PubMed · 14887741
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G A REINBERG. 1951. [Hemorrhoids].. https://pubmed.ncbi.nlm.nih.gov/14887741/
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For much of the twentieth century, surgery was frequently the solution for peptic ulcer disease. Our understanding of the pathophysiology of ulcers paralleled the development of potent pharmaceutical therapy. As the surgical world developed parietal cell vagotomy which would minimize the complications of surgery, patients failing medical therapy became rare. Emergent surgery for complicated peptic ulcers has not declined however. The development of proton pump inhibitors and the full understanding of the impact of H pylori has led to a trend towards minimalism in surgical therapy for complicated peptic ulcer disease. In addition to the changes in patient care, these developments have had an impact on the training of surgeons. This article outlines these trends and developments.
Since 1981, 4,029 consecutive inguinal herniorrhaphies (IH) were performed under protocol utilizing several emerging techniques progressively incorporated to lower complication rates. Patients were operated with identical protocols from 1981 to 1988 at a teaching institution (Group A patients) and from 1988 till the present at two community hospitals (Group B patients). Emergent techniques were sequentially incorporated, progressing from a modified Shouldice approach to the Rives technique, Lichtenstein rolled plugs, and finally to the Rutkow-Robbins mesh plug. Several technical as well as aseptic and antiseptic measures were incorporated in the protocol to prevent episodes of wound infection, testicular atrophy, and inguinodynia. A total of 4,029 IH were performed: Group A (1,199 primary and 113 recurrent IH), Group B (2,466 primary and 251 recurrent IH). There were 1,834 IH performed with the Shouldice technique [recurrence rate (RR) 1%], 224 utilizing the Rives technique (RR 0%), the Lichtenstein rolled plug in 47 (RR 0%), and plug mesh in 1,910 (RR 0.23%). One hundred and six recurrent hernias were operated by the Shouldice technique (RR 0%), nine by the Lichtenstein rolled plug (RR 0%), and 233 by the plug-mesh method (RR 0%). Five subfascial wound infections were encountered (0.12%). Testicular ischemia was observed in five (0.12%), all prior to 1983; 32 inconsequential distal hydroceles were seen, all after dividing inguinoscrotal sacs and leaving the distal portion undisturbed. Superficial, self-reabsorbing wound hematoma occurred in 29 patients, and 14 patients suffered from temporary urinary retention. No instances of postoperative neuralgia were observed. Personal and institutional follow-up in both groups evolved from 95.5% for 1 year to 70% after 6 years. There was no mortality. Utilizing evolving techniques, including strict operating room aseptic and antiseptic measures, plus the use of systemic and local antibiotics, inguinal herniorrhaphy can be performed with minimal complications. The plug-mesh technique is presently our technical choice for most primary and recurrent hernias.
The aim of this study was to quantify the incidence of complications following inguinal herniotomy in small babies weighing 5 kg or less. This was a retrospective review of inguinal herniotomies performed in our unit between December 1997 and March 2002 on babies weighing 5 kg or less. A total of 154 patients underwent hernia repair, of which 125 patients (221 hernias) were available for review (81%). The median weight at surgery was 3.6 kg (range 1.7-5 kg) and 84 patients (67%) were classified as premature (< 36 weeks gestation). Thirty-three patients presented with an irreducible hernia, in whom all but one were successfully reduced prior to surgery. Patients were reassessed at a clinic following surgery and follow-up data was obtained from the clinic notes after a median follow-up of 3 months (range 1-60 months). Five cases of hernia recurrence occurred in four patients (2.3%) and the incidence of testicular atrophy was 2.7% (six patients). In the testicular atrophy group, four of the six patients presented with an incarcerated hernia and of these, three were noted to have evidence of ischaemia at operation. There were six cases of high testes requiring subsequent orchidopexy (2.7%). Although neonatal inguinal herniotomy is a technically demanding procedure, this series has demonstrated a low complication rate. Testicular atrophy was associated with a history of preoperative incarceration in the majority of cases.