CURRENT TREATMENT, RISKS and CONSIDERATIONS IN THE MANAGEMENT OF HERNIAS: An historical approach
Hernias have been a surgical problem since time immemorial. Many of the great names of the surgical arena are attached to advances made in the anatomical understanding and surgical repair. None more so than the Italian anatomist and surgeon Bassini of Padua who in the late 19th century introduced the then radical concept of herniorraphy thus revolutionized hernia repair. Previously only the sac was excised(herniotomy).This was often fatal and rarely cured the hernia. Instead Bassini repaired the defect as well by suturing the muscles of the inguinal canal and their fascia – internal oblique abdominous, transverse abdominous, transversalis fascia and conjoint tendon down to the inguinal ligament. He immediately achieved a high cure and low short term recurrence rate. However over the next century there still remained a high longer term recurrence rate. The technique was more successful with indirect hernias but less so for direct hernias .with direct hernias because the tissues were already much weakened and the repair placed the sutures under tension. The technique endured and was the cornerstone of inguinal repair for over 100 years.
Hernia surgery is now becoming a specialty in its own right.
Introduction: Chronic groin pain is both a topical subject and important outcome measurement following inguinal hernia repair. It has been suggested its incidence is related to the management of the nerves of the inguinal canal as well as the type of mesh used and methods of fixation for both open and laparoscopic surgery.
Lumps & Bumps Webinar
The importance of the history and examination in arriving at a clinical diagnoses is stressed.The brain acts like a computer – matching a list of physical signs, pathological processes and anatomical location to arrive at a precise diagnoses.
CHRONIC PAIN ABSTRACT
The level of pre-operative and post operative pain, its duration as well as complications may all be factors in predicting whether chronic pain may develop. The method of measurement of chronic pain is itself a contentious issue. It is now apparent that the measurement of activity and functional status as well as qualitative measures is important.
A Recent Workshop in Sydney
There were participants from all over Australia with different skills levels but who are generally quite experienced and working in a variety of situations. A common theme was doctors wanted to refresh there skills, get a few tips on knot tying, suturing, management of wounds and lacerations. Some wished to address specific topics such digital block whilst many wanted to compare and enhance their procedural skills.
Three studies of venous thrombosis after long-haul flights give risk estimates
In the December 8 issue of Annals of Internal Medicine there are three articles on thromboembolism after long-haul flights. In the first German researchers assessed the incidence of venous thrombosis associated with long-haul flights in a prospective, controlled cohort study of 964 passengers returning from long-haul flights (flight duration, 8 hours or more) and 1213 non-traveling control subjects.