جستجوی مقالات مرتبط با کلیدواژه "herniorrhaphy" در نشریات گروه "پزشکی"

Herniorrhaphy is the most common inguinal surgery in children. Several methods such as caudal block, ilioinguinal iliohypogastric block, and wound infiltration have been studied for postoperative pain management in these patients. Caudal block is common in pediatrics. However, ilioinguinal iliohypogastric block is effective and less invasive. Previous studies have shown different comparative results regarding these blocks. This study compares the analgesic effect of caudal and bilateral ilioinguinal iliohypogastric block with ropivacaine in children.

This study is a randomized double-blind clinical trial. A total number of 66 patients aged between 1-7 years that volunteered for bilateral inguinal hernia repair were randomly assigned to two groups. After general anesthesia, caudal block with 1cc/kg ropivacaine 0.2% was performed for 33 patients and sonography-guided ilioinguinal iliohypogastric block with 0.1 cc/kg ropivacaine for each side was considered for another group. Hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and heart rate) during anesthesia, pain score (CHEOPS), delirium score (PAED), nurses’ satisfaction score (RN), need for additional narcotic, recovery time, and complications were compared in these two groups.

There was no statistically significant difference between the two groups in terms of hemodynamic parameters during the anesthesia process. Furthermore, the two groups had no statistically significant difference in CHEOPS score (6.27 in ilioinguinal block and 5.70 in caudal block, P=0.061), PAED score (5.64 vs 5.30, P=0.144), and RN satisfaction score. However, the need for narcotics, mean recovery time, and block complications were comparable in two groups.

Caudal block and ilioinguinal block are equally effective for post herniorrhaphy pain and emergence agitation management in pediatrics. Additionally, no differences were observed in complications. It is recommended that the study be performed with a larger sample size.

To assess the effect of preoperative smoking cessation on postoperative complications in patients undergoing herniorrhaphy.
This prospective study was conducted on 163 consecutive patients, undergoing herniorrhaphy. Demographic characteristics and postoperative complications were compared between smokers (group A), patients who reduced smoking by 50% (group B), and patients who completely quit smoking (group C).
The mean age of the patients was 42.9 (SD=10.3) years. Group A (n=77), group B (n=27), and group C (n=59) were not significantly different in terms of age, body mass index (BMI), medical history, laboratory data, smoking habit, type of hernia, type of anesthesia, the American Society of Anesthesiologists (ASA) class, repair method, surgery approach, and duration surgery (P>0.05 for all). However, significant differences were observed between group B and group A, group C and group A, and group C and group B regarding postoperative complications, such as wound healing complications and length of hospital stay (LOS) (P<0.05 for all).
Decreased preoperative smoking is associated with the reduced risk of respiratory, cardiovascular, and wound healing complications and decreased LOS in patients undergoing herniorrhaphy.

Background:

 The aim of this study was to evaluate the effect of preoperative oral carbohydrate on the perioperative agitation in pediatrics with elective herniorrhaphy.

Materials and Methods:

 In this randomized clinical trial study, 120 pediatrics, 6 months to 10 years-old who underwent elective herniorrhaphy were admitted. Sixty pediatrics in the intervention group received 5 ml/kg of 20% dextrose solution manufactured by Samen Company as carbohydrate beverage exactly 2 hours before surgery and the control group (n=60) received distilled water. The perioperative agitation score was calculated as follows. Score 1: quiet, silent child, score 2: mild but agitated, score 3: medium aggression, and score 4: severe agitation measured before surgery, at recovery, 5, 15 and 30 minutes after intervention. Also, the incidence of nausea and vomiting was recorded in each group.

Results :

Of the 60 pediatrics in the intervention group, 54 patients were quiet and silent at the time of entry into the operating room, and 6 patients had mild agitation; in the control group, 7 patients were quiet and silent, 41 patients were mild but agitated, and 12 were moderate. There was a significant difference in agitation between the two groups (P = 0.001). Five minutes after surgery, 54 patients scored 1, 6 patients scored 2 in the control group, 27 patients scored 1 and 33 patients scored 2. There was a significant difference between agitations of children 5 minutes after intervention in the two groups.

Conclusion :

Five ml/kg of 20% dextrose solution as carbohydrate beverage exactly 2 hours before anesthesia may lead to parental satisfaction and improvement in positive behavior of pediatrics at anesthesia induction and wake up from anesthesia.

Elective inguinal herniorrhaphy is one of the most prevalent surgical procedures in pediatric age group. |Postoperative pain is prevalent in children undergoing inguinal hernia repair. This study was aimed to compare the analgesic effect of dexmedetomidine with bupivacaine combination versus bupivacaine alone for ilioinguinal nerve block in children undergoing inguinal herniorrhaphy.

In this prospective randomized study, we studied 60 ASA class I and II patients with the age between 6 months to 6 years scheduled for unilateral inguinal herniorrhaphy. With the help of a computer-generated list, our patients were assigned randomly to two groups of 30 patients. Group A, received 5cc bupivacaine 0.25%, and group B received 5cc bupivacaine 0.25% with dexmedetomidine 0.3 μg/ kg. Statistical analysis was performed using SPSS. The t-student and Mann-Whitney tests were used to compare the variables between groups. The values were considered significant if P < 0.05.

