Abdominal compartment syndrome in patients with strangulated hernia.

BACKGROUND: Intestinal obstruction (IO) leads to increased intra-abdominal pressure and abdominal compartment syndrome. The purpose of this study was to investigate the characteristics of abdominal compartment syndrome in patients with IO secondary to strangulated hernia. METHODS: We studied 81 consecutive unselected patients presenting complicated hernias and IO. We measured intra-abdominal pressure using the intra-vesicular pressure method. RESULTS: Preoperative (15 min) intra-abdominal pressure was higher in patients with strangulated hernias. Postoperative (15 min) intra-abdominal pressure in both groups decreased to similar values. Intra-abdominal pressure was measured during the preoperative period in patients with strangulated hernias and during the postoperative period at 15 min (13.8 +/- 6.4 mmHg), 24 h (9.8 +/- 3.2 mmHg) and 48 h (7.4 +/- 2.4 mmHg). Abdominal compartment syndrome developed in 47% cases with strangulated hernias with a mortality of five patients. CONCLUSIONS: Serial measurements of intra-abdominal pressure evidenced the clinical severity of strangulated hernia. Intra-abdominal pressure measurement may be used as a predictor of intestinal strangulation in patients presenting acute abdominal compartment syndrome secondary to complicated hernia.

Long-term follow-up of tension-free Lichtenstein hernioplasty: application of a qualitative-and-quantitative measurement instrument.

Real outcomes for the inguinal tension-free Lichtenstein hernioplasty are not reflected by the usual parameters by which they are measured and habitually reported. It is possible to measure these outcomes from the point of view of the surgeon, as well as from the patient's, using an instrument specifically designed for that purpose. The aim of this study was to analyze the outcomes of the tension-free hernioplasty in 236 patients. Based upon the concept of quality-of-life, we designed a structured questionnaire in the form of a qualitative-and-quantitative measurement instrument. The study had two phases. First, we analyzed retrospectively the clinical records. Second, we interviewed the patients applying the instrument. The score demonstrated that 83% of the patients feel that the outcomes of their surgery are excellent, 9.7% feel that they are very good, and 3.8% feel that they are bad or very bad. Outcomes of the Lichtenstein hernioplasty should not only reflect the technological progress of hernia surgery but also the more intimate aspects of the patient's experience. It is possible to measure the outcomes of this common surgical procedure in a more complete way using a simple measurement instrument.