Improved functional outcome and more rapid return to normal activity following laparoscopic hernia repair.

BACKGROUND: The laparoscopic repair of inguinal hernias remains a controversial subject. Advantages in terms of reduced postoperative pain and improved functional status have been demonstrated in some studies and refuted in others. We performed a prospective study of a group of young healthy patients to measure pain levels and time to return to normal activity following totally extraperitoneal laparoscopic (TEP) hernia repair and compared these outcomes to those seen following conventional anterior repair. METHODS: A total of 151 patients were entered into a prospective nonrandomized study. Forty-eight patients underwent anterior repair; 103 underwent TEP repair. Patients were followed at 2 and 6 weeks to assess their level of function on a five-point scale. Their use of pain medication was also assessed, and total days away from work and days until return to full activity were documented. RESULTS: The open group returned to work at 11.5 days and to full activity at 26.7 days. The TEP group returned to work at 6.4 days and to full activity at 14.2 days (p < 0.001 for both data). There was no statistically significant difference in the use of pain medication. The TEP group reported better functional status at 2 weeks than the open group. At 6 weeks, this difference was no longer statistically significant. CONCLUSION: As compared to conventional open repair, TEP hernia repair offers advantages in postoperative function and an earlier return to full activity.

Risk factors predictive of positive findings at colonoscopy(1).

PURPOSE:The surgery department at our institution has become the primary provider of colonoscopy. We sought to determine which risk factors, if any, were most predictive of positive findings on colonoscopy.Between March and December 1999, 202 consecutive patients referred for colonoscopy were identified. Each patient was interviewed and a standard questionnaire completed before colonoscopy to establish possible risk factors for the presence of colorectal cancer or polyps. The colonoscopy findings, including pathology reports, were correlated with the questionnaire and subjected to chi-square analysis to determine statistical significance.The risk factors most likely to be associated with a finding of colorectal cancer or polyp were family history of colorectal cancer (65%), bleeding (65%), fecal occult blood positive (64%), abdominal pain (60%), and alteration of bowel habits (53%).No risk factor by history or presenting symptoms reached statistical significance as an independent predictor of a positive colonoscopy finding. However, most frequently associated with positive colonoscopy findings were a family history of colorectal cancer, bleeding, positive fecal occult blood test, presence of abdominal pain, and alteration of bowel habits. A history to include these risk factors can serve to prioritize the need for a colonoscopic examination.

Examination and anatomy of the hand.

In preparation for forthcoming chapters, the reader is offered a clear and thorough discussion of the anatomy of the hand, with important tips for examination and diagnosis.

Trigger finger: not always work related.

A retrospective chart review of 516 patients with 719 trigger fingers was undertaken to determine the relationship between trigger finger and occupation. Of the 516 patients, 361 were employed. One hundred seventy-eight (34.5%) of the employed patients had trigger fingers related to heavy lifting and/or high force gripping activities. The decision of causation is arbitrary and not based on science.

Carpal tunnel syndrome not always work related.

Carpal tunnel syndrome is all too frequently believed to be strictly a work related disease. A retrospective analysis of 1,884 carpal tunnel patients examined by one hand surgeon between 1977 and 1992 were evaluated for their rate of employment. Twenty-five percent of these CTS patients were not employed at the time their symptoms developed. We conclude that a significant rate of CTS illness exists in the nonemployed population.

Outcome of surgically treated mucous cysts of the hand.

The results of a surgical procedure for the treatment of mucous cysts of the hand are described. One hundred ninety-one mucous cysts from 178 patients were treated from 1973 to 1992. The average age of the study population was 57 years. The long finger was most frequently involved. There were only two recurrences and two postoperative infections. Both patients with recurrences presented more than 40 months after surgery. Sixty-four of the cysts had been previously treated elsewhere. The most common postoperative complaint was tenderness of the joint. Associated nail deformities were corrected in 40 of 46 cases.