No abstract

Therapeutic, IV.

The results of the laparoscopic inguinal hernia repair are important for discussion as operative methods differ from that of herniotomy. The detection rate of contralateral patent deep inguinal ring appears to be higher for direct visualization via umbilical 30 degrees laparoscopy versus 70 degrees scope via the hernia sac. Whilst laparoscopy offers potential advantage of improved visualization, longer term prospective data collection is needed to compare these methods of operative hernia management.

Background Spring-assisted cranioplasty has been proposed as an alternative to total calvarial remodelling for sagittal craniosynostosis. Advantages include its minimally invasive nature, reduced morbidity and hospital stay. Potential drawbacks include the need for a second procedure for removal and the lack of published long-term follow-up. We present a single institution experience of 100 consecutive cases using a novel spring design. Methods All patients treated at our institution between April 2010 and September 2014 were evaluated retrospectively. Patients with isolated non-syndromic sagittal craniosynostosis were included. Data were collected for operative time, anaesthetic time, hospital stay, transfusion requirement and complications in addition to cephalic index pre-operatively and at one day, three weeks and six months post-operatively. Results One hundred patients were included. Mean cephalic index was 68 pre-operatively, 71 at day 1 and 72 at 3 weeks and 6 months post-operatively. Nine patients required transfusion. Two patients developed a CSF leak requiring intervention. One patient required early removal of springs due to infection. One patient had a wound dehiscence over the spring and 1 patient sustained a venous infarct with hemiplegia. Five patients required further calvarial remodelling surgery. Conclusion Our modified spring design and protocol represents an effective strategy in the management of single-suture sagittal craniosynostosis with reduced total operative time and blood loss when compared to alternative treatment strategies. In patients referred within the first 6 months of birth this technique has become our procedure of choice. In a minority of cases especially in the older age groups further remodelling surgery is required