ambulatory repair of recurrent hernias. experience in 70 cases background: Recurrence is the most common long term complication of inguinal hernia repair. aim: To report the experience of ambulatory treatment of hernia recurrence. Patients and methods: Seventy patients aged 56 ± 14 years (59 men), with a low surgical risk and a body mass index below 40 kg/ m 2 were admitted to the program. The surgical repair of the hernia was performed under local anesthesia on an ambulatory basis. All patients received antibiotic and prophylaxis for venous thrombosis. results: The surgical procedure lasted 54 ± 25 minutes. A tissue repair was performed in 12 cases and a prosthetic one in 48. The ductus deferens was accidentally sectioned in one case. The postoperative complications were one hematoma which did not require surgery and two superficial infections that healed in an ambulatory basis. A long term follow up, for 9.3 ± 1.9 years after surgery was possible in 79% of cases. Two recurrences (3.5%) were observed and one patient complained of a light, intermittent pain in the inguinal region. There were two recurrences after tissue repair, both occurring after a Lichtenstein repair (4.2%). ninety two percent of patients were satisfied or very satisfied with the procedure. conclusion: Ambulatory treatment of recurrent hernias is feasible and safe.

Reconstruction of midline incisional hernias using a double isotensional sutureBackground: Incisional hernias of the midline are frequently multisacular and its treatment without a mesh is followed by a high rate of recurrences. Aim: To report a new technique for the treatment of midline incisional hernias, performing an isotensional suture of the midline with Vycril ® 2-0, followed by a double invaginant suture of the rectus aponeurosis with Ethybond ® 2-0. Material and Methods: Observational prospective study of 90 women and 26 men, aged 54 ± 13 and 59 ± 13 years respectively, with a hernia sac smaller than 15 cm and with an aponeurotic defect smaller than 3 cm, operated between January 2002 and December 2005. Results: Surgery was performed under local anesthesia on an ambulatory basis. The surgical procedure consisted in the excision of a skin lozenge which included the scar, dissection and reduction of all sacs and isotensional suture of the midline with Vycryl #1 ® . This suture was followed by a double invaginating suture of the rectus sheath in the midline with Ethylon ® 0. Five superficial infections and two hematomas were observed. Seven recurrences (7%) in 99 patients (85% of the sample), were found during a mean follow up of 4.6 years (range 2-6). Conclusions: The double invaginating isotensional suture (DIIS) is an acceptable alternative for the treatment of small and middle size incisional hernias of the midline. ResumenLas eventrorrafias sin malla de la línea media se asocian con una elevada tasa de recidivas. En esta publicación damos cuenta de una técnica fascial utilizable en eventraciones pequeñas y medianas de la línea media que hemos llamado doble sutura invaginante isotensional (DSII). El estudio observacional descriptivo es una serie clínica constituida por 90 mujeres con una edad promedio de 54 ± 12,9 años y 26 varones con una edad promedio de 59 ± 13,7 años, intervenidos entre el 1º de Enero de 2002 y el 31 de Diciembre de 2005. En 14 casos se trató de una eventración recidivada. Se intervinieron pacientes con un Rev. Chilena de Cirugía.

Chronic inguinal pain syndrome Background: Chronic inguinal pain syndrome (CIPS) is a frequent complaint in patents attending to a public ambulatory surgical service. Aim: To report a descriptive observational study of CIPS. Material and Methods: Retrospective review of medical records of patients presenting with CIPS between 1999 and 2006. The symptoms and physical examination of the groin, the spine and the coxofemoral joint of these patients was evaluated. Results: CIPS was diagnosed in 150 patients aged 17 to 71 years, 87 men. They represented 14% of groin problems diagnosed in the study period. Median duration of pain was 13 (3-150) months, with remissions that lasted from weeks to months. The characteristics of pain remained constant in each remission. Pain was present during the daily activities, but it was even worse during resting periods and during night sleep, leading the patient to assume pain reducing positions. Hernia was present in 29 patients and occupied inguinal channel in three. Five patients had a history of previous hernia repair. One hundred twenty patients had spine diseases. An anesthetic blockade of the ilioinguinal nerve was performed in 37 patients with a positive response in seven. Twenty nine of 47 groin ultrasound examinations were informed as abnormal and suggestive of inguinal hernia. Surgical treatment was performed in these patients and was associated with pain abolition in 12, reduction in seven and persistence in the rest. Remaining patients were treated with spine rehabilitation. The short time follow-up of both groups was encouraging. Conclusions: Inguinal hernia and radicular pain due to spine problems are the main causes of CIPS in this series of patients.

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