Patients: A total of 253 patients (239 men; mean age, 59 years) underwent repair by laparoscopic (n=110, 105 bilateral, 92 total extraperitoneal, and 18 transabdominal preperitoneal) or tension-free open (n=143, 133 unilateral) approach. Laparoscopic patients were significantly younger (52.0 vs 63.8 years, PϽ.001). Main Outcome Measures: Subjective measures included VAS scores (1-10, 1 indicates best) for pain at 1 day and 1 week postoperatively and overall satisfaction at 1 week. Objective measures included quantity and days of analgesic use and days before return to regular activities , including work and driving. Results were also compared by patient age (Spearman analysis). Results: Satisfaction was high for both procedures; the laparoscopic procedure was superior only for return to work and driving. Spearman analysis showed a significant inverse relation between age and first-day pain (r=−0.15, P =.01), independent of operative approach. Because laparoscopic patients were younger, patients younger than 65 years were analyzed separately; laparoscopic patients had significantly less first-day pain (5.44 vs 6.30, P =.02). Conclusions: Pain following hernia repair was age dependent. Following laparoscopic repair, patients had lower first-day pain scores in younger patients and earlier return to normal activities in all patients. Satisfaction was similar for both approaches. Subjective experiences can be quantified, compared to detect subtle differences in outcome for competing surgical techniques, and used to counsel patients before operation, with the goal of improving satisfaction.

By transferring skills in stages, a laparoscopic bariatric program can be established with minimal morbidity and mortality.

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Minimally invasive techniques are increasingly used in the management of trauma victims. We report the case of a young man in a motor vehicle crash who sustained a penetrating wound to the anterior left chest caused by the automobile stick shift. Subsequent imaging demonstrated a large foreign body in the left lung. The foreign body was removed successfully by videothoracoscopy, and the patient made a full recovery. This case demonstrates the inroads that minimally invasive surgery is making in care of the injured and highlights an excellent technique for dealing with pulmonary foreign bodies.

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