A randomized controlled trial of staple fixation versus N-butyl-2-cyanoacrylate fixation in laparoscopic inguinal hernia repair.

BACKGROUND: There has been paramount concern among most surgeons over complications caused by staples in the form of pubic injury and nerve entrapment leading to chronic pain in laparoscopic inguinal hernia repair OBJECTIVE: The present study aimed to compare the use of N-butyl-2-cyanoacrylate (Histoacryl) with that of staples in fixation of mesh in totally extraperitoneal laparoscopic inguinal hernia repair in terms of acute and chronic pain, complications, and recurrence within 1 year MATERIAL AND METHOD: 60 patients were allocated into 2 groups. The same protocol of general anesthesia was applied in both groups. In the staple group, Ultrapro mesh was used to cover the myopectineal orifice and was transfixed with staples. In the glue group, Histoacryl was sprayed to fix the mesh at the same area as in the staple group and also at the triangle of pain. Demographic data collected included fentanyl use, operation time, visual analogue pain score (VAS), chronic pain, complications and recurrence. RESULTS: Demographic data and complications showed no significant difference in the two groups. VAS in the staple group was significantly greater than that in the glue group after 24 hours (1.6 +/- 1.33 vs. 2.35 +/- 1.32) (p = 0.037). The incidence of chronic pain after 3 months and 1 year was higher in the staple group (33.0%, 33.0%, vs. 23.0%, 16.0%) (p = 0.390, 0.360). One patient in the staple group had a hernia recurrence eight months after the operation. CONCLUSION: N-butyl-2 cyanoacrylate might be an alternative choice of mesh fixation in TEP since overall complications and recurrence of hernia were not significantly different compared to staple fixation.

Long-term outcome of patients undergoing liver transplantation at Rajavithi Hospital, Thailand.

OBJECTIVE: Examine long-term outcome and survival of patients with liver transplantation at Rajavithi Hospital, a small-volume transplant center in Bangkok, Thailand. MATERIAL AND METHOD: Between May 1996 and December 2010, 21 liver transplantations were performed Piggyback technique and portal vein flushing with one liter of cold normal saline was used to prevent reperfusion injury. Color Doppler ultrasound was performed routinely. Data collection included demographic data, complications, operation time, ischemic time, duration of stay in intensive care unit (ICU), hospitalization period, and survival. RESULTS: There were two cases withdrawn from immunosuppressant drugs due to loss of follow-up and recidivism. Late death in three patients was from bleeding after hemiarthroplasty, chronic rejection, and lymphoma. Overall, 5-year and 10-year survival were 62% and 42% respectively Biliary complication rate was 9.5%. Two cases were under early reoperation due to bleeding from hepatic artery and retrohepatic vein. Hepatic vein occlusion was found in one case that had underlying Budd Chiari. One case with hepatocellular carcinoma, 10 nodules in both lobes of liver had survived more than three years after transplantation. CONCLUSION: Liver transplantation is a high-cost procedure. Good long-term results depend on expensive drugs, skilled surgeons, state-of-the-art equipment, and good team work. Policy and support from the government play an important role for successful transplantation, especially in developing countries.