Short-term safety of preoperative administration of botulinum toxin A for the treatment of large ventral hernia with loss of domain.

PURPOSE: Preoperative intramuscular-administered botulinum toxin A (BTA) in the lateral abdominal muscles prior to abdominal wall reconstruction has been reported to produce a flaccid paralysis and improve the primary closure rate of large ventral hernias with loss of domain. Complications to this treatment remain sparsely described. The aim of the current study was to report safety and short-term outcome of abdominal wall reconstruction aided by BTA administration. METHODS: This was a retrospective two-center study including all patients undergoing abdominal wall reconstruction for ventral hernia aided by preoperative BTA administration to the lateral abdominal muscles. Data were retrieved from patient charts and included preoperative demographic and perioperative information as well as postoperative 30-day complications and readmissions. RESULTS: A total of 37 patients underwent BTA administration prior to hernia repair. The mean age and body mass index were 59.5 (SD 10.1) years and 31.1 (SD 5.2) kg/m2. The BTA injections were administered mean 31.6 days (SD 10.0) prior to the hernia repair. One (2.7%) patient reported pain as a complication immediately after the BTA administration. Subsequent to the hernia repair, six (16.2%) patients were readmitted within 30 days. Nine patients (24.3%) had wound complications and medical complications occurred in seven (18.9%) patients. CONCLUSIONS: We found early preoperative administration of BTA a safe adjunct to large ventral hernia repair, without adverse events related to the administration preoperative. Future studies should further highlight the efficacy of preoperative BTA for reconstruction of otherwise untreatable hernias.

Randomized clinical trial of self-gripping mesh versus sutured mesh for Lichtenstein hernia repair.

BACKGROUND: Many patients develop discomfort after open repair of a groin hernia. It was hypothesized that suture fixation of the mesh is a cause of these symptoms. METHODS: This patient- and assessor-blinded randomized multicentre clinical trial compared a self-gripping mesh (Parietene Progrip(®)) and sutured mesh for open primary repair of uncomplicated inguinal hernia by the Lichtenstein technique. Patients were assessed before surgery, on the day of operation, and at 1 and 12 months after surgery. The primary endpoint was moderate or severe symptoms after 12 months, including a combination of chronic pain, numbness and discomfort. RESULTS: The intention-to-treat population comprised 163 patients with self-gripping mesh and 171 with sutured mesh. The 12-month prevalence of moderate or severe symptoms was 17·4 and 20·2 per cent respectively (P = 0·573). There were no significant differences between the groups in postoperative complications (33·7 versus 40·4 per cent; P = 0·215), rate of recurrent hernia within 1 year (1·2 per cent in both groups) or quality of life. CONCLUSION: The avoidance of suture fixation using a self-gripping mesh was not accompanied by a reduction in chronic symptoms after inguinal hernia repair. REGISTRATION NUMBER: NCT00815698 (http://www.clinicaltrials.gov).

[Vasectomy by the Li method]. / Vasectomia a.m. Li.

The vasectomies were performed by the residents of the department without prior training in this surgical procedure. Four and a half months after the operation, a questionnaire was sent to the patients, posing questions about discomfort, pain, swelling, discolouration and infection as well as pain and bleeding following ejaculation. Eighty-five percent of the patients returned the questionnaire. We found a low rate of primary surgical complications: seven cases of infection (including antibiotic treatment on the suspicion of infection; one was verified as epididymitis) and one granuloma. Sixty-four, 39 and 45% respectively complained about postoperative pain, swelling and discolouration, but only half of the patients in each of these groups indicated discomfort. We see this as an indication that the method has a low rate of complications and, that this may be further reduced if the surgeon achieves sufficient routine in the procedures.