A modified open intraperitoneal mesh (Garestin) technique for incisional ventral hernia repair.

BACKGROUND/OBJECTIVE: Incisional hernias (IHs) are a major problem following abdominal surgery. In an effort to resolve large IHs adequately, we herein present our own modified "open intraperitoneal mesh" technique, termed the Garestin technique. METHODS: We analyzed early postoperative complications (EPCs; wound infection, hematoma, and seroma) and late postoperative complications (recurrence) in 124 patients operated for IHs and recurrent IHs (RIHs) using our new technique. Our technique involved repairing hernias by preserving the hernia sac, which was later used to conceal the mesh that replaced the abdominal wall defect, thus dividing the mesh from subcutaneous tissue. RESULTS: We operated 66 patients with IH and 58 patients with RIH. In the 4-week postoperative follow-up, 29 patients had EPC; 9 of them had wound infections that healed upon antibiotic therapy, without the need for any surgical procedure. Of the 10 patients with recurrent herniation in the long-term follow-up, 6 previously had EPC. Recurrences occurred 4-25 months after the operation. CONCLUSION: Our method is reliable and safe for large ventral hernia disposal, but the final conclusion requires a larger number of patients and a longer follow-up period.

The effect of preemptive intravenous low-dose magnesium sulfate on early postoperative pain after laparoscopic cholecystectomy.

As an N-methyl-D-aspartate antagonist, magnesium sulfate has analgesic properties and reduces noxious input during surgery. The aim of the study was to determine the effect of preemptive intravenous low-dose magnesium sulfate on early postoperative pain after laparoscopic cholecystectomy. In this prospective, randomized study, 60 ASA I-II patients undergoing elective laparoscopic cholecystectomy were assigned to three groups (n = 20 each). After anesthesia induction, prior to surgical incision, patients received magnesium sulfate 5.0 mg/kg (group A), magnesium sulfate 7.5 mg/kg (group B) or saline intravenously (group C). General anesthesia was performed with the same drugs in all three groups. Postoperative pain intensities at rest, according to the visual analog scale (VAS 0-10), were evaluated at 1, 3, 6, 9 and 24 hours after surgery. According to the VAS scores, patients intravenously received metamizol 2.5 g (VAS 3-4), diclofenac 75 mg (VAS 5-7) or tramadol 1 mg/kg (VAS 8-10). VAS scores at 1 hour postoperatively were significantly lower in groups A (4.7 +/- 1.7; p < 0.05) and B (3.2 +/- 1.8; p < 0.01) than in group C (5.2 +/- 2.0). At 3 hours postoperatively, VAS score was significantly lower in group B (2.4 +/- 1.5) than in group A (3.7 +/- 1.8) or group C (3.8 +/- 2.3) (p < 0.05). After 6, 9 and 24 hours postoperatively, there were no differences in VAS scores among the groups. In conclusion, preemptive intravenous administration of both 5.0 mg/kg and 7.5 mg/kg of magnesium sulfate significantly reduced early postoperative pain after laparoscopic cholecystectomy, but 7.5 mg/kg was found to be more effective. There was no effect on pain reduction at 6, 9 and 24 hours after surgery and no adverse effects were recorded.