Comparing functional outcomes in minimally invasive versus open inguinal hernia repair using the army physical fitness test.

PURPOSE: The advantages of minimally invasive inguinal hernia repair (MIHR) over open hernia repair (OHR) continue to be debated. We compared MIHR to OHR by utilizing the Army Physical Fitness Test (APFT) as an outcome measure. METHODS: The APFT is a three-component test scored on a normalized 300 point scale taken semiannually by active-duty military. We identified 1119 patients who met inclusion criteria: 588 in the OHR group and 531 in the MIHR group. Changes in APFT scores, time on post-operative duty restrictions (military profile), and time interval to first post-operative APFT were compared using regression analysis. RESULTS: Postoperatively, no APFT score change difference was observed between the OHR or MIHR groups (- 7.3 ± 30 versus - 5.5 ± 27.7, p = 0.2989). Service members undergoing OHR and MIHR underwent their first post-operative APFT at equal mean timeframes (6.6 ± 5 months versus 6.7 ± 5.1, p = 0.74). No difference was observed for time in months spent on an official temporary duty restriction (military profile) for either OHR or MIHR (0.16 ± 0.16 versus 0.15 ± 0.17, p = 0.311). On adjusted regression analysis, higher pre-operative APFT scores and BMI ≥ 30 were independently associated with reduction in post-operative APFT scores. Higher-baseline APFT scores were independently associated with less time on a post-operative profile, whereas higher BMI (≥ 30) and lower rank were independently associated with longer post-operative profile duration. Higher-baseline APFT scores and lower rank were independently associated with shorter time intervals to the first post-operative APFT. CONCLUSION: Overall, no differences in post-operative APFT scores, military profile time, or time to first post-operative APFT were observed between minimally invasive or open hernioplasty in this military population.

Successful Placement of REBOA in a Rotary Wing Platform Within a Combat Theater: Novel Indication for Partial Aortic Occlusion.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to augment resuscitation in patients with noncompressible torso hemorrhage, which is a leading cause of death on the battlefield. However, the implementation of REBOA has resulted in considerable debate within the military medical community. We present a case of the first successful placement of an REBOA by a small surgical team within a mobile rotary wing platform.

Treatment of advanced and inaccessible sarcomas with continuous intra-arterial chemotherapy prior to definitive surgery or radiotherapy--a possible alternative to amputation or disabling radical surgery.

Four patients with advanced and inaccessible soft tissue sarcomas were treated with a regimen of intra-arterial chemotherapy followed by radiotherapy and/or surgical excision. Two of the patients had advanced sarcomas in the buttock and thigh regions which would otherwise have required hindquarter amputation in one case or disarticulation of the hip in the other case. These sarcomas responded significantly to intra-arterial chemotherapy to the extent that subsequent local surgery was effective in eradicating the residual tumours. No viable tumour cells were found in the resected specimens. In both patients amputation was avoided and local tumour eradication was achieved. In the other two patients, advanced and non-resectable sarcomas in the head were first treated with a similar regimen of intra-arterial chemotherapy. In both cases the tumours regressed in size prior to administration of local radiotherapy. After completion of chemotherapy and radiotherapy no viable tumour cells were detected in either lesion. In one case (originally a very extensive sarcoma of the jaw in a 5 year old child) a residual lump was resected but no viable tumour was detected in the resected specimen. These four patients represent our total experience with this plan of management. All responded well and there has been no evidence of local disease recurrence in any of the four patients. One patient (Case 2) did develop pulmonary and bone metastases from which she died 2 years later but the other three patients remain well with no evidence of residual disease, 11 years, 4 years and 20 months after presentation.

Postbulbar duodenal ulcer.

Postbulbar duodenal ulceration is not common, but when present is difficult to diagnose and treat. Between January 1965 and September 1971, 1,080 patients with duodenal ulcers were treated surgically at St James Hospital. Forty-one ulcers were found at operation to lie distal to the duodenal bulb. Pain was the most common indication for surgery. In six-patients it was clinically indistinguishable from biliary pain, giving rise to diagnostic difficulty. Twelve patients (29%) presented with haemorrhage, a percentage similar to the 25% of bulbar ulcers presenting with this complication over the period of this study. This is contrary to the finding in most other series, that postbulbar ulceration is more frequently complicated by haemorrhage than is bulbar ulceration. Perforation and stenosis are uncommon complications. Postbulbar ulceration is easily overlooked in conventional barium studies. Only one-third of the patients subjected to barium meal x-ray examination had their ulcers identified in the first study. In a further third the presence of an ulcer was suspected, and the remainder required multiple investigations for undiagnosed symptoms before the condition was demonstrated. Duodenoscopy was not performed in a sufficient number of patients for its value to be assessed, but other reports indicate that it should be a valuable manoeuvre. The technical difficulties and potential hazards of Polya gastrectomy are discussed and special reference is made to the surgical management of bleeding postbulbar ulcers.

Portal pyaemia secondary to carcinoma of the rectum.

A case of multiple liver abscesses occurring in association with a carcinoma of the rectum is presented. This complication has not been previously recorded. It gave rise to an unexplained pyrexia and a confusing liver scan.