Laparoscopic herniorrhaphy versus traditional open repair at a community hospital.

Over a 2-year period 157 inguinal hernias in 151 patients were consecutively entered in this descriptive, observational study to determine any difference in outcome between a laparoscopic inguinal hernia repair versus an open inguinal hernia repair in a community hospital setting. The laparoscopic transabdominal preperitoneal technique was utilized in 50 cases. A conventional open repair was used in 107 cases. There were statistically significant differences when the laparoscopic and open groups were compared for the number of days until driving a car (p < 0.01), the number of days until getting in and out of bed comfortably (p = 0.01), the number of days until working on a limited basis (p = 0.01), and the number of days until working on a full-time basis (p < 0.05), although these differences may be due to confounding factors in this nonrandomized study. The average length of operating time was 72.2 min laparoscopic versus 51.6 min open (p < 0.001). We have shown that laparoscopic inguinal hernia repairs may have benefits over conventional hernia repairs. This may make its use more widespread than it has already become.

Primary aortoduodenal fistula following radiotherapy.

Primary aortoduodenal fistula is a rare condition. Common causes include atherosclerosis, leading to formation of an aortic aneurysm (most common); syphilis; carcinoma of the pancreas; trauma; tuberculosis, and myocosis. Presented herein is the recognition and successful treatment of what appears to be the first patient with a primary aortoduodenal fistula following paraaortic radiotherapy. Once suspected, immediate surgical treatment is mandatory. Primary aortic control (closure or resection), along with resection of the diseased intestinal segment, would appear to be the safest and most acceptable treatment.