Herniotomy in young adults as an alternative to mesh repair: a retrospective cohort study.

INTRODUCTION: Inguinal hernia repair is one of the most frequently performed procedures. An alternative to mesh repair could be herniotomy, where no mesh is placed and only minimal dissection is done. The European Hernia Society guidelines on the treatment of inguinal hernia in adult patients, which were released in 2009 and expired some time ago, states that all adult (>30 years of age) male patients with a symptomatic inguinal hernia should be operated on using a mesh technique. We hypothesize that the herniotomy is a good alternative to mesh repair in young patients. METHODS: In this retrospective cohort study, the postoperative complications and recurrence rate after a herniotomy procedure were studied. All patients between the ages of 18 and 40 at the time of the surgery were included from January 1st 1997 until December 31st 2010. RESULTS: In our cohort of 234 patients, the recurrence rate was 4.7 %. When we focus on the patients in the ages ranging from 18 to 25 years old at the time of the surgery, we found a recurrence rate of 0 versus 9.2 % in ages 26-40. These recurrence rates are comparable to those in current literature. CONCLUSION: A herniotomy seems to be an efficient procedure with acceptable recurrence rates in patients up to 30 years of age. Postoperative pain seems to be low compared to other techniques. In patients older than 30 years recurrence rates seem to increase which necessitates the use of mesh implants. The main finding is zero recurrences in patients up to 25 years of age. Because there is a limited amount of similar studies that evaluated the complications of a herniotomy, we believe these results warrant the commencement of a randomized controlled trial to add more evidence to this topic. This cohort study is a small, but important contribution to the advice to perform a randomized controlled trial. Based on the limited evidence that is known so far, this procedure might be the treatment of choice in the repair of primary inguinal hernia in young adult patients up to 30 years of age.

Treatment of vertigo and postural instability using visual illusions.

BACKGROUND: Ototoxicity caused by medication can lead to debilitating symptoms such as dizziness, vertigo and postural instability. There is no current 'gold standard' treatment available. CASE REPORT: A 79-year-old male, with bilateral loss of vestibular function caused by gentamicin toxicity after surgery for prosthetic valve endocarditis, complained of dizziness, difficulty in walking and an increased risk of falling. Physical examination showed a positive head thrust test suggesting bilateral loss of vestibular function. RESULTS: The patient underwent a specific motion-based virtual reality enhanced protocol for peripheral vestibular disease. He showed a great improvement, with a 50 per cent reduction in his Dizziness Handicap Inventory score. CONCLUSION: Computer-aided rehabilitation programmes might represent an important advance in gait and posture training.