Moloney darn repair versus lichtenstein mesh hernioplasty for open inguinal hernia repair.

PURPOSE: To compare two tension-free techniques of inguinal hernia repair: the Moloney darn repair (MDR) and Lichtenstein mesh hernioplasty (LMH). METHODS: The subjects of this study were 651 patients from a total 732 who underwent open inguinal herniorrhaphy at our clinic between January 2000 and January 2006. We evaluated and compared analgesic requirement in the first 24 h, operative time, hospital stay, early postoperative complications, time until return to work, and recurrence, between patients who underwent MDR (group A) and patients who underwent LMH (group B). RESULTS: Group B patients required less analgesia in the first 24 h than group A patients. Conversely, the mean operative time and postoperative hospital stay were shorter in group A. Early postoperative complication rates and the time until return to work did not differ significantly between the two groups. During follow-up, recurrences developed in three patients from group A and four from group B. The cost of MDR was significantly less than that of LMH. CONCLUSIONS: Both MDR and LMH resulted in rapid recovery and low recurrence rates; however, the advantage of the MDR lies in the fact that it does not require mesh, so it is much less expensive.

Effect of the intraperitoneal paclitaxel on the healing of colonic anastomoses.

The effect of the antiangiogenic agent paclitaxel on the healing of colonic anastomoses was studied in a rat model. Ninety-six rats underwent end-to-end colonic anastomoses, and healing was evaluated by measuring bursting pressure, hydroxyproline content, and number of newly formed vessels. The rats with end-to-end anastomoses were randomized into control and study groups (n = 48). The rats in the control group were administrated 5 ml physiologic saline intraperitoneally, and those in the study group were given 4.5 mg/kg paclitaxel in 5 ml physiologic saline intraperitoneally. One-half of the rats in both groups were killed on day 4, and the other half were killed on day 7 after surgery with high doses of ether anesthesia. There were no deaths. No detectable improvement in anastomoses bursting pressure was observed in the paclitaxel group on day 4 after surgery. On postoperative day 7, a statistically significant difference was found between the groups (P < 0.05). On day 4 after surgery, there was no statistically significant difference in hydroxyproline levels and vessel density between the two groups (P > 0.05; hydroxyproline: 26.25 versus 16 microg/mg tissue; vessel contents: 110.8 versus 118.2 vessels/x 100 fields for control and study groups, respectively). On postoperative day 7, a significant difference was detected between the two groups (P < 0.0001; hydroxyproline: 40.5 versus 9.6 microg/mg tissue; P < 0.05; vessel contents: 105 versus 85.3 vessels/x 100 fields for control and study groups, respectively). Neovascularization and hydroxyproline levels in rats receiving paclitaxel were significantly reduced on postoperative day 7 (P < 0.05 and P < 0.0001, respectively). These findings suggest that the antiangiogenic efficiency of paclitaxel, and thus, negative impact on wound healing, is more prominent on postoperative day 7. Experimentally, paclitaxel may inhibit and delay healing of colonic anastomoses.