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Chronic groin pain after inguinal hernia mesh repair is a common problem. Mesh fixation without sutures has been suggested to have several advantages over the traditional suture fixation. The aim of this study was to compare two self-adhering meshes, the glued Adhesix® (AH) and the gripping Parietene ProGrip® (PP), and evaluate their impact on postoperative chronic pain and overall recovery. Two consultant surgeons performed altogether 393 open inguinal hernia operations at the Helsinki University Hospital during 2014 to 2015. The two groups, AH (n = 169) and PP (n = 224) were similar and comparable in terms of demographic data. The data were collected and analyzed from the patients’ medical records in the hospital's register. The patients were followed up for a period of 19 months (5-31 months). The number of patient contacts due to postoperative pain was significantly less common in the AH group than in the PP group, 4/169 (2.4%) versus 19/224 (8.5%) patients, respectively ( P = 0.011). The duration of pain was under three months for most patients, only two patients in the PP group had pain for over one year. The pain was treated most patients with anti-inflammatory painkillers, whereas injections of a local anesthetic and corticosteroid, and chronic pain medication was needed in some cases. It seems that the use of glue-coated mesh (Adhesix®) was associated with less postoperative visits due to pain compared with the self-fixating mesh with absorbable anchoring system (ProGrip®). Further studies with long-term follow-up are needed to confirm these results.

Study objective: Comparison of local anesthetic infiltration (LAI), spinal anesthesia (SPIN) and total intravenous anesthesia (TIVA) for open inguinal herniorrhaphy. We hypothesized that patients receiving LAI could be discharged faster than SPIN and TWA patients. Design: Randomized, prospective trial. Setting: University hospital day-surgery center. Patients: 156 adult male patients (ASA 1-3) undergoing day-case open inguinal herniorrhaphy. Interventions: Patients were randomized to either LAI (lidocaine + ropivacaine), SPIN (bupivacaine + fentanyl) or TWA (propofol + remifentanil). Perioperative Ringer infusion was 1.5 mL/h. Urinary bladder was scanned before and after surgery. Interviews were performed on postoperative days 1, 7 and 90. Measurements: Duration of surgery, duration of the patients' stay in the operating room and time until their readiness for discharge home. Patient satisfaction and adverse effects were registered. Main results: Surgery lasted longer in LAI group (median 40 min) than in SPIN group (35 min) (P = .003) and TWA group (33 min) (P

The long-term outcome between laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (MC) with ultrasonic dissection (UsD) technique has not been compared in randomized trials. Therefore, we investigated the outcome after conventional LC and MC with UsD in 78 patients (ClinicalTrials.gov Identifier: NCT0172340).Initially 88 patients with non-complicated symptomatic gallstone disease were randomized into MC (n = 44) or LC (n = 44) over a period of 2 years (2010-2012) and 78 of them (89%) were reached for a follow-up interview at 12 months after the surgery.Baseline parameters were similar in the two groups, and 1/44 MCs and 2/44 LCs were converted to open laparotomy. The prevalence of chronic post-surgical pain (CPSP) one year after the procedure was quite similar in the two groups: 3/36 (8%) in the MC group and 2/42 (5%) in the LC group (p = 0.502). Residual abdominal symptoms were common, but the proportion was similar in both groups (28% in MC and 33% in LC group, p = 0.665). Both groups were very satisfied with the cosmetic outcome (numeric rating scale, p = 0.470). The Quality of life (QoL) improved 34/36 (94%) in the MC group and 33/42 (79%) in the LC group (p = 0.046) and all patients in both groups were satisfied with the operation overall.Day-case MC and LC patients have a quite similar one-year outcome with no significant difference regarding residual abdominal symptoms, cosmetic satisfaction, QoL or CPSP.

