After 10 years and 1903 inguinal hernias,what is the outcome for the laparoscopic repair?

Background: The procedure of choice for inguinal hernia repair has remained controversial for decades. The laparoscopic approach has now been utilized for more than 10 years, and a significant volume of patient outcomes is now available for review. Methods: The hospital and office records of 1388 patients who underwent 1903 laparoscopic inguinal hernia repairs at Atlanta Medical Center during the past 10 years were retrospectively reviewed in order to determine demographics, recurrence rate, and complications. In addition, 123 hernia repairs were prospectively studied in 71 patients during this time period in order to accurately evaluate postoperative pain and return to activity. Results: Two hundred fifty-five (13.4%) hernias were recurrent and 1648 (86.6%) were primary. Five hundred and fifteen (37.1%) hernias were bilateral. The total extraperitoneal approach was utilized for 1561 (82.0%) of the 1903 repairs. The average operative time was 75.4 (14–193) minutes. Estimated blood loss was 22.0 (0–250) ml. Seventeen patients (1.2%) were converted to an open form of hernia repair. Minor complications occurred in 83 (6.0%) patients and major complications occurred in 18 (1.3%) patients. Conclusions: The laparoscopic approach is a safe form of inguinal hernia repair that offers the patient a shorter and less painful recovery with an extremely low recurrence rate.     

The relationship between first postoperative day epithelial status and eventual health of the ocular surface in penetrating keratoplasty

PURPOSE: To determine a possible relationship between donor epithelial status on the first postoperative day after keratoplasty and the eventual health of the corneal surface. METHODS: We analyzed 91 patients who underwent penetrating corneal transplantation between January 1998 and January 2000, monitoring the epithelial status of the corneas with fluorescein staining using slit-lamp biomicroscopy. Recipient pre- and postoperative variables and donor characteristics were recorded. Macroepithelial defects were classified into three groups according to the extent of the epithelial defect. The results on the first postoperative day were compared with the first and third operative month. Donor and recipient variables were compared with the epithelial status on the first and third month as well. RESULTS: On the first postoperative day, 64.84% of the patients had epithelial defects, 10.99% had defects at the 1-month postoperative visit, and none had defects at the third month. Graft recipients with macroepithelial defects in the first postoperative month were older, had a higher prevalence of blepharitis, higher prevalence of inadequate eye hydration, and slightly increased corneal sensation compared with the group without epithelial defects; however, none of these trends were statistically significant. Patients with macroepithelial defects in the first postoperative month received older donor tissue, and the average preservation-to-surgery time was longer. These donor variables, however, were not significant statistically (p value >0.10) in determining outcome of the epithelial status at the first or third months. CONCLUSIONS: Our results suggest that the epithelial status on the first postoperative day is not predictive of surface integrity at 1-month postoperative (p value is 0.2676 for the likehood ratio test). The epithelial status on the first postoperative day is not predictive of the status of the third month after keratoplasty, because none of the 91 patients had epithelial defects after 3 months.