Recurrence and chronic pain after mesh fixation with skin staples versus sutures in Lichtenstein's inguinal hernioplasty: a retrospective cohort study.

PURPOSE: Reduction in operating time has been reported with skin staples instead of original technique of mesh fixation with sutures in Lichtenstein's hernioplasty. Few studies have been conducted, however, with inadequate follow-up and variable results. We have undertaken this study to compare the duration of surgery and incidence of recurrence (beyond 1 year) and chronic pain after mesh fixation with staples versus sutures. METHODS: In this retrospective cohort study, adult males with primary unilateral inguinal hernia who underwent open Lichtenstein's hernioplasty from January 2009 till October 2010 were included. All patients with recurrent hernia, concomitant surgery, follow-up less than 1 year and missing data were excluded. Data collection was done via questionnaire and telephonic interviews. Outcomes are recurrence, chronic pain and duration of surgery. RESULTS: We reviewed 70 patients in each group. At median follow-up of 21 months (range 12-34), there was 0 % recurrence in both the groups and chronic pain was 4.4 % higher in suture versus staple group (11.4 vs. 7 %, p value = 0.7). Median duration of surgery was 30 min higher in suture as compared to staple group (90 vs. 60 min, p value = 0.004). CONCLUSION: Our study confirms that staples are superior to the sutures due to shorter operative time and do not cause any additive risk of recurrence or chronic pain. Prospective trial with long-term follow-up for each patient is required to validate these findings in order to generate definite guidelines.

Umbilical arterial catheter insertion length: in quest of a universal formula.

OBJECTIVE: The study was aimed at comparing the accuracy in length of insertion of umbilical arterial catheter in all new born groups stratified according to weight, by using two different methods, that is, Wright et al./Case (Group I): (4 × Body wt (BW) (kg)) +7; Shukla et al./Control (Group II): (3 × BW (kg)) +9. STUDY DESIGN: It was a randomized open label case control study in a Level III tertiary level Neonatal Intensive Care Unit over 9 months. RESULT: The babies in both the groups were similar in relation to weight, gender, prematurity and weight subgroups. Under insertion was seen in 8% (4/50) of babies in group I and over insertion was seen in group II where it was 32.6% (16/49). There was a reduction of 82% abnormal insertions and repositioning by using the Wright's formula as compared with the Shukla's formula in preterm babies. Statistically significant reduction in repositioning was seen in all babies <1500 g in Group I and under insertion seen in 8% of babies in group I did not attain statistical significance (P=0.34). CONCLUSIONS: There is no universal formula, which gives the accurate length of placement of an umbilical arterial catheter, but Wright's formula comes closer in neonates with different weight sub groups.