Cholecystectomy by minilaparotomy (MC) or by laparoscopy (LC) has been shown to have equal results of both early and late recovery. Although, the ultrasonic dissection (UsD) technique has seen used in LC, the technique is rarely used in MC.Initially, 88 patients with uncomplicated symptomatic gallstones were randomized into MC with UsD (n = 44) or conventional LC (n = 44) over a 2-year period (2010-2012). The two groups were similar in terms of age and American Society of Anesthesiologists (ASA) physical status score. Results. Both groups were similar in terms of the operative time and the time in the operation theatre, the success of day-surgery and satisfaction with the procedure. The MC group had significantly less postoperative pain than the LC group, p = 0.002, and the MC group used less analgesics doses during the first 24 h: 2.8 (1.2) doses vs. 3.8 (1.4) doses, p = 0.003. The convalescence needed was 3 days shorter in the MC group, 7 (3) days, than that in the LC-group, 10 (8) days, p = 0.024. In the MC group 4 patients and in the LC group 11 (p = 0.046) required more than 14 days of sick leave. In the MC group there was one and in the LC group two conversions to open surgery.The patients in the MC group had less early postoperative pain and had a shorter convalescence than the patients in the LC group.

Background Chronic groin pain after mesh repair of inguinal hernia has been attributed to the presence of sutures. Methods This randomized clinical trial compared inguinal hernia repair using a self-fixating composite mesh or a sutured lightweight mesh, with pain at 1 year as primary outcome. Patients completed a self-evaluation questionnaire at 2 weeks and were examined after 1 year. Results Some 198 patients received self-fixating mesh and 196 sutured mesh. There were no differences between the groups in mean pain scores measured on a visual analogue scale during 2 weeks of immediate convalescence or at 1 year. Chronic pain and discomfort was experienced by 36·3 per cent of patients in the self-fixating and 34·1 per cent in the sutured mesh group (P = 0·658), affecting the everyday life of 1·1 and 2·8 per cent respectively (P = 0·448). Conclusion Open inguinal hernia repair with a composite self-fixating mesh resulted in similar pain in the early postoperative convalescence period and at 1 year as repair with a sutured lightweight mesh. Registration number: NCT01026935 (http://www.clinicaltrials.gov).

To assess clamping injury to the rat abdominal aorta, the activities of two oxidoreductases, lactate dehydrogenase (LD) and succinate dehydrogenase (SD), were estimated histochemically at various points in time after clamping the aorta for 30 min (group A) or 60 min (group B) with two kinds of microvascular clips. Areas of depressed LD and SD activity were found 3 days after surgery in group A and 1 day and 3 days after surgery in group B. The random, intermittent occurrence of the changes in enzyme activity within the time groups pointed to a mild trauma induced by the clips. At 1 week and thereafter, no changes in enzyme activities were observed in the aortic wall. Two different patterns of depressed enzyme activity were observed: One was a narrow zone without activity throughout the medial layer, and the other consisted of a broader area of depressed activity in the outer parts of the media. Occluding the aorta with a mosquito clamp led to tissue destruction and loss of enzyme activity in the injured area. This study shows that enzyme histochemistry provides nonquantitative methods to detect and localize microvascular injury and that the injury caused by the microvascular clips was mild and reversible.

In order to evaluate the duration and localization of the metabolic changes elicited by the procedure of transplantation, the sequential changes in enzymatic activity of carotid artery grafts in rats were evaluated by histochemical demonstration of the activity of two oxido-reductases, lactate dehydrogenase (LD) and succinate dehydrogenase (SD), and two hydrolytic enzymes, adenosine triphosphatase (ATPase) and alkaline phosphatase (AFOS). The most intense staining for ATPase, LD and SD was seen in the media, both in the grafts and in the adjacent carotid artery. The activity of AFOS was concentrated to the inner parts of the adventitia. The medial layer of the microarterial graft showed no obvious changes in enzyme activity during the observation period of four weeks. At the anastomoses, LD and SD showed decreased activity from day one onwards. No intimal thickening or other clear structural changes were seen in the grafts.