the hospital after 17 days and died 23 month after surgery. Metastases of MC to the pancreas are rare. When detecting a mass of the pancreas in patients with a medical history of an MC, a metastasis of these tumour should be taken in consideration.