There was no significant difference in blood pressure (systolic or diastolic) and heart rate between the two groups (P=0.624, P=0.784 and P=0.167, respectively).  Analgesia duration was significantly longer in bupivacaine with dexmedetomidine group in comparison to bupivacaine alone group (P=0.008). However, there were no significant difference in frequency of analgesic consumption (P = 0.175) and total dose of analgesic consumption (P = 0.634) in the first 24 h between the two groups. One patient in group B developed bradycardia.

The use of dexmedetomidine, as an adjuvant to bupivacaine prolongs the length and the analgesic efficacy of the ilioinguinal nerve block after inguinal herniorrhaphy in pediatric age group.

Herniotomy is a common operation done by pediatric surgeons. Recent studies have shown that high ligation in herniation in adult is not necessary, but this method was not fully evaluated in children. We compared non-ligation with high-ligation sac in herniotomy in terms of surgical complications and duration.

This randomized controlled trial study was done on 104 children with inguinal hernia at Al-Zahra Hospital, Isfahan, Iran, between 2011 and 2013. Patients were equally randomized to undergo herniotomy with ligation of sac at the internal ring level or to undergo herniotomy without sac ligation. Patients were followed up just after the operation, and in the 1 st , 6 th , and 12 th weeks postoperation to discover early (scrotal hematoma, edema, wound infection, and postoperation fever) and late (adhesion and recurrence) complications. Also, duration of operation was recorded for each group.

The incidence of early complications (nine cases in high-ligation and eight cases in non-ligation group) was the same in both groups (P = 0.402). No late complication was observed in any group. The mean duration of operation in high-ligation group (18.84 ± 5.47 min) was significantly shorter than non-ligation group (21.46 ± 9.03 min) (P < 0.001).

Complications are the same in herniotomy with or without ligation of the sac, but the duration of the non-ligation procedure is shorter than that of high-ligation. We suggest that herniotomy without sac ligation in children be the procedure of choice to save time and also to prevent any other possible complications such as nerve damage, spermatic cord injury, or peritoneal tearing.

Bladder calculi, a rare condition in the pediatric population, occur most commonly as a result of either migration from the kidney or urinary stasis in the bladder. We report the case of a 3-year-old boy with recurrent urinary tract infections (UTI) secondary to bladder calculi formation on the sutures from a previous herniorrhaphy.A 3-year-old boy with previous history of herniorrhaphy presented with recurrent episodes of urinary tract infection, resistant to antibiotic therapy. Physical examination was unremarkable. Ultrasonography (US) showed an echogenic fixed intra-luminal lesion in the bladder. Cystoscopic evaluation was performed and confirmed presence of calculi forming around several permanent silk sutures fixed to the bladder wall. The patient undergone cystotomy and the calculi were resected. The stone analysis revealed 80% uric acid calculi. The final diagnosis was of bladder calculi due to remnant suture from past herniorrhaphy..

Postoperative apnea is a major concern in infants undergoing surgery. In this study, we evaluated incidence and related factors for postoperative apnea in infants less than 60 weeks postconceptual age after herniorrhaphy. One-hundred fifty infants with post conceptional age (PCA) less than 60 weeks who underwent elective herniorrhaphy were studied over eight months in 2012. General anesthesia was induced by sevoflurane and maintained by remifentanil, atracurium, and N2O 60%. Postoperatively, they were monitored for two hours in the recovery room and ten hours in the ward using pulse oximetry and nasal capnography. Totally, 31 (20.7%) cases of postoperative apnea were reported. By comparing the patients, factors associated with postoperative apnea included postconceptional age, birth weight, and history of apnea, oxygen therapy, metabolic diseases, icterus, or cardiac disease. Twenty-seven (18%) apnea cases occurred in recovery room in infants with gestational age (GA) of 35.64±2.73 weeks, while only four (2.6%) patients of GA 36.02±2.0 weeks developed delayed apnea). In our study, the incidence of postoperative apnea following inguinal herniorrhaphy under general anesthesia in infants younger than 60 weeks PCA was 20.7%, which is considerable. We recommend longer surveillance and monitoring in recovery room for these infants with high-risk of postoperative apnea. This should be followed by evaluation of risk factors to determine the indication for elective intensive care unit transfer for longer-term monitoring of higher-risk patients.

This study was performed to evaluate the effect of Stoppa hernia repair on sexual function of the patients with bilateral inguinal hernia. In a prospective follow-up study, 50 patients with bilateral inguinal hernia were investigated to assess sexual function before and 1 and 6 months after standardized Stoppahernioplasty using the International Index of Erectile Function (IIEF) questionnaire. The mean scores obtained on pre- and postoperative visits for all domains of sexual function were analyzed and compared with the Friedman and paired Wilcoxon tests. The mean score of IIEF at the first month after surgery was significantly declined compared to that before surgery and 6 months after surgery (P< 0.001), while the difference between preoperative score and the score at 6 months after surgery was not significant. Bilateral inguinal mesh repair with Stoppa technique can decreased sexual activity of the patients at one month after surgery, nevertheless it returns to its initial condition at 6 months after surgery. This suggests that the Stoppa technique does not affect the sexual function of patients with bilateral inguinal hernia.