Simultaneous repair of bilateral groin hernias using local anaesthesia: a review of 199 cases with a five-year follow-up.

BACKGROUND: There has been controversy concerning the simultaneous repair of bilateral groin hernias and the method of anaesthesia. METHODS: A consecutive series of 199 bilateral inguinal hernias was repaired by the Lichtenstein non-tension mesh technique over a two-year period (1997-98). In 96% of them local anaesthesia was used. These were reviewed after five years. RESULTS: There were no increased recurrence or infection rates, with both between 0.5-1%. Pulmonary and urinary complications did not occur. The cost of this technique is substantially less than sequential or laparoscopic operations. DISCUSSION: The reasons advanced for sequential repair of bilateral hernias have been the lower risks of infection and recurrence. Neither of these fears is evident from this study. Furthermore, the use of local anaesthesia permits the operation to be done in a day care clinic. CONCLUSIONS: Simultaneous bilateral repair of inguinal hernias using local anaesthesia is as effective as sequential repair, at lower cost and with less total time off work.

Three thousand one hundred seventy-five primary inguinal hernia repairs: advantages of ambulatory open mesh repair using local anesthesia.

BACKGROUND: Controversy exists over the relative advantages of open mesh repair compared with open stitching methods and the laparoscopic approach. STUDY DESIGN: Two thousand nine hundred six (2,906) consecutive unselected adult patients underwent 3,175 primary inguinal hernia repairs using polypropylene mesh, under local anesthesia on an ambulatory basis. The age range was 15-92 years. The study specifically investigated the postoperative course with regard to pain, complications, and time of return to work. RESULTS: There were no postoperative deaths and no cases of urinary retention. Two percent of patients developed a hematoma. The incidence of deep infection was 0.3%. No case of testicular atrophy occurred. Postoperatively 19% of patients used no analgesia at all; 60% used oral analgesics for up to 7 days. There was a gradual decrease in time of return to work over four successive 1-year periods. Manual workers returned to work in 15 days (median) in the first year, reducing to 9 days in the fourth year. The overall median time of return to work across the whole group was 9 days. There were eight recurrences with an 18-month to 5-year followup. CONCLUSIONS: Open mesh repair under local anesthesia is an effective day case technique, particularly in the elderly and medically unfit. The economic benefits are enhanced by low morbidity, early return to normal activities and low recurrence rates.

An assessment of tumor cell viability after in vitro freezing.

The identification of the minimum lethal temperature for tumor cells in vivo is difficult because of the secondary factors that are associated with the cryoinjury. This study attempts to identify this temperature by a combination of in vitro and in vivo techniques. Suspensions of Walker carcinoma cells were frozen at a rate of 1 degree C/min without cryoprotection, to either -10, -15, -20, -25, -30, -35 or -40 degrees C and held at that temperature for either 0, 10, 20, or 30 min. After spontaneous rewarming viability was assessed by a combination of vital dye studies and the growth of tumor cells inoculated into the liver and subcutaneous tissue of male, Sprague-Dawley rats. Trypan blue studies indicated that less than 1% of the cells frozen to -35 degrees C were considered viable, yet significant tumor take rates were noted, suggesting that for some cells the cryoinjury is reversible. As expected tumor take rates were reduced by lowering the temperature but were independent of the holding time. The volume doubling time and final tumor volume of the subcutaneous tumors was similar to that of controls, indicating that the growth potential of the cells which survive freezing is normal. The minimum lethal temperature was dependent upon the site of inoculation, subcutaneous tumors developing from cells frozen to -35 degrees C, whereas liver tumors did not develop from cells frozen beyond -25 degrees C, this may have important clinical implications.