Laparoscopic inguinal hernioplasty: a community hospital's experience.

Although controversial, laparoscopic inguinal hernia repair has become increasingly popular among surgeons. The overall advantages of this procedure over conventional hernia repair have not as yet been substantiated. One hundred and three consecutive laparoscopic, transabdominal, preperitoneal inguinal hernia repairs in 91 patients were evaluated retrospectively. Patients' satisfaction was assessed using the Visick grading system. The mean follow-up was 18.3 months. One case was converted to an open procedure. Eighty-eight patients (91%) were discharged on the day of surgery. Eighty-seven patients (96%) were satisfied with the operation (Visick grades I & II). Twenty-nine patients who previously underwent a traditional open herniorraphy stated that they would have preferred the laparoscopic method if they had the choice. Early complications included wound infection (n = 1), urinary retention (n = 1) and intestinal obstruction necessitating a laparotomy (n = 1). All patients were ambulating without significant pain after a mean of 7.6 days, and returned to work after 2.4 weeks on average. There was one case of recurrence. In conclusion, patients are satisfied with the laparoscopic hernioplasty technique, which is associated with a low morbidity and short term recurrence rate. Laparoscopic hernioplasty should be considered a viable and valuable alternative to the open method. It appears especially attractive for recurrent or bilateral hernias.

Ultrasonography in the diagnosis of acute appendicitis.

The purpose of this study was to assess our results of using graded compression ultrasonography (US) to confirm the diagnosis of acute appendicitis. Graded compression US was performed on 94 patients who presented at the Lehigh Valley Hospital, Allentown, Pennsylvania with an equivocal clinical picture of acute appendicitis. When used to diagnose acute appendicitis, US provided a specificity of 93.7%, sensitivity of 74.2%, and accuracy of 87.2%. We conclude that graded compression US was useful to rule out the diagnosis of acute appendicitis and helped to avoid unnecessary appendectomies and reduced negative laparotomies. Our results proved to be comparable to previously reported studies.